41歲男子李先生，多年來一直受皮膚過敏所苦，長期服藥也未見改善。最近經中山醫學大學附設醫院過敏免疫風濕科魏正宗醫師詳細診治，終於真相大白，是罕見的〝米〞過敏病例。
中山醫學大學附設醫院過敏免疫風濕科主治醫師暨中藥臨床試驗中心主任魏正宗說，這名男子罹患異位性皮膚炎，主因是過敏體質經常莫名奇妙地發作，經詳細過敏原檢測之後證實對米、麥、花生、哈密瓜、芒果、大豆、塵滿、德國蟑螂等過敏，經過食物避免及環境調整，配合減敏米精治療後，過敏指數ECP由20.9 IU/ml降至4.38 IU/ml，免疫球蛋白IgE由406 IU/ml降至174 IU/ml，嗜酸性白血球Eosinophil由170/mm3降至90/mm3，過敏體質已漸改善。
魏正宗醫師指出，大部分的過敏病人都不知道自己的過敏原為何，這就如同作戰不知道敵人在哪裡，當然也就無法戰勝過敏。中山醫大已有先進的過敏原診斷技術，除了傳統的CAP系統，尚有Immulite，Basotest等新方法，可以診斷出大部分常見的過敏原。
魏醫師說明，食物過敏的症狀通常較不明顯，常常需要靠檢驗才能查明。治療過敏的主要方法是避免過敏原，藥物治療及減敏療法。目前中山醫大中藥臨床試驗中心正進行一項減敏米麥精對過敏病人之臨床試驗，目前尚有30個名額，有過敏困擾者可洽04-24739595轉33340中藥臨床試驗中心或上網http://www.csh.org.tw/herbs
星期三, 2月 15, 2006
名醫兼病人 魏正宗 十足的AS人
中山醫學大學附設醫院過敏免疫風濕科魏正宗醫師，是國內知名的僵直性脊椎炎(AS)權威，曾任中華民國僵直性脊椎炎關懷協會理事長，曾到英、法、美國等國家學習僵直性脊椎炎的研究與新知。
和別人不一樣的是，魏正宗不僅是醫師，同時他也是僵直性脊椎炎的患者。為了使病友們都能有正確的知識，在民國八十五年，他和許多病友共同組成了「中華民國僵直性脊椎炎關懷協會」，從事衛教的工作。同時，他也架設僵直性脊椎炎網站，希望從書面以及網路媒體雙管齊下地來宣導，讓病友及社會都能對僵直性脊椎炎有明確的認知。
和別人不一樣的是，魏正宗不僅是醫師，同時他也是僵直性脊椎炎的患者。為了使病友們都能有正確的知識，在民國八十五年，他和許多病友共同組成了「中華民國僵直性脊椎炎關懷協會」，從事衛教的工作。同時，他也架設僵直性脊椎炎網站，希望從書面以及網路媒體雙管齊下地來宣導，讓病友及社會都能對僵直性脊椎炎有明確的認知。
手腳關節莫名酸痛小心"非典型脊椎關節炎"作祟
（中央社記者郝雪卿台中市八日電）一名經常進出大陸的吳姓台商，近幾個月來手腳關節常發生莫名其妙的酸痛，有時甚至腫得像香腸一樣，早上起床也覺得腰背酸痛僵硬，尿酸值檢驗並無明顯異常，經中山醫學大學附設醫院主治醫師魏正宗診斷，才確認是得了「非典型脊椎關節炎」。
中山醫學大學附設醫院過敏免疫風濕科主治醫師魏正宗今天說，非典型脊椎關節炎與僵直性脊椎炎、萊特氏症候群、乾癬性關節炎等疾病，總稱為」血清陰性脊椎關節炎」 (spondyloarthropathy)。脊椎關節炎的主要典型症狀是：慢性下背痛、起床腰背僵硬、運動過後症狀減輕，有時造成手腳關節炎、足底筋膜炎及跟腱炎，較不典型症狀包括香腸指、黏膜潰瘍、皮膚乾癬、眼睛葡萄膜炎、血尿等。
魏正宗表示，脊椎關節炎是一種不少見卻很容易被誤診的風濕病，台灣的脊椎關節炎盛行率估計為1 %，發病年齡為十六至四十歲，男女比例為三：一。這種疾病與HLA-B27基因有強烈關聯及遺傳傾向，是一種自體免疫疾病。
他強調，凡是有長期下背痛、反覆性無法解釋的關節炎、胸痛或脊椎僵硬、肌腱韌帶與骨骼交接處的發炎、眼睛葡萄膜炎、乾癬等任一情況，特別是有家族病史或HLA-B27基因陽性的人，都應懷疑是脊椎關節炎，必須找風濕免疫科醫師詳細診斷及治療。目前已有新一代的非類固醇類消炎止痛藥、免疫調節劑、抗腫瘤壞死因子療法等可以改善並控制病情。
中山醫學大學附設醫院過敏免疫風濕科主治醫師魏正宗今天說，非典型脊椎關節炎與僵直性脊椎炎、萊特氏症候群、乾癬性關節炎等疾病，總稱為」血清陰性脊椎關節炎」 (spondyloarthropathy)。脊椎關節炎的主要典型症狀是：慢性下背痛、起床腰背僵硬、運動過後症狀減輕，有時造成手腳關節炎、足底筋膜炎及跟腱炎，較不典型症狀包括香腸指、黏膜潰瘍、皮膚乾癬、眼睛葡萄膜炎、血尿等。
魏正宗表示，脊椎關節炎是一種不少見卻很容易被誤診的風濕病，台灣的脊椎關節炎盛行率估計為1 %，發病年齡為十六至四十歲，男女比例為三：一。這種疾病與HLA-B27基因有強烈關聯及遺傳傾向，是一種自體免疫疾病。
他強調，凡是有長期下背痛、反覆性無法解釋的關節炎、胸痛或脊椎僵硬、肌腱韌帶與骨骼交接處的發炎、眼睛葡萄膜炎、乾癬等任一情況，特別是有家族病史或HLA-B27基因陽性的人，都應懷疑是脊椎關節炎，必須找風濕免疫科醫師詳細診斷及治療。目前已有新一代的非類固醇類消炎止痛藥、免疫調節劑、抗腫瘤壞死因子療法等可以改善並控制病情。
Traditional Chinese Medicine in the Treatment of Patients with Ankylosing Spondylitis: A Randomized Case-Control Pilot Study.
