{"id":4497,"date":"2017-06-05T00:00:00","date_gmt":"2017-06-04T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=cd6eeab0ecab641bf1f39a2e9239e349"},"modified":"2018-08-21T12:18:57","modified_gmt":"2018-08-21T04:18:57","slug":"%e9%bd%8b%e9%81%8b%e5%8b%95%e6%88%92%e5%8f%a3-%e9%9b%a3%e6%b2%bb%e3%80%8c%e5%a3%9e%e8%86%bd%e3%80%8d-%e5%9a%b4%e9%87%8d%e9%ab%98%e8%86%bd-%e4%b8%80%e9%87%9d%e8%a6%8b%e6%95%88","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e9%bd%8b%e9%81%8b%e5%8b%95%e6%88%92%e5%8f%a3-%e9%9b%a3%e6%b2%bb%e3%80%8c%e5%a3%9e%e8%86%bd%e3%80%8d-%e5%9a%b4%e9%87%8d%e9%ab%98%e8%86%bd-%e4%b8%80%e9%87%9d%e8%a6%8b%e6%95%88\/","title":{"rendered":"\u3010\u6709\u7247\u3011\u9f4b\u904b\u52d5\u6212\u53e3 \u96e3\u6cbb\u300c\u58de\u81bd\u300d \u56b4\u91cd\u9ad8\u81bd \u4e00\u91dd\u898b\u6548"},"content":{"rendered":"

\u3010\u660e\u5831\u5c08\u8a0a\u3011\u9a57\u8840\u9a5a\u89ba\u81bd\u56fa\u9187\u8d85\u6a19\uff0c\u5f88\u591a\u4eba\u90fd\u6297\u62d2\u98df\u85e5\uff0c\u4ee5\u70ba\u6212\u53e3\u52a0\u904b\u52d5\u5c31\u53ef\u4ee5\u63a7\u5236\uff1f\u5176\u5be6\u4e03\u6210\u7684\u81bd\u56fa\u9187\u662f\u7531\u8eab\u9ad4\u81ea\u884c\u88fd\u9020\uff0c\u6212\u53e3\u6210\u6548\u6709\u9650\u3002\u5c24\u5176\u5c0d\u65bc\u60a3\u6709\u5bb6\u65cf\u6027\u9ad8\u81bd\u56fa\u9187\u8840\u75c7\uff0c\u6216\u66fe\u7d93\u5fc3\u81df\u75c5\u767c\u751a\u81f3\u4e2d\u98a8\u7684\u9ad8\u81bd\u56fa\u9187\u60a3\u8005\u4f86\u8aaa\uff0c\u9700\u8981\u628a\u58de\u81bd\u56fa\u9187\u6c34\u5e73\u964d\u81f3\u4f4e\u65bc1.8mmol\/l\u7684\u7406\u60f3\u6c34\u5e73\uff0c\u6212\u53e3\u3001\u904b\u52d5\uff0c\u518d\u52a0\u4e0a\u4ed6\u6c40\u85e5\u985e\u85e5\u7269\u4e09\u7ba1\u9f4a\u4e0b\uff0c\u9084\u53ef\u80fd\u9700\u8981\u51fa\u52d5\u7d42\u6975\u964d\u81bd\u56fa\u9187\u91dd\u5291\u3002<\/p>\n

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\u9019\u5341\u5e74\u9593\uff0c\u674e\u5148\u751f\u4e00\u76f4\u4e56\u4e56\u807d\u5f9e\u91ab\u751f\u5429\u5490\uff0c\u6309\u6642\u670d\u7528\u9ad8\u5291\u91cf\u4ed6\u6c40\u985e\u85e5\u7269\u53ca\u8f14\u52a9\u85e5\u7269\uff0c\u964d\u4f4e\u8840\u6db2\u7684\u58de\u81bd\u56fa\u9187\uff0c\u4f46\u6210\u6548\u672a\u898b\u5341\u5206\u7406\u60f3\uff0c\u4fd7\u7a31\u58de\u81bd\u56fa\u9187\u7684\u4f4e\u5bc6\u5ea6\u8102\u86cb\u767d\u81bd\u56fa\u9187\uff08LDL\uff09\uff0c\u6578\u503c\u59cb\u7d42\u5f98\u5f8a\u57283mmol\/l\u5de6\u53f3\uff08\u8a3b\ufe55\u7406\u60f3\u6c34\u5e73\uff0c\u4e00\u822c\u6210\u5e74\u4eba\u61c9\u4f4e\u65bc3.4mmol\/l\uff1b\u4e2d\u98a8\u3001\u51a0\u5fc3\u75c5\u3001\u7cd6\u5c3f\u75c5\u60a3\u8005\u61c9\u4f4e\u65bc1.8mmol\/l\uff09\uff0c\u800c\u6aa2\u67e5\u66f4\u767c\u73fe\u8840\u7ba1\u6709\u5927\u91cf\u81bd\u56fa\u9187\u7a4d\u805a\uff0c\u5c0e\u81f4\u8840\u7ba1\u56b4\u91cd\u6536\u7a84\uff0c\u589e\u52a0\u5fc3\u81df\u75c5\u53ca\u4e2d\u98a8\u98a8\u96aa\u3002<\/p>\n

