{"id":885,"date":"2020-11-11T15:05:20","date_gmt":"2020-11-11T07:05:20","guid":{"rendered":"http:\/\/web.csh.org.tw\/web\/cshmagazine\/?p=885"},"modified":"2020-11-12T11:11:53","modified_gmt":"2020-11-12T03:11:53","slug":"%e6%b8%9b%e9%87%8d%e8%97%a5%e7%89%a9%e4%bb%8b%e7%b4%b9%e8%88%87%e7%99%82%e6%95%88%e6%af%94%e8%bc%83","status":"publish","type":"post","link":"https:\/\/web.csh.org.tw\/web\/cshmagazine\/?p=885","title":{"rendered":"\u6e1b\u91cd\u85e5\u7269\u4ecb\u7d39\u8207\u7642\u6548\u6bd4\u8f03"},"content":{"rendered":"\n<p style=\"text-align:right\">\u6587\/\u5bb6\u91ab\u79d1 <strong>\u8607\u8056\u5091<\/strong> \u4f4f\u9662\u91ab\u5e2b<\/p>\n\n\n\n<p>\u53f0\u7063\u6210\u4eba\u904e\u91cd\u7684\u76db\u884c\u7387\uff0c\u81ea2013\u5e74\u4ee5\u4f86\u7537\u5973\u5408\u8a08\u5df2\u8d85\u904e40%\uff1b\u800c\u570b\u4eba\u5341\u5927\u6b7b\u56e0\u4e2d\uff0c\u8207\u80a5\u80d6\u76f8\u95dc\u7684\u75be\u75c5\u9ad8\u9054\u516b\u9805\uff0c\u80a5\u80d6\u6210\u70ba\u570b\u4eba\u4e0d\u5f97\u4e0d\u91cd\u8996\u7684\u5065\u5eb7\u8b70\u984c\u3002<\/p>\n\n\n\n<p>\u7576\u80a5\u80d6\u53ca\u4e09\u9ad8\u60a3\u8005\u81f3\u9580\u8a3a\u6c42\u52a9\uff0c\u61c9\u5efa\u8b70\u500b\u6848\u5148\u6539\u5584\u751f\u6d3b\u7fd2\u6163\uff0c\u4e5f\u5c31\u662f\u6539\u8b8a\u98f2\u98df\u53ca\u904b\u52d5\u7fd2\u6163\uff0c\u85c9\u6b64\u6e1b\u5c11\u71b1\u91cf\u651d\u53d6\u3001\u589e\u52a0\u71b1\u91cf\u6d88\u8017\u3002\u7136\u800c\u6e1b\u91cd\u5f8c\u5bb9\u6613\u5fa9\u80d6\uff0c\u6709\u7814\u7a76\u8b49\u5be6\u9019\u8ddf\u8377\u723e\u8499\u548c\u9175\u6d88\u5316\u9175\u7d20\u7684\u4ee3\u511f\u6709\u95dc\uff0c\u4f7f\u5f97\u6e1b\u91cd\u76f8\u7576\u4e0d\u6613\u3002<\/p>\n\n\n\n<p>\u81e8\u5e8a\u4e0a\u82e5\u662f\u75c5\u60a3BMI\u226730kg\/m<sup>2<\/sup>\u6216\u662fBMI\u226727 kg\/m<sup>2<\/sup>\u4e14\u81f3\u5c11\u6709\u4e00\u7a2e\u5408\u4f75\u75c7(\u9ad8\u8840\u58d3\u3001\u7b2c\u4e8c\u578b\u7cd6\u5c3f\u75c5\u6216\u8840\u8102\u7570\u5e38)\uff0c\u53ef\u4f7f\u7528\u6e1b\u91cd\u85e5\u7269\u4f5c\u70ba\u4f4e\u5361\u98f2\u98df\u53ca\u9069\u7576\u904b\u52d5\u7684\u8f14\u52a9\u6cbb\u7642\u3002<\/p>\n\n\n\n<p class=\"has-text-color