{"id":4492,"date":"2017-06-05T00:00:00","date_gmt":"2017-06-04T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=8b20e41a71e8eb0a71b23a0642492799"},"modified":"2018-08-21T12:19:22","modified_gmt":"2018-08-21T04:19:22","slug":"%e5%95%8f%e9%86%ab%e7%94%9f%ef%bc%9a%e6%89%8b%e6%a9%9fapp%e6%b8%ac%e5%bf%83%e8%a1%80%e7%ae%a1%e9%a2%a8%e9%9a%aa%ef%bc%8c%e6%ba%96%e5%97%8e%ef%bc%9f","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e5%95%8f%e9%86%ab%e7%94%9f%ef%bc%9a%e6%89%8b%e6%a9%9fapp%e6%b8%ac%e5%bf%83%e8%a1%80%e7%ae%a1%e9%a2%a8%e9%9a%aa%ef%bc%8c%e6%ba%96%e5%97%8e%ef%bc%9f\/","title":{"rendered":"\u554f\u91ab\u751f\uff1a\u624b\u6a5fApp\u6e2c\u5fc3\u8840\u7ba1\u98a8\u96aa\uff0c\u6e96\u55ce\uff1f"},"content":{"rendered":"

\u3010\u660e\u5831\u5c08\u8a0a\u3011\u5f35<\/strong>\uff1a\u990a\u548c\u91ab\u9662\u5bb6\u5ead\u91ab\u5b78\u5c08\u79d1\u91ab\u751f\u5f35\u5b87 \u7e46<\/strong>\uff1a\u5fc3\u81df\u79d1\u5c08\u79d1\u91ab\u751f\u7e46\u5efa\u6587<\/p>\n

\u5f35\ufe55\u91ab\u751f\u5728\u8655\u65b9\u81bd\u56fa\u9187\u85e5\u7269\u524d\uff0c\u6703\u70ba\u75c5\u4eba\u4f5c\u98a8\u96aa\u8a55\u4f30\u3002\u5fc3\u8840\u7ba1\u98a8\u96aa\u8a55\u4f30\u5982\u4f55\u8a08\u7b97\uff1f<\/p>\n

\u7e46\ufe55\u5fc3\u8840\u7ba1\u75c5\u6709\u5f88\u591a\u98a8\u96aa\u56e0\u7d20\uff0c\u5305\u62ec\u5e74\u9f61\u3001\u6027\u5225\u3001\u5438\u7159\u7fd2\u6163\u3001\u60a3\u6709\u7cd6\u5c3f\u75c5\u53ca\u9ad8\u8840\u58d3\u7b49\u3002\u5916\u570b\u4e0d\u5c11\u7814\u7a76\u6a5f\u69cb\u7d9c\u5408\u9019\u4e9b\u9ad8\u5371\u56e0\u7d20\uff0c\u63a8\u51fa\u4e00\u4e9b\u6a21\u578b\u8a55\u4f30\u98a8\u96aa\u9ad8\u4f4e\uff0c\u53ea\u8981\u5c07\u9ad8\u5371\u56e0\u7d20\u8f38\u5165\u624b\u6a5f\u7a0b\u5f0f\u6216\u96fb\u8166\u4fbf\u53ef\u904b\u7b97\uff0c\u5982\u679c\u60a3\u8005\u672a\u4f86\u5341\u5e74\u7684\u4e2d\u98a8\u6216\u5fc3\u81df\u75c5\u98a8\u96aa\u903e7.5%\u4fbf\u5c6c\u9ad8\u5371\u3002\u82e5\u80fd\u53ca\u65e9\u63a7\u5236\u81bd\u56fa\u9187\uff0c\u65e5\u5f8c\u4e2d\u98a8\u6216\u5fc3\u81df\u75c5\u98a8\u96aa\u6216\u53ef\u80fd\u964d\u4f4e\u3002<\/p>\n

