tag:blogger.com,1999:blog-26623431383767917342024-03-20T03:19:00.370-07:00史丹福狂想曲235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.comBlogger291125tag:blogger.com,1999:blog-2662343138376791734.post-48596490662076802502023-10-24T05:48:00.003-07:002023-10-24T20:10:44.612-07:00奧本海默夫人的死亡之旅<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo-CfdvkPAdKxm5RuEStcUQBTjfCH_hYccZHj_MF4kbb_jy02ZktA9kQRL5ZBXP7d-qgRGIG0qE603EhgwBFsg1eOBPNoGiL7KvxYIWdpNTeTQoaza0FyB6nv-3AF8AMcMgBz_8y-TMA9a9gget8-_S0wCe2Lu_HDqgA70_378uKUuzhsSr_AiC9GQ6GyF/s1024/oppenhiemer.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="683" data-original-width="1024" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo-CfdvkPAdKxm5RuEStcUQBTjfCH_hYccZHj_MF4kbb_jy02ZktA9kQRL5ZBXP7d-qgRGIG0qE603EhgwBFsg1eOBPNoGiL7KvxYIWdpNTeTQoaza0FyB6nv-3AF8AMcMgBz_8y-TMA9a9gget8-_S0wCe2Lu_HDqgA70_378uKUuzhsSr_AiC9GQ6GyF/w640-h426/oppenhiemer.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">左圖:電影中的奧本海默夫人,右圖:現實中的奧本海默夫人</td></tr></tbody></table><br /><span style="font-family: PMingLiU, serif;"><br /></span><p></p><p><span style="font-family: PMingLiU, serif;">有「原子彈之父」之稱的科學家奧本海默的一生如過山車般高潮迭起,充滿戲劇性。他的內心複雜而矛盾。他是位理論物理學家,而且是美國最早研究量子力學的科學家之一。在第二次世界大戰期間,他被美國軍方選中成為研究原子彈的「曼克頓計劃」的實驗室主管,並在計劃中展驗了他優秀的管理及執行能力。他研發的原子彈之後被投下日本廣島與長崎。一方面,他興幸自己負責研發的成果順利運作,另一方面,他卻因為原子彈所做成的傷亡而深感自責,並認為自己雙手沾滿了鮮血。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">奧本海默的成功本可令他名成利就,但他卻因為欠缺政治敏感度(與共產黨員私交甚篤)及過分理想化的道德價值觀(認為美國不應該研發比原子彈威力更大的氫彈)而被人作出政治攻擊,最終令他身敗名裂。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">奧本海默的一生如此精彩,伯德(</span>Kai
Bird<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)和舍溫(</span>Martin
J. Sherwin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)就把他的故事寫成《美國的普羅米修斯》(</span>American
Prometheus<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)一書,該書獲得了</span>2006<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年普立茲傳記文學獎。著名導演路蘭更把該傳記改篇成電影《奧本海默》。電影叫好叫座,並成了</span>2023<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年最具話題性的電影之一。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">奧本海默的故事固然精彩,但其實他妻子的一生同樣很有傳奇性。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">奧本海默夫人的前半生</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">奧本海默夫人叫做凱瑟琳(</span>Katherine<span lang="ZH-TW" style="font-family: PMingLiU, serif;">),不過大家都叫她吉蒂(</span>Kitty<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">吉蒂在遇到奧本海默之前有過三段婚婚姻,其中她的第二任丈夫是一位名叫達萊特(</span>Joseph
Anthony Dallet Jr.<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的美國共產黨員。吉蒂受到丈夫的影響,亦曾經加入過共產黨。吉蒂這段經歷為她的生命帶來了不可磨滅的印記,奧本海默的敵人之後亦有利用吉蒂這早年的經歷來攻擊奧本海默。吉蒂與達萊特本來移居法國,不過後來達萊特參加了西班牙內戰中的共產主義軍隊,並在戰鬥中陣亡。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">之後吉蒂返回美國,在賓夕法尼亞大學攻讀植物學學位,並於</span>1939<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年以榮譽畢業。她在同一年遇到了奧本海默。當時她仍與第三任丈夫、一位名叫夏里遜(</span>Richard
Harrison<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的英國醫生有婚姻關係。其後,吉蒂與丈夫離婚,並於</span>1940<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年</span>11<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>1<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日與奧本海默結婚。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">吉蒂與奧本海默結婚後不久,奧本海默就參與曼哈頓計劃,於是兩人移居到原子彈研究實驗室的所在地,美國新墨西哥州洛斯阿拉莫斯的沙漠中。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">吉蒂在洛斯阿拉莫斯的生活並不愉快。作為一名受過訓練的植物學家,吉蒂覺得自己懷才不遇,無法發揮。再加上照顧兩位孩子的壓力,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">令吉蒂的情緒受到很大的困擾,更養成了酗酒的習慣。儘管如此,吉蒂一直都是她丈夫的重要支柱。在曼哈頓計劃進行得如火如荼之時及奧本海默之後被政府迫害的期間,吉蒂和她的丈夫互相依靠,為彼此提供了堅實的支持。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">樂極生悲之旅</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">奧本海默於</span>1967<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年因喉癌逝世,終年</span>62<span lang="ZH-TW" style="font-family: PMingLiU, serif;">歲。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">與此同時,另一位參與曼哈頓計劃的科學家瑟伯爾(</span>Robert
Serber<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的妻子亦在差不多時間因為抑鬱症而自殺身亡。吉蒂與瑟伯爾兩人彼此支持,互舔傷口,漸生情愫。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">他們買下一艘的</span>16<span lang="ZH-TW" style="font-family: PMingLiU, serif;">米長的小型帆船,打算展開了新的航程,共同橫渡太平洋,從紐約出發,經過巴拿馬運河、加拉巴哥群島(</span>Galapagos
Islands<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)、大溪地(</span>Tahiti<span lang="ZH-TW" style="font-family: PMingLiU, serif;">),一路航行到日本。這段令人心動的旅程最後卻是樂極生悲,當他們二人航行到中美洲的格林納達,橫過巴拿馬運河時,吉蒂出現呼吸困難與胸口痛的症狀。她被送往美軍的戈加斯醫院(</span>Gorgas
Hospital<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)進行治療,卻已是返魂乏術,最後她於</span>1972<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年</span>10<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>27<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日過身。醫生斷定死因是肺栓塞(</span>pulmonary
embolism<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">在她過身後,瑟伯爾把她的遺體火化,並將其骨灰撒在位於聖約翰(</span>St.
John<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的大海中。這片大海就在奧本海默與吉蒂的故居附近。奧本海默死後,吉蒂也是把奧本海默的骨灰撒在同一片大海中。奧本海默與吉蒂二人終於在死後再聚。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">吉蒂的悲劇是一個天大的不幸,卻絕非單純的巧合。乘坐長途交通工具能夠誘發深層靜脈栓塞(</span>deep
vein thrombosis<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)與肺栓塞,這是一個常見的醫學現象。醫學界甚至為它起了一個專有的名稱--</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">「旅行血栓症」(</span>travel
related thrombosis<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">現代的交通發達,旅客如果想去外遊,大多都會選搭飛機。因此大部分有關旅行者血栓的研究都集中在與乘座客機相關的血栓,也就是所謂的</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">「經濟客</span><span lang="ZH-HK" style="font-family: PMingLiU, serif;">艙綜合症」</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">。研究顯示,大約每</span>4,600<span lang="ZH-TW" style="font-family: PMingLiU, serif;">個乘搭長途機旅客就有一人會得到旅行血栓症。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">各位讀者朋友可能很難具體化地理解這個數字,我們不妨試試套用一些實際數據去作分析。以我們香港的赤鱲角國際機場為例,機場在</span>2018<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的客運量逾</span>7,400<span lang="ZH-TW" style="font-family: PMingLiU, serif;">萬人次,我們假設當中的十分之一是乘搭長途機的旅客(史丹福非航空專家,十分之一這個數字是我自己胡亂作的估計,如各位朋友有確實數據,請指教),那麼根據數字估計,當年曾在赤鱲角國際機場乘搭航班的旅客中,就有</span>160<span lang="ZH-TW" style="font-family: PMingLiU, serif;">位患上了</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">旅行血栓症</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">。這個數字實在是不容小覷的。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">不過值得留意的是,</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">「經濟客</span><span lang="ZH-HK" style="font-family: PMingLiU, serif;">艙綜合症」雖然以</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">經濟客</span><span lang="ZH-HK" style="font-family: PMingLiU, serif;">艙來命名,但其實即使是乘坐</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">商務客位甚至是頭等客位的</span><span lang="ZH-HK" style="font-family: PMingLiU, serif;">旅客</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">都有可能有同樣的疾病。再退後多一步,即使不是乘坐飛機,而是搭乘火車、汽車或船等其他交通工具,都同樣可以誘發靜脈栓塞。一般來說,只要乘坐交通工具四小時或以上,靜脈栓塞的風險就會增加。吉蒂在乘坐帆船期間出現肺栓塞,這很有可能就是</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">一宗旅行血栓症的個案</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">其實不論是乘坐飛機、火車、汽車或船,血栓形成的機制都是相同的。靜脈血管並不是直接連接到心臟的心室中,所以靜脈血管內的血壓較低,並不足以推動靜脈血液的流動。因此,人體有另一機制去推動靜脈血液的流動,就是依靠肌肉的泵動。當肌肉收縮時,它就會擠壓靜脈,令入面的血液流動。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">乘搭長途交通工具的人很多時候都會長期靜止不動,這就令到靜脈血流失去了來自肌肉的推動力量,於是血流減慢。大家可以把靜脈血管想像成河流,當水流足夠時,河水中的沙石可以隨水而行,但當水流慢下來時,沙石就會沉澱在河床中。同樣道理,靜脈血流足夠時,血液中的細胞隨著血液流動,當血流變慢,血小板就有較大機會接觸到血管壁內皮,凝血因子也會較易積聚,令血栓容易形成。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">靜脈栓塞大多先在下肢中發生,這臨床情況叫做深層靜脈栓塞。如果血栓只是局限在下肢,那麼病人並不會有生命危險。患者可能會有下肢紅腫與疼痛的症狀,但當血栓溶解後,症狀就會消失。不過假如栓子脫離了下肢的靜脈,那就糟糕透頂了。栓子會隨著血液循環走到肺部,阻塞肺動脈,引起可怕得多的肺栓塞。肺栓塞會影響的肺部組織的氣體交換,令患者出現呼吸困難、胸痛。更甚的是,嚴重的肺栓塞會影響血液回流至左心房,進而影響心臟泵血至全身,令患者血壓降低、休克,並可以在短時間內死亡。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">吉蒂很有可能就是在乘坐帆船時雙腳的肌肉活動減少,令靜脈血液的流動減慢。血栓於是悄悄地在她的下肢形成。當她的雙腳重新活動時,血栓就被移開了,血栓脫離了下肢的靜脈,隨著靜脈的血流一直流到肺動脈,最後引起了這段悲劇。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">那麼,如果時間可以重來,根據現今的血液學知識,吉蒂有沒有方法去預防旅行者血栓這個悲劇呢?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">根據英國血液學學會(</span>British
Society for Haematology<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的指引(指引集中討論客機相關的血栓,不過正如之前所講,所有長途交通工具的情況其實都是大同小異),以下的幾個方法都有助減低出現旅行者血栓的機會。首先,吉蒂當然應該盡量在交通工具上多活動,以改善靜脈的血液流動。其次,雖然沒有直接證據顯示補充水分可以預防旅遊相關血管栓塞,然而理論上多喝水可以降低血液的黏度,因此她在交通工具上不妨多喝水。最後,如果乖搭長途交通工具的旅客屬於血栓的高危人士,也就是曾經有過旅遊相關或者無明確成因的血管栓塞病歷、短期內進行過重大手術或是患有癌症的病人,就應使用壓力襪及抗凝血藥物去預防血栓。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">中西大不同</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">最後值得一提的是,旅行血栓症這個情況在西方白種人中</span><span lang="ZH-TW">頗</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">為常見,但在亞洲人中則較少出現。研究顯示,白種人深層靜脈栓塞的發病率是每年每十萬人口有</span>103<span lang="ZH-TW" style="font-family: PMingLiU, serif;">宗,亞洲人的發病率則是</span>29<span lang="ZH-TW" style="font-family: PMingLiU, serif;">宗,差不多只有白種人的四分之一。究竟為何如此呢?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">原來亞洲人與西方白種人的凝血系統有所分別。正常人的體內會有天然的抗凝血物質去抑制凝血系統,防止血栓的形成。例如蛋白</span>C<span lang="ZH-TW" style="font-family: PMingLiU, serif;">(</span>protein
C<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)與蛋白</span>S<span lang="ZH-TW" style="font-family: PMingLiU, serif;">(</span>protein
S<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)會抑制凝血因子</span>V<span lang="ZH-TW" style="font-family: PMingLiU, serif;">及</span>VIII<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,而抗凝血酶(</span>antithrombin<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)則會抑制凝血酶與凝血因子</span>X<span lang="ZH-TW" style="font-family: PMingLiU, serif;">。但西方白種人常有一些特別的基因突變,令凝血物質不再被天然抗凝血物質所抑制。凝血物質於是就如脫韁野馬一樣,在沒有抗衡的情況下自行活動,因而較為容易形成血痊,這情況在臨床上被稱為易栓症(</span>thrombophilia<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">西方常見的易栓症例子包括凝血因子</span>V<span lang="ZH-TW" style="font-family: PMingLiU, serif;">萊頓(</span>Factor
V Leiden<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)及凝血酶</span>G20210A
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">(</span>Prothrombin
G20210A<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)突變。這些突變令凝血因子</span>V<span lang="ZH-TW" style="font-family: PMingLiU, serif;">及凝血酶分別不再受到蛋白</span>C
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">(</span>protein
C<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)及抗凝血酶(</span>antithrombin<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)等天然抗凝血劑所抑制,增加形成血栓的機會。這些基因突變在亞洲人中卻是絕無僅有的,這就可以解釋亞洲人與西方白種人的</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">血栓症發病率的分別</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">。</span></p><p class="MsoNormal"><span style="font-family: PMingLiU, serif; text-indent: -18pt;"><br /></span></p><p class="MsoNormal"><span style="font-family: PMingLiU, serif; text-indent: -18pt;">參考資料</span></p><p class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">1.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 7pt; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-size: 12pt; line-height: 107%;">Watson
HG, Baglin TP. Guidelines on travel-related venous thrombosis. <i>British
Journal of Haematology</i>. 2011;152(1):31-34.<o:p></o:p></span></p><p class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">2.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 7pt; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">
</span></span><!--[endif]--><span style="font-size: 12pt; line-height: 107%;">Aryal
KR, Al-Khaffaf H. Venous thromboembolic complications following air travel:
what's the quantitative risk? A literature review. <i>European Journal of
Vascular and Endovascular Surgery</i>. 200;31(2):187-199.<o:p></o:p></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">
</span></p><p class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;">3.<span style="font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 7pt; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal;">
</span></span><!--[endif]--><span style="background-color: white; background: white; color: #212121; font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Cannegieter SC, Doggen CJ, van Houwelingen HC, Rosendaal FR.
Travel-related venous thrombosis: results from a large population-based case
control study (MEGA study). <i>PLoS Med</i>. 2006;3(8):e307.</span><span style="font-size: 12pt; line-height: 107%;"><o:p></o:p></span></p><p class="MsoNormal"><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-88560853828828589062023-09-28T09:42:00.003-07:002023-09-28T09:42:19.398-07:00「齒間出血如蚯蚓者無數」的蘇東坡<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3XqVAhMptUV8pMoqqXvvzzDZbfnjXoFSoRbTxhgEES6hsImZMoid9-SrAqzbiUoqH6eNZdQS4ND29MNKdcuFd8UcO-TgAneP5ADjbYjGZBG3HS-AU4wwuaEYWN9x3p1rfmNzRj11HWaIB5evqoBBZ35Q9ZJID_04PfLdkVktP4hT7VfG_70rFtcgtojJ5/s772/so.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="772" data-original-width="770" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3XqVAhMptUV8pMoqqXvvzzDZbfnjXoFSoRbTxhgEES6hsImZMoid9-SrAqzbiUoqH6eNZdQS4ND29MNKdcuFd8UcO-TgAneP5ADjbYjGZBG3HS-AU4wwuaEYWN9x3p1rfmNzRj11HWaIB5evqoBBZ35Q9ZJID_04PfLdkVktP4hT7VfG_70rFtcgtojJ5/w399-h400/so.png" width="399" /></a></div><br /><span style="font-family: PMingLiU, serif;"><br /></span><p></p><p><span style="font-family: PMingLiU, serif;">又到中秋佳節,大家難免會想起著名詞人蘇東坡(原名蘇軾)筆下《水調歌頭》中「明月幾時有,把酒問青天」及「但願人長久,千里共嬋娟」等佳句。但大家又知不知道原來蘇東坡之死原本也與血液學有關?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">話說蘇東坡官場發展不如意,在黨爭中失利,在晚年被流放到遙遠的海南島。不知道為何,中國史上留下千古佳句的大文學家都是官場失意的,李白、杜甫、陶淵明、辛棄疾都是如此。幸好後來宋哲宗駕崩,宋徽宗即位,他隨即大赦天下。蘇東坡的流放生涯亦得以完結。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蘇東坡懷著興奮的心情回京。當時的交通沒有現在方便,回京的路途遙遠,連日的路程令蘇東坡疲憊不堪。再加上蘇東坡名滿天下,所到之處都有新交舊知為他設宴招待,詩詞唱和,又帶他四處欣賞湖光山色。他的仰慕者本是一番美意,奈何蘇東坡當時已是位花甲老人,體力實在不勝負荷,結果他勞累病倒。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">他在遊太湖之時覺得酷暑難當,大量飲用冰水。到了半夜就急瀉不止。到了第二天,他全身軟弱乏力,疲憊不堪。蘇東坡略懂醫術,於是利用黃芪等藥熬粥服食。當時蘇東坡胃口不佳,食慾不振,卻依然硬著頭皮參加朋友所設的宴會。此後他的病情持續轉差,據記載,他「某一夜發熱不可言,齒間出血如蚯蚓者無數。」意思就是指他開始發燒與牙齦出血。蘇東坡之後再服用了人參等補藥。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">到了常州之後,蘇東坡寫道自己「百病橫生,四肢腫滿,渴消唾血,全不能食者,二十餘日矣。自料必死。」他知道自己命不久矣,最後決定辭官在常州休養。他抵達常洲時,河岸邊有成千上萬的人夾道歡迎,但人們並不知道,蘇東坡此時已經病入膏肓。蘇東坡到了常州,病情每放愈下,最終在常州的藤花舊館逝世。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">清代的士大夫陸以湉對醫學很有興趣,他研究蘇東坡的病歷,在《冷廬醫話》一書中寫道「病暑飲冷暴下,不宜服黃芪,殆誤服之。胸脹熱雍,牙血氾濫,又不宜服人蔘、麥門冬。噫,此非為補藥所誤耶?」大意是說,蘇東坡的病症是「暑毒」,不宜服用黃芪及人參等補藥。蘇東坡自行斷症,濫服補藥,反而令到病情惡化。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">史丹福當然不懂傳統中國醫學的概念,亦對中草藥的認識相當有限,所以無法評論陸以湉先生的意見。不過根據現代醫學,蘇東坡先是腹瀉,之後發燒,病徵似乎與腸胃感染最為吻合。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而對血液學醫生來說,最感興趣的症狀自然是「齒間出血如蚯蚓者無數」。牙齦出血是止血系統異常的症狀。正常人體內有血小板與凝血因子等機制去預防出血。當這些系統出現異常,身體就會有不尋常的流血現象。一般來說,血小板的問題較易引起皮膚疼傷、流鼻血、牙齦出血及女士經血增多等。而凝血因子的問題則較常出現深層流血,例如肌肉內出血及關節出血等。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那麼假如蘇東坡真的患有感染,那又與出血症狀有何關係呢?合理的推斷是,蘇東坡腸胃中的細菌走到血液中,引起敗血症(</span>sepsis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。某些細菌的細胞壁外層含有脂多醣(</span>lipopolysaccharide<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),而細菌引起的免疫反應又會令免疫細胞釋放出細胞因子(</span>cytokine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),再加上不同的生化機制,令體內出現不受控的發炎反應。發炎反應會令血管的內皮組織產生大量的組織因子(</span>tissue
factor<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),凝血系統被大規模地激活,結果凝血因子及纖維蛋白原就被消耗得很快,血小板亦會同時消耗掉,結果令蘇東坡容易出血。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">凝血系統被激活反而會引起流血症狀,這看似很違背直覺,但其實並不難理解。打個比喻,一個人在不適當的時候大量花錢,不單不會令他變得富有,反而會令他變得一貧如洗,正如俗語所講,「冇咁大個頭唔好帶咁大頂帽」。同樣道理,在不適當的時候激活凝血系統,只會令身體中的凝血因子及血小板在毫無意義的情況下被用掉,結果反而會容易流血。臨床上,這情況叫做瀰漫性血管內凝血(</span>disseminated
intravascular coagulation<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>DIC<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過嚴格來說,瀰漫性血管內凝血並不是一個疾病,它只是一個由疾病引起得現象,它背後的疾病才是始作俑者。可以導致瀰漫性血管內凝血的疾病有很多,除了敗血症之外,還包括某些惡性腫瘤、大規劃創傷、中毒、急性溶血及妊娠併發症(如羊水栓塞)等。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">根據記載,除了牙齦出血之外,蘇東坡似乎未有其他嚴重的流血症狀。因此,雖然他可能有瀰漫性血管內凝血,但這並不是他的主要致命原因。他最終死亡的原因有可能是敗血症併發的多重器官衰竭。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了感染之外,又人認為蘇東坡是死於中暑,不過蘇東坡的症狀持續多時,假如蘇東坡真的出現中暑,他理應在很短時間內就會過身。假如他只是出現較輕微的熱衰竭(</span>heat
exhaustion<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),他只需回到陰涼及空氣流通處休息,並且多喝水,應該很快就會復原。因此不論是中暑或是熱衰竭,都很難解釋到蘇東坡持續發燒的症狀。</span><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-89133636093862378772023-07-14T07:31:00.005-07:002023-07-15T05:51:56.045-07:00摩納哥大親王、葡萄牙戰艦水母與過敏性反應<p><span style="font-family: PMingLiU, serif;">摩</span><span style="font-family: PMingLiU, serif;">納哥是世上面積第二小的國家。摩納哥為君主立憲制國家,君主為摩納哥大親王。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">摩納哥雖小,卻一樣有著很有趣的歷史。例如其前大親王阿爾貝一世(</span>Albert
I<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)就是一位很特別的君王,他是一位「被大親王耽誤的科學家」。他本身是一位海洋學專家。除此之前,他也對人類古生物學及礦物學很感興趣。摩納哥的外交人員甚至會在世界各國尋找科學論文寄給他。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">阿爾貝一世親王對海洋學的興趣後來竟然引致了一個重要的科學發現。話說阿爾貝一世在他的遊艇上收藏了各式各樣的海洋生物。在</span>1902<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,阿爾貝一世在邀請了法國生理學家里歇</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span>Charles
Richet<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)和醫生(</span>Paul
Portier<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)到其遊艇上研究僧帽水母(</span>Physalia
physalis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的毒液。這種水母有「葡萄牙戰艦」的稱號,其毒液毒性頗強,被這水母刺到的話,輕則劇痛,重則致命。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">兩位科學家從水母觸鬚中提取毒物的試驗。他們試圖利用類似疫苗免疫的原理令狗隻獲得對毒素的抵抗力。他們先把小劑量的毒素注入狗體內,讓狗隻免疫。隔一段時間後為狗隻注射第二劑毒素。他們本來以為免疫會令狗隻對毒素的抵抗力提升,誰不知結果卻完全相反。狗隻出現了嚴重的反應,出現呼吸困難,並很快死亡。他們發現無論第二劑的毒素劑量有多小,都不影響結果,狗隻都會出現嚴重反應並死亡。最後他們得出結論,認為反應並不是單純由毒素引起,而是一個免疫現象。他們把現象命名為</span>anaphylaxis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即過敏性反應。里歇其後繼續研究此現象,並於</span>1913<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年獲得諾貝爾生理學及醫學獎。摩納哥之後亦曾經發行過郵票去紀念這件美事。</span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxjFp9OouX8UCTtQAz0OzMmu6ozmID1_j4JJ1VY9AWB8jXSt2pguKG13GPbih2DvlASZDrHiAJXFduTBt-PV1ZLEfNCAN4CkN5px6hmSXJxcQz3sWQnVBL4jP_CR-WzpNcbl0joFTPUSX1b0Tk0Vp_bSA7jvoYQszpZJkwN_Ztt5jk4QYDxTdvXgtZR2M5/s831/monnaco.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="495" data-original-width="831" height="382" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxjFp9OouX8UCTtQAz0OzMmu6ozmID1_j4JJ1VY9AWB8jXSt2pguKG13GPbih2DvlASZDrHiAJXFduTBt-PV1ZLEfNCAN4CkN5px6hmSXJxcQz3sWQnVBL4jP_CR-WzpNcbl0joFTPUSX1b0Tk0Vp_bSA7jvoYQszpZJkwN_Ztt5jk4QYDxTdvXgtZR2M5/w640-h382/monnaco.jpg" width="640" /></a></div><br /><p class="MsoNormal"><br /></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那麼過敏性反應又與血液學有沒有關係呢?答案是肯定的。過敏性反應是由肥大細胞(</span>mast
cell<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)所釋放的組織胺(</span>histamine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)所引起。肥大細胞是血液細胞系統的一部分。有一種名為系統性肥大細胞增多症(</span>systemic
mastocytosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的血液癌症,其病因就是肥大細胞出現癌變而不受控地生長。患者有機會出現反覆的過敏性反應。而且系統性肥大細胞增多症非常特別,經常伴隨著另一些骨髓性的血液腫瘤同時出現。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></p><p class="MsoNormal">Cohen SG, Zelaya-Quesada M. Portier, Richet, and the
discovery of anaphylaxis: a centennial. J Allergy Clin Immunol. 2002;110(2):331-6.</p><p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com1tag:blogger.com,1999:blog-2662343138376791734.post-38549829362089966392023-05-02T06:23:00.000-07:002023-05-02T06:23:14.599-07:00以基因分析破解貝多芬的肝病之謎<p><span style="font-family: PMingLiU, serif;">貝多芬的健康狀況一直都是醫學界的未解之謎,這議題吸引了很多醫學學者的興趣。</span> </p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝多芬是一位失聰患者,失聰影響了他的音樂創作能力,但他憑著其不屈不朽的毅力,克服重重困難,最終在完全失聰的情況下創作出千古傳頌的《第九交響樂》。這狀舉至今仍為人所津津樂道。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY40LXukxseUVNP068jNR9kyeJLcSTtauBiTp-BK6i1YwRs7a4pUXr3iRNI2X89eCkbXL6Zhl8qUe8QaeclBoQev7fGkfpNwKqrJKdo9VLIcFtG4_7FT_2jw6GPZx6cd5r-ToRqsHv4mwQSAGgJ1vNG6nzHvyxUP75XA6rEByyOR0-XWhzUEk2tUBQ0Q/s962/Beethoven.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="962" data-original-width="800" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY40LXukxseUVNP068jNR9kyeJLcSTtauBiTp-BK6i1YwRs7a4pUXr3iRNI2X89eCkbXL6Zhl8qUe8QaeclBoQev7fGkfpNwKqrJKdo9VLIcFtG4_7FT_2jw6GPZx6cd5r-ToRqsHv4mwQSAGgJ1vNG6nzHvyxUP75XA6rEByyOR0-XWhzUEk2tUBQ0Q/w333-h400/Beethoven.jpg" width="333" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">貝多芬的畫像(來源:Wikipedia)</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了耳朵的毛病外,貝多芬亦患有慢性肝病。貝多芬生前曾出現黃疸、腹部腫脹、下肢腫脹等症狀,這些都是肝硬化與肝衰竭的症狀。醫生曾在死後為貝多芬進行解剖,並發現的他肝臟已經萎縮到正常肝臟體積的四分之一。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝多芬失聰與肝硬化的成因是甚麼?基因突變是否致病的因素之一?要解答這難題,最好的方法當然是抽取貝多芬的</span>DNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">樣本進行基因分析。奈何這項工作的技術需求極高,因此長期以來都未有科學團隊能夠進行這工作。直到近日,這個幻想終於成真,由劍橋大學的生物人類學家貝格(</span>Tristan
Begg<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)帶領的研究團隊成功對</span>
8 <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">組聲稱是貝多芬頭髮樣本中取得</span>
DNA <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">進行基因分析。他們的結果在</span>2023<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月被刊登在《當代生物學》(</span>Current
Biology<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)期刊中。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝多芬的肝臟</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">史丹福在經常強調,無論醫學檢測技術多麼先進,醫學診斷都始終離不開細心地研究病人的病歷。醫生們不能本末倒置,因為擁有尖端檢測技術而忽略病人的病歷。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因此,我們也不妨先從貝多芬的病歷說起。史丹福在在其他文章中詳盡地分析過貝多芬聽力問題相關的病歷,並在本文中集中討論與其肝病相關的病歷。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝多芬自</span>1792<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年開始已經有反覆的腹痛與腹瀉。之後,他時不時都會有類似的腸胃症狀。貝多芬曾經表示這些腹痛有時候會嚴重到令他需要「增加喝酒量去減少疼痛」。不過到了晚年,他發現喝酒反而會增加他的腹痛。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝多芬的父親嗜酒如命,而貝多芬同樣非常喜歡喝酒。據聞貝多芬生前至少每天喝一瓶葡萄酒,不過我們無從稽考這傳言是否屬實。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而我們可以從以下的故事中側面地了解到貝多芬有多喜歡喝酒。貝多芬曾經愛上自己的學生特雷莎.馬爾法蒂(</span>Therese
Malfatti<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。他原本計劃在特雷莎父親舉行的宴會上演奏自己為她而寫的作品並求婚,誰不知貝多芬在宴會上還未求婚就喝醉了,求婚的事於是就不了了之。他所寫的琴譜也遺留了在特雷莎的家裡,多年後才被找到。更有趣的是,貝多芬原本把作品命名為《給特雷莎》,不過他的字跡太潦,後人竟然把作品名稱錯讀為《給愛麗絲》(</span>Für
Elise<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。貝多芬這部愛意綿綿的鋼琴小品從未被女主角所聽過,但之後卻成為了名頌千古的作品,真是不得不令人慨嘆天意弄人。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了腸胃症狀外,貝多芬亦時不時有關節痛的問題。</span>1821<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,貝多芬出現黃疸、腹痛與嘔吐。黃疸足足維持了幾個月。</span>1825<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,貝多芬出現了另一次嚴重的黃疸,甚至有流鼻血與吐血的情況。翌年,他的健康情況急劇惡化,他出現發燒,肝臟腫大、腹漲。醫生多次為他進行腹腔穿刺術去抽取腹腔内的腹水,每次都抽到</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">升或以上的大量腹水。大家可以想像一下一個人的腹內如果有多達</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">升的液體,他的腹部會漲得多麼誇張。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最終,貝多芬在</span>1827<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>26<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日過身,享年</span>56<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲。貝多芬在死前仍然不忘喝酒,據說當貝多芬病入膏盲,時日不多時,他收到了友人贈送的葡萄酒,貝多芬已經病到連酒都喝不到,他說:「可惜,可惜,為時已晚!」</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這句話竟然成為了他最後的遺言。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">概括貝多芬的病歷,有學者認為反覆貝多芬的腹痛與腹瀉與發炎性腸病(</span>inflammatory
bowel disease<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)相關,又有學者認為他的關節痛可能是系統性紅斑性狼瘡(</span>systemic
lupus erythematosus<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的病徵。不過這些診斷的爭議較多,學界暫時並沒有共識。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而根據病歷,貝多芬肯定患有肝硬化與肝衰竭,他的病徵與肝硬化及肝衰竭完全吻合。學界對這個診斷也是毫無異議的。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肝臟負責排出一種名為膽紅素(</span>bilirubin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的色素。肝衰竭會令膽紅素積聚在體內。膽紅素雖然以「紅」命名,但其實它呈橙黃色。當過量的膽紅素積聚在體內,患者的皮膚與眼白會發黃,引起黃疸。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肝臟亦負責合成凝血因子,因此肝衰竭的患者缺少足夠的凝血因子,並容易有流血的問題。貝多芬曾有流鼻血的症狀,亦與肝衰竭吻合。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至於貝多芬吐血與腹水的症狀則相當有可能由肝硬化引起。肝硬化是指因肝臟長期受損而肝纖維組織增加的情況。肝硬化令血液相當難穿過肝臟內的血管,於是血液塞了在提供血液給肝贓的肝門靜脈,令該血管的壓力持久增高,引起肝門靜脈高壓(</span>portal
hypertension<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">大家可以把血管系統想像成水渠。當水渠被阻塞,污水排不走,就有機會產生「爆屎渠」這個災難性的現象,令排泄物如噴泉般從廁所湧出,這絕對是人生的其中一個大夢魘。同樣地,血液積聚在肝門靜脈中排不走,亦只好從其他的途徑排走。其中一個途徑是回流至胃食道靜脈。這會令該處的血管產生曲張,嚴重時甚至會破裂,令大量的血液從胃食道靜脈湧出。肝硬化的患者很容易因而死亡。貝多芬吐血的情況很有可能與肝門靜脈高壓引起胃食道靜脈曲張相關。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">另</span><span style="font-family: PMingLiU, serif;">一</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">方面,肝門靜脈高壓亦會令血液中的水份被「擠壓」到腹腔內,形成腹水。肝衰竭亦影響肝臟合成一種名為白蛋白(</span>albumin<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的蛋白質,令血管內的滲透壓(</span>oncotic
pressure<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)下降,血液中的水份可以透過滲透作用(</span>osmosis<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)離開血管,進一步加劇腹水的問題。貝多芬的腹上就是透過這些機制而形成的。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最後值得一提的是,肝病也可以影響紅血球的形態。在貝多芬的年代,血液病理學尚未有充足的發展,當年的醫生亦不懂得進行血液的形態分析。不過今天我們知道肝病會影響膽固醇代謝,令紅血球的膜出現異常,變成棘狀紅細胞(</span>acanthocytes<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。這種異常的紅血球像是「海膽」,三尖八角,它們的表面上有</span>2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>20<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個不規則的凸出。有些嚴重肝病的病人更會出現溶血性貧血,這個現象被稱為棘狀紅細胞溶血性貧血(</span>spur