has-vivid-red-color\"><strong>\u76ee\u524d\u4e94\u7a2e<\/strong><strong>FDA<\/strong><strong>\u8a8d\u8b49\u7684\u6e1b\u91cd\u85e5\u7269<\/strong><strong><\/strong><\/p>\n\n\n\n<p>FDA\u76ee\u524d\u6240\u8a8d\u53ef\u5177\u6e1b\u91cd\u9069\u61c9\u75c7\u7684\u85e5\u7269\u6709\u4e94\u9805\uff0c\u5206\u5225\u662fBupropion\/Naltrexone\u3001Liraglutide\u3001Lorcaserin\u3001Orlistat\u548cPhentermine\/Topiramate\u3002\u800c\u5176\u4e2d\u53f0\u7063\u98df\u85e5\u7f72\u6838\u53ef\u4f5c\u70ba\u6e1b\u91cd\u85e5\u7269\u4f7f\u7528\u7684\uff0c\u53ea\u6709Orlistat\u3002<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Orlistat (\u7f85\u6c0f\u9bae, Xenical<\/strong><sup><strong>\u00ae<\/strong><\/sup><strong>)<\/strong><br>1999\u5e74FDA\u51c6\u8a31\u4e0a\u5e02\uff0c2000\u5e74\u53f0\u7063\u98df\u85e5\u7f72\u6838\u53ef\u4e0a\u5e02\u3002\u70ba\u80f0\u8102\u9176\u6291\u5236\u5291\uff08pancreaticlipase inhibitor\uff09\uff0c\u8102\u80aa\u9700\u8981\u7d93\u7531\u80f0\u8102\u9176\u5206\u89e3\u6210\u8102\u80aa\u9846\u7c92\u5f8c\u624d\u80fd\u88ab\u4eba\u9ad4\u5438\u6536\uff0c\u6291\u5236\u80f0\u8102\u9176\u80fd\u4f7f\u98df\u7269\u4e2d\u7684\u8102\u80aa\u7121\u6cd5\u5206\u89e3\uff0c\u9032\u800c\u6e1b\u5c11\u8102\u80aa\u7684\u5438\u6536\u4e26\u7d93\u8178\u80c3\u9053\u6392\u51fa\u9ad4\u5916\u3002\u5e38\u898b\u7684\u526f\u4f5c\u7528\u6709\u6392\u4fbf\u6b21\u6578\u589e\u52a0\u3001\u5fcd\u4e0d\u4f4f\u7684\u4fbf\u610f\u3001\u6cb9\u4fbf\u3001\u8139\u6c23\u3002\u7531\u65bcOrlistat\u6703\u964d\u4f4e\u8102\u80aa\u5438\u6536\uff0c\u9023\u5e36\u5f71\u97ff\u8102\u6eb6\u6027\u7dad\u751f\u7d20\uff08\u7dad\u751f\u7d20A\u3001D\u3001E\u3001K\u3001\u03b2\u80e1\u863f\u8514\u7d20\uff09\u7684\u5438\u6536\uff0c\u56e0\u6b64\u9577\u671f\u4f7f\u7528\u5efa\u8b70\u88dc\u5145\u7dad\u4ed6\u547d\u3002<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Lorcaserin (\u6c9b\u9e97\u5a77, Belviq<\/strong><sup><strong>\u00ae<\/strong><\/sup><strong>) <\/strong>(\u56e0\u81f4\u764c\u98a8\u96aa\uff0c\u53f0\u7063\u5df2\u65bc2020\/02\u4e0b\u67b6)<br>2017\u5e74\u53f0\u7063\u98df\u85e5\u7f72\u6838\u53ef\u4e0a\u5e02\u3002\u4f5c\u7528\u662f\u8840\u6e05\u7d20\u81f4\u6548\u5291\uff08serotonin