\u4e0d\u904e\uff0c\u91ab\u751f\u4e5f\u4e0d\u6703\u76e1\u4fe1\u9019\u4e9b\u7a0b\u5f0f\uff0c\u56e0\u70ba\u5927\u90fd\u662f\u6839\u64da\u897f\u65b9\u7684\u6578\u64da\u7814\u767c\uff0c\u61c9\u7528\u5728\u4e9e\u6d32\u4eba\u8eab\u4e0a\u6216\u8a31\u6709\u504f\u5dee\u3002\u6545\u6b64\u9664\u4e86\u7528\u7a0b\u5f0f\u8a08\u7b97\u8a55\u5206\uff0c\u4e5f\u6703\u770b\u81e8\u7240\u5be6\u969b\u60c5\u51b5\uff0c\u4f8b\u5982\u5bb6\u65cf\u75c5\u53f2\uff0c\u6216\u4f7f\u7528\u8f14\u52a9\u6aa2\u67e5\uff0c\u5982\u9a57\u8840\u3001\u8840\u7ba1\u9223\u5316\u60c5\u51b5\u7b49\uff0c\u4ee5\u9032\u4e00\u6b65\u8a55\u4f30\u75c5\u4eba\u7684\u98a8\u96aa\u6c34\u5e73\u3002<\/p>\n

\u25a0\u4ed6\u6c40\u85e5\u9632\u6b62\u589e\u58de\u81bd\u3000\u5b55\u5a66\u4e0d\u9069\u7528<\/p>\n

\u5f35\ufe55\u964d\u81bd\u56fa\u9187\u85e5\u7269\u6709\u5f88\u591a\u7a2e\u985e\uff0c\u91ab\u751f\u5982\u4f55\u6c7a\u5b9a\u9078\u64c7\u54ea\u7a2e\u85e5\uff1f\u54ea\u4e9b\u75c5\u4eba\u4e0d\u9069\u7528\uff1f<\/p>\n

\u7e46\ufe55\u7528\u85e5\u4e4b\u524d\uff0c\u9996\u5148\u8981\u6539\u8b8a\u98f2\u98df\u7fd2\u6163\uff0c\u6b64\u8209\u80fd\u628a\u81bd\u56fa\u9187\u964d\u4f4e5%\u81f37%\uff1b\u4f46\u5c0d\u9ad8\u5371\u75c5\u4eba\u4f86\u8aaa\uff0c\u55ae\u9760\u98f2\u98df\u63a7\u5236\u53ca\u904b\u52d5\u4e5f\u4e0d\u80fd\u5c07\u81bd\u56fa\u9187\u964d\u81f3\u7406\u60f3\u6c34\u5e73\uff0c\u9019\u6642\u4fbf\u9700\u8981\u4f7f\u7528\u85e5\u7269\u5e6b\u52a9\u75c5\u4eba\u3002<\/p>\n

\u7814\u7a76\u986f\u793a\uff0c\u4ed6\u6c40\u985e\u85e5\u7269\u6709\u6548\u964d\u4f4e\u81bd\u56fa\u9187\uff0c\u4e26\u964d\u4f4e\u65e5\u5f8c\u7f79\u60a3\u5fc3\u8840\u7ba1\u75c5\u98a8\u96aa\u3002\u4e0d\u904e\u5b55\u5a66\u4e0d\u53ef\u4f7f\u7528\uff0c\u800c\u75c5\u4eba\u670d\u85e5\u5f8c\u82e5\u51fa\u73fe\u808c\u8089\u75bc\u75db\u3001\u56b4\u91cd\u809d\u9175\u7d20\u4e0a\u5347\uff0c\u4fbf\u4e0d\u80fd\u4f7f\u7528\u6216\u8981\u6e1b\u4f4e\u5291\u91cf\u3002<\/p>\n