\u5fc3\u81df\u79d1\u5c08\u79d1\u91ab\u751f\u7e46\u5efa\u6587\u6307\u51fa\uff0c\u597d\u81bd\u56fa\u9187\uff08\u5373\u9ad8\u5bc6\u5ea6\u8102\u86cb\u767d\u81bd\u56fa\u9187\uff0cHDL\uff09\u6709\u52a9\u7dad\u6301\u8840\u7ba1\u5065\u5eb7\uff0c\u76f8\u53cd\u58de\u81bd\u56fa\u9187\u8207\u52d5\u8108\u786c\u5316\u6709\u95dc\uff0c\u53ef\u4ee5\u7a4d\u805a\u5728\u8840\u7ba1\u58c1\uff0c\u4ee4\u8840\u7ba1\u786c\u5316\u53ca\u6536\u7a84\uff0c\u96a8\u6642\u5f15\u767c\u5fc3\u8840\u7ba1\u75be\u75c5\u3002\u56e0\u6b64\u964d\u4f4e\u58de\u81bd\u56fa\u9187\u81f3\u7406\u60f3\u6c34\u5e73\uff0c\u5c07\u6709\u52a9\u964d\u4f4e\u8840\u7ba1\u9223\u5316\uff0c\u5f9e\u800c\u6e1b\u4f4e\u60a3\u75c5\u7684\u98a8\u96aa\u3002<\/p>\n

\u7d04\u4e5d\u6210\u4eba\u7528\u50b3\u7d71\u85e5\u6536\u6548<\/p>\n

\u50b3\u7d71\u7684\u4ed6\u6c40\u985e\u85e5\u7269\u662f\u6cbf\u7528\u591a\u5e74\u7684\u964d\u81bd\u56fa\u9187\u85e5\u7269\uff0c\u80fd\u6291\u5236\u809d\u81df\u88fd\u9020\u58de\u81bd\u56fa\u9187\u3002\u7e46\u5efa\u6587\u7a31\uff0c\u7d04\u4e5d\u6210\u75c5\u4eba\u4f7f\u7528\u4ed6\u6c40\u5f8c\u9054\u5230\u6240\u9700\u7684\u6cbb\u7642\u6548\u679c\uff1b\u4f46\u5c0d\u65bc\u4e00\u4e9b\u56b4\u91cd\u500b\u6848\uff0c\u6216\u5df2\u7d93\u60a3\u6709\u5fc3\u8840\u7ba1\u75be\u75c5\u7684\u9ad8\u81bd\u56fa\u9187\u8840\u75c7\u60a3\u8005\uff0c\u50b3\u7d71\u85e5\u7269\u672a\u5fc5\u5e36\u4f86\u7406\u60f3\u7642\u6548\uff0c\u9700\u8981\u8003\u616e\u4f7f\u7528\u91dd\u5291PCSK9\u6291\u5236\u5291\u3002<\/p>\n

\u7814\u751f\u7269\u88fd\u5291\u3000\u964d\u516d\u4e03\u6210\u58de\u81bd<\/p>\n

\u4ed6\u89e3\u91cb\uff0cPCSK9\u662f\u4e00\u7a2e\u9175\u7d20\uff0c\u6703\u6e1b\u4f4e\u809d\u8d1c\u6e05\u9664\u8840\u6db2\u4e2d\u7684\u58de\u81bd\u56fa\u9187\u80fd\u529b\uff1b\u800c\u91dd\u5291\u662f\u4e00\u7a2e\u751f\u7269\u88fd\u5291\uff0c\u80fd\u6291\u5236PCSK9\uff0c\u85c9\u6b64\u4fc3\u9032\u56de\u6536\u58de\u81bd\u56fa\u9187\u3002\u4e00\u9805\u70ba\u671f\u4e09\u5e74\u7684\u81e8\u7240\u7814\u7a76\u986f\u793a\uff0c\u4ed6\u6c40\u52a0\u5165\u91dd\u5291\uff0c\u53ef\u4ee5\u4ee4\u75c5\u4eba\u7684\u58de\u81bd\u56fa\u9187\u6c34\u5e73\u964d\u4f4e\u516d\u81f3\u4e03\u6210\uff0c\u90e8\u5206\u4eba\u7684\u58de\u81bd\u56fa\u9187\u66f4\u7531\u7814\u7a76\u524d\u76841.8\u6216\u4ee5\u4e0a\uff0c\u964d\u81f30.7\uff0c\u5176\u9593\u5fc3\u81df\u75c5\u767c\u500b\u6848\u6e1b\u5c1115%\u3002<\/p>\n

