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\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/07\/_26yc102.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】一劑藥，有人藥到病除，有人卻出現不良反應，用藥後全身出疹、發燒、肝腎衰竭……過去歸咎個人體質「唔受得」，香港大學醫學院研究發現，一些藥物不良反應，甚至是疾病的併發症，原來是基因作怪。<\/p>\n

近年，醫學界積極發展精準醫學（Precision Medicine），精準醫學一詞，是2015年奧巴馬在任美國總統時提出的發展計劃。根據National Institutes of Health（NIH）解釋，就是在治病和防病計劃中，需要同時考慮每一個病人的基因、環境、生活等因素，找出最適合的方案。<\/p>\n

簡單說，精準醫學主要是根據個人DNA度身訂做的個人治療。<\/p>\n

藥後不適 非肝腎異常<\/p>\n

一直以來，當病人用藥後現不良反應，以前會懷疑是肝功能、腎功能異常，但如果檢查後證實肝、腎功能正常，就當作原因不明。」香港大學藥理及藥劑學系助理教授張正龍指出，港大醫學院基因研究中心針對甲狀腺機能亢進（簡稱甲亢）的基因研究，發現部分病人用藥後，出現嚴重藥物不良反應，白血球數量下降，出現發燒、感染，原來與基因有關。<\/p>\n

甲亢是指甲狀腺分泌過多荷爾蒙，超過半數病因是格雷氏症（Graves’ Disease）所致，因為自身免疫系統失調，抗體攻擊甲狀腺，令甲狀腺製造過多甲狀腺荷爾蒙，由於體內多個器官包括心臟、肌肉、眼睛、骨骼、皮膚等都受到甲狀腺影響，甲亢患者會有心跳過快、手震、眼凸、體重下降等不適。張正龍指出，治療甲亢，香港一直使用口服藥他巴唑／卡比馬唑（MMI\/CMZ）及丙硫氧嘧啶（PTU），已經使用超過50年，十分有效；但當中有0.2%至0.5%病人，出現用藥後不良反應白血球過低症。<\/p>\n

留意藥後反應 假感冒真併發<\/p>\n

「一名病人服用抗甲亢藥，數天後發燒，以為是感冒，自行服用退燒藥，但發燒持續數天不退，並感到全身乏力，最終要電召救護車送院；另外一名病人在用藥一星期後發高燒，加上皮膚出現紫斑，入院求醫。」張正龍指出，白血球過低症的早期徵狀與感冒、上呼吸道感染相似，所以提醒開始服用抗甲亢藥物的病人，服藥後30天內出現類似感冒的徵狀，如﹕發燒、喉嚨痛，就要立即求醫。<\/p>\n

併發白血球過低症　宜停藥改開刀<\/p>\n

「當發現是因為藥物不良反應引起白血球過低症，一般情况下，當停用相關藥物，白血球會慢慢回升；但若延誤診治，過去有病人因而送進深切治療，甚至有死亡案例。」張正龍在香港十間公立醫院，找到24名曾服用抗甲亢藥物而出現白血球過低症的病人基因，分析後結果發現第六條染色體中的HLA基因異常，「HLA基因，目前已知，會導致服用抗腦癇症藥物的病人，出現嚴重皮膚藥物過敏反應『史帝芬強生症候群』（SJS）有關。而今次結果顯示，帶有HLA-B*380201基因的人，超過九成病人會出現白血球過低症」。<\/p>\n

現在，港大為十間公立醫院的甲亢病人提供免費基因測試，希望及早找出可能因服用抗甲亢藥物出現不良反應的病人。張正龍表示，一旦驗出帶有HLA-B*380201基因，病人就應避免服用口服抗甲亢藥物，而需要考慮手術切除甲狀腺或放射碘治療。<\/p>\n

男患者會「被鬼壓」？<\/p>\n

除了藥物不良反應，有甲亢病人投訴「被鬼壓」，原來亦與基因有關。<\/p>\n

「尤其甲亢未受控制的病人，如未知自己患病或沒有定時服藥，會併發甲狀腺間歇性癱瘓（TPP），病人說夜間睡眠時突然全身動彈不得，但頭腦清醒，形容是『被鬼壓』。」張正龍解釋，TPP是甲亢的其中一個併發症，常見於東方男性，香港有13%的甲亢男患者患有TPP，病人會出現低血鉀，肌肉無力，「被鬼壓」是因為手腳肌肉無力所以無法動彈，嚴重可影響呼吸和心臟肌肉，引致呼吸停頓、心律不正，需要送院補充鉀質。<\/p>\n

「研究發現，TPP與KCNJ2基因有關，但只影響男性。男性甲亢病人若帶有這個基因變異，將有三分之一機會患上TPP。」張正龍表示，帶有這個基因的甲亢病人，就需要準時服藥，將甲狀腺水平控制好。<\/p>\n

■知多啲<\/p>\n

基因醫學講座 解碼甲狀腺<\/p>\n

香港大學醫學院基因研究中心和藥理及藥劑學系，將舉辦「基因醫學解碼II﹕對症下藥」公開講座，讓公眾了解香港基因醫學的發展，加深對與基因有關的健康問題的認識。<\/p>\n

◆3月主題：甲狀腺解碼<\/p>\n

講者﹕張正龍（香港大學藥理及藥劑學系助理教授）<\/p>\n

譚宛婷（註冊藥劑師、香港大學藥理及藥劑學系講師）<\/p>\n

日期：3月11日（本周六）<\/p>\n

時間：下午3:30至5:00<\/p>\n

地點：香港大學百周年校園平台三樓CPD-3.04講堂<\/p>\n

報名及查詢﹕<\/p>\n

1. 到hkuehealth.org<\/a>網上登記，成功登記人士會於兩個工作天內收到通知<\/p>\n

2. 於辦公時間致電2831 5087（上午10:00至下午5:00）<\/p>\n

文：鄭寶華<\/p>\n

編輯：林信君<\/p>\n

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