agonist\uff09\uff0c\u5982\u540c\u6297\u6182\u9b31\u85e5\u7269\u7684\u4f5c\u7528\uff0c\u4f5c\u7528\u5927\u8166\u7684\u98df\u617e\u6291\u5236\u795e\u7d93\u5143\u4ee5\u964d\u4f4e\u98df\u617e\u3002\u5e38\u898b\u7684\u526f\u4f5c\u7528\u70ba\u982d\u75db\u3001\u4e0a\u547c\u5438\u9053\u611f\u67d3\u3001\u7729\u6688\u3001\u5641\u5fc3\uff0c\u5b55\u5a66\u4e0d\u53ef\u4f7f\u7528\uff0c\u4e14\u4e0d\u53ef\u8207\u5176\u4ed6\u6703\u589e\u52a0\u8840\u6e05\u7d20\u6fc3\u5ea6\u7684\u85e5\u7269\u4e00\u8d77\u4f7f\u7528\uff0c\u5426\u5247\u5bb9\u6613\u9020\u6210\u8840\u6e05\u7d20\u75c7\u5019\u7fa4\uff08serotonin syndrome\uff09\uff0c\u51fa\u73fe\u610f\u8b58\u6df7\u4e82\u8207\u81ea\u5f8b\u795e\u7d93\u5931\u8abf\u75c7\u72c0\u3002<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Phentermine\/Topiramate(Qsymia<\/strong><sup><strong>\u00ae<\/strong><\/sup><strong>) <\/strong>(\u53f0\u7063\u5c1a\u672a\u4e0a\u5e02)<br>\u662f2012\u5e74FDA\u6838\u51c6\u4e0a\u5e02\u7684\u8907\u65b9\u88fd\u5291\u3002Phentermine\u53ef\u4fc3\u9032\u6b63\u814e\u4e0a\u817a\u7d20\u7684\u91cb\u653e\uff0c\u9032\u800c\u6291\u5236\u98df\u617e\uff0c\u5728\u7f8e\u570b\u6709\u55ae\u65b9\u88fd\u5291\u4e0a\u5e02\uff1bTopiramate\u70ba\u6297\u7672\u7647\u53ca\u9810\u9632\u504f\u982d\u75db\u7684\u85e5\u7269\uff0c\u4e5f\u6709\u6291\u5236\u98df\u617e\u7684\u6548\u679c\u3002\u5e38\u898b\u7684\u526f\u4f5c\u7528\u70ba\u53e3\u4e7e\u3001\u4fbf\u79d8\u3001\u611f\u89ba\u7570\u5e38\uff0c\u901a\u5e38\u4f7f\u7528\u4e00\u6bb5\u6642\u9593\u5f8c\u6703\u9010\u6f38\u7de9\u89e3\u3002\u4e0d\u5efa\u8b70\u7528\u5728\u9ad8\u8840\u58d3\u3001\u51a0\u5fc3\u75c7\u3001\u9752\u5149\u773c\u60a3\u8005\u3001\u5b55\u5a66\uff0c\u4ee5\u53ca14\u5929\u5167\u66fe\u4f7f\u7528\u55ae\u80fa\u6c27\u5316\u9176\u6291\u5236\u5291\uff08MAOI\uff09\u5982\u6297\u6182\u9b31\u85e5\u7269Eutac(\u6182\u505c\u819c\u8863\u9320)\u8005\u3002<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Bupropion\/Naltrexone(Contrave<\/strong><sup><strong>\u00ae<\/strong><\/sup><strong>) <\/strong>(\u53f0\u7063\u5c1a\u672a\u4e0a\u5e02)<br>\u662f2014\u5e74FDA\u6838\u51c6\u4e0a\u5e02\u7684\u8907\u65b9\u88fd\u3002Bupropion\u70ba\u6297\u6182\u9b31\u5291\uff0c\u53ef\u589e\u52a0\u591a\u5df4\u80fa\u53ca\u6b63\u814e\u4e0a\u817a\u7d20\u7684