\u4ed6\u6c40\u985e\u85e5\u7269\u662f\u900f\u904e\u622a\u65b7\u809d\u81df\u88fd\u9020\u58de\u81bd\u56fa\u9187\u7684\u6a5f\u5236\uff0c\u5f9e\u800c\u964d\u4f4e\u8840\u6db2\u4e2d\u7684\u58de\u81bd\u56fa\u9187\u3002\u7531\u65bc\u58de\u81bd\u56fa\u9187\u662f\u5c0e\u81f4\u8840\u7ba1\u786c\u5316\u7684\u4e3b\u56e0\uff0c\u7576\u8840\u6db2\u4e2d\u7684\u58de\u81bd\u56fa\u9187\u6e1b\u5c11\uff0c\u6c89\u7a4d\u5728\u8840\u7ba1\u58c1\u7684\u58de\u81bd\u56fa\u9187\u4e5f\u6703\u6e1b\u5c11\uff0c\u96d6\u4e0d\u80fd\u79fb\u9664\u5df2\u7a4d\u5b58\u7684\u81bd\u56fa\u9187\uff0c\u4f46\u53ef\u7a69\u5b9a\u8840\u7ba1\u58c1\u4e0a\u7684\u81bd\u56fa\u9187\uff0c\u6e1b\u4f4e\u6025\u6027\u5fc3\u808c\u6897\u585e\u7684\u98a8\u96aa\u3002<\/p>\n

\u82e5\u4f7f\u7528\u4ed6\u6c40\u985e\u85e5\u7269\u5f8c\u4ecd\u672a\u80fd\u628a\u81bd\u56fa\u9187\u63a7\u5236\u81f3\u7406\u60f3\u6c34\u5e73\uff0c\u4fbf\u9700\u8981\u4f7f\u7528\u5176\u4ed6\u8f14\u52a9\u85e5\u7269\uff0c\u4f8b\u5982\u6e1b\u4f4e\u8178\u81df\u5c0d\u81bd\u56fa\u9187\u5438\u6536\u7684\u53e3\u670d\u85e5\u3002<\/p>\n

\u25a0\u65b0\u85e5\u5169\u661f\u671f\u4e00\u91dd\u3000\u4fc3\u8eab\u9ad4\u56de\u6536\u58de\u81bd<\/p>\n

\u5f35\ufe55\u65b0\u4e00\u985e\u964d\u81bd\u56fa\u9187\u85e5\u7269PCSK9\u6291\u5236\u5291\uff0c\u91dd\u5c0d\u5bb6\u65cf\u6027\u53ca\u56b4\u91cd\u9ad8\u81bd\u56fa\u9187\u7684\u75c5\u4eba\u3002\u9019\u7a2e\u85e5\u7269\u5982\u4f55\u904b\u4f5c\uff1f <\/p>\n

\u7e46\ufe55PCSK9\u6291\u5236\u5291\u662f\u4e00\u7a2e\u751f\u7269\u88fd\u5291\uff0c\u900f\u904e\u6291\u5236\u809d\u81df\u7684\u4e00\u7a2e\u540d\u70baPCSK9\u7684\u9175\u7d20\uff0c\u53ef\u9032\u4e00\u6b65\u63a7\u5236\u81bd\u56fa\u9187\u3002PCSK9\u9175\u7d20\u662f\u8ca0\u8cac\u5206\u89e3\u58de\u81bd\u56fa\u9187\u4e2d\u7684\u53d7\u9ad4\uff1b\u9019\u53d7\u9ad4\u5c31\u597d\u4f3c\u4e00\u500b\u56de\u6536\u5668\uff0c\u8ca0\u8cac\u6536\u96c6\u8840\u6db2\u5167\u58de\u81bd\u56fa\u9187\u3002\u7576PCSK9\u9175\u7d20\u53d7\u5230\u6291\u5236\uff0c\u7121\u6cd5\u767c\u63ee\u6548\u7528\u5206\u89e3\u53d7\u9ad4\uff0c\u8eab\u9ad4\u4fbf\u6709\u66f4\u591a\u53d7\u9ad4\u53bb\u56de\u6536\u58de\u81bd\u56fa\u9187\uff0c\u81bd\u56fa\u9187\u4fbf\u53ef\u4ee5\u964d\u4f4e\u3002\u6b64\u85e5\u7528\u5728\u6b63\u670d\u7528\u4ed6\u6c40\u985e\u85e5\u7269\u7684\u75c5\u4eba\u8eab\u4e0a\uff0c\u58de\u81bd\u56fa\u9187\u53ef\u4ee5\u9032\u4e00\u6b65\u964d\u4f4e\u516d\u81f3\u4e03\u6210\u3002<\/p>\n