cell haemolytic anaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhU2MYSqZ-GB5L0MuHoJXKRVmJSA-IlEiGUtX9mJedwINBtc6KlWXol2vurhM8XSfwicnAChfOQUaBVFyi3YGotOfyYjY4lU_eowvtEjsoRZNciPymVDiNVTdTMZtsSBPcyVk-5zQBUI0dl1jbLzfQpjBvekGK0g37o60Wwu16toT6WTs5qqFqQqbQDGQ" style="margin-left: auto; margin-right: auto;"><img alt="" data-original-height="739" data-original-width="1103" height="428" src="https://blogger.googleusercontent.com/img/a/AVvXsEhU2MYSqZ-GB5L0MuHoJXKRVmJSA-IlEiGUtX9mJedwINBtc6KlWXol2vurhM8XSfwicnAChfOQUaBVFyi3YGotOfyYjY4lU_eowvtEjsoRZNciPymVDiNVTdTMZtsSBPcyVk-5zQBUI0dl1jbLzfQpjBvekGK0g37o60Wwu16toT6WTs5qqFqQqbQDGQ=w640-h428" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">慢性肝病患者的周邊血液抹片,紅色箭嘴指著的是棘狀紅細胞</td></tr></tbody></table><br /><br /></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">單從病歷推斷,貝多芬的肝硬化與肝衰竭可能是來自喝酒引起的酒精性肝病,另一個可能性是由乙型肝炎病毒或者丙型肝炎病毒引起的病毒性肝炎。除此之外,有一些的遺傳性疾病也可以引起肝病,例如遺傳性血色素沉着症(</span>hereditary
haemochromatosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、威爾遜氏症(</span>Wilson’s
disease<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及</span>α-1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">抗胰蛋白酶缺乏症(</span>α-1
antitrypsin deficiency<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等。因此文章最初提到的基因分析研究絕對有助我們了解貝多芬肝病的成因。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因分析的結果</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">文章最初提到的研究團隊總共為</span>8
<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">組聲稱是貝多芬的頭髮樣本進行了基因分析,其中只有</span>5<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">組被斷定為確實來自貝多芬。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在介紹團隊所做的檢驗前,請先容史丹福簡短地介紹一下基因與疾病的關係。基因可以透過不同的模式引起疾病。有些遺傅性疾病屬於單基因疾病,也就是說疾病被一個或少數幾個基因變異組合所影響。在這些疾病中,基因的影響效應極強。如果一個人有致病的基因組合,就差不多必定會有疾病。單基因疾病的例子包括血友病、地中海貧血症與</span>G6PD<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">缺乏症等。但有也有疾病被多種基因變異所影響,它們被稱為多基因疾病。在多基因疾病中,單獨的一組基因影響效應較小,但多組基因可以互相影響,再加上環境因素一起影響增加患病的機會。常見的例子包括糖尿病、冠心病等。也就是說,有一些基因變異可以增加人患上糖尿病、冠心病的機會,但假如那人有健康的生活、充足的運動、均衡的飲食,他一樣有機會不會患病。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在基因檢測的領域來說,單基因疾病是比較容易分析的。團隊分析了</span>55<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個與單基因失聰相關的基因與</span>137<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個與罕見單基因系統性紅斑性狼瘡及發炎性腸道疾病等相關的基因。結果為陰性,也就是說貝多芬並沒有單基因性失聰及其他單基因的系統性疾病。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">研究的另一個方向是探討貝多芬有否患上肝病及腸胃疾病。肝病及腸胃疾病大多屬於多基因疾病,因此基因分析較為複雜。研究的團隊於是採用了「多基因風險評分」的方法去分析。這方法綜合多個基因變異風險的總和去預計貝多芬患上這些疾病的機會率。結果發現貝多芬患有肝衰竭的風險很高,屬於第</span>96<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">百分位(</span>percentile<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),亦即是表示貝多芬患有肝衰竭的機會比</span>96%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的人高。另外,團隊亦在樣本中發現了乙型肝炎病毒的基因,顯示貝多芬生前受到乙型肝炎病毒感染。乙型肝炎病毒感染與高風險的基因變異加起來,為貝多芬肝衰竭的成因提出了充分的解釋。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">研究分析了眾多與肝衰竭相關的基因。由於史丹福並非肝科專家,所以對當中的大部分基因都談不上相當熟悉。但研究中談及到的其中一個結果卻相當能夠吸引史丹福的眼球,因為當中牽涉到的基因與血液學息息相關──貝多芬擁有</span>HFE
C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span>H63D<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的基因變異。</span><o:p></o:p></p>
<p class="MsoNormal" style="background: white; line-height: normal; margin-bottom: 0cm;"><span face=""Microsoft JhengHei",sans-serif" style="color: #050505; font-size: 11.5pt; mso-bidi-font-family: "Microsoft JhengHei";"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><u>HFE</u></b><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因與遺傳性血色素沉着症</span></u></b></p>
<p class="MsoNormal">HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因負責製造出一種參與鐵質吸收調控的蛋白質。而鐵質是一種與血液學息息相關,密不可分的營養素。因為血紅蛋白是需要依靠鐵質去合成的,因此紅血球必須有足夠的鐵質才可健康成長。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鐵質作為一種如此重要的營養素,我們的身體當然有一個精密的機制去確保體內的鐵質保持在一個適當的水平。正所謂過猶不及,身體中的鐵質不宜過多,也不宜太少。太少鐵質會影響紅血球的成長,引起貧血,但過多的鐵質則會蓄積於體內,毒害肝臟、心臟及胰臟等器官,引起器官病變,造成肝硬化、心臟衰竭與糖尿病。</span></p>
<p class="MsoNormal">HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因突變正正會令身體不受控地吸引鐵質,破壞那個美妙的平衡,引起一種名為遺傳性血色素沉着症的疾病。醫生一般會用血清中的鐵蛋白(</span>ferritin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)濃度去推斷有病人體內儲存鐵質的情況。正常男性的血清鐵蛋白濃度為</span>12
- 300ng/ml<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,女性</span>12 -
150ng/ml<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。如果檢測者的血清鐵蛋白濃度高於</span>1000
ng/ml<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,就可能患上了此病。</span></p>
<p class="MsoNormal">HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的</span>C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">和</span>H63D<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變是最常見的兩種致病突變。其中</span>C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變的致病能力較高,與遺傳性血色素沉着症顯著相關,而</span>H63D<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變對遺傳性血色素沉着症的影響則較低。</span>HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的基因突變在歐美國家頗為常見,</span>C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span>H63D<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變的頻率分別高達</span>6.2%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span>14.0%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。不過這些突變在亞洲人中非常罕見,因此香港的遺傳性血色素沉着症患者非常少。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">正常人的細胞中有一對</span>HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因,分別來自父親及母親。遺傳性血色素沉着症屬於一種體染色體隱性遺傳病(</span>autosomal
recessive disorder<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),也就是說單單一個</span>HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變不足以致病,一個人需要同時有突變出現在一對</span>HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因上,他才會有機會發病。根據統計,一個男士如果同時擁有兩條</span>HFE
C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變基因,他的發病機會為</span>28%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。如果他時擁有一條</span>HFE
C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變基因與一條</span>H63D<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">突變基因,發病機會則為</span>13.5%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝多芬同時擁有</span>HFE
C282Y<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span>H63D<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的基因變異,雖然這並不代表他必然會患上遺傳性血色素沉着症,不過他的身體有傾向吸收得較多鐵質,必然會增加肝臟的負荷。不幸的是,貝多芬除了</span>HFE<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因突變外,更同時擁有另一種高危基因</span>PNPLA3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的變異。</span>PNPLA3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的基因會增加貝多芬患上脂肪肝的風險。貝多芬的幾種基因突變,再加上他同時有乙型肝炎病毒感染,又喜歡喝酒。幾重打擊下,他的肝臟變得相當不堪一擊,他最終亦因為肝衰竭及肝硬化而過身。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那麼假如貝多芬活於現在,現代的醫學又能如何拯救他呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">所謂預防勝於治療,幫助貝多芬的最好方法就是在肝臟尚健康的時候開始保護它。首先,貝多芬必須戒酒。抗乙型肝炎病毒的藥物可以抑制病毒,減低病毒對肝臟的傷害。至於鐵質過量的問題則可以透過放血治療(</span>phlebotomy<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的方式處理,這種療法可以移除患者體內的紅血球,而鐵質亦會隨同紅血球一起排出體外。不過如果貝多芬已經出現了嚴重的肝衰竭與肝硬化,以上的療法就不再有效,因為肝臟的傷害很大程度上是不能逆轉的,這時候就只有肝臟移植的方法才能拯救貝多芬。</span><o:p></o:p></p>
<p class="MsoNormal"><br /></p><p class="MsoNormal"><span style="font-family: PMingLiU, serif;">資料來源:</span></p>
<p class="MsoNormal">Begg TJA, Schmidt A, Kocher A, Larmuseau MHD, Runfeldt G,
Maier PA, et al. Genomic analyses of hair from Ludwig van Beethoven. <i>Current
Biology</i>. 2023;33(8):1431-1447.e22. </p>
<p class="MsoNormal">Oiseth SJ. Beethoven's autopsy revisited: A pathologist
sounds a final note. <i>Journal of Medical Biography</i>. 2017;25(3):139-147.</p>
<p class="MsoNormal">Kubba AK, Young M. Ludwig van Beethoven: a medical
biography. <i>Lancet</i>. 1996;347(8995):167-70.</p>
<p class="MsoNormal">Murphree CR, Nguyen NN, Raghunathan V, Olson SR, DeLoughery
T, Shatzel JJ. Diagnosis and management of hereditary haemochromatosis. <i>Vox
Sang</i>. 2020;115(4):255-262.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-636508555054033632023-04-09T06:40:00.004-07:002023-04-09T07:08:19.159-07:00意大利前總理貝盧斯科尼所患的慢性白血病<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">有留意國際政壇的朋友肯定不會對貝盧斯科尼(</span>Silvio
Berlusconi<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)這位意大利前總理感到陌生。貝盧斯科尼大概是意大利近二十年來最具話題性的政治人物。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">近日,貝盧斯科尼因為呼吸困難而送往米蘭聖拉斐爾醫院(</span>San
Raffaele Hospital<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)深切治療部。根據報道,貝盧斯科尼罹患了一種頗為罕見的白血病--慢性骨髓性單核球性白血病(</span>chronic
myelomonocytic leukemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>CMML<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。貝盧斯科尼已到經患上此病一段時間,但病情暫時仍屬慢性的階段,也就是說尚未演化成急性白血病。</span><o:p></o:p></p>
<p class="MsoNormal">CMML<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">是一種罕見的白血病,大眾對他的應該應該不深。究竟這是一種怎樣的疾病?</span><o:p></o:p></p>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvwq0K_PM10pItFRWjbBbnmhxGTh134II0vK3lALY1XfcaitfGtKgPcr-UtY6-TcGeD3ySgds_hWQKiEVHgfZ036YiQaw9rv-SNk-1zAuG9qLjUA4pTiqBJxLQxS_zntfj7xircDxf3KObguC8VyL39GIhns6zI-lQk1YtHDb1jVbPKwwzxvyfA9RfvA/s862/1234.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="485" data-original-width="862" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvwq0K_PM10pItFRWjbBbnmhxGTh134II0vK3lALY1XfcaitfGtKgPcr-UtY6-TcGeD3ySgds_hWQKiEVHgfZ036YiQaw9rv-SNk-1zAuG9qLjUA4pTiqBJxLQxS_zntfj7xircDxf3KObguC8VyL39GIhns6zI-lQk1YtHDb1jVbPKwwzxvyfA9RfvA/w640-h360/1234.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: PMingLiU, serif; text-align: left;">貝盧斯科尼</span><span style="font-family: PMingLiU, serif;">(Reuters: Remo Casilli)</span></td></tr></tbody></table><br /><p class="MsoNormal"><br /></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝盧斯科尼的政治生涯</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過在史丹福介紹</span>CMML<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">之前,也許我們也應該先回顧一下貝盧斯科尼的生平。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝盧斯科尼生於</span>1936<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年。在從政之前,他已經是位相當成功的商人。他透過投資商業電視台而成了億萬傳媒大亨。他又在</span>1986<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年收購了</span>AC<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">米蘭足球會並成為主席,</span>
AC<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">米蘭在他的領導下曾經取得非常卓越的成績。</span><o:p></o:p></p>
<p class="MsoNormal">1994<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,貝盧斯科尼開始投身政治,並在同年首次出任意大利總理。他在其政治生涯中共三度擔任意大利總理,也是執政時間最長的意大利總理。即使後來離任總理,他仍在意大利政局有很大的影響力,並主宰著意大利政局的發展。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝盧斯科尼在政治上非常成功,但他的私生活卻非常混亂,因而被受批評。例如他曾被揭發舉辦性愛派對,又曾被指控與未成年妓女有性交易、欺詐及逃稅。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝盧斯科尼也因政治失態而著稱,經常失言。他曾稱美國的非裔前總統奧巴馬「年輕、英俊,而且還被曬黑了」,他以奧巴馬的種族來開玩笑,非常不合適。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">此番言論一經當地媒體報導,立即引起一片譁然。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而他矚目的一次失言事件莫過於在一次公開場合中對一位下議院女議員說「假如我還未婚的話,我現在就會立刻娶妳」及「我會帶著妳浪跡天涯」,這些調情的言論引起他當時妻子(兩人現已離婚)的不滿,她甚至要求貝盧斯科尼在敵對的媒體</span>la
Repubblica<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">新聞報上刊登一份道歉的公開信。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">上年,他又因為與普京私交甚篤而被受爭議。貝盧斯科尼與普京一直關係友好,在俄鳥戰爭爆發後,貝盧斯科尼仍與普京保持私交。他表示自己生日時收到了來自普京的</span>20<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">瓶伏特加和一封「甜蜜信件」作為禮物,而他也以葡萄酒與「同樣甜蜜的信件」作為回禮。他亦在烏克蘭問題上再次失言。他把戰爭的爆發歸咎於烏克蘭總統澤連斯基,言論激起眾怒。他所在的意大利力量黨亦需要急忙澄清在對烏問題上的立場,為事件降溫。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">貝盧斯科尼近年雖然仍活躍於政壇,但他的健康似乎欠佳,並出現多種健康問題。他曾在</span>2016<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年接受心臟手術。他又曾患上前列腺癌。他在</span>2020<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年確診</span>2019<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冠狀病毒病(</span>COVID-19<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)而需留院</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日,之後傳出多次進出醫院的消息。近日,他又因呼吸困難而需要在醫院的深切治療部留醫。</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日,醫生證實貝盧斯科尼患上慢性骨髓性單核球性白血病已有一段時間。</span><o:p></o:p></p>
<p class="MsoNormal"><b><u><o:p><span style="text-decoration: none;"> </span></o:p></u></b></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">淺談慢性骨髓性單核球性白血病</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">慢性骨髓性單核球性白血病究竟是一種怎樣的白血病?</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">白血病的分類相當複雜。即使是醫生,假如並沒有於血液學受訓,相信亦一樣會被各式各樣的白血病名稱搞得頭昏腦脹。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但假如我們追本溯源,認真分析名稱的含意,相信亦可以對疾病的特徵有一定理解。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">慢性骨髓性單核球性白血病是一種慢性白血病。慢性白血病的症狀較為溫和,甚至完全沒有病徵,病人就算不接受治療也可以存活一段長時間。至於急性白血病則會引起急性症狀。如果不接受治療,病人會在短時間內死亡。在傳統的理解上,慢性白血病與急性白血病的分野在於母細胞(</span>blasts<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的數量。母細胞是一種非常原始的血液細胞,如果母細胞在血液或骨髓中的比率少於</span>20%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,疾病就屬於慢性白血病,否則就屬於急性白血病。不過隨著分子遺傳學的發展,慢性白血病與急性白血病的分類方式已加入基因轉變的考慮,而非完全取決於母細胞的數量。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">慢性骨髓性單核球性白血病又顧名思義是一種「骨髓性」與「單核球性」的白血病。也就是說,該病中的癌細胞是骨髓性細胞(</span>myeloid
cells<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及單核球性(</span>monocytic
cells<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">患者的血液中常有單球球增多(</span>monocytosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的情況。這是疾病的必備條件。根據定義,如果患者血液中的單核球沒有增多,疾病就不能被歸類為慢性髓性單球性白血病。以下是慢性骨髓性單核球性白血病患者的周邊血液抹片,大家可以見到單核球(</span>monocytes<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的數量明顯增多。</span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXf-zdN5cCeMhvAVDGMrQWvHgAP6kczrq_Nka7rd_ju1E1mMmLP8guRwexuqjBJCnXoPToLiaPucyobSQ8Q-aKKtx2Dc55MjKt-Jcpgx-CppuKRMbw-iftGK2mtLuD-UVHMFQGEa3IoMFJ-N1vLP3-HslTel5FE-IIdHQagvuUXiX54KDcf0SGsUSTDQ/s819/CMML.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="562" data-original-width="819" height="440" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXf-zdN5cCeMhvAVDGMrQWvHgAP6kczrq_Nka7rd_ju1E1mMmLP8guRwexuqjBJCnXoPToLiaPucyobSQ8Q-aKKtx2Dc55MjKt-Jcpgx-CppuKRMbw-iftGK2mtLuD-UVHMFQGEa3IoMFJ-N1vLP3-HslTel5FE-IIdHQagvuUXiX54KDcf0SGsUSTDQ/w640-h440/CMML.png" width="640" /></a></div><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在分類上,慢性髓性單球性白血病屬於骨髓異變</span>/<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">骨髓增殖性腫瘤(</span>myeloproliferative/myelodysplastic
neoplasm<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。這些醫學術語看似嚇人,但其實完全是「鱷魚頭老襯底」,樣子嚇人,意思卻相當簡單。「異變」指長得醜,「增殖」指長得多。慢性髓性單球性白血病就是一種令髓性細胞及單球性細胞生得又多又醜的疾病。一般來說,患者的單核球增多,而骨髓性細胞、巨核細胞(</span>megakaryocytes<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)或紅血球先驅細胞都有機會變醜(即異變)。這些特徵在骨髓性腫瘤來說算是相當獨特,因為大部分的腫瘤都會偏向骨髓異變或骨髓增殖的其中一邊,而慢性骨髓性單核球性白血病卻兩者併存,可稱得上是骨髓性腫瘤(</span>myeloid
neoplasms<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中的異類。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">慢性髓性單球性白血病的臨床病徵也可分為「增殖」(細胞變多)及「異變」(細胞變醜)這兩類病徵。如果血液細胞太多,它們會積存在肝臟與脾臟中,做成肝脾腫脹。過多的血液細胞會激發細胞因子,引起發燒、夜間盜汗、體重減輕等全身癥狀(</span>constitutional
symptoms <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。另一方面,如果血液細胞太「醜」,這就意味著他們的發育不良,因此紅血球、嗜中性白血球、血小板等正常的血液細胞會降少,病人就會有貧血、感染、流血等問題。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">近年,分子遺傳學的技術發展迅速,醫學界對疾病的機制也有了較深的認識。科學家及現疾病的癌細胞中常帶有</span>ASXL1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span>TET2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span>SRSF2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因等的突變。這些突變可以負責組蛋白修飾(</span>histone
modification<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、</span>DNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">甲基化(</span>DNA
methylation<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及</span>RNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">剪接(</span>RNA
splicing<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等功能,它們的突變會影響血液細胞的正常生長,做成血液腫瘤。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過一般大眾對這些複雜的血液腫瘤分類及分子遺傳學興趣不大。對大眾來說,大家最感興趣的可能是疾病會如何影響貝盧斯科尼?貝盧斯科尼的存活時間有多長?他有甚麼治療方案?因為貝盧斯科尼在意大利的政壇仍然有很大的影響力,他的健康對歐洲以至全世界的局勢都可以產生影響。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">慢性髓性單球性白血病在慢性期時的病情一般較為穩定,但假以時日,疾病可以演化為急性期,患者的死亡率會大大提升。血液學家們透過數學分析,發明了一個名為</span>CPSS-Mol<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的計分系統去判斷病人的預後(</span>prognosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),並可以預測存活時間有多長。這個計分系統包括了患者是否需要依賴輸血、白血球數量、母細胞數量、細胞遺傳學與分子遺傳學的結果等。我們不知道貝盧斯科尼的這些血液學及遺傳學特徵,因此很難判斷其預後。不過根據貝盧斯科尼的醫生所解釋,貝盧斯科尼的疾病暫時仍處於慢性期,而未有演化成急性期。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至於治療方案,除了輸血等的舒緩性治療外,還有異體骨髓移植及低甲基化藥物(</span>hypomethylating
agent<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等兩大方案。但貝盧斯科尼以年屆</span>86<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲,已經不適合進行異體骨髓移植這種極為高危的治療,所以相信會是最主要的治療方案是阿扎胞苷(</span>azacitadine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等的低甲基化藥物。低甲基化藥物可以抑制幫助</span>DNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">甲基化的酶,引起「低甲基化」(</span>hypomethylation<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的現象,活化一些對抗癌症的基因,幫助異常細胞回復正常運作。</span><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-22614940434841109392023-04-02T06:03:00.003-07:002023-04-02T06:03:55.568-07:00十三世紀的壁畫——史上最早的淋巴瘤案例?<p><span style="font-family: PMingLiU, serif;">以下的一幅壁畫不但優雅奪目,更有可能隱藏著一個神秘的醫學故事。</span></p><p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxDlC_rApt5w1X_hDfK0Fglrco3KKLxr3OPPxVlu-x6lQnRqn_pDO-kq9JZ6G_d72wZWOfAPK_EqHrlYnNSExOpFEsg8GEz2xxAL6yvd0xEBOA3WjPzXiAAwa8KdKG1L7AzcWNXKDMBt_jHxzPgqxWoqXpi5mWbAWdjSb_CWKgVgTSQcl9nSM2CDMNVg/s1064/lymphoma.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="455" data-original-width="1064" height="274" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxDlC_rApt5w1X_hDfK0Fglrco3KKLxr3OPPxVlu-x6lQnRqn_pDO-kq9JZ6G_d72wZWOfAPK_EqHrlYnNSExOpFEsg8GEz2xxAL6yvd0xEBOA3WjPzXiAAwa8KdKG1L7AzcWNXKDMBt_jHxzPgqxWoqXpi5mWbAWdjSb_CWKgVgTSQcl9nSM2CDMNVg/w640-h274/lymphoma.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">來源: Lanza F, De Giorgio R, Zavagli G. The oldest case of lymphoma? Insights from a XIII century fresco. Br J Haematol. 2023 Mar 27.</td></tr></tbody></table><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">壁畫位於羅馬四殉道堂哥德堂,於十三世紀中繪畫,畫者不詳。意大利波倫亞大學</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">(</span>
University of Bologna <span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的血液學家蘭沙(</span>Francesco
Lanza<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)等人憑着他們對血液學的靈敏觸覺,留意到壁畫描畫的女士的右邊頸部位置有一個腫塊。他們認為這可能是史上最早有圖像紀錄的淋巴瘤個案。蘭沙在《英國血液學期刊》</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; font-size: 11pt; line-height: 107%;">(</span><span style="font-family: Calibri, sans-serif; font-size: 11pt; line-height: 107%;">British Journal of Haematology</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; font-size: 11pt; line-height: 107%;">)</span><span style="font-family: PMingLiU, serif;">中</span><span style="font-family: PMingLiU, serif;">刊登了他的發現。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">頸部位置的腫塊很有可能是由淋巴結腫脹引起。淋巴結是淋巴系統的一部分,其功能類似過濾器,淋巴球(</span>lymphocytes<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)會在這裡聚集,幫助消滅不同的病原體。當過量的淋巴球或其他異常細胞在淋巴結中聚集,就會引起淋巴結腫脹的現象。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">淋巴結腫大的主要原因有三大類,分別是癌症、感染與自身免疫性疾病。在癌症的病人中,異常生長的癌細胞可以侵入淋巴結,令淋巴結腫大。最常引起淋巴結腫大的血液癌症包括淋巴瘤(</span>lymphoma<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)與慢性淋巴性白血病(</span>chronic
lymphocytic leukaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。至於感染與自身免疫性疾病則會令免疫系統過於活躍,使大量的淋巴球積聚在淋巴結中,使淋巴結變大。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那壁畫中的女士又因何出現淋巴腫脹呢?自身免疫性疾病與一般的病毒感染甚少引起如此巨大的淋巴結。在傳染病中,結核病與鼠疫都可以特別巨大的淋巴結,但這些的淋巴結的表面皮膚大多會變紅,而壁畫中的女士並沒有這現象。再加上鼠疫在</span>1346<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年才開始在歐洲出現爆發,壁畫出現的時間比這早了近一世紀。慢性淋巴性白血病的病人大多年紀較大,壁畫中的女士年紀較輕,絕少會患上此病。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">經過重重推敲,蘭沙認為只有淋巴瘤最合乎壁畫所描繪的臨床情況。而這幅十三世紀的壁畫可能描繪了史上最早有圖像紀錄的淋巴瘤個案。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p>
<p class="MsoNormal">Lanza F, De Giorgio R, Zavagli G. The oldest case of
lymphoma? Insights from a XIII century fresco. Br J Haematol. 2023 Mar 27.</p><p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-35121530536813474222022-12-24T08:47:00.001-08:002022-12-24T08:47:26.156-08:00「聖誕磨菇」與蘑菇形狀紅血球<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtLEdGeknp1B5e02YiU1oSUyrgOtCTFyhtCl-vwbTKQzAovwAzX62bDFU4r7ZRsEJHR8OHtaaS1aWmDJLjikLb4jZzBKuNUjGGNi8XSp0Fjz7TyZGp6-7new82PSa51tBdwbjvM-1mKVPHZ5tJX-rb2zt6WEAnWrERVgbmdwvHuKutgkOxO7AKHCIz9g/s2148/Untitled.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1000" data-original-width="2148" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtLEdGeknp1B5e02YiU1oSUyrgOtCTFyhtCl-vwbTKQzAovwAzX62bDFU4r7ZRsEJHR8OHtaaS1aWmDJLjikLb4jZzBKuNUjGGNi8XSp0Fjz7TyZGp6-7new82PSa51tBdwbjvM-1mKVPHZ5tJX-rb2zt6WEAnWrERVgbmdwvHuKutgkOxO7AKHCIz9g/w640-h298/Untitled.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">左:蘑菇形狀紅血球(來源:Dienstmann G, Barbosa Dos Santos V, Comar SR. Mushroom-shaped red blood cells (pincer cells): a brief update. Hematol Transfus Cell Ther. 2022 Jul-Sep;44(3):462-463.),右:「聖誕磨菇」毒蠅傘</td></tr></tbody></table><br /><p><span style="font-family: PMingLiU, serif;">為甚麼聖誕老人穿的服裝都是鑲了白邊的紅衣服、紅褲子及紅帽子?為什麼聖誕裝飾物很多都是紅白色?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">其中一個說法是可口可樂在一次廣告活動中首先使用了白邊紅裝的聖經老人,此</span><span style="font-family: PMingLiU, serif;">聖</span><span style="font-family: PMingLiU, serif;">誕老人形象至此深入民心,並成了聖誕老人的標準服飾。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">不過民族植物學家歐特(</span>Jonathan
Ott<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)卻提出了另一套有報的理論,他認為聖誕老人的構想可能與毒蠅傘(</span>Amanita
muscaria<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)--一種獨特的蘑菇相關。這種蘑菇普遍被認為與聖誕的關係很大,因此又有「聖誕蘑菇」的稱號。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">毒蠅傘的蕈傘呈深紅色,並有大型的白色菌褶與斑點。毒蠅傘原生於松樹和落葉性的樹林中,並與松樹等樹木形成共生關係。因此毒蠅傘經常在松樹底下生長。毒蠅傘具有毒性,做成中毒的活性成分是蠅蕈素,中毒的症狀包括情緒改變、出現幻覺、精神錯亂等。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">西伯利亞地區居民發現食用毒蠅傘可以引起幻覺,並有類似靈魂出竅的感覺。因此在他們的文化當中,毒蠅傘具有重要的宗教意義,並且是很神聖的。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">古時,西伯利亞的薩滿巫師所穿著的服裝就很像一朵毒蠅傘,他們穿著紅色的帽子、鑲了白邊的紅色衣服、黑色的靴子。當地巫師會把毒蠅傘烘乾後作為冬至的禮物送給人們。他們把蘑菇放在一個大袋子中派發。如果冬天的大雪把門口擋住,巫師更會派過煙囪派發蘑菇。聖誕老人的來源可能就是啟發自派發蘑菇的巫師。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">除此之外,同樣象徵聖誕的馴鹿也很喜歡吃毒蠅傘的。以上幾個原因加起來,就令這種蘑菇充滿了聖誕氣氛。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">談起蘑菇,《英國血液學期刊》(</span>British
Journal of Haematology<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)亦都在上年刊登了一份與蘑菇有關的有趣報告</span><span style="font-family: PMingLiU, serif;">(</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><a href="https://onlinelibrary.wiley.com/doi/10.1111/bjh.17127">https://onlinelibrary.wiley.com/doi/10.1111/bjh.17127</a></span><span style="font-family: PMingLiU, serif;">)</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,顯示</span>2019<span lang="ZH-TW" style="font-family: PMingLiU, serif;">冠狀病毒病可以影響紅血球的形態,令紅血球變成蘑菇形狀。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyqmpV9yuwrJAUzLFChEp5tmdPPxBuXD263Vq9m6CXBAXIdhqaiL7QzF3Bv7RIEhmC8UYuQqoaUB15sZNYtjSr9wiu_64VPsJvNbEzBLRoauZwIYLlFjTdw7V2Sfrl2p3VKXJer2bO9e2XcLD3dpeZK4RQST-i_R_Qs6EPfsIZmE6C2GgNmqKCGSx0kQ/s844/Untitled2.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="844" data-original-width="844" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyqmpV9yuwrJAUzLFChEp5tmdPPxBuXD263Vq9m6CXBAXIdhqaiL7QzF3Bv7RIEhmC8UYuQqoaUB15sZNYtjSr9wiu_64VPsJvNbEzBLRoauZwIYLlFjTdw7V2Sfrl2p3VKXJer2bO9e2XcLD3dpeZK4RQST-i_R_Qs6EPfsIZmE6C2GgNmqKCGSx0kQ/w640-h640/Untitled2.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">蘑菇形狀紅血球(來源:Gérard D, Ben Brahim S, Lesesve JF, Perrin J. Are mushroom-shaped erythrocytes an indicator of COVID-19? Br J Haematol. 2021 Jan;192(2):230.)</td></tr></tbody></table><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">報告的作者檢查了</span>50<span lang="ZH-TW" style="font-family: PMingLiU, serif;">位患者的周邊血液抹片,發現</span>66%<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的病人抹片中都有少量蘑菇形狀的紅血球。這種紅血球可以在氧化性溶血(</span>oxidative
haemolysis<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)病人中出現。氧化性溶血可以破壞紅血球的膜,形成漢氏小體(</span>Heinz
body<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。當紅血球中有兩個漢氏小體同時被脾臟移除後,紅血球就會出現蘑菇般的形態。因此作者相信</span>SARS-CoV-2<span lang="ZH-TW" style="font-family: PMingLiU, serif;">病毒會引起氧化壓力(</span>oxidative
