B肝亂換藥 病毒更兇B viral liver disorder dressing more fierce

B肝亂換藥 病毒更兇 濫用抗生素，會產生抗藥性，事實上，治療B肝時，如果隨便換藥，或是中斷服藥，病毒也可能出現抗藥性，治療起來更棘手。醫師呼籲，B肝患者應遵從醫囑用藥，且不可自行至藥房購買藥物服用，以免引發多重抗藥性問題。 許先生從小就是B肝帶原者，從高中開始，就固定就醫，檢查肝功能指數，五年多前，發現身體容易疲累，如果中午不小睡一下，到了下午整個人就會很不舒服。 到醫院抽血檢查，病毒量超高，在醫師建議下，開始服用藥物，自覺副作用並不明顯，只是空腹服用，會覺得噁心。不過，服用一段時間後，身體逐漸恢復正常。但最近回診時抽血，沒想到病毒量飆高，醫師研判，已產生了抗藥性。 台北榮民總醫院內科部胃腸科主治醫師黃怡翔表示，使用抗B肝藥物越久，抗藥性問題就會越高。目前一線抗B肝病毒藥物，包括了「干安能」、「貝勒克」、「喜必福」等三種，服用一年之後，都會產生抗藥性，不過，比率不盡相同。 「貝勒克」的抗藥性最低，在1%以下，其次為「喜必福」，約在9%至15%之間，傳統用藥「干安能」則抗藥性最高，約在20%左右，一旦產生了抗藥性，還是得繼續服用一線藥物，但需合併使用二線用藥「安適能」。 黃怡翔指出，除了用藥時間、藥物屬性之外，引發B肝藥物抗藥性的因素，還包括了療程不完整。門診就發現，部分患者用藥服從性偏低，或因工作太忙，或是自覺症狀不明顯，於是沒有按時吃藥。 為了掌握患者服用B肝藥物之後，是否產生抗藥性，黃怡翔強調，治療之前，一定要先抽血檢測病毒數量，等服用三個月時，如果病毒數量已經下降，就再繼續治療三個月。 如果服用了三個月之後，病毒量沒有下降，甚至升高，則顯示病人對此藥物的反應不好，或是病人沒有好好服用藥物，這個時候就應該換藥。 黃怡翔解釋，病毒量多寡以2000國際單位為標準，要是治療一段時間之後，病毒數量仍大於2000以上，就代表出現了抗藥性，需加上二線藥物。 一般來說，肝功能指數（GPT）正常值約在40上下，如果超過兩倍以上，也就是在80以上，就屬於肝功能異常，但大部分患者仍無異狀，如果超過了200，就會出現了倦怠、容易疲倦等症狀，B肝帶原者應該多注意自己身體狀況。 黃怡翔強調，B型肝炎患者服用藥物六個月後，就應抽血檢測血中病毒量，如果病毒量下降，甚至偵測不出，即表示達到了治療效果，就應繼續服用原本藥物，不應換藥。 ／李樹人 2008-11-16 B viral liver disorder dressing more fierce Misuse of antibiotics, the resistance will, in fact, the treatment of liver B, if not dressing, medication or interruption of the virus may also appear resistant to treatment with even more difficult. Doctors called for, B patients with liver should comply with medication orders, and not on its own to pharmacies to buy drugs to take, so we do not have multi-drug resistance. Mr. Xu is small liver B carriers from the beginning of high school, fixed on the medical check liver function index, more than five years ago, tired easily found in the body, if not nap about noon, a man in the afternoon will be very uncomfortable. To the hospital for blood tests, ultra-high amount of virus in a doctor's suggestion, began taking the drug, side effects are not clearly conscious, but taken on an empty stomach will feel nausea. However, take some time, the body gradually returned to normal. But recently when the blood back to the clinic, the virus did not expect the high volume whirlwind, doctors judged that has resulted in resistance. Taipei Veterans General Hospital Department of Internal Medicine Section gastrointestinal physician Lau Wong said that the use of anti-drug B liver longer, the problem would be more resistant. At present, first-line anti-retroviral drugs liver B, including "to dry-an," "Bei Leke" and "hi-fu will" of the three, after taking a year will be resistance, but not exactly the same rate. "Bei Leke" minimum resistance, less than 1%, followed by "hi-fu will", in about 9-15 percent between traditional medicine "can do an" resistance is the highest, about 20% Once had a drug-resistant, or continue to take a first-line drugs, but the combined use of second-line drugs, "to well-being." Lau Wong pointed out that in addition to drug use, drug attributes, caused liver B drug resistance factors, including the incomplete course of treatment. Found out that some patients with medication obedient low or too busy working, consciously or not obvious symptoms, they do not take medicine on time. In order to grasp the liver in patients with B drug, whether or not resistance, Lau Wong stressed that before treatment, we must first blood viral load testing, and so on to take three months, if the viral load has declined to continue treatment for three months. If you take three months, the amount of the virus has not declined, and even increased, the patient's reaction to this drug is not good, or the patient did not take medication, they should at this time the dressing was changed. Lau Wong explained that the amount of virus in 2000, the number of international standards for the unit, if the treatment for a period of time, the virus is still greater than the number of over 2000, on behalf of the emergence of drug resistance, to be coupled with second-line drugs. In general, liver function index (GPT) in the normal value of about 40 up and down, more than double than if, that is, more than 80, belonging to the abnormal liver function, but most of the patients with no Yizhuang, if more than 200, There will be a burnout, easy to symptoms such as fatigue, B liver carriers should pay attention to his physical condition. Lau Wong stressed, B hepatitis in patients taking the drug after six months, it should be blood testing blood virus, the virus if the decline, not even detect, said that to achieve the effect of the treatment, they should continue taking the drug had not Dressing should be. / Li people 2008-11-16 View more information, see the World Journal reported that e-ePaper

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