公婆急抱孫 B肝婦女自行停藥險換肝！

[MK]

http://tw.news.yahoo.com/article/url/d/ ... 1mdtv.html
更新日期:2009/07/03 12:37 中時健康 王國強／台北報
慢性B型肝炎的治療期平均約在2年以上，許多患者都希望能早日達到停藥的治療目標，但是如果自行停藥，後果可能不堪設想。一名快三十歲的B肝婦女，因為公婆急於抱孫的壓力，讓自認為肝功能已恢復正常的她，沒有經過醫師評估就自行停藥，結果導致急性肝衰竭，差點需要換肝救命！

大林慈濟醫院肝膽腸胃科主任周安良表示，停藥時機需由醫師先評估患者治療的成效才能判斷，包括e抗原陽性的患者是否達到陰轉、病毒測不到且肝功能恢復正常等條件，如果任意停藥，潛藏在肝臟細胞中的少數病毒會開始重新複製，引起病毒量升高的危險。

選擇高藥效且高安全性藥物能及早達成停藥目標
通常患者在經過一段治療時間後，就能有效控制病毒量且達到肝發炎指數下降的成效，但是據臨床經驗，e抗原陰轉的機率，在治療第二年以後才會有較好的成效，以目前B肝口服抗病毒藥物來說，干安能、干適能、貝樂克都有3成左右的陰轉率，而新式藥物喜必福的e抗原陰轉率更高達3成7，是目前陰轉率較高的藥物，更有機會達到停藥的治療目標，不過周安良仍建議e抗原陰轉後，應再持續服藥半年至一年作為鞏固療法，停藥後，也要定期追蹤檢查。

為什麼e抗原陰轉是及早達到停藥目標的關鍵呢？周安良說明，e抗原陽性的患者停藥後，一年內肝炎復發的機率近9成，而陰性的患者復發機率卻不到一半，因此治療後若能達到e抗原陰轉，將能有效控制停藥後復發的機率。

此外，安全性議題也值得受到重視，在台灣，平均每五至六人就有一位是Ｂ型肝炎帶原者，當中有許多都是正計畫生育的男女患者，周安良建議，為避免基因毒性或是畸胎問題，最好在停藥半年後再計畫生育，不然建議選擇已被美國食品暨藥物管理局(FDA)列為安全等級為「懷孕B級」的藥物較為適合。

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