stress<span lang="ZH-TW" style="font-family: PMingLiU, serif;">),令紅血球出現氧化相關的形態轉變。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">資料來源:</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><span style="font-family: "Times New Roman"; text-align: center;">Gérard D, Ben Brahim S, Lesesve JF, Perrin J. Are mushroom-shaped erythrocytes an indicator of COVID-19? Br J Haematol. 2021 Jan;192(2):230.</span></span></p><p class="MsoNormal"><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-54946814265895104392022-12-03T07:01:00.005-08:002022-12-03T07:01:52.487-08:00悲傷是我們為愛付出的代價——多發性骨髓瘤與女王伊利沙伯二世之死<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsbTY1yYIl9RfsyRVNJ3wOot_OM9ad7O0kwNh2B1_eHLUxngyhYFpeJPe8v2f-GR48hnWguR-PDSaJxA6Q-haOoM6vd7zhYqAstvMHk6Kj4H1bYmI6CSPqZ9T39TH_ivKPCNDAlSEezkdQ91E08NBWii_4lp3BKMmhetWTyx87kUom2BF7J8PFJF4bXQ/s1280/Queen.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="852" data-original-width="1280" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsbTY1yYIl9RfsyRVNJ3wOot_OM9ad7O0kwNh2B1_eHLUxngyhYFpeJPe8v2f-GR48hnWguR-PDSaJxA6Q-haOoM6vd7zhYqAstvMHk6Kj4H1bYmI6CSPqZ9T39TH_ivKPCNDAlSEezkdQ91E08NBWii_4lp3BKMmhetWTyx87kUom2BF7J8PFJF4bXQ/w640-h426/Queen.jpg" width="640" /></a></div><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span><p></p><p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">英女王伊利沙伯二世(</span>Elizabeth
II<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)在</span>2022<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年</span>9<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>8<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日過身,享年</span>96<span lang="ZH-TW" style="font-family: PMingLiU, serif;">歲。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">女王優雅、剛毅、親民。她終其一生都在為英國服務,恰如其分地履行職責,不踰越,不干政。在英國民眾心中,女王陪伴他們走過許多國家最艱難的時刻。女王雖然沒有實權,但擁有至高無上的聲譽和人氣,是大眾心中崇高的精神領袖。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在香港,女王同樣有很高的聲望,不少香港人對她有莫名的親切感,很多人甚至仍然親切地稱呼她為「事頭婆」。當然,英女王跟香港的管治本身未必有很直接的關係,但香港人都會把一些令人懷念的美好價值投射到英女王這一個精神象徵身上。女王過身後,香港人排長隊等候進入英國領事館留言獻花,蜿蜒數百米。其中一名排隊民眾在接受香港《</span>Now<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">新聞台》訪問時就表示:「我的目的就是來紀念這偉大的領袖,你看看有這麼多人就知道了,這個叫民心,這就是民心所向。」</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為國家鞠躬盡瘁的女王</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><o:p> </o:p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">伊利沙伯女王的健康細節甚少對外公開,因此我們對之所知甚少。不過根據官方資料及新聞報導,女王的健康狀況一向良好。即使年屆九十多,女王</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; font-size: 12pt; line-height: 107%;">依然行動自如,經常</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">執行公務,在生前更是全球最年長的國家元首。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而在她的丈夫菲臘親王(</span>Prince
Philip<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)於</span>2021<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>9<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日逝世之後,</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">女王就多次因健康理由而需要暫停執行公務,令外界擔心她的身體轉差,例如她就缺席了</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日的聯合國氣候峰會(</span>COP26<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的晚宴及</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>14<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日的國殤紀念日(</span>Remembrance
Day<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)儀式。</span></p>
<p class="MsoNormal">2022<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>20<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日,白金漢宮公布,英女王確診</span>2019<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冠狀病毒病(</span>Coronavirus
disease 2019<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。有報導指女王的症狀輕微,不過亦有不同的報導指女王在康復之後行動能力轉差。《太陽報》甚至引述消息人士指女王虛弱到無法帶她心愛的哥基犬散步。</span></p>
<p class="MsoNormal">2022<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年是女王登基的</span>70<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">週年,因此英國自</span>6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日起連辦</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">天的「白金禧年大慶」(</span>Platinum
Jubilee<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),不過女王也僅是在當天的白金漢宮陽台上,向前來道賀的群眾揮手致意,而並沒有出席其他的活動。白金漢宮指原因是女王行動不便且感到有些許不適。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過在白金禧時,一段女王與英國知名小童故事角色柏靈頓熊(</span>Paddington
Bear<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)合拍的短片被釋出。在短片中,女王與柏靈頓熊共進下午茶,其間她透露了自己和柏靈頓熊一樣喜愛吃果醬三明治,更會把三明治藏在她的手提包內。影片盡顯了女王幽默及親民的一面,成為了一時佳話。女王辭世過後,很多網民都紛紛翻看這短片,以懷念女王。影片最後,帕丁頓熊說:「謝謝您,謝謝您所做的一切。」女王也微笑表示:「你真是太客氣了。」,令人鼻子酸酸的。</span></p>
<p class="MsoNormal">2022<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>9<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日,女王在蘇格蘭巴爾莫拉爾城堡(</span>Balmoral
Castle<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)任命卓慧思(</span>Liz
Truss<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)為英國新首相。這是她最後一次公開露面。從官方公布的照片看來,女王的右手手背有瘀痕,估計她可能曾經手背的血管進行過靜脈注射。這令到外界再一次關心她的健康狀況。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">就在接見完卓慧思的兩天後,白金漢宮公佈女王正在醫學監察,並指醫生對她的身體狀況表達擔憂。之後,王儲查理斯王子及其妻卡米拉、英女王的孫子威廉王子和哈里王子都立即前往巴爾莫拉爾城堡陪伴她。女王最終於英國時間</span>9<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>8<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日下午</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">時</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分在巴爾莫拉爾城堡離世。</span><o:p></o:p></p>
<p class="MsoNormal"><span style="background: white; color: #333333; font-family: "PMingLiU",serif;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="background: white; color: #333333; font-family: "PMingLiU",serif;">英女王的死因</span></u></b><b><u><span style="background: white; color: #333333; font-family: "PMingLiU",serif;"><o:p></o:p></span></u></b></p>
<p class="MsoNormal"><span style="background: white; color: #333333; font-family: "PMingLiU",serif;"><o:p> </o:p></span><span style="font-family: PMingLiU, serif;">儘管英女王年事已高,但對很多人來說,女王的離世仍然是來得相當突然。大眾亦都相當關心究竟女王的死因是甚麼。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">英國蘇格蘭國家檔案館其後公開了女王的死亡證,這是首次有英國君主的死亡證被公開。死亡證中列明女王的死亡原因是年老(</span>old
age<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過,根據《每日星報》及《鏡報》的報導,已故菲臘親王的好朋友傳記作家布蘭德雷斯(</span>Gyles
Brandreth<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)即將推出一本名為《伊利沙伯:私人寫照》(</span>Elizabeth:
An Intimate Portrait<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的女王傳記。書中透露,女王離世的原因是多發性骨髓瘤(</span>multiple
myeloma<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),所以女王晚年常有疲倦、體重減輕、行動不便的症狀。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">布蘭德雷斯形容多發性骨髓瘤是種罕見癌症,不過這癌症其實是血液學醫生經常遇到的病症。根據香港癌症資料統計中心的數據,香港單是</span>2020<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年就有</span>305<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">宗新個案。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">多發性骨髓瘤是一種因惡性的漿細胞(</span>plasma
cells<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)過度增生而引起的血液癌症。漿細胞是一種負責製造抗體的免疫細胞,由</span>B<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">淋巴細胞演化而成。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">這些惡性的漿細胞會影響正常的骨髓造血功能,引起貧血。惡性漿細胞會入侵骨髓,激活蝕骨細胞(</span>osteoclast<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),抑制成骨細胞(</span>osteoblast<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),骨骼中的鈣因而流失到血液中,導致「溶骨性病變」(</span>osteolytic
bone lesion<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。患者不但會有骨痛的症狀,更因骨骼變得脆弱而可能在沒有嚴重撞擊的情況下仍然出現骨折。除此以外,鈣流失血液中引起高血鈣症(</span>hypercalcaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),常見症狀包括肌肉無力、噁心、腹痛、便秘,甚至是心律不正。另外,異常的漿細胞也會製造出大量副蛋白(</span>paraprotein<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。它們會積聚在腎小管中,令腎功能受損。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">為了方便記憶,醫學教科書便取多發性骨髓瘤四大症狀的首個英名字母,把這幾個症狀統稱為「蟹症狀」(</span>CRAB
symptoms<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">):</span><o:p></o:p></p>
<p class="MsoNormal">C<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">代表</span>calcium<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即高血鈣</span><o:p></o:p></p>
<p class="MsoNormal">R<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">代表</span>renal
impairment<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即腎功能受損</span><o:p></o:p></p>
<p class="MsoNormal">A<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">代表</span>anaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即貧血</span><o:p></o:p></p>
<p class="MsoNormal">B<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">代表</span>bone
lesion<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即骨骼病變</span><o:p></o:p></p>
<p class="MsoNormal"><span style="border: none windowtext 1.0pt; color: black; font-family: "Microsoft JhengHei UI",sans-serif; font-size: 10.0pt; line-height: 107%; mso-border-alt: none windowtext 0cm; padding: 0cm;"><br />
</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">多發性骨髓瘤的患者可能因貧血而疲倦,亦可以因骨痛而影響行動,這些症狀都與女王的情況吻合。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">診斷多發性骨髓瘤需要綜合不同的檢查,例如血清蛋白質電泳(</span>serum
protein electrophoresis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)(用來測量血液中的副蛋白)、</span>X<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">光檢查及骨髓檢查等。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">多發性骨髓瘤可以令患者出現骨骼病變,在</span>X<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">光下就看似是骨骼被打孔機打了幾個洞一樣。例如下圖的顱骨</span>X<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">光片就是來自一位多發性骨髓瘤的患者。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz2xi8T-WwpySRS6Y_SYd-RHqi72cqF0fbDsPl9jDSnTDCDv8rKRP5khbLxsn4k2PHmYV3x38K1t1EwJF7QcaVDryN64BfC5MjH6Qp2aFmKXrUuWLe8SJiGQyud7JqOW1sGE0eq2pDUy3J7CSXTLZgKDMrfqhUzk1R7TDvkrLWuTzJp5dsD2pmUpHXMw/s841/C7_1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="704" data-original-width="841" height="536" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz2xi8T-WwpySRS6Y_SYd-RHqi72cqF0fbDsPl9jDSnTDCDv8rKRP5khbLxsn4k2PHmYV3x38K1t1EwJF7QcaVDryN64BfC5MjH6Qp2aFmKXrUuWLe8SJiGQyud7JqOW1sGE0eq2pDUy3J7CSXTLZgKDMrfqhUzk1R7TDvkrLWuTzJp5dsD2pmUpHXMw/w640-h536/C7_1.jpg" width="640" /></a></div><br /><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至於骨髓檢查則會顯示到增生的異常漿細胞。在顯微鏡下,漿細胞的細胞質顏色偏藍,細胞核側了在細胞一邊,而且細胞核旁有一個淡色的部分。而多發性骨髓瘤患者的異常漿細胞比一般的漿細胞要大且形狀不規則,且偶爾會有很明顯的核仁(</span>nucleolus<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr-_QEDky19_euwkTFpcb6Xh3M3abEdTNdCMko3tCYuxJvoMXUrnwWmN9vuxreDbPxcP-WlWFjNJH8la4grFG-MmgqPsBuFbg3K3sTwHy0FUrz_4B9hb8EHO_lU3qXP3ECmkzsZG4lXdoyYpgfluj_GG7tTdETiqL08lVlPUc4t1bEVPYIf4pIvhYtmg/s2059/plasma%20cell%20myeloma.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1349" data-original-width="2059" height="420" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjr-_QEDky19_euwkTFpcb6Xh3M3abEdTNdCMko3tCYuxJvoMXUrnwWmN9vuxreDbPxcP-WlWFjNJH8la4grFG-MmgqPsBuFbg3K3sTwHy0FUrz_4B9hb8EHO_lU3qXP3ECmkzsZG4lXdoyYpgfluj_GG7tTdETiqL08lVlPUc4t1bEVPYIf4pIvhYtmg/w640-h420/plasma%20cell%20myeloma.png" width="640" /></a></div><br /><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">多發性骨髓瘤是一個難纏的疾病,即使患者接受了治療,復發的情況依然時常出現。可幸的是,多發性骨髓瘤的治療在近年有了相當明顯的發展,新藥多不勝數,例如新型免疫調節劑來那度胺(</span>lenalidomide<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及泊馬度胺(</span>pomalidomide<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、新型蛋白酶體抑制劑(</span>proteasome
inhibitor<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)卡非佐米(</span>carfilzomib<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及伊沙佐米(</span>ixazomib<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),與</span>CD38<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">抑制劑達雷木單抗(</span>daratumumab<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">究竟女王的死因是否多發性骨髓瘤呢?我們暫時仍然無從得知,畢竟這個消失只是來自布蘭德雷斯所寫的傳記,我們無從得知資料是否準確。但相信隨著更多的資料被釋出,女王死亡的細節會慢慢變得清晰。不過姑勿論女王的死因是甚麼,都不會影響人民對她的愛戴。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">女王曾經說過:「悲傷是我們為愛付出的代價」。得知女王的死訊後,英國人民、香港人民,甚至是世界各地的人民都悲傷不已,相信這就正正顯示了女王有多受人民的愛戴。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p>
<p class="MsoNormal">Cowan AJ, Green DJ, Kwok M, Lee S, Coffey DG, Holmberg LA,
Tuazon S, Gopal AK, Libby EN. Diagnosis and Management of Multiple Myeloma: A
Review. JAMA. 202;327(5):464-477.</p><p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-83279022869752167812022-10-15T09:42:00.003-07:002022-10-15T09:42:26.705-07:00流產不斷的安妮女王<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzhdkw9pgW0OBLs9nnJ9KlXetpj7XyDqIp5ImLg7KZXly5cueYR1dRbZb0XPk9eJIWAVk9obyugbFHiRy9XRfyaDjtZlLCi9uPFzr2GJ1e38cEgJd8DRH1_-YtVOZ8Q9p32Ta80fn2dI6vhqiVG0uD0dwr0SDucjKy90z7bSRJuErGjd2PZ5H3bBM70g/s1920/queen-anne.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="987" data-original-width="1920" height="330" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzhdkw9pgW0OBLs9nnJ9KlXetpj7XyDqIp5ImLg7KZXly5cueYR1dRbZb0XPk9eJIWAVk9obyugbFHiRy9XRfyaDjtZlLCi9uPFzr2GJ1e38cEgJd8DRH1_-YtVOZ8Q9p32Ta80fn2dI6vhqiVG0uD0dwr0SDucjKy90z7bSRJuErGjd2PZ5H3bBM70g/w640-h330/queen-anne.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">安妮女王(來源:Historic UK)</td></tr></tbody></table><span style="font-family: PMingLiU, serif;"></span><p></p><p><br /></p><p><br /></p><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">縱觀歷史,女王的統治似乎與英國的國運有著難以言喻的微妙關係,英國歷史上好幾個最輝煌的時期都是在女王統治時出現的。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">安妮女王(</span>Queen
Anne<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的功積雖然未及威震天下的伊利沙白一世與維多利亞女王,但她在任期間的建樹頗多。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">安妮是一位順應時代變化的君主。在她即位時,議會已掌握相當的權力。安妮安守本份,不會貪戀權力,反而樂於把權力下放給議會,並擔當起政黨間協調與平衡的角色。安妮女王統治期間完善了政黨政治,令君主立憲制得以在英國成功發展。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在安妮女王的統治下,英國對內對外都有不錯的成就。對內,英格蘭與蘇格蘭正式合併,奠定後來大英帝國的基礎。對外,英國在西班牙王位繼承戰爭期間攻佔西班牙軍事要地直布羅陀(</span>Gibraltar<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。直布羅陀極具戰略意義,它位於伊比利半島的末端,是通往地中海的入口。英國控制此地,就能夠控制地中海到大西洋的海上貿易。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而,相較起歷史功積,後世似乎對安妮女王的「八卦史」更感興趣。如果我們問一位英國人對安妮女王有何印象,他大概會回答「流產過很多次」。事實上,安妮女王共懷孕過</span>17<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次,當中有</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次都發生流產,</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次為死胎,兩位在</span>18<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月前離世,活得最久的孩子威廉(</span>William<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)也只活到</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">流產對婦女的心理打擊非常大,安妮要面對</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次流產,其他的孩子也很早就過身,她的心內想必面臨過如刀割般的痛楚。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">安妮女王的病歷</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">反覆流產是婦產科中重要課題,成因大致上包括染色體異常、子宮畸形、內分泌異常及抗磷脂質綜合症(</span>antiphospholipid
syndrome<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)等。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那安妮女王反覆流產的原因是甚麼呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">史丹福在讀醫時,教授們經常強調,病歷是最重要的診斷工具,一份好的病歷有時甚至比高科技的儀器檢查更為重要。因此我們不妨細閱女王的病歷,從中尋找蛛絲馬跡。</span></p>
<p class="MsoNormal">1683<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,安妮</span>17<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲下嫁給丹麥的佐治王子(</span>Prince
George<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),當時她仍未登基為女王。</span>1684<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,她的首次懷孕誕下了死胎。她在</span>1685<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年及</span>1686<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年誕下兩個女兒,可惜她們都在</span>1687<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年死於天花。之後安妮共流產</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次。</span>1689<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,她誕下兒子威廉。威廉是位體弱的孩子,他的頭部比例太大,而且有步行困難。以今天的醫學知識分析,他有可能患有水腦症(</span>hydrocephalus<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,又稱腦積水)。威廉在</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲生日後幾天便發燒並過身,相信是死於某種感染。威廉出生後,安妮誕下了一位女兒及一位兒子,二人都在出生後一天內離世。之後她再懷孕了</span>8<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">次,但全都出現流產或死胎。她的最後一次懷孕發生在</span>1700<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年。</span></p>
<p class="MsoNormal">1702<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,她登位為女王。</span>1708<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,她心愛的丈夫佐治過身,安妮亦在</span>1714<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年過身,享年</span>49<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如果從產科的角度來說,首兩位女兒死於天花以及兒子威廉死於感染應該與安妮自己的身體狀況無關,然而其餘的流產、死胎及出生後短時間內過身的孩子則明顯與安妮自身的健康有莫大關係。因此我們需要再了解一下安妮的其他病歷。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">安妮的非產科病歷中有三點值得留意的地方。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第一點是「痛風」。</span>1698<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,安妮</span>33<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲時首次被紀錄患有「痛風」,她的「痛風」影響了手指、腳指、膝等多個關節,並令她行動困難。例如她在</span>35<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲時參加登基典禮的時候就需要人用轎子抬她過去。聰明的讀者朋友大概會留意到我用引號括著痛風,原因是安妮的症狀與現代醫學中的痛風有很大出入,痛風的患者多是年齡較大的男性,而且大多影響單一關節,最常受影響的是腳大姆指的蹠趾關節(</span>metatarsophalangeal
joint<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。安妮的病發年紀比一般的患者小很多,而且典型的痛風並不會如安妮的症狀般影響多個關節。基於以上的分析,我們可以合理地懷疑安妮所患的應該是另一種會影響多關節的關節炎。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第二個重要的病歷要點乃她臉上的紅疹,這些紅疹出現的時間與她「痛風」發作的時間吻合。這些紅疹似乎令安妮女王非常困擾,甚至有紀錄顯示安妮需要用顏料去遮住臉上的紅疹。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最後,安妮女王的身型非常浮腫。當時的人可能純粹覺得女王肥胖,不過以現代醫學來說,浮腫的原因可以是水腫(</span>oedema<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),甚至是腹腔積水。水腫的主要成因包括腎病綜合症(</span>nephrotic
syndrome<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、肝衰竭與心臟衰竭。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">到此,安妮女王反覆流產的原因已經呼之欲出。假如你有受過一定的醫學訓練的話,相信你已經能夠推斷出安妮所患何病。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">安妮女</span><span style="font-family: PMingLiU, serif;">王</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">很有可能患上系統性紅斑狼瘡症(</span>systemic
lupus erythematosus<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">系統性紅斑狼瘡症是一種自身免疫性疾病。患者的免疫系統失調,不正常地產生過多抗體,並攻擊病人自己的身體組織。打個比喻,人體的免疫系統本來負責守衛身體的安全,就像外國的警察一樣。而系統性紅斑狼瘡症患者體內的情況就好像外國的警察忽然失控,攻擊市民一樣。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">系統性紅斑狼瘡症主要影響年輕女士,發病年紀約為</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>40<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲。此病在女性中出現的機會大很多,男女患病的比例約為</span>1:9<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。安妮女王的性別與發病年紀都與典型的患者相當吻合。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">讓我們再來看看系統性紅斑狼瘡症症狀。系統性紅斑狼瘡症是種惡名昭彰的全身性疾病,可以影響身體多個系統,以下為此病的一些主要病徵:</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;"><br /></span></p><p class="MsoNormal"></p><ul style="text-align: left;"><li><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">蝴蝶斑(</span><span style="text-indent: -18pt;">malar
rash</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">):臉部雙頰出現紅斑,最典型的形狀是類似一雙蝴蝶。安妮女王臉上的紅疹很有可能就是蝴蝶斑。</span></li><li>圓盤狀皮膚疹(<span style="text-indent: -18pt;">discoid
rash</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">)</span></li><li>光敏感,被陽光照射之後皮膚會出現強烈的反應</li><li>口腔潰瘍</li><li>關節炎:患者的多個關節都會發炎,安妮女王所謂的「痛風」應該就是系統性紅斑狼瘡症所引起的多發性關節炎。</li><li>腎<span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">臟病變</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">:</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">患者會有蛋白尿的情況。蛋白質持續從尿液中流出,令血液中的蛋白質減少,這會令血液的水份透過滲透作用</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">(</span><span style="text-indent: -18pt;">osmosis</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">)</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">滲出血管,走到身體的軟組織內,引起水腫。</span></li><li>漿膜炎(<span style="text-indent: -18pt;">serositis</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">):漿膜是為覆蓋器官外層的組織,例子包括胸膜、腹膜及心包膜。漿膜炎可令漿膜產生異常的液體,並積聚在體腔內。安妮女王腹部漲大,這可能是由漿膜炎相關的腹腔積水引起。</span></li><li>神經或精神異常</li><li>血液變化<span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">:包括溶血性貧血、白血球過低、淋巴球過低症、血小</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">板</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">減少(終於來到我們最愛的血液!不過從安妮女王的病歷來看,我們沒有證據去顯示她有以上提及的血液問題</span></li><li>免疫<span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">學變化</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">:由於</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">患者</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">的免疫系統失調,他們的體內會出現各種異常的抗體,例如抗雙縷</span><span style="text-indent: -18pt;">
DNA </span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">抗體陽性(</span><span style="text-indent: -18pt;">anti-dsDNA
antibody</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">)、抗</span><span style="text-indent: -18pt;"> SM </span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">抗體(</span><span style="text-indent: -18pt;">anti-SM
antibody</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">)及狼瘡性抗凝固素(</span><span style="text-indent: -18pt;">lupus
anticoagulant</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; text-indent: -18pt;">)。</span></li></ul><p></p>
<p class="MsoNormal"><span style="font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;"><o:p> </o:p></span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">那麼</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">流產呢?我們已經介紹了很多的病徵,為何始終未有提及系統性紅斑狼瘡症與流產的關係?請別著急。讓我們賣一個關子,先介入一下剛剛提及過的狼瘡性抗凝固素。</span></p>
<p class="MsoListParagraph"><span style="font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">耐人尋味的狼瘡性抗凝固素</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">狼瘡性抗凝固素(</span>lupus
anticoagulant<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)是一種怪異的抗體,並會引起一種耐有尋味的凝血現象。要理解其奇怪之處,我們必須由凝血檢查說起。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">簡單來說,最基本的凝血檢查可以分為凝血酶原時間(</span>prothrombin
time<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>PT<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及活化部分凝血活酶時間(</span>activated
partial thromboplastin time<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>APTT<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)兩種,它們兩者分別代表了外在路徑(</span>extrinsic
pathway<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及內在路徑(</span>intrinsic
pathway<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的功能。時間延長就代表凝血路徑的功能異常,變相令病人更易流血。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而,狼瘡性抗凝固素卻反其道而行,這種物質雖然可以延長</span>APTT<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,卻不單不</span><span lang="ZH-HK" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">會令病人容易流血,更會增加他們出現血栓的機會。這個與直覺相違背的現象與</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">膜聯蛋白</span>A5<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span>annexin A5<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的運作有關,不過史丹福就不在此詳細說明當中的生理機制了,有興趣的朋友可以參考小弟舊作《血液狂想曲</span>2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">——血液的抗爭與救贖》中的文章《凝血檢查知多少》。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">狼瘡抗凝血因子除了會令病人容易生成血栓,更會引起流產(終於賣完關子!)。安妮女王反覆流產的原兇很有可能就是狼瘡性抗凝固素或相關的抗心磷脂抗體(</span>anti-cardiolipid
antibody<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及抗</span>β2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">糖蛋白</span>1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">抗體(</span>anti-β2
glycoprotein 1 antibody<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如果病人有反覆流產或血栓,並且在血液中檢測到狼瘡抗凝血因子、抗心磷脂抗體或抗</span>β2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">糖蛋白</span>1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">抗體,臨床上就會被稱為抗磷脂質綜合症。研究顯示約</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>15%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的反覆流產女士都患有抗磷脂質綜合症。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至於狼瘡性抗凝固素為何會引起反覆流產呢?當中的機制尚未完全清晰,但相信與抗體引起的發炎反應、補體(</span>complement<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)活化與胎盤血栓相關。這幾個機制都會損害胎盤,令母親無法把氧氣與養份正常地傳送給腹中的胎兒,影響胎兒的正常生長。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歷史的漣漪</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">安妮女王並無子嗣,這個不幸如漣漪般漸漸擴大,最於把英國歷史推向了一個截然不同的道路。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">根據《</span>1701<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年王位繼承法》,英國王位繼承人必須是新教信徒,而血緣和安妮女王最接近的新教信徒竟然是位關係已經非常遙遠的德國貴族</span>——<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">喬治(</span>George
Louis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。喬治就這樣成為漢諾威王室的第一位國王,史稱喬治一世。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">喬治一世是位德國人,根本就不懂英語。他身在英國,連基本的溝通都有所困難,更惶論是統治國家。於是他任命了輝格黨(</span>Whigs<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)領袖沃波爾(</span>Robert
Walpole<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)為內閣首領,這是首相職位概念的前身。雖然「首相」一詞在當時並沒有得到法律的官方認可,不過後人普遍認為他是英國歷史上第一位首相。自此,國王不再親身出席議會會議,令王權進一步下降,促進了英國的君主立憲制度與首相制的發展。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如果安妮女王留有子嗣,今天英國的王室亦會截然不同。因為今天的英國王室成員都是喬治一世的直系血親,例如現任英王查理斯三世就是喬治一世的曾曾曾曾曾曾曾孫。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span></p>
<p class="MsoNormal">Emson HE. For the want of an heir: the obstetrical history
of Queen Anne. <i>BMJ</i>. 1992;304(6838):1365-6.</p>
<p class="MsoNormal">Ross J. Queen Anne (1665-1714) and her health. <i>J Med
Biogr</i>. 2015;23(1):54-9.</p>
<p class="MsoNormal">Tsonis O, Balogun S, Adjei JO, Mogekwu O, Iliodromiti S.
