肝昏迷他變了一個人

[MK]

http://udn.com/NEWS/HEALTH/HEA2/6293028.shtml

【聯合晚報╱許金川(台大醫學院內科教授)】 2011.04.24 03:14 pm


許金川（台大醫學院內科教授/財團法人肝病防治學術基金會執行長）

「醫師，我老公那些糖漿不要再開了!」

「是治療肝昏迷會讓病人瀉肚子排毒的那種糖漿嗎?」

我仔細看了他老公一眼，皮膚黃、眼睛黃，脾臟也腫大，是肝硬化末期，動不動就肝昏迷，除非是換肝，否則是一定要繼續服用的。我看了病人的太太，語氣怪怪的，難道是要「謀X害X」？

「他前陣子迷迷糊糊的時候，買了粉多間房子，現在都賺大錢了。」

「幾年前，他肝功能還不錯的時候，叫他買房子，他都膽小如鼠，這幾年常常意識不清，做起事情來阿莎力多了!」

原來如此，是肝不好以致人格改變，投資房地產不經深思熟慮，反而賺了大錢!

人體新陳代謝之後會產生毒素，這些毒素要經由肝臟解毒，其中最有關係的就是氨(NH3)或稱為阿摩尼亞，這是蛋白質分解後的產物，正常人會由肝臟中的酶將它轉換為無毒的尿素，但如果肝不好，氨無法轉換為尿素，氨會貯留在血液中，抑制腦細胞的活性，人就會意識不清阿達阿達，形成所謂的「肝性腦病變」，厲害者甚至會肝昏迷死亡。

在肝昏迷的初期，本來沉默寡言的可能變得愛說話，本來個性保守謹慎的可能會變得大膽開放，好像變了一個人似的；同時睡覺習慣也會改變，可能晚上睡不著，白天卻昏沉沉的睡，這樣經過一陣子之後，終於慢慢昏迷不醒，進入肝性腦病變的第二或第三期，最後死亡。

因此，身邊有肝硬化的家人，如果發現他有人格異於平常的現象，一定要帶他及早就醫，找出導致肝昏迷的原因，及早治療避免惡化，才是正道。

不管如何，留得「好肝」在，不怕沒柴燒，唯有健康的身體，才能感受美食與豪宅的喜樂，如果肝昏迷，即便買了豪宅，也無法與家人共享，屆時住在裡面享福的可能是家裡的瑪利亞了。

【2011/04/24 聯合晚報】

[shimmer]

肝昏迷現在有新藥，去年登在的 NEJM 的大型 phase 3 trial 拿到了 FDA 的 approval
這個藥叫做 rifaximin 可以用來預防肝腦病變的惡化
是幾乎完全不吸收的抗生素，所以長期使用沒啥副作用
用來殺腸道的細菌，現在也拿到了 irritable bowel syndrome 的 indication
接下來是準備拿 inflammatory bowel disease 的 indication

不過可以想見的是這個藥一定很貴
美國賣的價錢現在一天吃下來好像要一千多塊錢
健保不知道會不會納入給付

[image]

原來就是缺肝昏迷...... (嘆息)

[MK]

肝昏迷現在有新藥，去年登在的 NEJM 的大型 phase 3 trial 拿到了 FDA 的 approval
這個藥叫做 rifaximin 可以用來預防肝腦病變的惡化
是幾乎完全不吸收的抗生素，所以長期使用沒啥副作用
用來殺腸道的細菌，現在也拿到了 irritable bowel syndrome 的 indication
接下來是準備拿 inflammatory bowel disease 的 indication

不過可以想見的是這個藥一定很貴
美國賣的價錢現在一天吃下來好像要一千多塊錢
健保不知道會不會納入給付

http://forum.doctorvoice.org/viewtopic.php?f=24&t=54309

請問跟Neomycin的比較呢？！

[shimmer]

http://forum.doctorvoice.org/viewtopic.php?f=24&t=54309

請問跟Neomycin的比較呢？！

neomycin 是之前 FDA 對於肝腦病變除了 lactulose 之外唯一核准的藥物
但是他的 indication 是給 acute episode 用的
所以對於慢性使用是沒有角色

主要的原因還是在吸收率不夠低，所以長期使用會產生副作用跟抗藥性
之前被提出來類似概念的藥物還包括 metronidazole 跟 vancomycin
大致上都是類似的情況

因為現況下使用 lactulose 安全好用又便宜
所以 neomycin 幾乎沒有人在用

但是 rifaximin 吸收率夠低，所以無副作用，也不會產生抗藥性
所以可以長期服用降低急性發作的頻率

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