中藥方劑治療僵直性脊椎炎之先導性臨床試驗
魏正宗1、許清祥、游恆懿、謝長奇2、李采娟2、詹明修3
1中山醫學大學附設醫院過敏免疫風濕科、中藥臨床試驗中心；2中國醫藥大學中西結合研究所；3中山醫學大學醫學系微免科
Background. There are still many unmet needs in the treatment of ankylosing spondylitis (AS) among present therapies including non-steroid anti-inflammatory drugs (NSAID), disease-modifying anti-rheumatic drugs (DMARD), thalidomide and anti-tumor necrosis factor (TNF a).
Aim. To exploratorily test TCM formulas in the treatment of patients with AS.
Methods. Sixty AS patients were enrolled in this 12 weeks’ trial. Thirty-six patients with active AS, defined by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) > 3 cm in spite of 6 weeks’ NSAID treatment, were randomized to receive same NSAID alone, sulfasalazine add-on or TCM formula 小活絡丹 add-on. The other 24 patients with inactive late-stage AS, defined by BASDAI < 3 and Bath Ankylosing Spondylitis Functional Index (BASFI) > 2 cm, were randomized to receive龜鹿二仙膠 or左歸丸. Primary endpoint was the ASAS response criteria in intend-to-treat analysis. Secondary endpoints were BASDAI, BASFI, Bath Ankylosing Spondylitis Global Index (BAS-G), quality-of-life (QOL), ESR, HS-CRP and IgA. Cytokines level, including TNFa, IL-10 and TGFb in serum or peripheral blood mononuclear cell culture supernatant, were assayed by ELISA.
Results. Fifty-six patients completed this 12 weeks’ trial. Four patients dropped out due to poor compliance. In the active AS patients, 33.33% of NSAID arm, 41.67% of sulfasalazine arm, and 16.67% of小活絡丹 arm fit the ASAS response criteria. In the inactive AS patients, 8.3% of龜鹿二仙膠 and 25% of 左歸丸 reach the ASAS response criteria. Patients with左歸丸 got significant improvement in BASFI （p=0.018）and QOL score（p=0.024） but not BASDAI, ESR, HS-CRP, IgA. No significant differences were found in the cytokines level. No significant adverse events were found in all TCM groups.
Conclusions. In active AS patients, NSAID and sulfasalazine were superior than小活絡丹. In inactive AS patients, 左歸丸 revealed promising benefit. Further double blind placebo controlled trials are necessary.
魏正宗1、許清祥、游恆懿、謝長奇2、李采娟2、詹明修3
1中山醫學大學附設醫院過敏免疫風濕科、中藥臨床試驗中心；2中國醫藥大學中西結合研究所；3中山醫學大學醫學系微免科
Background. There are still many unmet needs in the treatment of ankylosing spondylitis (AS) among present therapies including non-steroid anti-inflammatory drugs (NSAID), disease-modifying anti-rheumatic drugs (DMARD), thalidomide and anti-tumor necrosis factor (TNF a).
Aim. To exploratorily test TCM formulas in the treatment of patients with AS.
Methods. Sixty AS patients were enrolled in this 12 weeks’ trial. Thirty-six patients with active AS, defined by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) > 3 cm in spite of 6 weeks’ NSAID treatment, were randomized to receive same NSAID alone, sulfasalazine add-on or TCM formula 小活絡丹 add-on. The other 24 patients with inactive late-stage AS, defined by BASDAI < 3 and Bath Ankylosing Spondylitis Functional Index (BASFI) > 2 cm, were randomized to receive龜鹿二仙膠 or左歸丸. Primary endpoint was the ASAS response criteria in intend-to-treat analysis. Secondary endpoints were BASDAI, BASFI, Bath Ankylosing Spondylitis Global Index (BAS-G), quality-of-life (QOL), ESR, HS-CRP and IgA. Cytokines level, including TNFa, IL-10 and TGFb in serum or peripheral blood mononuclear cell culture supernatant, were assayed by ELISA.
Results. Fifty-six patients completed this 12 weeks’ trial. Four patients dropped out due to poor compliance. In the active AS patients, 33.33% of NSAID arm, 41.67% of sulfasalazine arm, and 16.67% of小活絡丹 arm fit the ASAS response criteria. In the inactive AS patients, 8.3% of龜鹿二仙膠 and 25% of 左歸丸 reach the ASAS response criteria. Patients with左歸丸 got significant improvement in BASFI （p=0.018）and QOL score（p=0.024） but not BASDAI, ESR, HS-CRP, IgA. No significant differences were found in the cytokines level. No significant adverse events were found in all TCM groups.
Conclusions. In active AS patients, NSAID and sulfasalazine were superior than小活絡丹. In inactive AS patients, 左歸丸 revealed promising benefit. Further double blind placebo controlled trials are necessary.
星期日, 2月 12, 2006
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