Management of recurrent miscarriages: an overview of current evidence. <i>Curr
Opin Obstet Gynecol</i>. 2021;33(5):370-377.</p>
<p class="MsoNormal">Arachchillage DRJ, Laffan M. Pathogenesis and management of
antiphospholipid syndrome. <i>Br J Haematol.</i> 2017;178(2):181-195.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-21595187706735622462022-09-29T09:35:00.002-07:002022-09-29T09:35:23.092-07:00諾貝爾獎前奏:血液疾病遺傳基礎的破解者<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0f3zr_0iRuA4K0kbmvRnCI4W889kShSwIvnSmJsV8VnzLGknjafXCRGtRUFpaYU4gW1SKR2uf089sSNbQO_43tFplaGLCelVkxFuMY0ZwcM_IJRlw3vQF8UPaKiuLizDmuiH-1X25AbV4H5UBegoBs7y8Xl_Cs5SEwmlJDLQaPS6H8KJwoTSJ7x3wFw/s566/stuart_orkin_sog_2915_09.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="487" data-original-width="566" height="344" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0f3zr_0iRuA4K0kbmvRnCI4W889kShSwIvnSmJsV8VnzLGknjafXCRGtRUFpaYU4gW1SKR2uf089sSNbQO_43tFplaGLCelVkxFuMY0ZwcM_IJRlw3vQF8UPaKiuLizDmuiH-1X25AbV4H5UBegoBs7y8Xl_Cs5SEwmlJDLQaPS6H8KJwoTSJ7x3wFw/w400-h344/stuart_orkin_sog_2915_09.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">斯圖爾特·奧金(來源:https://dana-farber.org/)<br /><br /></td></tr></tbody></table><p>2022<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的諾貝爾獎得獎名單將於下星期公佈。在此之前,英國調查公司科睿唯安(</span>Clarivate<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)宣佈了科睿唯安引文桂冠獎(</span>Clarivate
Citation Laureate<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的得主。這獎項綜合考慮了論文的被引用次數、其他獎項的獲獎情況、對研究的貢獻度等。引文桂冠獎的很多得獎者之後都會問鼎諾貝爾獎,因此它被視為一個諾貝爾獎指標。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在</span>20<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">位得獎者中,以獲得生理學或醫學獎的哈佛醫學院兒科教授斯圖爾特·奧金(</span>Stuart
Holland Orkin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)最引起史丹福的注意。因為奧金研究的是血液疾病的遺傳基礎,他的發現徹底革新了血液學的發展。</span></p><p class="MsoNormal"><span style="font-family: PMingLiU, serif;">奧金研究主要集中在紅血蛋白疾病上,因此我們不妨簡單地重溫一下紅血蛋白的生化知識,以便大家了解奧金的貢獻。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">紅血蛋白分子由四個亞基(</span>subunit<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)組成,每個亞基都包含了一個血基質與一個球蛋白肽鏈(</span>globin
chain<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。成年人最主要的血紅蛋白是</span>HbA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,由</span>α<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈與</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈兩種球蛋白肽鏈組成。</span>HbA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">佔成年人紅血球中血紅蛋白約</span>95%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。新生嬰兒中最主要的血紅蛋白是</span>HbF<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,它由一對</span>α<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈與一對</span>γ<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈組成。當嬰兒長到約</span>6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月大時,嬰兒的就會慢慢不再合成</span>γ<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈,改為合成</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈,體內的紅血蛋白亦會因此由</span>HbF<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">慢慢轉換成</span>HbA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而我們熟悉的地中海貧血症就是由於球蛋白肽鏈失衡而引起。正常成人血液中最重要的血紅蛋白是</span>HbA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,包含了兩條</span>α<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白鏈與兩條</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白鏈。</span>α<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白鏈與</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白鏈就似是一陰一陽,本是非常平衡,陰陽調和。當這個美妙的平衡被打破,血紅蛋白就會出現問題了。情況就如一個聯校舞會,一定要有男校生與女校生參加,否則男女平衡被打破,多出的一方找不到舞伴,於是只好男生與男生配在一起跳舞,或者女生與女生配在一起跳舞,非常尷尬。同樣地,當</span>α<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈或</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈其中一面太多,就只好自己配在一起,形成異常的血紅蛋白。這些異常的血紅蛋白並不穩定,令紅血球易受破壞,做成溶血。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">奧金早年的研究興趣是尋找引起乙型地中海貧血症(</span>β
thalassaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白鏈基因突變。他發現東南亞、印度與地中海等不同種族的人各有不同的流行基因突變。他發現乙型地中海貧血症的遺傳基礎原來比大家所想像的要複雜得多,因為</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白鏈基因突變的方式有很多,有的會影響轉錄(</span>transcription<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),有的會影響轉譯(</span>translation<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),有的甚至會影響</span>RNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">剪接(</span>RNA
splicing<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal">1986<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,他利用定位克隆法(</span>positional
cloning<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)發現與慢性肉芽腫病(</span>chronic
granulomatous disease<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)相關的基因──</span>CYBB<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。慢性肉芽腫病是一種罕見的先天性免疫缺陷疾病,患者的</span>NADPH<span lang="ZH-TW" style="font-family: PMingLiU, serif;">氧化酶功能出現問題,影響嚐中性白血球殺菌的能力,令病人的免疫力變弱,極容易受到細菌感染。</span></p>
<p class="MsoNormal">1989<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,他發現了首個造血的轉錄調控基因──</span>GATA1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。他之後又再發現了很多其他造血的轉錄調控基因。他利用小鼠的基因標的(</span>gene
targeting<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)技術,發現這些轉錄調控基因的功能,因此他又有「分子造血之父」(</span>father
of molecular haematopoiesis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的稱號。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">近來,奧金又有另一個突破性的發現。他發現嬰兒由合成</span>γ<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈轉換成合成</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈的過程由</span>BCL11A<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因控制。這個發現除了是基礎科學上的重大突破外,也在臨床醫學上有重要的應用。因為乙型地中海貧血症與鐮刀型紅血球貧血症(</span>sickle
cell anaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)都是</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈的問題所引致,假如我們有方法把成人病人由合成</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈從新轉換成合成</span>γ<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鏈,那麼病人體內的血紅蛋白就可以由</span>HbA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">轉回</span>HbF<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span>HbF<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">是新生嬰兒使用的血紅蛋白,但功能上完全正常。病人的血紅蛋白回復正常後,就不用再飽受貧血及其他併發症之苦。近年,利用</span>CRISPR-Cas9<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">技術來抑制</span>BCL11A<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因成了治療乙型地中海貧血症與鐮刀型紅血球貧血症的新研究方向,而這治療方案的理念正正是沿自奧金的發現。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">奧金作為多種血液疾病遺傳基礎的破解者,對血液學的發展作出了重大的貢獻。不知道他的貢獻又會否得到諾貝爾委員會的認同呢?</span><br />
<br style="mso-special-character: line-break;" />
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<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p>
<p class="MsoNormal">Kazazian HH Jr. 2014 William Allan Award introduction:
Stuart Orkin. <i>Am J Hum Genet</i>. 2015 Mar 5;96(3):352-3.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-42101217967136903412022-09-23T05:36:00.002-07:002022-09-23T05:36:08.346-07:00搞笑諾貝爾獎 - 以雪糕舒緩骨髓移植的副作用<p>2022<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的搞笑諾貝爾獎頒獎典禮於</span>9<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>15<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日舉行,頒發了</span>10<span lang="ZH-TW" style="font-family: PMingLiU, serif;">個獎狀。當中的醫學獎由波蘭華沙醫學大學團隊的幾為成員所獲得。團隊證實使用雪糕作為冷凍療法可以有效減少自身骨髓移植所引起的口腔黏膜炎。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">以雪糕作為療法雖然感覺上相當有趣,但研究團隊成員在頒獎典禮上介紹得獎發現時就不忘強調,他們的發現不只是一個搞笑的笑話,而是真實的實證醫學,可以實則地幫助病人。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">今次的獎項難得牽涉到史丹福的專業</span>——<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血液學,我當然要把握機會為大家介紹一下。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">自身骨髓移植,顧名思義就是把病人自己的骨髓捐給自己。大家或許會感到疑惑,病人接受的骨髓來自自己,那為何又可以治有呢?原來自身骨髓移植的主角根本不是骨髓的幹細胞,而是化療藥物。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">醫生在收集好自身病人的骨髓幹細胞後,會為他下一次非常非常重的化療,劑量是平常化療的幾十倍,甚至更高,這個程序叫做「預處理」(</span>conditioning<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。如此重劑量的化療理論上可以把病人的癌細胞都殺光。但同時也把正常的骨髓細胞殺得七七八八,令骨髓接近真空。這時,醫生再把早收集好的骨髓幹細胞輸回病人體內,那麼他的骨髓功能就可以慢慢回復。所以這個方法可以說是「焦土政策」,就像是把自己軍隊先行撤退,然後一把火把整個戰場所有東西燒光燒淨,之後再派軍隊重新進駐。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">化療藥物威克瘤錠(</span>melphalan<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)是預處理時常用的藥物,不過此藥經常引起口腔黏膜炎的副作用。傳統的預防方法是要病人含著冰塊,這樣可以令口腔的血管收縮,減少發黨,並減少口腔黏膜與化療藥物的接觸。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但含著冰塊一段長時間是件很痛苦的事,有些骨髓移植中心會利用雪糕去代替冰塊。不過波蘭華沙醫學大學的團隊翻查文獻,發現沒有文獻研究過這做法的有效性,於是他們就決定研究這問題。團隊為注射威克瘤錠的病人提供</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">劑量的雪糕,並容許病人從醫院餐廳中自由選擇的口味。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">結果有接受雪糕「冷凍療法」的病人中,有</span>28.85%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">出現口腔黏膜炎,而在沒有接受雪糕「冷凍療法」的病人中,有</span>59.09%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">出現口腔黏膜炎</span><span lang="ZH-TW"> </span>(p = 0.02)<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。在統計學上,雪糕「冷凍療法」可以有效地減少自身骨髓移植預處理所引起的口腔黏膜炎。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIB0h59395kSC60hxegdBSa0qZ4SdCqsHBdrS9_L15CqmqvN4zCcT9qqBub0CIj35hvZSgqqZXTJQYSUsUV8bMYddBWFJOzEE0FALj9IYHvuSX6LWtBdaLpanC1JWguoAIzfEPqiguboiXBE06R8pyRQ19CbySfxhV_Q6pWRfV-FEzuU4eKorEatdzdg/s995/ice-cream.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="995" data-original-width="968" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIB0h59395kSC60hxegdBSa0qZ4SdCqsHBdrS9_L15CqmqvN4zCcT9qqBub0CIj35hvZSgqqZXTJQYSUsUV8bMYddBWFJOzEE0FALj9IYHvuSX6LWtBdaLpanC1JWguoAIzfEPqiguboiXBE06R8pyRQ19CbySfxhV_Q6pWRfV-FEzuU4eKorEatdzdg/w389-h400/ice-cream.png" width="389" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">顯示研究結果的圖片,取自獲獎的研究報告</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">搞笑諾貝爾獎的頒獎標準是「大笑之後,發人深省」。今次獲獎的研究除了發人深省次外,更實在地幫助到病人,為他們找到了一個低成本且容易接受的方法去減少自身骨髓移植的副作用,非常難得。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p>
<p class="MsoNormal">Jasiński, M., Maciejewska, M., Brodziak, A. et al. Ice-cream
used as cryotherapy during high-dose melphalan conditioning reduces oral
mucositis after autologous hematopoietic stem cell transplantation. <i>Sci
Rep</i> 11, 22507 (2021). <o:p></o:p></p><br /><p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-254423671590237862022-09-13T06:01:00.002-07:002022-09-13T19:22:42.835-07:00搞笑諾貝爾獎:令人意想不到的性病傳播途徑<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">本年度的搞笑諾貝爾獎(</span>Ig
Nobel Prize<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)將於</span>9<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>15<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日頒發。搞笑諾貝爾獎雖然號稱搞笑,卻絕不兒戲,有不少的獲獎研究有幽默感之餘,亦有豐富的科學內涵。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在眾多的獲獎研究中,史丹福印象最深刻的是</span>1996<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年公共衛生獎,得獎者是</span>Ellen
Kleist<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span>Harald
Moi<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">兩位醫學學者。他們於</span>1993<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年在《泌尿生殖醫學》期刊中發表了一篇案例報告,展現了一個非一般的性病傳播途徑。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">香港人非常憎恨的淋病(</span>Gonorrhoea<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)是一種由淋病雙球菌(</span>Neisseria
gonorrhoeae<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)所引起的性病。由於病菌不能在環境中存活,所以此病在絕大多數的情況只能經性接觸傳染。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL6Jl8IfYGKippSPNwwCBnM1e-rE-qZEGLqR9XPVCuTiVvC5sHapZgsaFkzgMD8H9ev9tcbnTTZ_eY43ltcFoV_e2yKEoxvLk5cO_N8Dc8I5-jFlRIB8Q7ktQjNmQhYmelCU1NLfmz-7PsUOagA_vyy2FerzRRU_EaW6R6-VWUan9ZygDbUF5T91r67w/s800/Neisseria_gonorrhoeae.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="522" data-original-width="800" height="418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL6Jl8IfYGKippSPNwwCBnM1e-rE-qZEGLqR9XPVCuTiVvC5sHapZgsaFkzgMD8H9ev9tcbnTTZ_eY43ltcFoV_e2yKEoxvLk5cO_N8Dc8I5-jFlRIB8Q7ktQjNmQhYmelCU1NLfmz-7PsUOagA_vyy2FerzRRU_EaW6R6-VWUan9ZygDbUF5T91r67w/w640-h418/Neisseria_gonorrhoeae.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">引起淋病的淋病雙球菌(來源:Wikimedia Commons)</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">案例中描述的病人是一位漁船船長,出海</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月之後出現尿道異常分泌,因而求醫。醫生為他進行檢測,並發現他患上淋病。奇怪的是,船上並無女士,船長也表示沒有進行過男男性行為,那麼他從哪裡感染到淋病呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">船長後來不情願地表示,漁船曾經在晚上發生過機件問題,於是船長叫喚船上的工程師作檢查。在工程師離開了自己的房間後,船長發現工程師有一個吹氣娃娃,入面有人工陰道。船長於是偷偷地使用來吹氣娃娃。之後在幾天後就開始出現症狀。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">醫生之後為工程師進行檢查,發現他也患上淋病。工程師表示自己被船長叫喚前曾使用吹氣娃娃,並在人工陰道內射精,且之後沒有進行清潔。他在上船出海前曾與一位女士發生性行為。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至此,船長感染淋病的原因終於真相大白。這也成了史上首個被報告經吹氣娃娃傳播的淋病個案。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p>
<p class="MsoNormal">Kleist E, Moi H. Transmission of gonorrhoea through an
inflatable doll. Genitourin Med. 1993 Aug;69(4):322.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-2960497467345838412022-08-05T04:20:00.001-07:002022-08-05T04:44:03.075-07:00太平洋戰爭中的瘧疾抗戰<p>1941<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年</span>12<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>7<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日,日軍偷襲美國太平洋海軍艦隊基地珍珠港,引發了太平洋戰爭。在戰爭爆發的初期,日軍勢如破竹,迅速攻佔了太平洋上美國、英國及荷蘭的多個屬地,包括英屬馬來亞、英屬香港、荷屬東印度、所羅門群島、威克島、關島等地區。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">很快,各個西方國家的太平洋地區屬地相繼落入日軍手上,不過菲律賓的美軍卻依然頑強抵抗。然而,軍隊在日軍的攻勢下需要持續撤退,而撤退的途中往往都會留下大量的醫療物資,包括抗瘧疾藥物。另一方面,有很多士兵也認為抗瘧疾藥物是種無用的藥物,因此經常拋棄它們。這幾個因素加起來,令到瘧疾問題在美軍中非常嚴重。根據美國軍隊遺產及教育中心(</span>United
States Army Heritage and Education Center<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的數據,在當時的</span>75,000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">名抗日美國及菲律賓士兵中,有</span>24,000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">名染上瘧疾。相較起來,在戰役初期,日軍只投入了</span>57,000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">名士兵。美國原本是有人數上的優勢的,卻因瘧疾而嚴重影響戰鬥力,最終戰敗。這是美軍在太平洋戰爭中最大的敗仗。在菲律賓巴丹半島投降的美國與菲律賓戰俘之後被日軍強迫在熱帶高溫的天氣下徒步趕往</span>100<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">多公里外營地關押,路上只獲得極少的糧食和水。戰俘還受到日軍的虐待,無法步行的戰俘會射殺或被刺刀刺死,非常殘暴,史稱「巴丹死亡行軍」(</span>Bataan
Death March<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在菲律賓的悲劇後,美軍在</span>1942<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年繼續在其他戰場上飽受瘧疾的煎熬。例如巴布亞新幾內亞(</span>Papua
New Guinea<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)米爾恩灣(</span>Milne
Bay<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)上有一個重要的盟軍基地,用於支援布納(</span>Buna<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及哥納(</span>Gona<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的作戰。根據美國陸軍軍事歷史中心(</span>United
States Army Center of Military History<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的數字,該個基地每</span>1,000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">名士兵每年共出現</span>4,000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">宗感染,也就是說平均每名士兵每年約感染瘧疾四次。在布納的戰鬥中,瘧疾引起的傷亡是作戰傷亡的</span>7<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">倍,這實在是一個高得令人咋舌的數字。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">到了</span>1943<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,美軍終於意識到瘧疾問題的嚴重性,軍隊開始投入了大量的資源去減低士兵染上瘧疾的機會。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">首先,軍隊增設了戰場瘧疾學家一職,由軍醫史密斯上校(</span>Colonel
Howard F. Smith<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)出任,他的職責是帶領軍隊進行有關瘧疾的研究及找出方法去減低瘧疾在軍隊中的傳播率。軍隊很快提出了兩個方針,一是確保抗瘧疾藥物的供應穩定,二是向軍隊宣傳抗瘧疾藥物的重要性。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當年最流行的抗瘧疾藥物是從金雞納樹(</span>Cinchona<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中提取的奎寧(</span>quinine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),而荷蘭的殖民地爪哇是最重要的金雞納樹栽種地。</span>1941<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,日本佔領了爪哇,嚴重地影響了盟軍的<a name="_Hlk109077896">奎寧</a>供應。於是,盟軍唯一盡力尋找奎寧的替代品。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最終,他們使用了美帕克林(</span>mepacrine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。美帕克林由德國科學家於</span>1931<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年開發,美國及其盟國在戰爭時間已充分掌握該藥物的生產方法,於是他們立即投入進行大規模生產,令抗瘧疾藥物的供應迅速穩定下來。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">然而,穩定的供應卻不代表高服用率。美帕克林雖然有效預防及治療瘧疾,卻有很多副作用,令士兵卻步。常見的副作用包括噁心、頭痛、肚瀉等。當藥物在瓜達康納爾島(</span>Guadalcanal<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的部隊最先被使用時,使用的劑量為每日</span>0.2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">克。這個劑量高得令</span>20%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的美軍士兵出現副作用,包括負責領導作戰的帕奇少將(</span>Alexander
M. Patch<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。於是,軍隊很快就決定把劑量下降到每日</span>0.05<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">克。這個劑量既有足夠的抗瘧疾功效,又令出現副作用的比率下降到一個可以接受的水平。雖然如此,仍然有不少的士兵因副作用而不願意服用美帕克林。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了剛才提及的問題外,美帕克林還會產生一種奇怪的副作用,就是令服用者的膚色變黃。這其實對身體沒有實則的影響,而且停藥一段時間後就會消失,不過卻對服用者做成心理上很大的困擾,有不少士兵甚至因此而抗拒藥物。</span></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHQ7Y6PNeZzsQczfoP-kaynlosSHLnB-dE-gQpFFMHTYdUvuk9mni4zbtYUIH8iEwQwxXuE00Or-dq5LnxWGiTjrMSXH376FsNnZMzDCz6FVgrpnOKSjDEQCZ1qHZXPSHZWB08MHsmx3rAk6_1Y4-LRrSaE2RquhqLfGB7AGRy_NR5XNUa9Att2l8K6A/s801/Malaria.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="386" data-original-width="801" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHQ7Y6PNeZzsQczfoP-kaynlosSHLnB-dE-gQpFFMHTYdUvuk9mni4zbtYUIH8iEwQwxXuE00Or-dq5LnxWGiTjrMSXH376FsNnZMzDCz6FVgrpnOKSjDEQCZ1qHZXPSHZWB08MHsmx3rAk6_1Y4-LRrSaE2RquhqLfGB7AGRy_NR5XNUa9Att2l8K6A/w400-h193/Malaria.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">第二次世界大戰時期,美國呼籲士兵預防瘧疾的宣傳海報</td></tr></tbody></table><br /><p class="MsoNormal"><span style="font-family: PMingLiU, serif;">日軍為了降低美軍美帕克林的服用率,更刻意散播謠言,指長期服用美帕克林會令人不育。這雖然是虛假的,卻很有效地減低士兵服用美帕克林的比率。為了解決此問題,軍隊最終決定要讓軍醫設立派發站集中派藥,並監督士兵服藥,確保他們服用藥物後才可放他們走。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了美帕克林外,美軍還有另一種抗瘧利器──殺蟲劑滴滴涕(學名雙對氯苯基三氯乙烷,英文</span>Dichloro-Diphenyl-Trichloroethane<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>DDT<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。滴滴涕是極為有效的殺蟲劑,可以有效滅蚊,對減低瘧疾的傳播非常有效。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">當然,要完全停止瘧疾傳播是不可能的,在第二次世界大戰的南太平洋戰場上,有近</span>50-60%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的美軍士兵都曾於戰爭的某個時段感染過瘧疾。不過藉著美帕克林及滴滴涕這兩大武器,美軍成功令瘧疾感染率減低了七成,對美軍戰勝太平洋戰爭有著不可或缺的貢獻。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p>
<p class="MsoNormal">Joy RJ. Malaria in American troops in the South and
Southwest Pacific in World War II. Med Hist. 1999 Apr;43(2):192-207.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-24691372296143577252022-07-25T05:45:00.001-07:002022-07-25T06:30:39.593-07:00水蛭與醫學<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">古希臘時期的醫生相信疾病是由於體液失衡引起,排走血液可以令體液回復平衡,於是發展出放血療法。</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; font-size: 12pt; line-height: 107%;">除了直接用刀割開動脈或靜脈,或者重覆地割破皮膚外,古時的醫生也發展出利用</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">水蛭進行放血的方法。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">水蛭是一種身體扁平的環節動物,目前已知有三百餘種。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">雖然水蛭吸血的形象深入民心,但其實大部分品種的水蛭都不會吸血,而是捕食小型無脊椎動物為生,會吸血的水蛭只佔小部分。會吸血的水蛭又可被進一步分類為吻蛭類與無吻蛭類。有吻蛭類群可用口器刺入宿主皮膚吸血,無吻蛭類群則是用顎切開宿主皮膚吸血。並非所有的吸血水蛭都可用作醫學用途,醫學用水蛭性情較為溫順,沒有那麼強的攻擊性。在西方醫學史中最常用的水蛭品種為歐洲醫蛭(</span>Hirudo
medicinalis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。牠們有三個顎,每個顎上有約</span>100<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">顆牙齒,可以咬開寄主以助牠們吸血。牠們每次可以吸入達體重</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">倍的血,即平均約</span>5<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">毫升的血液。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p><p class="MsoNormal"><o:p><b><u><span lang="ZH-TW" style="font-family: PMingLiU, serif;">水蛭</span></u></b><b><u><span lang="ZH-TW" style="background: white; font-family: PMingLiU, serif;">醫學史</span></u></b></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">水蛭的醫療應用源遠流長,早在三千多年前的古埃及時代已經出現,法老墳墓的壁畫就有相關的描述。古希臘詩人荷馬於公元前</span>7<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">世紀所寫的史詩作品伊利亞德(</span>Iliad<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)亦有提及古希臘醫生在特洛伊戰爭中利用吸血類水蛭來治療士兵的傷口。然而,利用水蛭作醫療用途的最早正式紀錄應該是公元前兩世紀古希臘醫學家尼坎德(</span>Nicander
of Colophon<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)所著的《毒與解毒劑》(</span>Alexipharmaca<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。中世紀波斯醫學家伊本</span>·<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">西那(</span>Ibn
Sina<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)在其作用《醫典》(</span>Canon
of Medicine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中把水蛭療法進一步發揚光大。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過令水蛭療法攀上巔峰的人是拿破崙軍中的外科醫生布魯塞斯(</span>François-Joseph-Victor
Broussais<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。布魯塞斯對水蛭療法的狂熱已經到了瘋狂的地步,在他心目中,水蛭能醫百病,幾乎所有疾病都可以用水蛭放血來治療。他甚至發展出一套完整的病理學理論去解釋他對水蛭療法的偏愛,他曾在驗屍時在消化系統內發現血跡,因此推斷出所有疾病都源於內臟發炎,而放血療法可以舒緩內臟發炎。相較起利用切開血管的方法進行放血,水蛭吸血似乎更安全,致死率也低行多,因此他大力推廣這療法。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">布魯塞斯身體力行地宣揚水蛭療法,除了在病人中應用療法外,他也會在醫學演講中講解他的理論。當時布魯塞斯在醫學界中很受敬重,可以說是紅透半邊天,他的演講場場爆滿,據聞甚至出現過未能進入演講廳的狂熱群眾希望破門而入的情況,要出動軍方與警方維持秩序。</span></p>
<p class="MsoNormal">1820<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年到</span>1845<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,歐洲水蛭的運用達到頂點。當時,單是一次的水蛭治療就可以用上</span>80<span lang="ZH-TW" style="font-family: PMingLiU, serif;">隻水蛭。其總使用量更是驚人。俄羅斯每年消耗大約</span>3000<span lang="ZH-TW" style="font-family: PMingLiU, serif;">萬隻水蛭。英國僅倫敦一家醫院一年就能消耗</span>2<span lang="ZH-TW" style="font-family: PMingLiU, serif;">萬多隻水蛭。至於水蛭熱潮的發沿地法國則更為誇張,單單在</span>1833<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,法國就進口了</span>4200<span lang="ZH-TW" style="font-family: PMingLiU, serif;">萬隻水蛭,而每年的消耗量則貼近一億隻水蛭。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">單用統計數字也許很難令大家直接地了解到當年的瘋狂。究竟這個數字的水蛭使用量有甚麼意義呢?答案就是大得足以令到水蛭瀕臨絕種。歐洲醫蛭在多個歐洲國家的數量大幅減少,並且分佈得越來越稀疏。即使到今天,歐洲醫蛭仍被國際自然與自然資源保護聯盟(</span>International
Union for Conservation of Nature and Natural Resources<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>IUCN<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)歸類為「近危」。在法國及比利時,牠們分佈得很稀疏。在英國,牠們就只餘下</span>20<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個分散的群落。因此,幾乎所有歐洲醫蛭原生分佈的國家都有立法去保護這物種。歐洲對水蛭療法的狂熱竟然引起了一場生態危機,真是非常驚人。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">到了</span>19<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">世紀的尾聲,隨著現代生理學、病理學及實證醫學的發展,不少醫學家都開始質疑這療法的成效,水蛭療法的熱潮因而漸漸退卻。以英國為例,當地一間醫院的紀錄顯示醫院在</span>1832<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年使用了近</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">萬隻水蛭,到了</span>50<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年之後,其每年使用量則大幅下降至</span>2000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">隻水蛭。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">水蛭</span><span style="font-family: PMingLiU, serif;">療</span><span style="font-family: PMingLiU, serif;">法的高峰雖然已過,但近年它卻捲土重來,在整型外科的微手術中重新找到了自己的定位。例如在整型外科的重建手術中,肌肉及皮膚組織從病人的其他部位移植到新的地方。這時,外科醫生就需要重新建立新的血液供應。在這情況下,動脈血管較少引起嚴重問題,但靜脈的血管則容易被瘀血阻塞,可以令新移植的組織在短時間內壞死。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">外科醫生當然有很多常規的方法去處理這問題。但如果常規方法無效的話,醫生還可以考慮使用水蛭這種終極武器。水蛭可以吸走新移植的組織中的血液,避免瘀血堆積。另外,水蛭的口水也有神奇的作用,可以令被咬到的傷口持續出血,這也可以減少血液淤積並促進血液循環。</span></p>
<p class="MsoNormal">2004<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,美國食品藥物管理局(</span>The
United States Food and Drug Administration<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)正式把水蛭納入「醫療器材」,批准把它們用於醫學用途。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">水蛭亦可被用於其他出現血液淤積的臨床情況,例如下圖就顯示了利用水蛭來治療舌頭血腫(</span>tongue
haematoma<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的過程。圖片出自《荷蘭重症監護期刊》(</span>Netherlands
Journal of Critical Care<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的案例報告。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSYFXn8t-ItRfINtIQjO5PGXIqFm-u5_yXRFWhanM03W0iUDtsecYU8LCRoSmpSciw5-i-N8XgdjHwfOs2rJzMWo1ifL6yCWQgT8bjiX2v975eA-zAld3gbZFMUflRhAu_aAbKUuPA4wnbg2JUWQKyZ48QrJaXFHUToDBS1_HwrhJ3UrSRcrdGtg1Z4w/s850/leeches.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="563" data-original-width="850" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSYFXn8t-ItRfINtIQjO5PGXIqFm-u5_yXRFWhanM03W0iUDtsecYU8LCRoSmpSciw5-i-N8XgdjHwfOs2rJzMWo1ifL6yCWQgT8bjiX2v975eA-zAld3gbZFMUflRhAu_aAbKUuPA4wnbg2JUWQKyZ48QrJaXFHUToDBS1_HwrhJ3UrSRcrdGtg1Z4w/w640-h424/leeches.png" width="640" /></a></div><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">從水蛭口水提取的抗凝血藥</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了微外科手術外,水蛭的獨特性質竟然也把它帶進了血液學的的領域。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">原來被水蛭咬到後,傷口可以持續出口達數小時,非常難止血。</span>1884<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,英國的醫生及生理學教授海克拉夫(</span>John
Berry Haycraft<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)發現水蛭的口水具有抗凝血的作用,這就可以解釋到水蛭咬到的傷口難以止血的現象。</span>1904<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,英國科學家雅各比(</span>C.