\u96d6\u7136\u81bd\u56fa\u9187\u904e\u591a\u4e0d\u662f\u597d\u4e8b\uff0c\u4f46\u592a\u5c11\u4e5f\u4e0d\u5229\u5065\u5eb7\uff0c\u56e0\u70ba\u81bd\u56fa\u9187\u662f\u7d30\u80de\u4e0d\u53ef\u7f3a\u5c11\u7684\u91cd\u8981\u7269\u8cea\uff0c\u7f3a\u4e4f\u81bd\u56fa\u9187\u4ee4\u4eba\u64d4\u5fc3\u6703\u5f71\u97ff\u8166\u90e8\u529f\u80fd\uff0c\u6216\u5c0e\u81f4\u8166\u9000\u5316\u3002\u7e46\u6307\u51fa\uff0c\u6839\u64da\u6709\u95dc\u85e5\u7269\u7684\u81e8\u7240\u7814\u7a76\u8ddf\u9032\uff0c\u66ab\u672a\u767c\u73fe\u75c5\u4eba\u7528\u85e5\u5f8c\u8a8d\u77e5\u80fd\u529b\u4e0b\u964d\uff0c\u81f3\u65bc\u9577\u671f\u6703\u5426\u6709\u5f71\u97ff\u5247\u4ecd\u9700\u76e3\u5bdf\u3002<\/p>\n

\u9069\u5408\u5bb6\u65cf\u6027\u9ad8\u81bd\u3001\u5fc3\u8840\u7ba1\u75c5\u4eba<\/p>\n

\u4ed6\u5f37\u8abf\uff0c\u4e26\u975e\u6240\u6709\u75c5\u4eba\u4e5f\u9700\u8981\u4f7f\u7528PCSK9\u6291\u5236\u5291\uff0c\u5b83\u53ea\u9069\u5408\u4e00\u4e9b\u7528\u76e1\u50b3\u7d71\u85e5\u7269\u5f8c\u4ecd\u672a\u9054\u6a19\uff0c\u6216\u51fa\u73fe\u56b4\u91cd\u526f\u4f5c\u7528\uff0c\u53c8\u6216\u5df2\u7d93\u60a3\u6709\u5fc3\u8840\u7ba1\u75be\u75c5\u800c\u53c8\u672a\u80fd\u628a\u58de\u81bd\u56fa\u9187\u964d\u4f4e\u7406\u60f3\u6c34\u5e73\u7684\u75c5\u4eba\u63a1\u7528\u3002\u4f8b\u5982\u500b\u6848\u4e2d\u7684\u674e\u5148\u751f\uff0c\u5728\u7b2c\u4e8c\u6b21\u901a\u6ce2\u4ed4\u5f8c\u958b\u59cb\u4f7f\u7528\u91dd\u5291\u85e5\u7269\uff0c\u4e00\u500b\u6708\u5f8c\u58de\u81bd\u56fa\u9187\u75313.2\u964d\u81f30.6\u3002<\/p>\n

\u4e8b\u5be6\u4e0a\uff0c\u60a3\u6709\u5bb6\u65cf\u6027\u9ad8\u81bd\u56fa\u9187\u8840\u75c7\u60a3\u8005\u901a\u5e38\u4e5f\u6c92\u6709\u5fb5\u72c0\uff0c\u5f88\u591a\u6642\u65e9\u81f3\u4e09\u56db\u5341\u6b72\u5df2\u60a3\u4e0a\u5fc3\u8840\u7ba1\u75be\u75c5\u3002\u7e46\u5efa\u6587\u8868\u793a\uff0c\u9019\u985e\u75c5\u4eba\u5f80\u5f80\u5230\u8840\u7ba1\u6813\u585e\u800c\u5c0e\u81f4\u5fc3\u81df\u75c5\u767c\u751a\u81f3\u4e2d\u98a8\u624d\u767c\u73fe\uff0c\u90e8\u5206\u4eba\u773c\u76ae\u53ef\u80fd\u6703\u6709\u9ec3\u6591\u7624\u3002\u4ed6\u5efa\u8b70\u5e02\u6c11\u8981\u591a\u7559\u610f\u81ea\u5df1\u7684\u81bd\u56fa\u9187\u6c34\u5e73\uff0c\u5c24\u5176\u662f\u8fd1\u89aa\u4e2d\u7684\u7537\u6216\u5973\u5206\u5225\u572855\u53ca65\u6b72\u4ee5\u524d\u51fa\u73fe\u9ad8\u81bd\u56fa\u9187\u8840\u75c7\u4f75\u767c\u75c7\uff0c\u66f4\u9700\u8981\u6ce8\u610f\u53ca\u63a7\u5236\u81bd\u56fa\u9187\u3002<\/p>\n