\u6291\u5236\u5291\u662f\u4ee5\u76ae\u4e0b\u6ce8\u5c04\u5f62\u5f0f\u7d66\u85e5\uff0c\u75c5\u4eba\u53ef\u5728\u809a\u76ae\u3001\u5927\u817f\u7b49\u8102\u80aa\u8f03\u591a\u7684\u4f4d\u7f6e\u843d\u91dd\uff0c\u7d04\u6bcf\u5169\u661f\u671f\u6ce8\u5c04\u4e00\u6b21\u3002<\/p>\n

\u25a0\u91dd\u85e5\u975e\u4eba\u4eba\u5571\u3000\u60a3\u5bb6\u65cf\u6027\u9ad8\u81bd\u53ef\u8003\u616e<\/p>\n

\u5f35\ufe55PCSK9\u6291\u5236\u5291\u6709\u4ec0\u9ebc\u7981\u5fcc\u53ca\u6ce8\u610f\u4e8b\u9805\uff1f<\/p>\n

\u7e46\ufe55\u5927\u578b\u7814\u7a76\u7d50\u679c\u986f\u793a\uff0c\u4f7f\u7528\u6b64\u91dd\u85e5\u63a7\u5236\u64d4\u56fa\u9187\u672a\u6709\u5f15\u8d77\u592a\u591a\u7684\u526f\u4f5c\u7528\uff0c\u5f88\u591a\u6642\u53ea\u662f\u91dd\u53e3\u4f4d\u6709\u9ede\u75db\u3002\u4f46\u9019\u85e5\u4e26\u975e\u9069\u5408\u6bcf\u500b\u75c5\u4eba\u4f7f\u7528\uff0c\u4e3b\u8981\u662f\u61c9\u7528\u5728\u4e00\u4e9b\u5bb6\u65cf\u6027\u9ad8\u81bd\u56fa\u9187\u8840\u75c7\u7684\u75c5\u4eba\uff0c\u670d\u7528\u50b3\u7d71\u4ed6\u6c40\u985e\u85e5\u7269\u4e5f\u7121\u6cd5\u63a7\u5236\u58de\u81bd\u56fa\u9187\u6642\uff0c\u5169\u85e5\u540c\u7528\u5c31\u53ef\u4ee5\u5e6b\u52a9\u628a\u58de\u81bd\u56fa\u9187\u964d\u81f3\u76ee\u6a19\u3002\u53e6\u5916\uff0c\u66fe\u5fc3\u81df\u75c5\u767c\u7684\u75c5\u4eba\uff0c\u5982\u8a66\u904e\u901a\u6ce2\u4ed4\u6216\u5fc3\u808c\u6897\u585e\uff0c\u670d\u7528\u4ed6\u6c40\u5f8c\u4ecd\u7121\u6cd5\u5c07\u81bd\u56fa\u9187\u964d\u81f3\u7406\u60f3\u6c34\u5e73\uff0c\u6216\u56e0\u800c\u5f15\u8d77\u56b4\u91cd\u526f\u4f5c\u7528\uff0c\u4e0d\u80fd\u900f\u904e\u85e5\u7269\u63a8\u4f4e\u58de\u81bd\u56fa\u9187\uff0c\u5c31\u53ef\u4ee5\u8003\u616e\u9019\u7a2e\u91dd\u85e5\u3002<\/p>\n

\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/07\/_29YC004_.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】張：張宇醫生 繆：繆建文醫生<\/p>\n

張﹕醫生在處方膽固醇藥物前，會為病人作風險評估。心血管風險評估如何計算？<\/p>\n

繆﹕心血管病有很多風險因素，包括年齡、性別、吸煙習慣、患有糖尿病及高血壓等。外國不少研究機構綜合這些高危因素，推出一些模型評估風險高低，只要將高危因素輸入手機程式或電腦便可運算，如果患者未來十年的中風或心臟病風險逾7.5%便屬高危。若能及早控制膽固醇，日後中風或心臟病風險或可能降低。<\/p>\n