Jacoby<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)從水蛭口水中純化出當中抗凝血的成分,並把它命名為水蛭素(</span>hirudin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span>1986<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,科學家成功利用基因工程的方式製造出水蛭素。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過,要單從水螅的口水中提取足夠的水蛭素是很困難的,畢竟每隻水蛭所分泌的口水並不多。因此,今天在臨床上所用到的水蛭素類抗凝血藥物都是化學合成的水蛭素衍生物,其中包括了來匹盧定(</span>lepirudin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)與比伐盧定(</span>bivalirudin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。它們兩者的抗凝血原理與水蛭素相同,都是一種直接凝血酶抑制劑(</span>direct
thrombin inhibitor<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">大家或許會想,現時不是已經有肝素(</span>heparin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)與華法林(</span>warfarin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)這兩種有效的抗凝血藥物被廣泛使用嗎?為何還要發展水蛭素衍生出的抗凝血藥物呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">原來肝素雖然有效,卻有一個致命的缺點,就是它可以引起一種名為肝素誘導血小板減少症(</span>heparin
induced thrombocytopenia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的可怕副作用。顧名思義,患者當然會有血小板減少的情況。雖然病人血小板數量減少,卻很少出現流血症狀,反而會有血栓(</span>thrombosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的問題。肝素誘導血小板減少症所引起的血栓總類繁多,包括深層靜脈栓塞、肺栓塞、中風、冠心病,甚至是罕見的血栓,例如内臟静脈栓塞(</span>splanchnic
vein thrombosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等。有別於大部分其他與血栓相關的疾病,肝素誘導血小板減少症既可以影響動脈,亦可以影響靜脈。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">肝素誘導血小板減少症的機制是病人的免疫系統製造出一種抗體去攻擊肝素與血小板因子</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span>platelet
factor 4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>PF4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)形成的複合物,其中血小板因子</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">是血小板中顆粒的成分。這種抗體會激活血小板,令到血小板凝集,引起血栓。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">大家可以想像,肝素是肝素誘導血小板減少症的原兇,我們當然不能利用肝素去處理相關的血栓,否則只會火上加油,雪上加霜。那麼使用另一種常見的抗凝血藥物華法林又可行嗎?也不可。原來華法林會抑制維生素</span>K<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。維生素</span>K<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了用於合成凝血因子</span>II<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span>VII<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span>IX<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span>X<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">外,亦會幫助合成蛋白</span>C<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span>protein
C<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)與蛋白</span>S<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span>protein
S<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)這兩種天然抗凝血物質。在肝素誘導血小板減少症的情況下使用華法林反而會因蛋白</span>C<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與蛋白</span>S<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的減少而引起皮膚壞死與肢體靜脈壞疽等可怕的副作用。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">由於肝素與華法林這兩種抗凝血藥物在肝素誘導血小板減少症時都無用武之地,於是水蛭素洐生的抗凝血藥物就可以在這時大放異彩。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了應付一般的血栓外,比伐盧定更可特別地被用於俗稱「通波仔」的經皮冠狀動脈介入治療術(</span>percutaneous
coronary intervention<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中。「通波仔」手術一般都會用到肝素去預防血栓形成,但如果病人同時患有肝素誘導血小板減少症,那麼肝素就不可被使用了。基於其特殊的藥理特性,比伐盧定就成了這情況下的最佳抗凝血藥物。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「高峰過總會有下坡」這句歌詞很適合用來形容水蛭在醫學中的應用。不過水蛭的熱潮雖已過去,牠們卻在整型外科與血液學的領域中重先找到了自己的定位,為醫學作出貢獻。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源</span><span lang="ZH-TW" style="background: white; color: #222222; font-family: "PMingLiU",serif; font-size: 10.0pt; line-height: 107%;">:</span></span></p><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">
<p class="MsoNormal">Munshi Y, Ara I, Rafique H, Ahmad Z. Leeching in the
history--a review. <i>Pak J Biol Sci</i>. 2008;11(13):1650-3.<o:p></o:p></p>
<p class="MsoNormal">Hyson JM. Leech therapy: a history. <i>J Hist Dent</i>. 2005;53(1):25-7.<o:p></o:p></p>
<p class="MsoNormal">Spear M. Medicinal Leech Therapy: Friend or Foe. <i>Plast
Surg Nurs</i>. 2016;36(3):121-5.<o:p></o:p></p>
<p class="MsoNormal">Fields WS. The history of leeching and hirudin. <i>Haemostasis</i>.
1991;21 Suppl 1:3-10.<o:p></o:p></p>
<p class="MsoNormal">Warkentin TE, Greinacher A, Koster A. Bivalirudin. <i>Thromb
Haemost</i>. 2008;99(5):830-9.<o:p></o:p></p>
<p class="MsoNormal">Ramzan M, Droog W, Visser SS, van Roesse EW. Leech got your
tongue? haematoma of the tongue treated with medicinal leeches: A case report. <i>Netherlands
Journal of Critical Care</i>. 2010;14(4);268-70.</p></span><p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-25315018360313426302022-05-29T07:50:00.006-07:002022-05-29T07:50:55.978-07:00圖坦卡蒙患有鐮刀型細胞貧血症嗎?<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">考古學家卡特(</span>Howard
Carter<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)經過</span>19<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的努力後,終於在</span>1922<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年</span>11<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>5<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日發現了古埃及法老圖坦卡蒙(</span>Tutankhamun<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的陵墓。它竟然開鑿於斷崖底下,位於另一個著名法老拉美西斯六世(</span>Ramesses
VI<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的陵墓下面。陵墓中有各式各樣的奇珍異寶,如黃金內棺、黃金面具、黃金寶座等,令卡特的考古發掘隊目不暇給。需知道經歷了近三千年後,大部分古埃及法老陵墓都早已被洗劫一空,唯獨圖坦卡蒙的陵墓可以如此完整地保留下來。因此圖坦卡蒙的陵墓可以說是</span>20<span lang="ZH-TW" style="font-family: PMingLiU, serif;">世紀最重要的考古學發現,它把整個世界都迷住了。</span></p><p><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigCjZQUsf5N5PjyPm-vct03ITC6ri0rBE5yJnuEkE5VCOgZmQBVKt8n9KQAo9kx3WImHjyi3DUwPtCzXNqtebNzXr4LqOwqmH0_n89qhXVQo_SLsYfl_f3pEAWrhZG85yd_4I-nGH-D8XExqrkg7PYPS_0Ouur8lWAOHUTceI-HbtKNFdwKVzPRpZN8w/s1344/Tutankhamun.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1344" data-original-width="1008" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigCjZQUsf5N5PjyPm-vct03ITC6ri0rBE5yJnuEkE5VCOgZmQBVKt8n9KQAo9kx3WImHjyi3DUwPtCzXNqtebNzXr4LqOwqmH0_n89qhXVQo_SLsYfl_f3pEAWrhZG85yd_4I-nGH-D8XExqrkg7PYPS_0Ouur8lWAOHUTceI-HbtKNFdwKVzPRpZN8w/w480-h640/Tutankhamun.jpg" width="480" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">圖坦卡蒙的木乃伊面具</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">談起圖坦卡蒙,當然就不得不提所謂的「詛咒」。據說圖坦卡蒙的墓室口刻著「誰擾亂了法老的安眠,死神將張開翅膀降臨他的頭上」的詛咒。巧合的是幾個最早進入墳墓的人皆因各種原因早死。資助卡特的考察,並與他一起進入陵墓的卡納凡勳爵(</span>George
Herbert, 5th Earl of Carnarvon<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)在幾個月後就因感染而死亡。卡納凡勳爵的朋友,到訪過墓室的伍德(</span>George
Jay Gould<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)在埃及開始發燒,回到法國後因肺炎死亡。</span>1928<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,卡特的助手,幫助打通圖坦卡門陵墓的考古學家梅斯(</span>Arthur
Cruttenden Mace<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)也因肺炎而不幸死亡。這</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">被當時的媒體大肆渲染成「法老的詛咒」,使得圖坦卡蒙的名字在西方更為家喻戶曉。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">但值得留意的是,其實絕大部分與該次探索相關的人員都是死於自然的醫學原因,例如陵墓的主要發現者卡特就是在</span>64<span lang="ZH-TW" style="font-family: PMingLiU, serif;">歲時死於何杰金氏淋巴癌(</span>Hodgkin
lymphoma<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。傳媒把很多直接或間接與發現圖坦卡蒙扯上關係的人描述為死於非命,其實是很牽強的。</span></p>
<p class="MsoNormal"><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>圖坦卡蒙的死因</b></span></u></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">撇開了所謂的「詛咒」,圖坦卡蒙的生平本身也是充滿傳奇性的。他在</span>9<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲時登上王位,但卻英年早逝,死時年僅</span>18<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲。他的功積不多,最著名的政治影響在於取消了父親阿肯那頓(</span>Akhenaten<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的宗教改革,恢復寺廟,並把首都遷回底比斯。在政治上,圖坦卡蒙並不亮眼,他的名氣主要來自他保存完好的陵墓,而且持續有相關的文物展出。但他的英年早逝卻吸引了很多人的注意。他的死因都現在仍然未明,並成了歷史學者、考古學者及醫學學者積極研究的課題。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">考古學者發現描繪他的生活的壁畫裏有很多都有他拄著拐杖的畫面,而出土的遺物中有大量的拐杖,因此推斷出圖坦卡蒙應該自少就有足部的問題,並需要使用拐杖行走。不過足部問題卻不足以致死。考古學者又提出了其他的猜測去解釋其死因,包括被暗殺、被人毒死、得痲瘋病死掉或是被蛇咬死等。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">要研究圖坦卡蒙之死,除了需要利用傅統考古學上的證據外,亦需要用到最新的科學技術。一隊由開羅大學醫學院及埃及國家研究中心學者組成的科學團隊在</span>2007<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>9 <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月至</span>2009<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月間試圖以人類學、放射學及遺傳學等的方法多方面地檢驗圖坦卡蒙以及其家人的木乃伊,以加深我們對圖坦卡蒙的健康情況的理解。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">電腦掃瞄檢查發現圖坦卡蒙左腳的第二及第三蹠骨(</span>metatarsal
bone<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)變型,顯示蹠骨有慢性壞死(</span>chronic
necrosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的情況。另外,圖坦卡蒙的左膝在死前應該有出現過複合性骨折,並導致腿部受感染。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">古埃及時期的衛生環境及醫療技術遠不如今天,傳染病是一個非常常見的致死原因。因此團隊又以遺傳學的技術檢驗了幾款常見的傳染病,包括鼠疫、結核病、痲瘋及利什曼病(</span>Leishmaniasis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),結果全為陰性。不過,團隊卻在圖坦卡蒙及另外幾個王室木乃伊的樣本中檢驗出惡性瘧原蟲(</span>Plasmodium
falciparum<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的基因。惡性瘧原蟲是一種會引起嚴重瘧疾的寄生蟲。檢查結果證實圖坦卡蒙在生前曾經染上瘧疾。</span></p>
<p class="MsoNormal"><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><b>圖坦卡蒙患有鐮刀型細胞貧血症嗎?</b></span></u></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">團隊的發現大大增進了我們對圖坦卡蒙健康狀況的認識,令人鼓舞。但要如何分析這些數據呢?專家們似乎都有不同的想法,以致有很多的問題至今都未有共識。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">例如圖坦卡蒙左腳蹠骨壞死的原因是甚麼呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">一篇刊登在歐洲病理學期刊《維爾肖歸檔》(</span>Virchows
Archiv<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的回顧文章整理了現存的所有理論,發現至少有</span>7<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個理論去解釋他的蹠骨壞死,包括科勒氏症(</span>Köhler
disease<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、鐮刀型細胞貧血症(</span>sickle
cell anaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、高雪氏症(</span>Gaucher's disesase<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、酒精或急性胰臟炎相關的骨壞死、骨髓炎(</span>osteomyelitis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、系統性紅斑性狼瘡症(</span>systemic
lupus erythematosus<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及異壓性創傷(</span>dysbaric
trauma<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">作為一名血液學工作者,史丹福自然對鐮刀型細胞貧血症的理論最感興趣。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">史丹福翻查文獻,在搜索到的文獻記錄中,發現最早提到鐮刀型細胞貧血症猜想的應該是德國漢堡伯納德諾赫特熱帶醫學研究所(</span>Bernhard
Nocht Institute for Tropical Medicine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的兩名醫生提曼(</span>Christian
Timmann<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及邁耶(</span>Christian
G. Meyer<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。他們以「給編輯的信」的形式在《美國醫學會雜誌》(</span>JAMA:
The Journal of the American Medical Association<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)回應開羅大學醫學院及埃及國家研究的研究時提出電腦掃瞄檢查的結果與鐮刀型細胞貧血症引起的骨病變相似。他們進一步解釋,鐮刀型細胞貧血症的突變基因在埃及很常見,達</span>9-22%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。另外遺傳學的檢測結果顯示圖坦卡蒙的不少近親都曾被惡性瘧原蟲感染,卻可以活至</span>50<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲以上,這在古埃及的時代來說算是相當長壽,也許他們的身體有機制對抗瘧疾,令瘧疾對他們的影響較輕,而鐮刀型細胞貧血症的變異基因正正可以減低患上重症瘧疾的機會。最後,圖坦卡蒙的父母是近親,所以他患上體染色體隱性(</span>autosomal
recessive<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)遺傳病(鐮刀型細胞貧血症也是一種染色體隱性遺傳病)的機會亦較高。綜合幾個原因,作者們認為應該把鐮刀型細胞貧血症納入鑑別診斷(</span>differential
diagnosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即有可能的診斷)中,並建議埃及的研究團隊為圖坦卡蒙檢查</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白(</span>β
globin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)基因,探測一下有沒有引起鐮刀型細胞貧血症的突變。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">你可能會覺得疑惑,鐮刀型細胞貧血症不是一種貧血症嗎?為何會影響到骨骼呢?又為何可以低患上重症瘧疾的機會呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">其實鐮刀型細胞貧血症的變異基因其實是由血紅蛋白中</span>β<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">球蛋白基因的突變引起的,這突變令到血紅蛋白中的其中一個胺基酸改變了,變成</span>HbS<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血紅蛋白</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;">。</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">瘧原蟲的生命周期需要進入紅血球,並在裡面成長。這個血紅蛋白的變異卻影響了瘧原蟲進入紅血球,令患者有較少機會患上嚴重的瘧疾。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">鐮刀型細胞貧血症的基因屬於體染色體隱性基因,意思是如果患者只有一條突變基因,他將是一個基因攜帶者,但卻不會有鐮刀型細胞貧血症的症狀,更有較低機會被瘧原蟲感染,令他更有生存優勢。基於達爾文「物競天擇,適者生存」的原理,變異基因就在非洲人中變得流行起來。不幸的是,如果患者同時擁有一對變異基因,就會得到惡名昭彰的鐮刀型細胞貧血症</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;">。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在缺乏氧氣的情況下,</span>HbS<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血紅蛋白會連結聚合在一起,形成鐮刀型的紅血球。這些病變的血紅蛋白令紅血球很易受到破壞,病人會出現溶血性貧血。不過原來鐮刀型細胞貧血症最可怕之處並不在於貧血。鐮刀型紅血球更會阻塞血管,令身體不同的組織缺氧而受損,影響之大遍佈全身。患者的脾臟會因缺血而失去功能,令他們容易受到嚴重感染。患者又不時會有週期性的骨骼及胸部疼痛。其他常見的併發症包括中風、視網膜病變、關節缺血性壞死(</span>avascular
necrosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、腎病變、陰莖異常勃起(</span>priapism<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;">。</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">提曼及邁耶就認為圖坦卡蒙左腳蹠骨的病變與鐮刀型細胞貧血症所引起的骨病變脗合。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjnKft54kV-ijlxu0qxCSUNbkLtJzQPwwxgt0kYhmYhEaaimUWGW0e6ZwBpTDwJLR755W_CANNF9LviU29cwJKLr9YM_QkyoG8E8TmxGxBnJIpP5LNnmPc5t0pRcE12aLC6uBYPCVRfk1tyYv7k99caqrA_14YpARKamEemr_XM8u_mWN944g8vhy1Tg/s2457/sickle%20cell.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1537" data-original-width="2457" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjnKft54kV-ijlxu0qxCSUNbkLtJzQPwwxgt0kYhmYhEaaimUWGW0e6ZwBpTDwJLR755W_CANNF9LviU29cwJKLr9YM_QkyoG8E8TmxGxBnJIpP5LNnmPc5t0pRcE12aLC6uBYPCVRfk1tyYv7k99caqrA_14YpARKamEemr_XM8u_mWN944g8vhy1Tg/w640-h400/sickle%20cell.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">鐮刀型細胞貧血症患者的周邊血液抺片</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過來自法國勒奈</span>·<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">笛卡爾</span>—<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">巴黎第五大學(</span>Université
Paris V - René Descartes<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的佩思(</span>J.F.
Pays<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)卻在《外來病理學會公報》(</span>Bulletin
de la société de pathologie exotique<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)發表了文章反駁德國專家的理論。他提出的論點有幾個。首先,以古埃及的醫療衛生情況,鐮刀型細胞貧血症的患者壽命應該大概只有</span>5<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲,之後患者需要面臨貧血、感染或其他併發症,像圖坦卡蒙一樣存活至</span>19<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲屬於非常罕見。另外,除了左腳的第二及第三蹠骨外,科學團隊並沒有在其他骨骼中發現鐮刀型細胞貧血症相關的骨病變,例如股骨頸(</span>femur
neck<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的缺血性壞死等。而且圖坦卡蒙亦沒有骨髓增生的跡象,這同樣是在鐮刀型細胞貧血症患者中常會出現的現象。佩思認為綜合所有資料後,圖坦卡蒙的蹠骨病變更像是由科勒氏症引起的。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">史丹福並非骨科的專家,對科勒氏症的認識並不深,所以就不多加介紹了。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">史丹福反而想花很短的篇幅談談《維爾肖歸檔》的回顧文章中提到的另一個疾病高雪氏症。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">高雪氏症嚴格來說並不是一種血液學疾病,而是一種遺傳性的代謝疾病。不過由於患者常有肝脾腫大與血細胞減少的病徵,症狀與血液癌症相似,所以作診斷時常會牽涉到血液學醫生。疾病的成因是葡萄糖腦苷脂酶(</span>glucocerebrosidase<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的基因突變,令患者身體無法正常合成這種酶,影響葡萄糖腦苷脂(</span>glucocerebroside<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的新陳代謝。葡萄糖腦苷脂會積聚在細胞中並毒害細胞。除了剛才提及的血液學病徵外,患者亦可有神經病變及骨骼變形等症狀。患者的骨髓中常有巨噬細胞</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; font-size: 11pt; line-height: 107%;">(</span><span style="font-family: Calibri, sans-serif; font-size: 11pt; line-height: 107%;">macrophage</span><span lang="ZH-TW" style="font-family: PMingLiU, serif; font-size: 11pt; line-height: 107%;">)</span><span style="font-family: PMingLiU, serif;">的增生,而且它們的細胞質會有特別的形態轉變,看起來像是皺紙般。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-mOBTTi5MT0RZX-yVmc4wljvYAkXKh6dZTttdYMRWyEYWdJT1CnAWdLocnwOCPHRt31xBG6HbAmCtpRYAe2yuJxUB2i8luzrsKdxw5vzqBvMuSyntLS2rG2Dxiryg4kU9KvUIdx2fUAH2I8j453DNq3tKEGD4GKRHc-NPtCsGl_TZG-VPWraTqs_66w/s827/gaucher.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="553" data-original-width="827" height="429" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-mOBTTi5MT0RZX-yVmc4wljvYAkXKh6dZTttdYMRWyEYWdJT1CnAWdLocnwOCPHRt31xBG6HbAmCtpRYAe2yuJxUB2i8luzrsKdxw5vzqBvMuSyntLS2rG2Dxiryg4kU9KvUIdx2fUAH2I8j453DNq3tKEGD4GKRHc-NPtCsGl_TZG-VPWraTqs_66w/w640-h429/gaucher.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">高雪氏症患者的骨髓抽吸抺片,大家可以見到一些細胞質像是皺紙般的巨噬細胞</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了蹠骨壞死外,又有科學家提出圖坦卡蒙可能患有各式各樣的遺傳性疾病,如安特利</span>-<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">比克斯勒綜合症(</span>Antley–Bixler
syndrome<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、馬凡氏綜合症(</span>Marfan
syndrome<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、克氏綜合症(</span>Marfan
syndrome<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等。但因為這些都非血液學的疾病,我們就不作詳談了。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蹠骨壞死及遺傳性疾病都應該不是圖坦卡蒙死亡的直接原因,學者們普遍都相信骨折或瘧疾是較為重要的致死原因。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">參與研究的考古學家兼埃及古物最高委員會秘書長哈瓦斯(</span>Zahi
Hawass<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)就寫到:「他可能一直對抗著先天缺陷,直到瘧疾病發或是在事故中嚴重折斷一條腿而導致增加了一個疾病壓力,讓他的身體可能無法再承受負荷了。」</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">圖坦卡蒙的死因暫時已然有很多未解之謎。不過看著專家們在各科學期刊上唇槍舌劍,高手過招,實在令我大開眼界。對很多人來就,科學就是「絕對」、「明確」的代名詞,但其實在真正的科學分析中,不同的科學家在面對同樣的科學證據時都可以有不同的分析方法,因而得出不同的結論。不過真理越辯越明,史丹福相信隨著更多的科學研究與討論,我們對圖坦卡蒙的健康及死因一定會有更深入的認識。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源</span><span lang="ZH-TW" style="background: white; color: #222222; font-family: "PMingLiU",serif; font-size: 10.0pt; line-height: 107%;">:</span></p>
<p class="MsoNormal">Hussein K, Matin E, Nerlich AG. Paleopathology of the
juvenile Pharaoh Tutankhamun-90th anniversary of discovery. <i>Virchows Archiv</i>.
2013;463(3):475-479.</p>
<p class="MsoNormal">Hawass Z, Gad YZ, Ismail S, Khairat R, Fathalla D, Hasan N, et
al. Ancestry and pathology in King Tutankhamun's family. <i>JAMA</i>. 2010;303(7):638-447.</p>
<p class="MsoNormal">Timmann C, Meyer CG. King Tutankhamun's family and demise. <i>JAMA</i>.
2010;303(24):2473; author reply 2473-2475.</p>
<p class="MsoNormal">Pays JF. Toutankhamon et sicklanémie [Tutankhamun and
sickle-cell anaemia]. <i>Bulletin de la société de pathologie exotique</i>.
2010;103(5):346-347.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-13267219046504130502022-05-20T02:43:00.002-07:002022-05-20T02:43:09.717-07:00以mirror來命名的血液現象<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">如果你自問是一位「鏡粉」,那麼你應該愛屋及烏,熱愛一切與鏡有關的事物。如果你是鏡熱潮的受害者,甚至是所謂的「前夫」,那麼你也應該好好認識一下令你受苦的根源以及相關的事物。因此史丹福今次將為大家介紹一種以</span>mirror<span lang="ZH-TW" style="font-family: PMingLiU, serif;">來命名的血液<span lang="ZH-TW" style="font-size: 11pt; line-height: 107%;">現象</span>。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">大家請看看以下的周邊血液抹片,裡面有幾顆母細胞(</span>blasts<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。有趣的是,母細胞的細胞質(</span>
cytoplasm<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)都有一個凸了出來的部分,有點像條尾巴。</span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsKB463-2P9A9Q_kMQlTPb2G4ZKjZWOgSCwSFqmEoiUHpyXKMWPzEBUBvxgay3xmz9KP2BE7hRtAgqnBEdKpHKqs71kuJNHoN8UH3Ka3gT5FalORsDbNwqlYuWvIDXiYWhzcJb_MZ5sdSs2ffMTAaotJrR5-Pk4GuzdzRjLVX_GM5a3Do-dtuwTQvpzA/s792/1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="533" data-original-width="792" height="430" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsKB463-2P9A9Q_kMQlTPb2G4ZKjZWOgSCwSFqmEoiUHpyXKMWPzEBUBvxgay3xmz9KP2BE7hRtAgqnBEdKpHKqs71kuJNHoN8UH3Ka3gT5FalORsDbNwqlYuWvIDXiYWhzcJb_MZ5sdSs2ffMTAaotJrR5-Pk4GuzdzRjLVX_GM5a3Do-dtuwTQvpzA/w640-h430/1.png" width="640" /></a></div><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">血液學家們的想像力更為豐富,他們聯想到這種細胞很像手握的鏡子,於是生動地把它們稱為「手鏡細胞」(</span>hand
mirror cell<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0EBJ41Jp_R6lwJMeoVBIco823HwZlk4rnUAeGpNmAKziFdisuc_GPc24OLblxBbBcOlpraJ6DTSER3K65a36ePoOH6iOLm1ZUAF-Uv0hCbg4IbGIgMudmjkSuIVNxkwgpinxUfJV6feeMS5vXKlEd7WmgY4r-CtjLBKa7KTBGYifu03XBiIgJtdWIYQ/s612/hand_mirror.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="612" data-original-width="612" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0EBJ41Jp_R6lwJMeoVBIco823HwZlk4rnUAeGpNmAKziFdisuc_GPc24OLblxBbBcOlpraJ6DTSER3K65a36ePoOH6iOLm1ZUAF-Uv0hCbg4IbGIgMudmjkSuIVNxkwgpinxUfJV6feeMS5vXKlEd7WmgY4r-CtjLBKa7KTBGYifu03XBiIgJtdWIYQ/w400-h400/hand_mirror.jpeg" width="400" /></a></div><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">值得留意的是,「手鏡細胞」只是一個形態學(</span>morphology<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)上的形容詞,也就是說這只是細胞外觀的形容。事實上,有好幾款不同的血液癌細胞都可以出現「手鏡細胞」的形態。其中以急性淋巴性白血病(</span>acute
lymphoblastic leukaemia<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span>ALL<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)最為人所知。此外,</span>T<span lang="ZH-TW" style="font-family: PMingLiU, serif;">細胞淋巴癌(</span>T-cell
lymphoma<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)及母細胞性漿細胞樣樹突細胞腫瘤(</span>blastic
plasmacytoid dendritic cell neoplasm<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的癌細胞也可出現「手鏡細胞」的形態。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">雖然「手鏡細胞」形態多在淋巴性癌症中出現,不過偶爾亦可以在急性骨髓性白血病(</span>acute
myeloid leukaemia<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)中見到。而這些個案大多都有第</span>13<span lang="ZH-TW" style="font-family: PMingLiU, serif;">號染色體的異常。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">至於「手鏡細胞」的形成機制則尚未完全清楚,但相信與細胞內的免疫複合物(</span>immune
complex<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)相關。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">總的來說,「手鏡細胞」是個有趣的形態學現象,但由於它在多款血液癌症中都可以出現,因此對診斷的幫助不大。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源:</span><o:p></o:p></p><p class="MsoNormal">Zaharopoulos P, Wong JY, Wen JW. Extramedullary hand mirror
cells in pathologic conditions of lymphoid tissue. Acta Cytol. 1990;34(6):868-74.<o:p></o:p></p><p class="MsoNormal">
</p><p class="MsoNormal">Sandes AF, Rizzatti EG. Magic mirror in my hand, which is
the lineage in the end? A case of acute leukemia with hand-mirror cells. Blood.