\u6d3b\u6027\uff0c\u9054\u5230\u6291\u5236\u98df\u617e\u3001\u589e\u52a0\u80fd\u91cf\u6d88\u8017\u7684\u6548\u679c\uff1bNaltrexone\u70ba\u9d09\u7247\u62ee\u6297\u5291\uff0c\u53ef\u6291\u5236\u98df\u617e\u3002\u526f\u4f5c\u7528\u8f03\u5927\uff08\u5fc3\u8df3\u3001\u8840\u58d3\u4e0a\u5347\uff09\uff0c\u56e0\u6b64\u4e0d\u5217\u70ba\u9996\u9078\u85e5\u7269\u3002\u4f7f\u7528\u7981\u5fcc\u70ba\u9ad8\u8840\u58d3\u672a\u63a7\u5236\u3001\u7672\u7647\u3001\u9577\u671f\u4f7f\u7528\u9d09\u7247\u985e\u85e5\u7269\u300114\u5929\u5167\u66fe\u4f7f\u7528\u55ae\u80fa\u6c27\u5316\u9176\u6291\u5236\u5291\uff08MAOI\uff09\u8005\u3002<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Liraglutide(Saxenda<\/strong><sup><strong>\u00ae<\/strong><\/sup><strong>)<\/strong> (\u53f0\u7063\u5c1a\u672a\u4e0a\u5e02)<br>2014\u5e74FDA\u6838\u51c6\u4e0a\u5e02\u7684\u85e5\u7269\uff0c\u6210\u5206\u662fGLP-1\u985e\u4f3c\u7269(Glucagon-likepeptide-1 agonist)\uff0c\u80fd\u6d3b\u5316\u80f0\u81df\u03b2\u7d30\u80de\uff0c\u523a\u6fc0\u80f0\u5cf6\u7d20\u91cb\u653e\uff0c\u4fc3\u4f7f\u98ef\u5f8c\u8840\u7cd6\u964d\u4f4e\uff0c\u8b93\u8840\u7cd6\u80fd\u6062\u5fa9\u5230\u6b63\u5e38\u7684\u7bc4\u570d\uff0cGLP-1\u4e5f\u80fd\u6291\u5236\u80f0\u81df\u03b1\u7d30\u80de\u5206\u6ccc\u6607\u7cd6\u7d20\uff0c\u964d\u4f4e\u809d\u81df\u7cd6\u8cea\u65b0\u751f\u4f5c\u7528\uff0c\u5ef6\u9072\u80c3\u6392\u7a7a\u901f\u5ea6\uff0c\u964d\u4f4e\u98df\u617e\uff0c\u6545\u6709\u63a7\u5236\u9ad4\u91cd\u7684\u6548\u679c\u3002\u9019\u985e\u85e5\u7269\u4f5c\u7528\u7684\u7a0b\u5ea6\uff0c\u6703\u96a8\u8457\u7576\u4e0b\u7684\u8840\u7cd6\u8b8a\u5316\uff0c\u56e0\u6b64\u8f03\u4e0d\u6703\u5f15\u8d77\u4f4e\u8840\u7cd6\u7684\u526f\u4f5c\u7528\u3002\u57282010\u5e74Liraglutdie\u5728\u7f8e\u570b\u88ab\u7528\u65bc\u6cbb\u7642\u4e8c\u578b\u7cd6\u5c3f\u75c5\uff0c\u76f4\u81f32014\u5e74\u5e95\uff0cFDA\u624d\u6279\u51c6\u4f5c\u70ba\u6162\u6027\u9ad4\u91cd\u7ba1\u7406\u85e5\u7269\u3002<\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>\u4e94\u7a2e\u85e5\u7269\u6e1b\u91cd\u7684\u6548\u679c\u6bd4\u8f03<\/strong><br>\u767c\u8868\u65bcJAMA\u7684\u7d71\u5408\u5206\u6790\u6587\u7ae0\uff0c\u6bd4\u8f03\u4e94\u7a2e\u85e5\u7269\u6e1b\