不過，醫生也不會盡信這些程式，因為大都是根據西方的數據研發，應用在亞洲人身上或許有偏差。故此除了用程式計算評分，也會看臨牀實際情况，例如家族病史，或使用輔助檢查，如驗血、血管鈣化情况等，以進一步評估病人的風險水平。<\/p>\n

■他汀藥防止增壞膽　孕婦不適用<\/p>\n

張﹕降膽固醇藥物有很多種類，醫生如何決定選擇哪種藥？哪些病人不適用？<\/p>\n

繆﹕用藥之前，首先要改變飲食習慣，此舉能把膽固醇降低5%至7%；但對高危病人來說，單靠飲食控制及運動也不能將膽固醇降至理想水平，這時便需要使用藥物幫助病人。<\/p>\n

研究顯示，他汀類藥物有效降低膽固醇，並降低日後罹患心血管病風險。不過孕婦不可使用，而病人服藥後若出現肌肉疼痛、嚴重肝酵素上升，便不能使用或要減低劑量。<\/p>\n

他汀類藥物是透過截斷肝臟製造壞膽固醇的機制，從而降低血液中的壞膽固醇。由於壞膽固醇是導致血管硬化的主因，當血液中的壞膽固醇減少，沉積在血管壁的壞膽固醇也會減少，雖不能移除已積存的膽固醇，但可穩定血管壁上的膽固醇，減低急性心肌梗塞的風險。<\/p>\n

若使用他汀類藥物後仍未能把膽固醇控制至理想水平，便需要使用其他輔助藥物，例如減低腸臟對膽固醇吸收的口服藥。<\/p>\n

■新藥兩星期一針　促身體回收壞膽<\/p>\n

張﹕新一類降膽固醇藥物PCSK9抑制劑，針對家族性及嚴重高膽固醇的病人。這種藥物如何運作？ <\/p>\n

繆﹕PCSK9抑制劑是一種生物製劑，透過抑制肝臟的一種名為PCSK9的酵素，可進一步控制膽固醇。PCSK9酵素是負責分解壞膽固醇中的受體；這受體就好似一個回收器，負責收集血液內壞膽固醇。當PCSK9酵素受到抑制，無法發揮效用分解受體，身體便有更多受體去回收壞膽固醇，膽固醇便可以降低。此藥用在正服用他汀類藥物的病人身上，壞膽固醇可以進一步降低六至七成。<\/p>\n

抑制劑是以皮下注射形式給藥，病人可在肚皮、大腿等脂肪較多的位置落針，約每兩星期注射一次。<\/p>\n

■針藥非人人啱　患家族性高膽可考慮<\/p>\n

張﹕PCSK9抑制劑有什麼禁忌及注意事項？<\/p>\n

繆﹕大型研究結果顯示，使用此針藥控制擔固醇未有引起太多的副作用，很多時只是針口位有點痛。但這藥並非適合每個病人使用，主要是應用在一些家族性高膽固醇血症的病人，服用傳統他汀類藥物也無法控制壞膽固醇時，兩藥同用就可以幫助把壞膽固醇降至目標。另外，曾心臟病發的病人，如試過通波仔或心肌梗塞，服用他汀後仍無法將膽固醇降至理想水平，或因而引起嚴重副作用，不能透過藥物推低壞膽固醇，就可以考慮這種針藥。<\/p>\n

<\/inline><\/p>\n","protected":false},"author":2,"featured_media":4551,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[3],"tags":[826,824,338],"class_list":["post-4492","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-3","tag-826","tag-824","tag-338"],"publishpress_future_action":{"enabled":false,"date":"2026-11-16 11:40:39","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts\/4492"}],"collection":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/comments?post=4492"}],"version-history":[{"count":0,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts\/4492\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/media\/4551"}],"wp:attachment":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/media?parent=4492"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/categories?post=4492"},{"taxonomy":"post_tag","embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/tags?post=4492"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}