2014;124(3):317.<o:p></o:p></p><p class="MsoNormal"><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-82195162068602472222022-05-13T10:33:00.005-07:002022-05-13T10:33:55.198-07:00如何成為一位血液學專科醫生?(考試篇)<p><span style="font-family: PMingLiU, serif;">要成為一位血液學專科醫生,必須要過五關斬六將,不斷受訓及不斷考試。今次史丹福將為大家介紹一下血液學的專業試,有興趣投身血液學的朋友可以以此為參考。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">首先,如果要在香港成為專科醫生,必須要接受由香港醫學專科學院訂出的六年培訓及考核規格。香港醫學專科學院轄下再細分</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個專科學院,每個專科學院培訓及考核都不一樣。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血液學屬於病理學中的專科,由香港病理學專科學院負責。值得留意的是,內科亦有血液及血液腫瘤科的專科,但這與病理學中血液學專科並不一樣。受訓醫生完成訓練,並通過會員考試及院士考核這兩個考試後,就可以獲得香港病理學專科學院及香港醫學專科學院的院士資格,正式成為血液學的專科醫生。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">不過為確保符合國際水平,香港的血液學大多會另外再報考其他國家的病理學專科學院的院士資格,例如英國皇家病理學院(</span>The
Royal College of Pathologists<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)或澳洲皇家病理學院(</span>Royal
College of Pathologists of Australasia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">以澳洲皇家病理學院為例,受訓的醫生必須要通知一個基礎病理科學(</span>Basic
Pathology Science<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)考試及血液學第一部分與第二部分考試。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">顧名思義,基礎病理科學考試就是考基礎的病理科學,內容大多都是大學學過的基礎知識,包括發炎反應、細胞受損、腫瘤生成、動脈粥狀硬化、免疫學、微生物學等。基本上就是病理學經典教科書</span>Robbins<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的頭</span>11<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">章。考試共有</span>100<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">題多項選擇題。這只是個入門考試,大部分考生都可以順利通過的。</span><o:p></o:p></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMLf_kyFYgGOJCmArN89Su0Ae5towYCpcdeLpLMlqsiW5pZeLtkQz4UNjDijqsmMuaXP6nbPV8rlKCpvC7lKorY9Ykmog7-y3gedVBMkPCFGYLtt8EF4DUa3btGZg6Rfl7_PqIal_VM8S3dBELP-HFMv6zaGOhWEYzdmpIxaxziY34WMxNQRifC09H9A/s1197/Written.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="825" data-original-width="1197" height="442" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMLf_kyFYgGOJCmArN89Su0Ae5towYCpcdeLpLMlqsiW5pZeLtkQz4UNjDijqsmMuaXP6nbPV8rlKCpvC7lKorY9Ykmog7-y3gedVBMkPCFGYLtt8EF4DUa3btGZg6Rfl7_PqIal_VM8S3dBELP-HFMv6zaGOhWEYzdmpIxaxziY34WMxNQRifC09H9A/w640-h442/Written.png" width="640" /></a></div><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血液學第一部分考試則困難及深入得多,大多數醫生都會在受訓的第四年報考。考試共有四份試卷,包括筆試、形態學考試(即顯微鏡分析)、「乾」實踐考核(</span>dry
practical<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,即資料分析)與口試。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">筆試有</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">題短文形式題目,作答時間為</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小時</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分鐘。題目會牽涉到非常罕見及非常刁鑽的內容,而且</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小時</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分鐘內寫</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">篇短文,時間非常緊迫,絕對是腦力及手力的雙重挑戰。以下是</span>2020<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的考試題目,供大家參考。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">形態學考試即顯微鏡分析考試。這部分的內容比較貼近一位血液學醫生的日常工作。考試有</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">題題目(作答時間為</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小時</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分鐘),包括周邊血液抺片(</span>peripheral
blood smear<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、骨髓抽吸抺片(</span>bone
marrow aspirate<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及骨髓環鑽活檢(</span>bone
marrow trephine biopsy<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)片。考生需要用顯微鏡分析之後寫出報告,並作出診斷。抹片中的變化可以很細微,有時甚至同時有幾款疾病,考生必須要非常細心,抽絲剝繭。同樣地,考核的內容可以牽涉到非常罕見的病例,例如史丹福當年考試就遇到了一個疑似先天性紅血球生成性貧血(</span>congenital
dyserythropoietic anemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的罕見個案。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「乾」實踐考核,即資料分析考試。考試有</span>8<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">題題目(作答時間為</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小時</span>15<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">分鐘),內容包括血紅蛋白分析(</span>haemoglobin
analysis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、凝血(</span>coagulation<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、輸血醫學、血清學(</span>serology<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、流式細胞術(</span>flow
cytometry<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、細胞遺傳學(</span>cytogenetics<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)、分子遺傳學(</span>molecular
genetics<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及品質保證(</span>quality
assurance<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等,基本上就是血液化驗室所牽涉的範疇。相信有不少讀者朋友都玩過史丹福的「血液學達人挑戰」遊戲,而這考試所需的知識就與「血液學達人挑戰」尾二一個等級相近,因此是絕對不簡單的。以下是模擬考試的其中一些題目,可供大家參考。</span><o:p></o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb65xNEO2AzAPEqK9IuTTQclDZCw_48i1KMcDkl4t14-Qt-akXvtOE2ZY-ZfUEKRaGyapKGLVAhDFr0EjcqRT8NKm1SifXdsZIbSrvoGTwbOw4zLxqVfRfxly9exf2K1lfnzyrtfP-QzpFAIbrL3a9J6ei4Yq_rSTw0YmHdb866z7unI54kqz0snzDvw/s1208/Dry_practical_1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="745" data-original-width="1208" height="394" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb65xNEO2AzAPEqK9IuTTQclDZCw_48i1KMcDkl4t14-Qt-akXvtOE2ZY-ZfUEKRaGyapKGLVAhDFr0EjcqRT8NKm1SifXdsZIbSrvoGTwbOw4zLxqVfRfxly9exf2K1lfnzyrtfP-QzpFAIbrL3a9J6ei4Yq_rSTw0YmHdb866z7unI54kqz0snzDvw/w640-h394/Dry_practical_1.png" width="640" /></a></div><br /><p class="MsoNormal"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUbxj7KZI06jMVIEZtngv46XQazJQMcm-4KTk4iyZhqaYqgMyaOpX5DYh2XPVAwBRGsMLXQiK58uHN-Wjw7kKv59pHJN-m_0MFa4Id7YMGrewLxHhK2qZjbDMLBTd2UlFwQm5APUGeBHtF58Rq_qSlLFAvGyDR6bQ4kjOoNN_8yvFaj1Hxui2YmEnS5A/s870/Dry_practical_2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="870" data-original-width="552" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUbxj7KZI06jMVIEZtngv46XQazJQMcm-4KTk4iyZhqaYqgMyaOpX5DYh2XPVAwBRGsMLXQiK58uHN-Wjw7kKv59pHJN-m_0MFa4Id7YMGrewLxHhK2qZjbDMLBTd2UlFwQm5APUGeBHtF58Rq_qSlLFAvGyDR6bQ4kjOoNN_8yvFaj1Hxui2YmEnS5A/w406-h640/Dry_practical_2.png" width="406" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwBSMuF_GdyouRnRQb38xmrTA9xNjrn3uRPS6gaXH9Dep7CVY-2EYYRb5A2ukMHQipE0u1GcyUCmwJUzMupU6yDQAmTYK7K4xOIOietn83_sFjP_tTKTQR53Z8BRg2fbc1o1wQux5i09m7CVCVep_CXh97QjUeNbZpK8avwW5ewJ_4cPUgHQLfNj3cEQ/s856/Dry_practical_3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="856" data-original-width="652" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwBSMuF_GdyouRnRQb38xmrTA9xNjrn3uRPS6gaXH9Dep7CVY-2EYYRb5A2ukMHQipE0u1GcyUCmwJUzMupU6yDQAmTYK7K4xOIOietn83_sFjP_tTKTQR53Z8BRg2fbc1o1wQux5i09m7CVCVep_CXh97QjUeNbZpK8avwW5ewJ_4cPUgHQLfNj3cEQ/w488-h640/Dry_practical_3.png" width="488" /></a></div><br /><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">口試共有</span>8<span lang="ZH-TW" style="font-family: PMingLiU, serif;">題題目。史丹福覺得在四部分考試中,口試是較為簡單的,問題大約是一般血液學(</span>general
haematology<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)、血液腫瘤、凝血及輸血各佔兩題。例如史丹福當年就被問過「螢光原位雜交(</span>fluorescent
in situ hybridization<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span>FISH<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的探示器(</span>probe<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)分哪幾種?</span>FISH<span lang="ZH-TW" style="font-family: PMingLiU, serif;">比起傳統的細胞遺傳學分析有甚麼好處與缺點?」、「脾靜脈血栓(</span>splenic
vein thrombosis<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)有甚麼成因?有甚麼檢查可以幫助找出成因?」、「一位服用過抗凝血藥</span>rivaroxaban<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的病人因骨折入院,骨科醫生希望可以即時為他做手術,應該如何處理?」等。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在通過第一部分考試後,考生需要寫一篇論文。當論文及格之後,就可以報考血液學第二部分考試,大多數醫生都會在受訓的第五年報考。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第二部分考試只有一個口試,共有</span>6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">題題目,題目會集中問一些較高層次的化驗室管理題目,考核考生有沒有足夠知識去成為化驗室的管理人員。史丹福當年就被問起「如何建立一個化驗室資訊系統(</span>laboratory
information system<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)?」、「如何為化驗室引入新的</span>ADAMTS13<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">檢測?」、「如何儲存化驗室內的易燃物品?如何處理生物樣本洩漏?」、「一位研究人員希望利用醫院化驗室的樣本作研究,應如何處理?」等。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">經過以上的考試,受訓的醫生終於完成澳洲皇家病理學院的考核,可以成為該學院的院士。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但比起香港的考試,澳洲考試的實屬小巫見大巫。一般來說,香港病理學專科學院的考試遠比澳洲皇家病理學院的考試困難及刁鑽,而且時間更為緊張。我自己的經驗是考試時候連思考的時間都沒有,一見到題目就要立即反射性以摩打手作答</span>...
<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">有機會再與大家分享。</span><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-12216640572691218582022-05-03T03:32:00.000-07:002022-05-03T03:32:09.152-07:00哈利波特中的醫學──石化<p><span face="新細明體, serif">經過漫長的等待,戲院終於在近日重開,電影迷可以再次到戲院感受觀影視的盛宴。在新上畫的電影中,最受矚目的大概是《怪獸與鄧不利多的秘密》。這電影是《哈利波特》系列的前傳。</span></p>
<p class="MsoNormal"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">《哈利波特》雖然是個魔幻系列,但當中有很多神秘的魔法現象都與麻瓜(即不懂法的人)的醫學現象有相似之處。例如如果人類或動物通過反射、折射等方式間接看到蛇妖的眼睛時,就會被「石化」(</span><span lang="EN-HK">petrification</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">「石化」(</span><span lang="EN-HK">petrification</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)是種可怕黑魔法,受害者會無法動彈且無法對外界做出反應,就像變成石頭一樣。在《哈利波特之消失的密室》中,就因蛇妖襲擊霍格華茲校園而有大量受害者被石化,就連哈利波特的好朋友妙麗也是受害者之一。</span></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhazVGXWRtEu-u39ikD6-cH8h6ge1dtr3pwuN-fXkClt99PQLXjVnl5Upc2pH-FOPLF0DfZLRqiGJx0SyOouqpxhcppj-kNXFDv6CsJDXVpBqY7UcupjIcE7-gUIDz8d5EqHbgRbhyW4QuLf2DQI-HOFH7N0va3IZJAyqyibkBCLylaJF425g7w27MFfg/s567/osteopetrosis2.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="425" data-original-width="567" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhazVGXWRtEu-u39ikD6-cH8h6ge1dtr3pwuN-fXkClt99PQLXjVnl5Upc2pH-FOPLF0DfZLRqiGJx0SyOouqpxhcppj-kNXFDv6CsJDXVpBqY7UcupjIcE7-gUIDz8d5EqHbgRbhyW4QuLf2DQI-HOFH7N0va3IZJAyqyibkBCLylaJF425g7w27MFfg/w640-h480/osteopetrosis2.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">《哈利波特之消失的密室》劇照,圖為被石化的妙麗</td></tr></tbody></table><br /><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在麻瓜的醫學中,也有種名為骨質石化症(</span><span lang="EN-HK">osteopetrosis</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的疾病。大家可能留意到</span><span lang="EN-HK">petrification</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">與</span><span lang="EN-HK">osteopetrosis</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">兩個英名字都由</span><span lang="EN-HK">”petra”</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">部分組成,這個詞在拉丁文中就是石頭的意思。</span></p>
<p class="MsoNormal"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">骨質石化症是種罕見的遺傳性疾病,成因是基因突變(例如</span><span lang="EN-HK">TCIRG1</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">、</span><span lang="EN-HK">CLCN7</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或</span><span lang="EN-HK">CA2</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">基因突變)令蝕骨細胞(</span><span lang="EN-HK">osteoclasts</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,又稱破骨細胞)功能受損。蝕骨細胞是負責吸收舊的骨組織。當它們失去功能的話,舊的骨組織不能被吸收,新的骨組織卻不斷生成。骨骼的密度和厚度會不斷增加,最終骨骼的重量可達至正常人的兩至三倍,就像變成了石頭一樣,骨質石化症的名稱就是這樣來的。</span></p>
<p class="MsoNormal"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">患者的骨骼很硬,但由於骨結構非常雜亂無章,令骨骼變脆,容易骨折。除了容易骨折外,骨質石化症還會引起其他問題。首先,由於病人的骨髓組織被骨骼組織取代,令造血功能受損,病人會出現血細胞低下的症狀。另外,顱骨的過份生長會壓迫到穿過顱骨的腦神經(</span><span lang="EN-HK">cranial nerves</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),令腦神經受損,病人會因而出現神經的症狀,甚至可以導致失明及失聰。</span></p>
<p class="MsoNormal"><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因為骨質石化症會影響到血液細胞,所以這疾病又不經意地踏入了血液學的領域。血液病理學家檢查骨髓環鑽活檢(</span><span lang="EN-HK">trephine biopsy</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)時除了可以偵測到骨髓造血細胞的問題外,更可以檢查到</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">骨</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">骼的結構,從而診斷到骨質石化症。</span></p>
<p class="MsoNormal"><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">下面的骨</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">髓</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">環鑽活檢</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span><span lang="EN-HK">trephine biopsy</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)染片</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">來自一位</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">骨質石化症</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的病人。大家可</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">以</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">見到骨小樑</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span><span lang="EN-HK">bony trabeculae</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">增厚,</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蝕骨細胞</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">增加,小樑間隙中的</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">造血</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">細</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">胞</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">減少,並有骨</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">髓</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">纖</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">維</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">化的現</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">象</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。這些都是</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">骨質石化症</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的病理學特</span><span face=""新細明體",serif" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">徵</span><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span><span lang="EN-HK" style="mso-fareast-language: ZH-HK;"><o:p></o:p></span></p><p class="MsoNormal"><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRhbeU44_J6l6x6DOuA145S6yIvFBrH1zPspdrWqdviZWq7gRH5LiqTMPbVd_8q-x4RAmEKZHkja4IRH7GNZLGWj8W0-WJDiXyIiyv44vj08ijhN2dTNwgly_EIb-jofKjI7SA1smLaA-RkJxS3DA2z4duE8d3tiZJ1dFw1GYvyheiXarvELj811Vm-g/s501/osteopetrosis.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="326" data-original-width="501" height="416" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRhbeU44_J6l6x6DOuA145S6yIvFBrH1zPspdrWqdviZWq7gRH5LiqTMPbVd_8q-x4RAmEKZHkja4IRH7GNZLGWj8W0-WJDiXyIiyv44vj08ijhN2dTNwgly_EIb-jofKjI7SA1smLaA-RkJxS3DA2z4duE8d3tiZJ1dFw1GYvyheiXarvELj811Vm-g/w640-h416/osteopetrosis.png" width="640" /></a></div><br /><span face=""新細明體",serif" lang="ZH-HK" style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 新細明體; mso-fareast-language: ZH-HK; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-62319674131013292002022-04-21T10:04:00.000-07:002022-04-21T10:04:03.066-07:00居禮夫人的真正死因<p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9k5tUmZn_XesKMqroqD4XVtXjGf9IqaIPxz2hfneOF8TzPBLHm36_CDi7iXH5RUZdYtb9upNoRdYBC37NQO84qq7o7tMO3lRJ0kqoKmkWDq6olzTI643VCshtYc9JTE5HqfFJH0IjKlt4ckT89YhGorwOpOWf2WYpa9ttNMS3PfFoAx5knDabrEpXig/s1862/curie.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1048" data-original-width="1862" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9k5tUmZn_XesKMqroqD4XVtXjGf9IqaIPxz2hfneOF8TzPBLHm36_CDi7iXH5RUZdYtb9upNoRdYBC37NQO84qq7o7tMO3lRJ0kqoKmkWDq6olzTI643VCshtYc9JTE5HqfFJH0IjKlt4ckT89YhGorwOpOWf2WYpa9ttNMS3PfFoAx5knDabrEpXig/w640-h360/curie.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">居禮夫人</td></tr></tbody></table><span style="font-family: PMingLiU, serif;"></span></p><p><span style="font-family: PMingLiU, serif;"><br /></span></p>居禮夫人是史上最著名的女性科學家,同時也是女性科學家的典範。<p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">居禮夫人原名瑪麗亞(</span><span lang="EN-US">Marya Sklodowska</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。她在</span><span lang="EN-US">1867</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年生於波蘭,她天資聰穎,對科學特別感興趣。當時她的祖國被俄羅斯所吞佔,人民生活很苦,也沒什麼自由。在俄國的統治下,波蘭人受到壓迫,一位波蘭藉的女士根本沒有可能接受到高等教育。不過瑪麗亞卻沒有放棄,她一邊自學科學,一邊儲錢,最終獲得了到法國巴黎大學進修的機會。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">在法國,她把自己波蘭語的名字瑪麗亞改為法文的瑪麗。在這裡,她不單獲得了接受高等教育的機會,更遇到了她未來的丈夫及事業伙伴</span><span lang="EN-US">──</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">皮埃爾‧居禮(</span><span lang="EN-US">Pierre Curie</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">二人結為夫婦並合作研究,他們首先從礦石中發現了一種新的放射性元素,居禮夫人為了紀念她熱愛的祖國波蘭,把新元素命名為釙(</span><span lang="EN-US">polonium</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span><span lang="EN-US">1898</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,他們又發現了另一個放射性更強的元素</span><span lang="EN-US">──</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">鐳(</span><span lang="EN-US">radium</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。因為鐳的發現,居禮夫婦獲得了</span><span lang="EN-US">1903 </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的諾貝爾物理獎。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">不幸的是,居禮先生在</span><span lang="EN-US">1906 </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年不幸死於交通意外。居禮夫人喪夫之後依然投入科學研究。當時,有「熱力學之父」之稱的物理學大師凱爾文爵士(</span><span lang="EN-US">Lord William Thomson Kelvin</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)質疑鐳不是一種元素,只是一種化合物。為了回應過質疑,居禮夫人立志把鐳元素純化出來,最後她成功了。因為這貢獻,她又獲得了</span><span lang="EN-US">1911</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的諾貝爾化學獎。到現時為止,她仍然是史上唯一一位同時獲得諾貝爾物理學及化學獎的科學家,可以說是前無古人,暫時亦都後無來者。</span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">疾病纏身的居禮夫人</span><span lang="EN-US"><o:p></o:p></span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">居禮夫人一生與放射性物質為伍,當年的她並不知道放射性物質有多危險,所以她是在沒有任何防護設施的情況下研究放射性物質。居禮夫人更愛把含有鐳的管子裝在口袋,時不時欣賞它發出的藍色微光。居禮夫人的筆記至今仍然具有放射性,因此它們必須被保存在法國國立圖書館內的鉛箱裡,學者研究筆記時亦需使用防輻射裝備,大家可以從此想像到居禮夫人接觸到的輻射劑量有多驚人。更糟糕的是,居禮夫人除了接觸過大量放射性物質外,她還在第一次世界大戰中自願到戰場上使用流動</span><span lang="EN-US">X</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">光車幫助診斷傷兵,所以她也接觸過很高劑量的</span><span lang="EN-US">X</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">射線。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">居禮夫人因長期在沒有任何防護設施的情況下研究放射性物質,健康受到嚴重損害。她首先出現的症狀是視力的退化,原來她患上了白內障。由於視力嚴重受損,她的演講稿字體必須放大到</span><span lang="EN-US">2.5</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">英寸她才看得清楚。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">從</span><span lang="EN-US"> 1932 </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年起,居禮夫人感到極度疲倦,並出現持續的貧血,健康情況每況愈下。</span><span lang="EN-US">1934 </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,居禮夫人出現了急速惡化的發燒症狀,最終在</span><span lang="EN-US"> 7 </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span><span lang="EN-US"> 4 </span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">日於法國薩伏伊省靠近阿爾卑斯山的一間安養院去世。醫生宣布她的正式死因是「再生障礙性惡性貧血」(</span><span lang="EN-US">”aplastic pernicious anaemia”</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">值得留意的是,今天的血液學中是沒有「再生障礙性惡性貧血」這個疾病的。現今在名稱上最接近的疾病是再生障礙性貧血(</span><span lang="EN-US">aplastic anaemia</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">),這個疾病的成因是骨髓中的造血細胞減少,令骨髓無法生產足夠的血細胞。放射性物質產生的電離輻射可以殺死骨髓中的造血細胞,所以接觸電離輻射與患上再生障礙性貧血是相關的。從這方面來看,居禮夫人患上再生障礙性貧血的推論是相當合理的。再生障礙性貧血可以令血液中的嚐中性白血球(</span><span lang="EN-US">neutrophil</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)減少,令居禮夫人更容易受到細菌感染,因而發燒。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">不過值得留意的是,當年的血液學發展遠不如今天,當年醫生所作的診斷亦不一定正確。再加上當年所用的醫學字眼也與今天所用的不完全相同,所以如果我們純粹以字面意思解讀,有可能誤判了居禮夫人的真正死因。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">一篇在</span><span lang="EN-US">2012</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年發表在《白血病研究》(</span><span lang="EN-US">Leukaemia Research</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的文章提出的,「再生障礙性惡性貧血」這字眼亦被當時的病理學醫生用來描述過一位受雇於美國鐳企業,替手錶的錶面塗上可以發亮的鐳顏料的工廠女工的情況。文章的作者指出「惡性」這詞語顯示居禮夫人及工廠女工都不只出現一般的血細胞減少,她們的血細胞也可能有「異變」(</span><span lang="EN-US">dysplasia</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的情況。所謂的異變,是指細胞出現了異常的形態轉變,令其在顯微鏡下的外觀變得相當奇怪。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">下圖就顯示了異變的嚐中性白血球。正常的嚐中性白血球細胞質有粉橙色的顆粒,而這位異變的嚐中性白血球細胞質卻是暗淡無色。</span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5aLW9RxmZmXbH_hjw8RJQIaBjsKscDrKaURVZk8Ar6jKI_7Wrqa5PVRzX3M9q8l8SUXl9KWPcyisT05sEtBLMM8-QYFHh8dTPXB09oxM2qrR211_UPi5TDZU5sxmkhk4OOmncAKGrsCcjNWhlMZQIF_YA_3mRf54E_fmieZB8n9RXAyxNSBrDMm3BzA/s1215/dysplastic%20neutrophils.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="857" data-original-width="1215" height="452" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5aLW9RxmZmXbH_hjw8RJQIaBjsKscDrKaURVZk8Ar6jKI_7Wrqa5PVRzX3M9q8l8SUXl9KWPcyisT05sEtBLMM8-QYFHh8dTPXB09oxM2qrR211_UPi5TDZU5sxmkhk4OOmncAKGrsCcjNWhlMZQIF_YA_3mRf54E_fmieZB8n9RXAyxNSBrDMm3BzA/w640-h452/dysplastic%20neutrophils.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">異變的嚐中性白血球</td></tr></tbody></table><br /><span style="font-family: PMingLiU, serif;"><br /></span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitWpj7lTq1cfj7qQ7AWQ3UyKTw33w7MyjsC9uOUvpjaGL-cgjkZLXvTs9T-_vdhSvJty2soJx53GMEwKhRbb3sbN0ZHTHcGX0KVqzbz_c3PzfNhVoPylvrtzDHDIsJsNc-G4JVP8HXotmfHHez9NCB1mWtKKWjF5cqaUIUkvSdX2Ox6CUqB2fQ9TVXHQ/s2125/neutrophils.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1489" data-original-width="2125" height="448" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitWpj7lTq1cfj7qQ7AWQ3UyKTw33w7MyjsC9uOUvpjaGL-cgjkZLXvTs9T-_vdhSvJty2soJx53GMEwKhRbb3sbN0ZHTHcGX0KVqzbz_c3PzfNhVoPylvrtzDHDIsJsNc-G4JVP8HXotmfHHez9NCB1mWtKKWjF5cqaUIUkvSdX2Ox6CUqB2fQ9TVXHQ/w640-h448/neutrophils.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">正常的嚐中性白血球</td></tr></tbody></table><br /></o:p></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">異變的血細胞是骨髓異變綜合症(</span><span lang="EN-US">myelodysplastic syndrome</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span><span lang="EN-US">MDS</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的特徵。骨髓異變綜合症可以被當成急性骨髓性白血病(</span><span lang="EN-US">acute myeloid leukaemia</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span><span lang="EN-US">AML</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的前期。假以時日,理論上所有的骨髓異變綜合症個案都會轉化成急性骨髓性白血病。</span><span lang="EN-US"><o:p></o:p></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">「異變」這個概念在</span><span lang="EN-US">1973</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年才被提出,骨髓異變綜合症這疾病也是在之後才有更準確的描述。當年為居禮夫人患病時,醫學界根本不知道這疾病的存在,醫生也自然無法診斷這病。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">因此,對於居禮夫人的真正死因,大家都眾說紛云。有文獻記載居禮夫人是死於再生障礙性惡性貧血,亦有文獻指出居禮夫人是死於骨髓異變綜合症或相關的急性骨髓性白血病。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">其實在病理學上,再生障礙性惡性貧血、骨髓異變綜合症及急性骨髓性白血病三者有時候是不容易純粹靠形態分辨的,因為骨髓異變綜合症或急性骨髓性白血病患者的骨髓有時都會出現細胞過少(</span><span lang="EN-US">hypocellular</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的情況,令它在形態上與再生障礙性惡性貧血相似。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">不過不管居禮夫人最終是死於再生障礙性惡性貧血、骨髓異變綜合症或是急性骨髓性白血病,文獻基本上都一致認為她的死是與輻射有關。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">究竟輻射如何危害居禮夫人的健康?它與血液疾病又有甚麼關係呢?</span></p>
<p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">電離輻射與血液癌症</span><span lang="EN-US"><o:p></o:p></span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">在討論輻射所引起的血液疾病之前,史丹福想先澄清一些定義。在物理學上,輻射是指能量以波或是次原子粒子移動的型態,在真空或介質中傳送。輻射可分為電離輻射(</span><span lang="EN-US">ionizing radiation</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)和非電離輻射(</span><span lang="EN-US">non-ionizing radiation</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。其中電離輻射是能量高的波或粒子,它可以令原子失去電子,成為離子(</span><span lang="EN-US">ion</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。電離輻射的例子包括</span><span lang="EN-US">α</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">粒子、</span><span lang="EN-US">β</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">粒子、</span><span lang="EN-US">γ</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">射線、</span><span lang="EN-US">X</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">射線等。而非電離輻射則是指能量較低,並且不足以令原子失去電子而成為離子的波或粒子,例子包括無線電波、微波、紅外線及可見光等。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">在非物理學的討論中,人們未必一定會嚴格地分別它們輻射可分為電離輻射和非電離輻射。由於只有電離輻射會嚴重地影響健康,所以在醫學的討論上,很多人都把「輻射」等同於「電離輻射」。這其實並不完全準確,物理學家見到的話大概會被氣得怒髮衝冠。史丹福會在之後的討論中盡量保持用詞準確,清楚地分開致電離輻射與非致電離輻射。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">電離輻射危險的地方在於它可以傷害細胞。它所做成的傷害可被分為直接傷害與間接傷害。直接傷害是指電離輻射令到細胞中</span><span lang="EN-US">DNA</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">的鍵結斷裂,間接傷害則是指電離輻射製造出自由基(</span><span lang="EN-US">free radical</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。不論是直接或間接傷害都會破壞</span><span lang="EN-US">DNA</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,這可以令細胞死亡,也可以促進細胞的基因突變,增加它成為癌細胞的機會。一般來說,常進行細胞分裂的細胞較易受到電離輻射的影響,而造血細胞正是一種常進行細胞分裂的細胞。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">其實早在</span><span lang="EN-US">1902</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年已出現了首個因電離輻射而誘發皮膚癌的案例報告。</span><span lang="EN-US">1911</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,甚至出現了放射工作者患上白血病的報告。</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">不過由於這些個案</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">並不多,科學家很難系統性地研究電離輻射與血液癌症的關係。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">第二次世界大戰時,美國在日本的廣島、長崎投下原子彈。有很多受害者都當場死亡,幸存的生還者亦暴露了在高劑量的電離輻射中。這為科學家提供了更多的數據去研究電離輻射與血液癌症間的關係。事實上,我們對電離輻射的了解有很大部分都是來自日本原爆的數據。</span></p>
<p class="MsoNormal"><span lang="EN-US">1940</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年代末,日本的醫生行醫時最先發現原爆生還者似乎有高機會患上白血病,於是科學家開始收集數據,他們發現爆炸後兩年,白血病的發病率逐年增高,在</span><span lang="EN-US">6</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">至</span><span lang="EN-US">8</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年時達到高峰。一個名為「壽命研究」(</span><span lang="EN-US">Life Span Study</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的大型研究的數據顯示,直到</span><span lang="EN-US">2000</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年為止,</span><span lang="EN-US">49,204</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">位原爆生還者中有</span><span lang="EN-US">204</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">位患上白血病,據統計當中有</span><span lang="EN-US">46%</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">的個案與原爆的電離輻射有關。「壽命研究」顯示原爆生還者有較高機會患上急性骨髓性白血病、急性骨髓性白血病(</span><span lang="EN-US">chronic myeloid leukaemia</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span><span lang="EN-US">CML</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)及急性淋巴性白血病(</span><span lang="EN-US">acute
lymphoblastic leukaemia</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span><span lang="EN-US">ALL</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)這幾種白血病。相較起沒有受原爆影響的日本人,接觸過劑量高於</span><span lang="EN-US">0.005</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">戈雷(</span><span lang="EN-US">Gray</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">,</span><span lang="ZH-TW" style="background: white; font-family: PMingLiU, serif; font-size: 11.5pt;">電離輻射</span><span lang="ZH-TW" style="background: white; color: #202122; font-family: PMingLiU, serif; font-size: 11.5pt;">能量</span><span lang="ZH-TW" style="background: white; font-family: PMingLiU, serif; font-size: 11.5pt;">吸收劑量</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">的標準單位)以上電離輻射的原爆生還者有</span><span lang="EN-US">1.5</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">倍的機會患上白血病。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">除了原爆生還者外,另外一個探索電離輻射與血液癌症關係的途徑就是研究接受了放射治療的病人。一份在</span><span lang="EN-US">2011</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">年刊登在</span><span lang="EN-US">BMC</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">癌症(</span><span lang="EN-US">BMC Cancer</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的報告比較了只接受手術而沒有接受放射治療與同時接受了手術及放射治療的乳癌病人,發現同時接受了手術及放射治療的病人有</span><span lang="EN-US">3.32</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">倍的機會患上骨髓異變綜合症或急性骨髓性白血病。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">這些研究都很明確地顯示電離輻射會增加接觸者患上血液癌症的機會。</span></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">居禮夫人全心全意研究放射性物質,為科學帶來重要貢獻,但最終卻死於自己熱愛的輻射,令人惋惜。假如當年的她知道電離輻射的危險性,並有充足的防護設施進行研究,她也許可以活得更長久,做更多的研究,這也會是科學界之福。</span></p><p class="MsoNormal"><span style="font-family: PMingLiU, serif;"><br /></span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">資料來源</span><span lang="ZH-TW" style="background: white; color: #222222; font-family: PMingLiU, serif; font-size: 10pt;">:</span></p>
<p class="MsoNormal"><span lang="EN-US" style="background: white; color: #222222; font-family: "PMingLiU",serif; font-size: 10.0pt;"><o:p> </o:p></span>Steensma DP. Historical perspectives on
myelodysplastic syndromes. <i>Leuk Res</i>. 2012;36:1441-52. </p>
<p class="MsoNormal">Shah DJ, Sachs RK, Wilson DJ.