u91cd\u6548\u679c\u548c\u526f\u4f5c\u7528\u3002\u767c\u73fe\u9019\u4e94\u7a2e\u85e5\u7269\u5728\u4f7f\u752852\u5468\u6642\u90fd\u6709\u81f3\u5c115%\u4ee5\u4e0a\u7684\u6e1b\u91cd\u6548\u679c\uff0c\u800c\u5176\u4e2d\u4ee5Phentermine\/Topiramate\u7684\u6548\u679c\u6700\u597d\u3002\u56e0\u526f\u4f5c\u7528\u800c\u4e2d\u65b7\u4f7f\u7528\u7684\u500b\u6848\u6578\uff0c\u5247\u4ee5Liraglutide\u548cBupropion\/Naltrexone\u6700\u591a\u3002<\/li><\/ul>\n\n\n\n<p><strong>\u4e94\u7a2e\u6e1b\u91cd\u85e5\u7269\u8207\u5b89\u6170\u5291\u76f8\u6bd4\u4e4b\u5e73\u5747\u6e1b\u5c11\u9ad4\u91cd\u8868<\/strong><\/p>\n\n\n\n<table class=\"wp-block-table\"><tbody><tr><td>\n  \u85e5\u7269\n  <\/td><td>\n  \u8ad6\u6587\u7bc7\u6578\n  <\/td><td>\n  \u5e73\u5747\u4e0b\u964d\u9ad4\u91cd(kg)\n  <\/td><td>\n  \u6392\u540d\n  <\/td><\/tr><tr><td>\n  Orlistat\n  <\/td><td>\n  14\n  <\/td><td>\n  \u22122.63\n  <\/td><td>\n  5\n  <\/td><\/tr><tr><td>\n  Lorcaserin\n  <\/td><td>\n  3\n  <\/td><td>\n  \u22123.25\n  <\/td><td>\n  4\n  <\/td><\/tr><tr><td>\n  Bupropion\/Naltrexone\n  <\/td><td>\n  2\n  <\/td><td>\n  \u22124.95\n  <\/td><td>\n  3\n  <\/td><\/tr><tr><td>\n  Phentermine\/Topiramate\n  <\/td><td>\n  1\n  <\/td><td>\n  \u22128.80\n  <\/td><td>\n  1\n  <\/td><\/tr><tr><td>\n  Liraglutide\n  <\/td><td>\n  3\n  <\/td><td>\n  \u22125.24\n  <\/td><td>\n  2\n  <\/td><\/tr><\/tbody><\/table>\n\n\n\n<p><strong>\u56e0\u70ba\u526f\u4f5c\u7528\u800c\u4e2d\u65b7\u85e5\u7269\u4f7f\u7528\u6392\u540d\u8868<\/strong><\/p>\n\n\n\n<table class=\"wp-block-table\"><tbody><tr><td>\n  \u85e5\u7269\n  <\/td><td>\n  \u8ad6\u6587\u7bc7\u6578\n  <\/td><td>\n  \u6392\u540d\n  <\/td><\/tr><tr><td>\n  Orlistat\n  <\/td><td>\n  16\n  <\/td><td>\n  4\n  <\/td><\/tr><tr><td>\n  Lorcaserin\n  <\/td><td>\n  3\n  <\/td><td>\n  5\n  <\/td><\/tr><tr><td>\n  Bupropion\/Naltrexone\n  <\/td><td>\n  4\n  <\/td><td>\n  2\n  <\/td><\/tr><tr><td>\n  Phentermine\/Topiramate\n  <\/td><td>\n  2\n  <\/td><td>\n  3\n  <\/td><\/tr><tr><td>\n  Liraglutide\n  <\/td><td>\n  3\n  <\/td><td>\n  1\n  <\/td><\/tr><\/tbody><\/table>\n\n\n\n<p class=\"has-text-color 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