\u63a1\u8a2a\uff1a\u912d\u5bf6\u83ef<\/p>\n

\u6587\uff1a\u5f35\u610f\u5b87<\/p>\n

\u7de8\u8f2f\uff1a\u6797\u4fe1\u541b<\/p>\n<\/p>\n

https:\/\/video3.mingpao.com\/201704\/HET20170429_01.mp4\u964d\u58de\u81bd\u56fa\u9187 \u9632\u4e2d\u98a8\u5fc3\u81df\u75c5;https:\/\/video3.mingpao.com\/201704\/HET20170429_02.mp4\u63a7\u5236\u98f2\u98df\u9ad4\u91cd \u964d5%\u81bd\u56fa\u9187;https:\/\/video3.mingpao.com\/201704\/HET20170429_03.mp4\u4ed6\u6c40 \u978f\u56fa\u58de\u81bd\u9187;https:\/\/video3.mingpao.com\/201704\/HET20170429_04.mp4\u65b0\u85e5 \u964d\u516d\u6210\u81bd\u56fa\u9187;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170605\/news\/_05ya101.jpg\u56db\u7ba1\u9f4a\u4e0b\u2014\u2014\u5c0d\u4ed8\u56b4\u91cd\u7684\u9ad8\u81bd\u56fa\u9187\uff0c\u55ae\u55ae\u900f\u904e\u98f2\u98df\u3001\u904b\u52d5\u4ee4\u58de\u81bd\u56fa\u9187\u4e0b\u964d\uff0c\u6548\u679c\u6709\u9650\uff0c\u9700\u8981\u670d\u7528\u4ed6\u6c40\u985e\u85e5\u7269\u6216\u5176\u4ed6\u8f14\u52a9\u85e5\u7269\uff0c\u5fc5\u8981\u6642\u9084\u8981\u8003\u616e\u6ce8\u5c04PCSK9\u6291\u5236\u5291\u3002\uff08leolintang\u3001Melnikoff@iStockphoto\uff09;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170605\/news\/_05ya102.jpg\u91dd\u5291\u85e5\u7269\u2014\u2014PCSK9\u6291\u5236\u5291\u4ee5\u76ae\u4e0b\u6ce8\u5c04\u5f62\u5f0f\u7d66\u85e5\uff0c\u75c5\u4eba\u53ef\u5728\u809a\u76ae\u3001\u5927\u817f\u7b49\u8102\u80aa\u8f03\u591a\u4f4d\u7f6e\u843d\u91dd\uff0c\u5169\u661f\u671f\u6ce8\u5c04\u4e00\u6b21\u3002\uff08\u5289\u710c\u9676\u651d\uff09;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170605\/news\/_05ya103.jpg\uff08\u5289\u710c\u9676\u651d\uff09;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】驗血驚覺膽固醇超標，很多人都抗拒食藥，以為戒口加運動就可以控制？其實七成的膽固醇是由身體自行製造，戒口成效有限。尤其對於患有家族性高膽固醇血症，或曾經心臟病發甚至中風的高膽固醇患者來說，需要把壞膽固醇水平降至低於1.8mmol\/l的理想水平，戒口、運動，再加上他汀藥類藥物三管齊下，還可能需要出動終極降膽固醇針劑。<\/p>\n

很多人以為年長、超重、體型肥胖才會有高膽固醇，但即使是正值壯年且有標準身形，也可能膽固醇超標。好像43歲的李先生，十年前已經因為膽固醇過高，令心臟動脈栓塞而出現急性心肌梗塞，需要接受通波仔手術，但十年後血管又被膽固醇阻塞，需要再做手術。<\/p>\n