Radiation-induced cancer: a modern view. <i>Br J Radiol</i>.
2012;85(1020):e1166-e1173.</p>
<p class="MsoNormal">HG Kaplan, JA Malmgren, MK Atwood. Increased
incidence of myelodysplastic syndrome and acute myeloid leukemia following
breast cancer treatment with radiation alone or combined with chemotherapy: a
registry cohort analysis 1990-2005. BMC Cancer. 2011; 11, 260.</p>
<p class="MsoNormal">Preston DL, Kusumi S, et al. Cancer
incidence in atomic-bomb survivors. Part III: Leukemia, lymphoma, and multiple
myeloma, 1950-1987. <i>Radiation Research</i>. 1994; 137:S68-97.</p>
<p class="MsoNormal">Preston DL, Pierce DA, et al. Effect of
recent changes in atomic bomb survivor dosimetry on cancer mortality risk
estimates. <i>Radiation Research</i>. 2004; 162:377-89.</p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-60585031860148464432022-04-17T19:19:00.002-07:002022-04-17T19:19:31.206-07:00復活節的血液學聯想<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">今天是復活節長假期的最後一天,史丹福與</span>Peaches<span lang="ZH-TW" style="font-family: PMingLiU, serif;">再一次祝大家復活節快樂!</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">提起復活節,不知道大家會想起甚麼呢?復活蛋?耶穌被釘上十字架?</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血液病理學家的想像力非常豐富,在他們的心中,血液中的細胞都可以與復活節的事物扯上關係。</span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">復活蛋</span></u></b></p><p class="MsoNormal">
<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">下圖中紅血球非常巨型,而且略帶橢圓形,並不如正常紅色球般圓,形狀就像復活蛋一樣。這種「巨型復活蛋紅血球」被稱為巨卵形紅細胞(</span>macroovalocytes<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span><o:p></o:p></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6Qco_MR9Z-yPIAZHeVLvXjQsRwDDYLolvKCVSRWLV515m-UdI-v59QVcE1n_JJb9JPbn1psvbxNwhE3Y65CvRpV6Ph9IdYNwv5JPalP3m8014TLkQZbJMVW_ZQiK37c4Yke1_tPuu80QeZjFv3wz7rd7BhfTkHneHl50OI4UJkDUmkd7lQ7NCfWfpDw/s2392/megaloblastic%20anaemia.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1772" data-original-width="2392" height="474" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6Qco_MR9Z-yPIAZHeVLvXjQsRwDDYLolvKCVSRWLV515m-UdI-v59QVcE1n_JJb9JPbn1psvbxNwhE3Y65CvRpV6Ph9IdYNwv5JPalP3m8014TLkQZbJMVW_ZQiK37c4Yke1_tPuu80QeZjFv3wz7rd7BhfTkHneHl50OI4UJkDUmkd7lQ7NCfWfpDw/w640-h474/megaloblastic%20anaemia.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">巨母紅血球性貧血病人的周邊血液抹片,箭嘴指著巨卵形紅細胞</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">我們不妨拿正常的紅血球去進行比較,大家就會更加清楚。</span><o:p></o:p></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinKvGcNtUUhx5XF_C7INol7wSTBOvewz8z6m0pOIJmfTimYjQcUn6KX0-1kQPI_wkwIa3VKVCzhk0UFCz2BvEm97XuQZ-DqT4JHaVEzM8riy2kzH4GP68MhQ9i9VnUFhojSGdZaj8wUOqNoul9vIcYCGPyObMkbFwm4FVGbPh0XZ6m1BeZYhxgbIG-6A/s1957/Untitled.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1453" data-original-width="1957" height="476" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinKvGcNtUUhx5XF_C7INol7wSTBOvewz8z6m0pOIJmfTimYjQcUn6KX0-1kQPI_wkwIa3VKVCzhk0UFCz2BvEm97XuQZ-DqT4JHaVEzM8riy2kzH4GP68MhQ9i9VnUFhojSGdZaj8wUOqNoul9vIcYCGPyObMkbFwm4FVGbPh0XZ6m1BeZYhxgbIG-6A/w640-h476/Untitled.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">正常的周邊血液抹片,箭嘴指著正常的紅血球</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">巨卵形紅細胞會在巨母紅血球性貧血(</span>megaloblastic
anaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中出現。這疾病閃由於維生素</span>B12<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">或葉酸缺乏所引起的。它們是協助</span>DNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">合成的重要物質,缺乏它們會影響血細胞的成長。</span>DNA<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">合成的問題令紅血球成熟過程受阻,於是細胞質比細胞核成熟,紅血球因而比正常的為大。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">除了紅血球外,病人血液中的嗜中性白血球都會有變化。正常的嗜中性白血球的細胞核分成數塊葉,一般是二至五塊,不過巨母紅血球性貧血的病人則會有較多塊葉。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">正常現代人營養充足,甚少會有維生素</span>B12<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">缺乏。因此這情況大多只會在胃病及腸病的病人中出現。由於維生素</span>B12<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">來自肉類。長期食素的人理論上也有較大機會出現維生素</span>B12<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">缺乏。</span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">十字架</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">根據聖經記載,耶穌被釘上十字架,犧牲自己為人類受苦受難至死。至此,十字架成了基督教的象徵。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">而一種叫焦蟲(</span>babesia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的寄生蟲入侵紅血球後,就會呈十字架的模樣。血液病理學家用了一個更仔細的描述方法,稱這現象為「馬爾他十字」(</span>Maltese
cross<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),因為它很像中世紀時候創立的天主教組織馬爾他騎士團的徽章。焦蟲在紅血球中的形態與瘧疾很像,而「馬爾他十字」的形態就可以為血液病理學家提供一個證據去分辨兩種不同的寄生蟲感染。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh40dTpA1sdtqmquXTsdVysrbosgXJl-KagRfB1F9goHLfOW4YVRTn0Q_Bg6HMUSnZeeFpHtwSId8hYAf1DZGRTBbpHKd1hM__GBUs6hajQ8PoBcSl4u4UAlFr-bqAWqC-i73wH9vkfYyGMttwp6cp9OSP6stnZSlpECBA1g6vIGmFpPkcU7qk5Oogvmw/s600/babesia.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="400" data-original-width="600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh40dTpA1sdtqmquXTsdVysrbosgXJl-KagRfB1F9goHLfOW4YVRTn0Q_Bg6HMUSnZeeFpHtwSId8hYAf1DZGRTBbpHKd1hM__GBUs6hajQ8PoBcSl4u4UAlFr-bqAWqC-i73wH9vkfYyGMttwp6cp9OSP6stnZSlpECBA1g6vIGmFpPkcU7qk5Oogvmw/w640-h426/babesia.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">感染焦蟲病人的周邊血液抹片,箭嘴指著「馬爾他十字」<br /></td></tr></tbody></table><br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6HBLQWLR_YN4Xau_bnpSrEKXagprLbwBi7sye3TsHg_3OsiEniFUef-b0EReXXwoJWbAv9-dfHJlZ92M-Uf0xDNPnRkQSFP9Z7UQXh7qpfheyGehTFCXTApEAbEHlosvUUs1PTdrOWFWdi3wVxwk4CvfbUm6sCYUmHT1co55A22Kqof5xqL07YI9owg/s1681/maltesecross.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1043" data-original-width="1681" height="398" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj6HBLQWLR_YN4Xau_bnpSrEKXagprLbwBi7sye3TsHg_3OsiEniFUef-b0EReXXwoJWbAv9-dfHJlZ92M-Uf0xDNPnRkQSFP9Z7UQXh7qpfheyGehTFCXTApEAbEHlosvUUs1PTdrOWFWdi3wVxwk4CvfbUm6sCYUmHT1co55A22Kqof5xqL07YI9owg/w640-h398/maltesecross.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">馬爾他騎士團的旗幟</td></tr></tbody></table><br /><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">焦蟲由蜱蟲(</span>tick<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)傳播,在美國於歐洲部分地方最為常見。焦蟲感染的病徵包括發燒、貧血、肌肉痛、頭痛等。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">提外話,馬爾他騎士團到現時依然存在,是一個很特別的主權實體,有人甚至認為它可以算得上是國家。它的「領土」只有兩棟位於羅馬的建築,卻與一百零六個國家有邦交,在全球設有幾十處大使館。幾乎所有的南美洲國家、歐洲與非洲大多國家都承認這個「國家」。他有自己發行的護照、郵票、車牌,甚至有自己的軍隊。馬爾他騎士團現時將心力大量投注在醫療與人道服務上,對世界貢獻很多。馬爾他騎士團也在其他許多國際組織有派駐代表,包括世界衛生組織。有一些國家會因為自己的政治私利,千方百計地阻止對世界衛生有重大貢獻的政權派駐代表到世界衛生組織,犧牲了當地人民提升衛生與健康的機會。不過意大利卻深明馬爾他騎士團的貢獻,即使馬爾他騎士團的「領土」為於意大利境內,意大利也不會阻止馬爾他騎士團在國際組織派駐代表。</span></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">復活兔</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">最後想介紹一下兔子在血液學中的作用。兔子除了是復活節的象徵外,原來牠們也對輸血科學貢獻良多。</span><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">人類有一種罕見的血型--</span>Bv<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血型。這是一種變異的</span>B<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血型,它非常罕見,在香港,約每</span>12,000<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">人才有一人擁有此血型。這種變異血型的紅血球上有一種兔子紅血球才有的抗原。化驗師可以用特殊的試劑去偵測</span>Bv<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">血型。這種試劑是經兔子血液吸附(</span>adsorb<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的抗</span>B(anti-B<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)試劑。一般的</span>B<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">型紅血球會對試劑呈陽性反應,而</span>Bv<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">型血紅球則會呈陰性反應。</span><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-70189028617442948282022-04-16T09:42:00.001-07:002022-04-16T09:42:08.673-07:00高斯的復活節演算法<p><span style="font-family: PMingLiU, serif;">相信大家都知道復活節的日期年年不同。那究竟復活節的日期是怎樣計算的呢?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">根據羅馬教會定出的規則,復活節的日期是在</span>3<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>21<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日當日或之後的滿月日後的首個星期日。這個規則非常奇怪,究竟教會為何要定出如此令人難以理解的方法?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">原來根據聖經記載,耶穌復活的日子是猶太人的逾越節(即是猶太曆尼散月十四日)後的首個星期日。猶太曆屬於陰曆,尼散月十四日基本上就是春分後的滿月日的前一天。於是羅馬教會用了</span>3<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>21<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日作為春分的估測(春分並不一定在</span>3<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>21<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日,根據今天使用的格里曆曆法,它也可以在</span>3<span lang="ZH-TW" style="font-family: PMingLiU, serif;">月</span>22<span lang="ZH-TW" style="font-family: PMingLiU, serif;">日,根據舊的儒略曆曆法,更加可以差得非常遠)。綜合了以上眾多的考慮,教會最終作出了這規定。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">這規則同時考慮到陰曆、陽曆及星期等的曆法概念,非常複雜。</span>1800<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年,有「數學王子」之稱的德國數學家高斯就發明了一個演算法去計算不同年份中的復活節日期。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTbfpIXJjaREF535WobFR_L1wx3YbjIFjv2DgP_wV3JuQvS0O3e6a666NSrcxFAZIpjlRejyijNMrHNvi8Xus9wVWSe72_-BEEsWNx7jrb1CJK8WuOq0mqQdpD7qRQq5gmNlhxgurZw1jRZFuJAjHFcwQLy_I1SQR6FwPD28j0oqFHY1IC3bYuRUjMkw/s1529/gauss.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1529" data-original-width="1200" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTbfpIXJjaREF535WobFR_L1wx3YbjIFjv2DgP_wV3JuQvS0O3e6a666NSrcxFAZIpjlRejyijNMrHNvi8Xus9wVWSe72_-BEEsWNx7jrb1CJK8WuOq0mqQdpD7qRQq5gmNlhxgurZw1jRZFuJAjHFcwQLy_I1SQR6FwPD28j0oqFHY1IC3bYuRUjMkw/w502-h640/gauss.png" width="502" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">發明復活節演算法的數學家哥斯</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">演算法如下</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">1. a = <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年份</span>
(mod 19) <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(即年份除以</span>19<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的餘數,下同)</span><o:p></o:p></p>
<p class="MsoNormal">2. b = <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年份</span>
(mod 4)<o:p></o:p></p>
<p class="MsoNormal">3. c = <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年份</span>
(mod 7)<o:p></o:p></p>
<p class="MsoNormal">4. k = <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌊ </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年份</span><span lang="ZH-TW"> </span>/ 100<!--[if gte msEquation 12]><m:oMath><b><i><span
style='font-family:"Cambria Math",serif'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="bi"/></m:rPr> </m:r></span></i></b></m:oMath><![endif]--><!--[if !msEquation]--><span style="font-family: "Calibri",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-HK; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: PMingLiU; mso-fareast-language: ZH-TW; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-text-raise: -3.0pt; position: relative; top: 3.0pt;"><!--[if gte vml 1]><v:shapetype
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path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f">
<v:stroke joinstyle="miter"/>
<v:formulas>
<v:f eqn="if lineDrawn pixelLineWidth 0"/>
<v:f eqn="sum @0 1 0"/>
<v:f eqn="sum 0 0 @1"/>
<v:f eqn="prod @2 1 2"/>
<v:f eqn="prod @3 21600 pixelWidth"/>
<v:f eqn="prod @3 21600 pixelHeight"/>
<v:f eqn="sum @0 0 1"/>
<v:f eqn="prod @6 1 2"/>
<v:f eqn="prod @7 21600 pixelWidth"/>
<v:f eqn="sum @8 21600 0"/>
<v:f eqn="prod @7 21600 pixelHeight"/>
<v:f eqn="sum @10 21600 0"/>
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<v:path o:extrusionok="f" gradientshapeok="t" o:connecttype="rect"/>
<o:lock v:ext="edit" aspectratio="t"/>
</v:shapetype><v:shape id="_x0000_i1025" type="#_x0000_t75" style='width:2.25pt;
height:14.25pt'>
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</v:shape><![endif]--><!--[if !vml]--><img height="19" src="file:///C:/Users/LICLIF~1/AppData/Local/Temp/msohtmlclip1/01/clip_image002.png" v:shapes="_x0000_i1025" width="3" /><!--[endif]--></span><!--[endif]--><span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌋ </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span><span lang="ZH-TW" style="background: white; color: #202124; font-family: "PMingLiU",serif; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">小於或等於</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年份除以</span>100<span lang="ZH-TW" style="background: white; color: #202124; font-family: "PMingLiU",serif; mso-ascii-font-family: Arial; mso-bidi-font-family: Arial; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Arial;">的最大整</span><span lang="ZH-TW" style="background: white; color: #202124; font-family: "Microsoft JhengHei",sans-serif; mso-bidi-font-family: "Microsoft JhengHei";">數</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,下同)</span><o:p></o:p></p>
<p class="MsoNormal">5. p = <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌊</span> (13 + 8) / 25<!--[if gte msEquation 12]><m:oMath><b><i><span
style='font-family:"Cambria Math",serif'><m:r><m:rPr><m:scr m:val="roman"/><m:sty
m:val="bi"/></m:rPr> </m:r></span></i></b></m:oMath><![endif]--><!--[if !msEquation]--><span style="font-family: "Calibri",sans-serif; font-size: 11.0pt; line-height: 107%; mso-ansi-language: EN-HK; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: PMingLiU; mso-fareast-language: ZH-TW; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-text-raise: -3.0pt; position: relative; top: 3.0pt;"><!--[if gte vml 1]><v:shape
id="_x0000_i1025" type="#_x0000_t75" style='width:2.25pt;height:14.25pt'>
<v:imagedata src="file:///C:/Users/LICLIF~1/AppData/Local/Temp/msohtmlclip1/01/clip_image001.png"
o:title="" chromakey="white"/>
</v:shape><![endif]--><!--[if !vml]--><img height="19" src="file:///C:/Users/LICLIF~1/AppData/Local/Temp/msohtmlclip1/01/clip_image002.png" v:shapes="_x0000_i1025" width="3" /><!--[endif]--></span><!--[endif]--><span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌋</span><o:p></o:p></p>
<p class="MsoNormal">6. q = <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌊</span> k / 4 <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌋</span><o:p></o:p></p>
<p class="MsoNormal">7. M = 15 – p + k – q (mod 30)<o:p></o:p></p>
<p class="MsoNormal">8. N = 4 + k – q (mod 7)<o:p></o:p></p>
<p class="MsoNormal">9. d = 19a + M (mod 30)<o:p></o:p></p>
<p class="MsoNormal">10. e = 2b + 4c + 6d + N (mod 7)<o:p></o:p></p>
<p class="MsoNormal">11. <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">復活節的日子是</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>(22 + d
+ e)<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日或</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>(d + e
– 9 )<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日</span><o:p></o:p></p>
<p class="MsoNormal">12. <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如果</span>d
= 29<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">及</span>e = 6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,那麼用</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>26<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日去取代</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>19<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日</span><o:p></o:p></p>
<p class="MsoNormal">13. <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如果</span>d
= 28<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,</span>e = 6<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">及</span>11M +
11 (mod 30) < 19<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,那麼用</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>25<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日去取代</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>18<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">我們試以</span>2022<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年為例子去試用一下這演算法。</span><o:p></o:p></p>
<p class="MsoNormal">1. a = 2022 (mod 19) = 8<o:p></o:p></p>
<p class="MsoNormal">2. b = 2022 (mod 4) = 2<o:p></o:p></p>
<p class="MsoNormal">3. c = 2022 (mod 7) = 6<o:p></o:p></p>
<p class="MsoNormal">4. k = <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌊</span> 2022 / 100 <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌋</span>
= 20<o:p></o:p></p>
<p class="MsoNormal">5. p = <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌊</span> (13 + 8 x 20) / 25 <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌋</span>
= 6<o:p></o:p></p>
<p class="MsoNormal">6. q = <span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌊</span> 20 / 4<span style="font-family: "Cambria Math",serif; mso-bidi-font-family: "Cambria Math";">⌋</span> = 5<o:p></o:p></p>
<p class="MsoNormal">7. M = 15 – 6 + 20 – 5 (mod 30) = 24<o:p></o:p></p>
<p class="MsoNormal">8. N = 4 + k – q (mod 7) = 5<o:p></o:p></p>
<p class="MsoNormal">9. d = 19(8) + 24 (mod 30) = 26<o:p></o:p></p>
<p class="MsoNormal">10. e = 2(2) + 4(6) + 6(26) + 5 (mod 7) = 0<o:p></o:p></p>
<p class="MsoNormal">11. <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">因此復活節的日子是</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>(22 + 26
+ 0)<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日或</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>(26 + 0
– 9 )<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日,即</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>48<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日或</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>17<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日。</span>3<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>48<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日當然是不可能的,那復活節的日期應是</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span>17<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日。這也與我們的認知相符。</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">由於這演算法很複雜,史丹福好難在此詳盡解釋它的原理,甚至高斯自己也曾表示「不可能展示他是透過甚麼分析去得出這公式」。不過簡單來說,演算法分了兩部分,第一部分是估月亮的運行,第二部分是確實計算出月圓日後的星期日。</span></p><p class="MsoNormal"><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-40870938719116813682022-04-04T08:44:00.001-07:002022-04-04T08:57:19.498-07:00蕭邦的心臟<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">蕭邦(</span>Fryderyk
Chopin<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)是一位生於波蘭的著名作曲家及演奏家。他對鋼琴情有獨鍾,鋼琴是蕭邦的生命,他以鋼琴演奏出他人生的悲喜、對民族的熱情、對家鄉的懷念。他譜寫的序曲、練習曲、圓舞曲,旋律優美,浪漫中帶有些憂鬱的氣質,即使到近二百年後的今天仍被人讚頌。俄國鋼琴家魯賓斯坦(</span>Anton
Rubinstein<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)就曾說過:「蕭邦是鋼琴的靈魂,是鋼琴的吟遊詩人。蕭邦與鋼琴原是一體。」</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蕭邦一向體弱多病,一生病痛不斷。在青少年的時期,他就已經經常有咳嗽與肚瀉。</span>1826<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,他</span>16<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲的時候試過生病近半年,病徵包括咳嗽、頭痛及頸部淋巴腫脹。他</span>20<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲住在維也納時也有過類似的症狀。在</span>1831<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年至</span>1835<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年間,他多次患上氣管炎與喉炎。</span>1837<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年在巴黎時,他患病並出現發高燒及咳血的病徵。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在他</span>28<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">歲的時候,他與情人喬治·桑(</span>George
Sand<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)搬到了西班牙的馬略卡島的小城</span><span face=""Microsoft JhengHei",sans-serif" lang="ZH-TW" style="mso-bidi-font-family: "Microsoft JhengHei";">⽡</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">德摩莎</span><span lang="ZH-TW"> </span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">(</span>Valldemossa<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中渡假,這本來是一個氣候溫暖的地中海小島。但那年的馬略卡島異常寒冷,令蕭邦的健康轉差。他又再次出現發燒、咳嗽及肚瀉的病徵。當地的醫生診斷他患上結核病(</span>tuberculosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,俗稱肺癆)。值得一提的是,雖然蕭邦在馬略卡島時健康很差,但產量卻極為驚人。後來他又在</span>1841<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至</span>46<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年搬往了喬治桑的鄉間寓所休養並寫曲。蕭邦朋友在</span>1844<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年為他畫了一幅畫像,入面顯示蕭邦可能有桶狀胸(</span>barrel
chest<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),這是一個醫學徵象,正常人的指胸腔是扁的,但桶狀胸則是指胸腔前後距離增加,令胸腔呈圓桶形。這個醫學徵象多數出現在肺氣腫的病人中,而肺結核正正就是肺氣腫的其中一個成因。</span></p>
<p class="MsoNormal">1846<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,蕭邦與喬治桑感情出現了問題,最終二人緣盡分手。此後蕭邦的健康情況一落千丈,<span style="color: black;">他也幾乎再寫不出任何作品。他在人生最後的日子曾應邀到</span>英國倫敦表演。他<span style="color: black;">在倫敦頗受上流社會歡迎,並在維多利亞女王御前演奏</span></span><span lang="ZH-TW" style="color: black; font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;">。不過</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">倫敦<span style="color: black;">潮濕多霧</span></span><span lang="ZH-TW" style="color: black; font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;">的天氣令他的病情進一步轉差。他最終在</span>1849 <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>10 <span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月</span> 17<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">日離世。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蕭邦的官方死因是結核病,但他的解剖驗屍圾報告已經遺失了,所以科學界及醫學界很久未能肯定他的真正死因。有些科學家提出不同的看法,他們翻查蕭邦的病歷,並認為蕭邦亦有可能患上</span>α-1<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">抗胰蛋白酶缺乏症(</span>alpha-1
antitrypsin deficiency<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,一種可以影響肺部的遺傳性疾病)、囊腫性纖維化(</span>cystic
fibrosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,另一種可以影響肺部的遺傳性疾病)或二尖瓣狹窄(</span>mitral
stenosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蕭邦臨死前跟他的姐姐提出了另人匪夷所思的遺願,希望姐姐可以幫他達成。他的遺願就是在死後葬在法國,但他希望姐姐在他死後取出他的心臟,並把心臟帶回祖國波蘭。這樣象徵蕭邦雖然因不滿俄羅斯佔領波蘭而自我流放,但他的心仍永遠歸向祖國波蘭。另外一個說法是蕭邦很害怕自己會被以外地生葬,取出他的心臟才埋葬他就不會有這個問題了。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-bidi-font-family: PMingLiU;">顛沛流離的心臟</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蕭邦大概想不到,他的遺願令其心臟踏上了一段顛沛流離的旅程。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">蕭邦的姐姐先把心臟放在玻璃瓶內,瓶內裝了一些淺啡色的液體,那有可能是干邑白蘭地(</span>cognac<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。由於干邑白蘭地含有高濃度的酒精,以當時的技術來說,算是不錯的組織保存方法。傳聞說她把瓶放在自己的裙下並偷運到華沙。蕭邦最初希望心臟可以與他的家人一起被葬於波瓦斯基公墓(</span>Powazki
Cemetery<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),但公墓只接受安葬屍體,不接受單獨的心臟。於是蕭邦姐姐把心臟交給了聖十字架教堂(</span>Holy
Cross Church<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。這是蕭邦小時候的教區教堂,很多的家族慶典都在那裡舉行,對蕭邦別具意義。但可惜的是,聖十字架教堂也不希望接收蕭邦的心臟,因為教堂的成員覺得蕭邦與喬治桑的關係是段不倫戀,會影響教堂的名聲。最後心臟就如垃圾般被</span><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><span lang="ZH-TW" style="font-size: 11pt; line-height: 107%;">棄</span>於教堂的地穴中。</span></p>
<p class="MsoNormal">1863<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,波蘭發生了反俄羅斯帝國的一月起義。在起義中,俄羅斯士兵搶掠了聖十字架教堂。但因為蕭邦的心臟被藏於不見天日的地穴中,反而得以保存下來,可以說是因禍得福。到了</span>1880<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,教堂終於決定重新安放這一代偉人的心臟,並打算為蕭邦訂造墓石。但問題來了,此時教堂的職員已經不知道蕭邦的心臟被放了在哪兒。幸得當地一位記者幫手尋找,最終在地穴中找回,蕭邦的心臟也得以重回主教堂。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">但心臟顛沛流離的旅程還未完結。心臟之後又要面臨比一月起義更大的危機</span>──<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">第二次世界大戰。</span></p>
<p class="MsoNormal">1944<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年,波蘭華沙爆發了反抗納粹德國的起義。一位德國的牧師擔心蕭邦心臟受到戰火破壞,於是提出暫時保管心臟,波蘭的神職員也同意了。心臟最先由納粹親衛隊的指揮官賴內法特(</span>Heinz
Reinefarth<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)保管,他剛好是一位蕭邦的仰慕者。心臟在之後的華沙起義過程中被存放在德國納粹親衛隊的高級指揮官巴赫</span>-<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">熱勒維斯基(</span>Erich
von dem Bach-Zelewski<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的總部。巴赫</span>-<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">熱勒維斯基以殘暴見稱,他負責鎮壓華沙起義,並在過程中共殘殺了二十萬人。他卻竟然特意去保護一位波蘭作曲家的心臟,實在是令人難以置信。有一個說法是,蕭邦影響了很多之後的德國音樂家,以致德國人也認為蕭邦的心臟是屬於德國的,因而加以保護。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">更令人難以置信的是,巴赫</span>-<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">熱勒維斯基在華沙起義之後竟然把蕭邦的心臟歸還給波蘭的斯拉戈夫斯基(</span>Antoni
Szlagowski<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)大主教。究竟他是真心專重蕭邦與波蘭人,還是只是做一場政治騷去減少被鎮壓的波蘭人的不滿,我們說不得而知了。但斯拉戈夫斯基大主教獲歸還心臟後,也擔心納粹德國會反口,於是他們把心臟運出華沙,送到米拉努韋克(</span>Milanówek<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)城,並藏於一座鋼琴中,直到第二次世界大戰之後才重新運回華沙聖十字架教堂。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">之後,蕭邦的心贓終於可以安穩下來,自始安定地住在聖十字架教堂。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">經過</span>69<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年的安穩生活後,一隊科學專家團隊於</span>2014<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年</span>4<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月得到教堂的批准去檢查蕭邦的心贓。他們的目的有兩個,一是觀察心臟的保存狀況,看看有否復修的需要,二是藉此機會去找出蕭邦的真正死因。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">他們把觀察結果寫成報告,亦刊登了在《美國醫學期刊》(</span>American
Journal of Medicine<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中。根據他們的報告,心臟有幾個像是結核瘤(</span>tuberculoma<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的結節,另外有一層纖維狀的物質覆蓋著整個心包(</span>pericardium<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)的表面。解剖的切口出現血性滲漏液(</span>haemorrhagic
effusion<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。總的來說,報告認為蕭邦很有可能有慢性結核病,但其後結核菌入侵心包,引起的心包膜炎(</span>pericarditis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">),令他病情急速惡化被最終死亡。蕭邦的死因終於有了一個科學的證明。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU01XdriHo051GQMo1-qdTUEA0j2aWmkfgqFFbyh18iCv7gGHfp1VAWax_n0gdwmt5ABGLV7o01NY3Delt_u2WMhyaUfs62I3agP5ThRk-Alq3N5lTdW322OwpWerMOYZKNuh73TAxgp58MclDn9U8Sjw6vD0sXbNvFUSCRrddrqc56XSWFkvC2tNU2Q/s818/1-s2.0-S0002934317310252-ajm14320-fig-0001_lrg.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="818" data-original-width="600" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU01XdriHo051GQMo1-qdTUEA0j2aWmkfgqFFbyh18iCv7gGHfp1VAWax_n0gdwmt5ABGLV7o01NY3Delt_u2WMhyaUfs62I3agP5ThRk-Alq3N5lTdW322OwpWerMOYZKNuh73TAxgp58MclDn9U8Sjw6vD0sXbNvFUSCRrddrqc56XSWFkvC2tNU2Q/w470-h640/1-s2.0-S0002934317310252-ajm14320-fig-0001_lrg.jpg" width="470" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">《美國醫學期刊》報告中蕭邦心臟的圖片</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><o:p> </o:p><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">結核病與血液學</span></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">結核病是一種可怕的疾病,它由結核分枝桿菌(</span>Mycobacterium
tuberculosis<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)引起,通常影響肺部,但亦可以影響身體的其他部份,例如淋巴結、腎、骨、關節、骨髓等,其中當然以骨髓與血液學的關係最大。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在鏈黴素(</span>streptomycin<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)在</span>1940<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">年代被發現前,結核病是一種不治之症。在工業革命之後,由於歐洲的人口增長迅速,但工人的居住環境極差,令患上結核病的人數急劇上升。自此,結核病就成了一種很流行的嚴重傳染病。在七十年代香港盛行的粵語長片中,一個很常見的劇情就是男女主角因患上結核病而在手帕上咳出鮮血。今天,大家已經很少聽到結核病,相信很多人都以為結核病就像粵語片一樣,已成歷史。但原來,結核病到現時依然非常流行,例如在香港每年就有有約五千宗新確診的結核病個案。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">結核分枝桿菌其實毒性不強,生長緩慢,但卻非常頑強,對酸性、鹼性、氧化物、補體(</span>complement<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)及大部分抗生素都是免疫的。即使被負責免疫的巨噬細胞(</span>macrophages<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)所吞噬,巨噬細胞的溶小體(</span>lysozome<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)都無法把它消化。巨噬細胞「消化不良」,最後引起慢性炎症反應,慢慢地破壞身體組織。因此結核病並不是一種急性疾病,但它會慢慢地影響患者的身體功能,令身體越來越衰弱,最終死亡。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">至於結核病又與血液學有何關係呢?</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">首先,結核病會引起慢性發炎,所以患者常有慢性病性貧血(</span>anemia
of chronic disease<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。另外,如果結核菌入侵了骨髓,就可能患起血球下降。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">如果骨髓被結核菌入侵,病理學醫生也可以在骨髓環鑽活檢中找到些與慢性發炎相關的組織學變化,例如肉芽腫(</span>granuloma<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)等。慢性發炎是一個複雜的病理學概念,史丹福就不在此詳述了。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5zIJf5UpAonscJDUCzMRDyqk_CRIhZw6xoCTu_tuJUUpoNJ2JYuPlbYPEfl0ocXD1jVb-0orlPjpyYFKRpOk3Vh9pME8SjOoL6mPi3vRR5U-Nwx0sauR7RRgGhBBIS5g-66BMZsBUEKsELkCuKRA79he-S90sVJ33R14F2dYRSFLusJd1xVxtfBNzww/s1115/Untitled2.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="721" data-original-width="1115" height="414" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5zIJf5UpAonscJDUCzMRDyqk_CRIhZw6xoCTu_tuJUUpoNJ2JYuPlbYPEfl0ocXD1jVb-0orlPjpyYFKRpOk3Vh9pME8SjOoL6mPi3vRR5U-Nwx0sauR7RRgGhBBIS5g-66BMZsBUEKsELkCuKRA79he-S90sVJ33R14F2dYRSFLusJd1xVxtfBNzww/w640-h414/Untitled2.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">被結核菌入侵的骨髓,圖中顯示了一個肉芽腫</td></tr></tbody></table><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span><p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">病理學醫生甚至可以齊爾</span>-<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">尼爾森染料(</span>Ziehl-Neelson
stain<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)這種特殊的染料去為結核分枝桿菌上色,這樣就可以利用顯微鏡直接觀察到結核分枝桿菌,並診斷到結核病。在齊爾</span>-<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">尼爾森染料下,結核分枝桿菌呈現成一條條紅紅的線,看起來就像是番紅花香料。</span><o:p></o:p></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></p><p class="MsoNormal"></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAuPcQ3XzNYQLSafW3JArK5hSIK0lwJMsVe-75HOmh9HBAxUkbePZ6gFBMma61QG5j0A4SKzhVYQEfdyoW4Q0tnqr7IfADr8yJKw6m0a9007nfds29qQ26l6mh8rkINBEWPAsCnUssmCHeFzJtIDwEYbmvhHpd509W2-l_PLIpBmvy_uk_nhSEkd3GHA/s1014/Untitled.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="671" data-original-width="1014" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAuPcQ3XzNYQLSafW3JArK5hSIK0lwJMsVe-75HOmh9HBAxUkbePZ6gFBMma61QG5j0A4SKzhVYQEfdyoW4Q0tnqr7IfADr8yJKw6m0a9007nfds29qQ26l6mh8rkINBEWPAsCnUssmCHeFzJtIDwEYbmvhHpd509W2-l_PLIpBmvy_uk_nhSEkd3GHA/w640-h424/Untitled.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">被結核菌入侵的骨髓。在齊爾-尼爾森染料下,結核分枝桿菌呈現成一條條紅紅的線,看起來就像是番紅花香料。<br /></td></tr></tbody></table><br /><p></p><div><span lang="ZH-TW" style="font-family: PMingLiU, serif;">資料來源</span><span lang="ZH-TW" style="background: white; color: #222222; font-family: PMingLiU, serif; font-size: 10pt; line-height: 107%;">:</span></div><div><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">
</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">Witt M, Szklener A, Kawecki J, Rużyłło W, Negrusz-Kawecka M,
Jeleń M, Langfort R, Marchwica W, Dobosz T. A Closer Look at Frederic Chopin's
Cause of Death. Am J Med. 2018 Feb;131(2):211-212.<o:p></o:p></span></p><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">
<p class="MsoNormal">https://www.thefirstnews.com/article/home-is-where-the-heart-lies-the-amazing-story-of-chopins-heart-10636<o:p></o:p></p>
<p class="MsoNormal">https://tidsskriftet.no/en/2011/04/frederic-chopin-and-his-suffering</p></span><p></p></div>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-54020077378649005692021-12-24T08:50:00.003-08:002021-12-24T22:17:41.535-08:00 聖誕老人較容易患上甚麼血液疾病?<p><span lang="ZH-TW" style="background: white; color: #050505; font-family: PMingLiU, serif; font-size: 11.5pt; line-height: 107%;">又到聖誕,史丹福與</span><span style="background: white; color: #050505; font-family: "Segoe UI Historic", sans-serif; font-size: 11.5pt; line-height: 107%;">Peaches</span><span lang="ZH-TW" style="background: white; color: #050505; font-family: PMingLiU, serif; font-size: 11.5pt; line-height: 107%;">謹祝大家聖誕快樂,好人一生平安</span><span lang="ZH-TW" style="background: white; color: #050505; font-family: "Microsoft JhengHei", sans-serif; font-size: 11.5pt; line-height: 107%;">。</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">史丹福每年聖誕都會介紹一個與節日相關的題目,今次就談一下聖誕老人容易患上的血液病。</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhkoiZUdZOF2RHdej-7JTMGlWMFccPnQfZakxH2_DcuubCS1dMf2R8pSJyQz2jVbckNqS2QTY_C20Gk0uAhjdOTk85aDGqe0NIf7oitdUxE8APV4dj-iMaW1AQXZ_7RWdExUcFokcoDnOJ6dxvF5MRORr2iHHi3TvTSK7N8Gd23hZ82CT71koK7lDPy8Q=s1500" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1500" data-original-width="1125" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEhkoiZUdZOF2RHdej-7JTMGlWMFccPnQfZakxH2_DcuubCS1dMf2R8pSJyQz2jVbckNqS2QTY_C20Gk0uAhjdOTk85aDGqe0NIf7oitdUxE8APV4dj-iMaW1AQXZ_7RWdExUcFokcoDnOJ6dxvF5MRORr2iHHi3TvTSK7N8Gd23hZ82CT71koK7lDPy8Q=w480-h640" width="480" /></a></div><br /><p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">大家普通都相信聖誕老人住在芬蘭北部拉普蘭區(</span>Lapin
maakunta<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的羅瓦涅米。鼎鼎大名的聖誕老人村就是位於那裏。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">拉普蘭區位於北極圈內並擁有寒冷的冬季氣候,而且冬季特別漫長,大約持續</span>7<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">個月左右。拉普蘭每年</span>12<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月的平均氣溫在攝氏</span>-10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">度,在</span>2<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">月最冷的時候甚至可以低至攝氏</span>-30<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">度。它的積雪平均在十月份或者九月底開始降落,這跟芬蘭南部相比就早多了。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">住在如此嚴寒的地方,雖然可以感受到濃濃的聖誕感覺,更有機會欣賞到艷麗的極光,但對身體的影響亦都相當的大。不少的呼吸系統疾病(如哮喘、慢性阻塞性肺病)及心血管疾病(如心肌梗塞)都與寒冷天氣相關。例如有研究就顯示氣溫每下解</span>10<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">攝氏度,病人得到</span>ST<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">上升型心肌梗塞(</span>ST
elevation myocardial infarction<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>STEMI<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,乃心肌梗塞中最嚴重的一款)就會上升</span>7%<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那有沒有血液疾病都與寒冷天氣相關呢?當然有。其中最著名的例子就是冷凝集素病(</span>cold
agglutinin disease<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">冷凝集素病是一種自身免疫問題引起的溶血性貧血(</span>haemolytic
anaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)。病人的免疫系統失調,做出冷型自身抗體(</span>cold
autoantibodies<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)去攻擊紅血球。這些抗體在低溫中較為活躍,所以寒冷天氣可以誘發疾病。受到抗體攻擊的紅血球會被肝臟中被網狀內皮系統(</span>reticuloendothelial
system<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)中的巨噬細胞(</span>macrophages<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)吞噬,令紅血球減少,引起貧血。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">在化驗診斷方面,病人的紅血球在周邊血液抹片中會出現凝集,黏在一起。當血液被放在</span>37<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">度的環境下暖化,周邊血液抹片中的紅血球凝集就會消失。</span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjncMA2DeOMc9InJAAte0mZYr1WLAAPOdJ7M2MOQET9PNlQRZFPEgOVtK_iXHz6QDJzt5KlWWX46VPGYvgI1eNMYhaIqFT-v_Jq6N5sma9dIwnDgypShWJRxx_dg0aSxjI443dTDb_2zbdlIgY30ImmZ4gJpT_6smKyZZQPfftdmo7dvWYJVTXk0GQFig=s2000" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2000" data-original-width="2000" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEjncMA2DeOMc9InJAAte0mZYr1WLAAPOdJ7M2MOQET9PNlQRZFPEgOVtK_iXHz6QDJzt5KlWWX46VPGYvgI1eNMYhaIqFT-v_Jq6N5sma9dIwnDgypShWJRxx_dg0aSxjI443dTDb_2zbdlIgY30ImmZ4gJpT_6smKyZZQPfftdmo7dvWYJVTXk0GQFig=w640-h640" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">冷凝集素病患者的周邊血液抹片</td></tr></tbody></table><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">一篇在</span>2020<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年刊登於血液期刊的研究報告就比較了挪威與意大利倫巴第區中冷凝集素病的發病率(</span>incidence<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)與流行率(</span>prevalence<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。挪威位處高緯度,部分地區更位於北極圈內,平均溫度乃攝氏</span>6.0<span lang="ZH-TW" style="font-family: PMingLiU, serif;">度。意大利倫巴第區則位於歐洲南部,氣候較為和暖,平均溫度乃攝氏</span>13.1<span lang="ZH-TW" style="font-family: PMingLiU, serif;">度。報告顯示挪威的發病率是</span>1.9<span lang="ZH-TW" style="font-family: PMingLiU, serif;">每</span>108<span lang="ZH-TW" style="font-family: PMingLiU, serif;">人,意大利倫巴第區的發病率則是</span>0.48<span lang="ZH-TW" style="font-family: PMingLiU, serif;">每</span>108<span lang="ZH-TW" style="font-family: PMingLiU, serif;">人。挪威的流行率是</span>20.5<span lang="ZH-TW" style="font-family: PMingLiU, serif;">每</span>108<span lang="ZH-TW" style="font-family: PMingLiU, serif;">人,意大利倫巴第區的發病率則是</span>5.0<span lang="ZH-TW" style="font-family: PMingLiU, serif;">每</span>108<span lang="ZH-TW" style="font-family: PMingLiU, serif;">人。挪威的流行率接近是意大利倫巴第區的</span>4<span lang="ZH-TW" style="font-family: PMingLiU, serif;">倍。這份研究報告提供了證據去引證寒冷氣候的地區有較高的冷凝集素病的發病率與流行率。</span></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">挪威與芬蘭同樣處於高緯度,氣候較為接近。拉普蘭區更是芬蘭中最寒冷的地方,我們有理由相信芬蘭拉普蘭區的冷凝集素病發病率與流行率亦會比其他地方高。因此聖誕老人也有較高的機會患上冷凝集素病。</span><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">那究竟聖誕老人有沒有患上冷凝集素病呢?患有貧血的病人因血紅蛋白不足,臉色會較蒼白。幸好根據史丹福的觀察,聖誕老人的臉色紅潤,患有貧血的機會不大。聖誕老人應該有足夠的血紅蛋白去應付這幾天的龐大工作量,環遊全世界去派禮物給我們。</span><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">資料來源</span><span lang="ZH-TW" style="background: white; color: #222222; font-family: "PMingLiU",serif; font-size: 10.0pt; line-height: 107%;">:</span></p>
<p class="MsoNormal">Tofield A. Cold weather and myocardial infarction. <i>Eur
Heart J</i>. 2017;38(3):140.</p>
<p class="MsoNormal">Berentsen S, Barcellini W, D'Sa S, Randen U, Tvedt THA, Fattizzo
B, Haukås E, Kell M, Brudevold R, Dahm AEA, Dalgaard J, Frøen H, Hallstensen
RF, Jæger PH, Hjorth-Hansen H, Małecka A, Oksman M, Rolke J, Sekhar M, Sørbø
JH, Tjønnfjord E, Tsykunova G, Tjønnfjord GE. Cold agglutinin disease
revisited: a multinational, observational study of 232 patients. <i>Blood</i>.
2020;136(4):480-488.<o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-44290525150716196522021-12-02T05:07:00.004-08:002021-12-02T05:12:45.681-08:00「身為學生,唔好好讀書,掛住搞政治」<p><span style="font-family: PMingLiU, serif;">史丹福看新聞報道時見到一位理應社會地位頗高的人指一名學生「身為學生,唔好好讀書,掛住搞政治」。史丹福對此批評不以為然、嗤之以鼻,並認為這是一個很低層次及思想很狹窄的批評。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p><span style="font-family: PMingLiU, serif;">事實上,學術與政治同樣需要批判思考及求真精神,兩者之間從來都沒有必然的矛盾關係。做學問的人其實很應該關心社會問題。相反地,如果從事學術的人都只於象牙塔內閉門造車,這樣的社會絕不可取。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">學者關心政治的例子比比皆是,其中有不少更是諾貝爾級的頂尖學者。例如鮑林(</span>Linus
Carl Pauling<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)是位天才化學家。他是量子化學的先驅,並憑著對化學鏈的研究而獲得</span>1954<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的諾貝爾化學獎。他後來又對生物化學產生了興趣,並發現了蛋白質中的</span>α<span lang="ZH-TW" style="font-family: PMingLiU, serif;">螺旋結構。他同時也是首先發現鎌刀型細胞貧血症(</span>sickle
cell anaemia<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)是一個分子遺傳學疾病的科學家。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlHMb00XrsVowxVSqCDGXtAUpte3fyXX0oTLhFMFXAiw5OAXUDOAb0sRuy_M0KydNx2dJefvQFP2ppbLcBijxpI0PTCUMQF4theYqXDi74WwGhO3OHMjZYHgx7_A_Lojj5SxiFuGYQJp7i/s1920/pauling.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1920" data-original-width="1920" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlHMb00XrsVowxVSqCDGXtAUpte3fyXX0oTLhFMFXAiw5OAXUDOAb0sRuy_M0KydNx2dJefvQFP2ppbLcBijxpI0PTCUMQF4theYqXDi74WwGhO3OHMjZYHgx7_A_Lojj5SxiFuGYQJp7i/w400-h400/pauling.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">諾貝爾化學獎得獎者鮑林</td></tr></tbody></table><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">但鮑林同時也很關心政治。他是位積極的和平主義者,極力呼籲停止核子試爆及宣揚反核武。他之後又積極反對美國介入越戰。他的政府立場令他得罪了美國政府,美國政府認為他親共親蘇,於是對他展開調查,甚至限制他出境。據說因為出境限制的影響,他無法得知有關</span>DNA<span lang="ZH-TW" style="font-family: PMingLiU, serif;">研究的關鍵資料,間接令他失去了首都發現</span>DNA<span lang="ZH-TW" style="font-family: PMingLiU, serif;">雙螺旋結構的機會。不過鮑林卻因為他反對核試的工作而獲得了</span>1962
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年的諾貝爾和平獎,令他成為了史上唯一一位同時獲得諾貝爾科學類獎及非科學類獎的人。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">另一位更為人所知的例子是愛因斯坦。愛因斯坦的學術成就無需要我多加介紹了。愛因斯坦是位率直的和平主義者和人道主義者,並反對種族主義。愛因斯坦經常公開表達自己的政治思想,納粹黨曾認為愛因斯坦的言論與舉動嚴重威脅到納粹運動的發展,令愛因斯坦要流亡美國。他又支持猶太建國主義,以色列建國後他甚至被邀成為以色列的總統,由此可見他的政治影響力有多大。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">另一方面,很多出色的政治家都有很厲害的學術背景。例如有「鐵娘子」之稱的前英國首相戴卓爾夫人在位時扭轉英國了的經濟頹勢,又帶領英國贏得福克蘭群島戰役。她更兩度連任,任職三屆英國首相,是二十世紀英國在位時間最長的首相。這位政治家年少時在牛津大學攻讀化學,師承諾貝爾化學獎得獎者何杰金夫人(</span>Dorothy
Hodgkin<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。她的畢業論文是以</span>X<span lang="ZH-TW" style="font-family: PMingLiU, serif;">射線繞射術去研究抗生素</span>Gramicidin<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的昌體結構。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">更近期的例子是剛離任的德國總理默克爾。默克爾畢業於萊比錫大學物理系。默克爾在碩士畢業後一直於原東德科學院的物理化學研究中心從事科研工作,並於</span>1986<span lang="ZH-TW" style="font-family: PMingLiU, serif;">年取得了物理學博士學位。他的專長是量子化學,畢業論文是研究碳氫化合物的反應。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">難道鮑林、愛因斯坦、戴卓爾夫人及默克爾又是「身為學生,唔好好讀書,掛住搞政治」嗎?</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family: PMingLiU, serif;">史丹福非常尊重學術,亦鼓勵人專心鑽研學問,但這並不等如需要連判斷是非對錯的心都捨棄掉。事實上,學者正正就是最著重是非對錯的人,他們往往甘願為正確的事情而犧牲自己,即使被壓榨迫害亦無所畏懼。君不見伽利略正正就是因為宣揚他所相信是正確的宇宙模型而被教會迫害軟禁嗎?</span></p><p class="MsoNormal"><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0tag:blogger.com,1999:blog-2662343138376791734.post-62416579704197944552021-11-05T19:14:00.004-07:002021-11-05T19:14:43.248-07:00從小粉紅到深紅:白血病中的顏色<p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">病理學家總對顏色有著一種超乎常人的執著,就以紅色為例,不同的基因突變可以令急性骨髓性白血病(</span>acute
myeloid leukaemia<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)出現不同紅色的顆粒,從小粉紅到晚霞紅到深紫紅。</span></p><p><span lang="ZH-TW" style="font-family: PMingLiU, serif;">因此一位細心的病理學家單以顯微鏡就可以從細胞顆粒的顏色推斷出引起</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的基因突變。有時候,顯微鏡加上雙眼的威力竟然可以及得上先進的分子遺傳學技術,實在是非常令人驚訝。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">小粉紅</span><o:p></o:p></u></b></p>
<p class="MsoNormal">AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">中最常見的染色體變化是</span>t(8;21)(q22;q22)<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,即第</span>8<span lang="ZH-TW" style="font-family: PMingLiU, serif;">號染色體的短臂與第</span>21<span lang="ZH-TW" style="font-family: PMingLiU, serif;">號染色體的短臂交換了物質,出現</span>8;21<span lang="ZH-TW" style="font-family: PMingLiU, serif;">易位(</span>translocation<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。這會令到</span>RUNX1<span lang="ZH-TW" style="font-family: PMingLiU, serif;">及</span>RUNX1T1<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的基因融合。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的癌細胞叫做母細胞(</span>blasts<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span>8;21<span lang="ZH-TW" style="font-family: PMingLiU, serif;">易位</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">的</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的母細胞有獨特的形態。它們有一個深藍色的細胞質邊沿,細胞核旁的細胞質呈淺藍色。這些母細胞常有長而幼的奧爾氏桿(</span>Auer
rods<span lang="ZH-TW" style="font-family: PMingLiU, serif;">),即細胞質中有細長紅色的包含體。而其他骨髓性細胞(</span>myeloid
cells<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)常會有一種特別的細胞質顆粒,它們帶有少少淡粉紅的顏色。血液病理學家常稱它為「三文魚粉紅」(</span>salmon
pink<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"></span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">下圖的骨髓抹片來自一位</span>8;21<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">易位</span>AML<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">的病人,大家可以比較一下細胞質顆粒與三文魚的顏色。</span><o:p></o:p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2fDVJhkCZpD74nYqUYOnM6DcPBklVOa9TyEGl6AC_bOvl_I-cAJdbcOucy9Q2Q2MGVbo3jaH1xl-dp5-i-rmPIEiom9-Btj_2L46iLiVZkZZDMME0uC3XgIJsfq2Gxs-nwYwkomBFXgUU/s1171/8-21-AML.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="781" data-original-width="1171" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2fDVJhkCZpD74nYqUYOnM6DcPBklVOa9TyEGl6AC_bOvl_I-cAJdbcOucy9Q2Q2MGVbo3jaH1xl-dp5-i-rmPIEiom9-Btj_2L46iLiVZkZZDMME0uC3XgIJsfq2Gxs-nwYwkomBFXgUU/w640-h426/8-21-AML.jpg" width="640" /></a></div><br /><p></p>
<p class="MsoNormal"><b><u></u></b></p><div class="separator" style="clear: both; text-align: center;"><b><u><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuOzv7zjp81Vv-62_o9NETCPFovT1KcORquMFyxewd0psYmpkIm0rZ_MZymwWfqsyOM8Wb0xdVQeDJXcRjnWItocRfRcD6zC-eKPkpm0NdliQvjIBgG-0Z2HrI-dbiq9vjzMnsP01E2Uhr/s854/salmon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="854" data-original-width="620" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuOzv7zjp81Vv-62_o9NETCPFovT1KcORquMFyxewd0psYmpkIm0rZ_MZymwWfqsyOM8Wb0xdVQeDJXcRjnWItocRfRcD6zC-eKPkpm0NdliQvjIBgG-0Z2HrI-dbiq9vjzMnsP01E2Uhr/w464-h640/salmon.jpg" width="464" /></a></u></b></div><b><u><br /><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;"><br /></span></u></b><p></p><p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">晚霞紅</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">晚霞紅是另一種令血液病理學家難以忘懷的顏色,它會出現在<a name="_Hlk26995042">急性前骨髓細胞性白血病(</a></span>acute
promyelocytic leukaemia<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">,簡稱</span>APL<span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">)</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">的癌細胞中。</span>APL<span lang="ZH-TW" style="font-family: PMingLiU, serif;">是急性骨髓性白血病(</span>acute
myeloid leukemia<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的一種,然而它的特性卻與其他的</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">頗為不同。</span>APL<span lang="ZH-TW" style="font-family: PMingLiU, serif;">是其中一種最危急的血液疾病,因為它可以引起瀰漫性血管內凝血(</span>disseminated
intravascular coagulation<span lang="ZH-TW" style="font-family: PMingLiU, serif;">,簡稱</span>DIC<span lang="ZH-TW" style="font-family: PMingLiU, serif;">),令患者流血不止,假如得不到適當的治療的話病人很容易就會在數日甚至數小時內因腦出血而死。因此</span>APL<span lang="ZH-TW" style="font-family: PMingLiU, serif;">曾經是一種死亡率非常高的疾病。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">APL<span lang="ZH-TW" style="font-family: PMingLiU, serif;">其實是由一種獨特的</span><a name="_Hlk26995059">t(15;17)(q22;q12)</a><span lang="ZH-TW" style="font-family: PMingLiU, serif;">染色體變異引起的,即第</span>15<span lang="ZH-TW" style="font-family: PMingLiU, serif;">條染色體及第</span>17<span lang="ZH-TW" style="font-family: PMingLiU, serif;">條染色體出現易位,導致產生了一種名為</span>PML-RARA<span lang="ZH-TW" style="font-family: PMingLiU, serif;">的融合基因,這基因會製造出壞蛋白,會阻礙白血球成熟,令粒細胞(</span>granulocyte<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的成長只停留在前髓細胞(</span>promyelocyte<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)的階段而不能繼續成熟。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">在</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">顯微鏡下,這些</span><span lang="ZH-TW" style="font-family: PMingLiU, serif;">不正常的前髓細胞有三大特徵,包括兩塊葉似的細胞核、奧爾氏桿、橙紅色的如晚霞般的細胞質顆粒。</span><span style="font-family: PMingLiU, serif; font-size: 11pt;">但一般來說,這些細胞未必有齊有所有特徵,如下圖中的細胞就只有晚霞色的細胞質顆粒而沒有明顯的兩葉細胞核及奧爾氏桿。</span><span style="font-family: PMingLiU, serif; font-size: 11pt;">大家又覺得顆粒的顏色像不像晚霞呢?</span></p><p class="MsoNormal"><span style="font-family: PMingLiU, serif; font-size: 11pt;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4p0zsh7VIPAdplpsEgrN6p8MwBuGLaZQZ53fQXfODisHdCJ8kRoEXu5kwIoOiw5fXtkwVy2Tag9wxavCkvm8pXYmYmSmtAJ4LY569a_v7NlRJ5lNJ_5Wq-ZMirs8jDhRZB2pTSXDaRDPV/s1175/APL.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="814" data-original-width="1175" height="444" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4p0zsh7VIPAdplpsEgrN6p8MwBuGLaZQZ53fQXfODisHdCJ8kRoEXu5kwIoOiw5fXtkwVy2Tag9wxavCkvm8pXYmYmSmtAJ4LY569a_v7NlRJ5lNJ_5Wq-ZMirs8jDhRZB2pTSXDaRDPV/w640-h444/APL.jpg" width="640" /></a></div><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span><p></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRLUmRvkf-dbySQpuQVk08ENcSCvcZLtzunCy-25pvuGE5yfKGRtJoZNKqP0pauPtVmDI_aJsIsJy8sfFuiPiW_w1DDEcVDqlFaknI-JqyWPab2PrEpBW0JHIYHdPkzrJrj3_IRcuVoGUL/s2048/123.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1536" data-original-width="2048" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRLUmRvkf-dbySQpuQVk08ENcSCvcZLtzunCy-25pvuGE5yfKGRtJoZNKqP0pauPtVmDI_aJsIsJy8sfFuiPiW_w1DDEcVDqlFaknI-JqyWPab2PrEpBW0JHIYHdPkzrJrj3_IRcuVoGUL/w640-h480/123.jpg" width="640" /></a></div><br /><p></p>
<p class="MsoNormal"><b><u><span lang="ZH-TW" style="font-family: "PMingLiU",serif; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">深紫紅</span><o:p></o:p></u></b></p>
<p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;">我們又淺入深(顏色上),最後要為大家介紹一下深紫紅色。它是一種可在</span>inv(16)(p13q22)<span lang="ZH-TW" style="font-family: PMingLiU, serif;">相關</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">中所見到的顏色。</span>inv(16)<span lang="ZH-TW" style="font-family: PMingLiU, serif;">即第</span>16<span lang="ZH-TW" style="font-family: PMingLiU, serif;">號染色體出現倒位(</span>inversion<span lang="ZH-TW" style="font-family: PMingLiU, serif;">),這染色體變化會製造出</span>CBFB-MYH11<span lang="ZH-TW" style="font-family: PMingLiU, serif;">融合基因,產生信號令細胞異常生長,成為癌細胞。</span></p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal">inv(16) <span lang="ZH-TW" style="font-family: PMingLiU, serif;">相關的</span>AML<span lang="ZH-TW" style="font-family: PMingLiU, serif;">常伴隨著異變的嗜酸性白血球先驅細胞(</span>eosinophilic
precursor<span lang="ZH-TW" style="font-family: PMingLiU, serif;">)。一般的嗜酸性白血球先驅細胞顆粒是橙紅色的,但</span>inv(16)
<span lang="ZH-TW" style="font-family: PMingLiU, serif;">中的異常嗜酸性白血球先驅細胞則帶有粗粗的深紫色顆粒。</span></p><p class="MsoNormal"><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span></p><p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioZvs6rsY5zDSiqnXULnBUEnV-2KSjlP49oHrM1eZYOloB-h6Vuz5qtcV1Z5OH9a2iuGu4WDxHqDMvqkq0pR8g8N1bc46XpWLSNlvGy9px6z0h01tNUCJi3ewAZ8t_3vxsM9C-zIjkXTn3/s1024/inv16-AML.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1024" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioZvs6rsY5zDSiqnXULnBUEnV-2KSjlP49oHrM1eZYOloB-h6Vuz5qtcV1Z5OH9a2iuGu4WDxHqDMvqkq0pR8g8N1bc46XpWLSNlvGy9px6z0h01tNUCJi3ewAZ8t_3vxsM9C-zIjkXTn3/w640-h480/inv16-AML.jpg" width="640" /></a></div><br /><span lang="ZH-TW" style="font-family: PMingLiU, serif;"><br /></span><p></p><p class="MsoNormal"><o:p></o:p></p>235711http://www.blogger.com/profile/02818207967287513891noreply@blogger.com0