這十年間，李先生一直乖乖聽從醫生吩咐，按時服用高劑量他汀類藥物及輔助藥物，降低血液的壞膽固醇，但成效未見十分理想，俗稱壞膽固醇的低密度脂蛋白膽固醇（LDL），數值始終徘徊在3mmol\/l左右（註﹕理想水平，一般成年人應低於3.4mmol\/l；中風、冠心病、糖尿病患者應低於1.8mmol\/l），而檢查更發現血管有大量膽固醇積聚，導致血管嚴重收窄，增加心臟病及中風風險。<\/p>\n

心臟科專科醫生繆建文指出，好膽固醇（即高密度脂蛋白膽固醇，HDL）有助維持血管健康，相反壞膽固醇與動脈硬化有關，可以積聚在血管壁，令血管硬化及收窄，隨時引發心血管疾病。因此降低壞膽固醇至理想水平，將有助降低血管鈣化，從而減低患病的風險。<\/p>\n

約九成人用傳統藥收效<\/p>\n

傳統的他汀類藥物是沿用多年的降膽固醇藥物，能抑制肝臟製造壞膽固醇。繆建文稱，約九成病人使用他汀後達到所需的治療效果；但對於一些嚴重個案，或已經患有心血管疾病的高膽固醇血症患者，傳統藥物未必帶來理想療效，需要考慮使用針劑PCSK9抑制劑。<\/p>\n

研生物製劑　降六七成壞膽<\/p>\n

他解釋，PCSK9是一種酵素，會減低肝贜清除血液中的壞膽固醇能力；而針劑是一種生物製劑，能抑制PCSK9，藉此促進回收壞膽固醇。一項為期三年的臨牀研究顯示，他汀加入針劑，可以令病人的壞膽固醇水平降低六至七成，部分人的壞膽固醇更由研究前的1.8或以上，降至0.7，其間心臟病發個案減少15%。<\/p>\n

雖然膽固醇過多不是好事，但太少也不利健康，因為膽固醇是細胞不可缺少的重要物質，缺乏膽固醇令人擔心會影響腦部功能，或導致腦退化。繆指出，根據有關藥物的臨牀研究跟進，暫未發現病人用藥後認知能力下降，至於長期會否有影響則仍需監察。<\/p>\n

適合家族性高膽、心血管病人<\/p>\n

他強調，並非所有病人也需要使用PCSK9抑制劑，它只適合一些用盡傳統藥物後仍未達標，或出現嚴重副作用，又或已經患有心血管疾病而又未能把壞膽固醇降低理想水平的病人採用。例如個案中的李先生，在第二次通波仔後開始使用針劑藥物，一個月後壞膽固醇由3.2降至0.6。<\/p>\n

事實上，患有家族性高膽固醇血症患者通常也沒有徵狀，很多時早至三四十歲已患上心血管疾病。繆建文表示，這類病人往往到血管栓塞而導致心臟病發甚至中風才發現，部分人眼皮可能會有黃斑瘤。他建議市民要多留意自己的膽固醇水平，尤其是近親中的男或女分別在55及65歲以前出現高膽固醇血症併發症，更需要注意及控制膽固醇。<\/p>\n

採訪：鄭寶華<\/p>\n

文：張意宇<\/p>\n

編輯：林信君<\/p>\n

■有片睇<\/p>\n

想現場直擊家庭醫生睇醫生，可登入 www.mingpaohealth.com\/doc.htm<\/a><\/p>\n

https:\/\/video3.mingpao.com\/201704\/HET20170429_01.mp4降壞膽固醇 防中風心臟病;https:\/\/video3.mingpao.com\/201704\/HET20170429_02.mp4控制飲食體重 降5%膽固醇;https:\/\/video3.mingpao.com\/201704\/HET20170429_03.mp4他汀 鞏固壞膽醇;https:\/\/video3.mingpao.com\/201704\/HET20170429_04.mp4新藥 降六成膽固醇;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170605\/news\/_05ya101.jpg四管齊下——對付嚴重的高膽固醇，單單透過飲食、運動令壞膽固醇下降，效果有限，需要服用他汀類藥物或其他輔助藥物，必要時還要考慮注射PCSK9抑制劑。（leolintang、Melnikoff@iStockphoto）;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170605\/news\/_05ya102.jpg針劑藥物——PCSK9抑制劑以皮下注射形式給藥，病人可在肚皮、大腿等脂肪較多位置落針，兩星期注射一次。（劉焌陶攝）;https:\/\/health2.mingpao.com\/ftp\/Health2\/20170605\/news\/_05ya103.jpg（劉焌陶攝）;<\/inline><\/p>\n","protected":false},"author":2,"featured_media":4494,"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 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