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腸胃肝膽健康・醫學週報
整合台灣熱門醫學新聞與頂尖期刊（NEJM・Lancet）肝・膽・胃・腸・減重・代謝領域最新研究，每週自動更新
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台灣醫學新聞 TOP 5
健保9/1起首度給付罕見膽汁鬱積搔癢新藥 ALGS、PFIC病童受惠
健保署自9月1日起新增給付含 maralixibat 成分藥品，用於一歲以上阿拉吉歐症候群（ALGS）與進行性家族性肝內膽汁滯留症（PFIC）病人的膽汁鬱積搔癢，可降低血清膽酸、改善反覆摳抓破皮；另納入PNH口服新藥，本次新措施總挹注藥費25.48億元。
一次切除15顆大腸腺瘤！醫：大多數大腸癌由腺瘤演變，定期篩檢最有效
胃腸肝膽科醫師張靖分享單次大腸鏡切除15顆腺瘤的罕見個案，強調大腸癌多由腺瘤長大癌變而來，發現就該切除。除家族遺傳外，建議少吃加工肉品、多攝取蔬菜纖維、規律運動避免肥胖，並定期做大腸鏡或糞便潛血檢查。
流感疫情持續上升 疾管署：公費抗病毒藥擴大用藥條件延長至10/31
疾管署9月18日表示流感已進入流行期且持續上升，公費流感抗病毒藥劑「有類流感症狀之高傳播族群」（醫事人員、長照機構、幼托與學生、與高風險者同住等7類）適用期限延長至10月31日；符合條件者不需快篩即可由醫師開立，全國約4千家合約院所配置克流感與易剋冒。
放屁特別臭別只怪吃肉 醫：合併腹瀉、脂肪便、體重下降要就醫
胃腸肝膽科醫師楊子緯指出，成人每天放屁10～20次屬正常，臭味多來自腸道菌分解含硫胺基酸（紅肉、蛋、豆類、十字花科蔬菜）。但若持續惡臭並合併腹瀉、油亮黏膩的脂肪便與不明原因體重下降，可能是吸收不良、菌相失衡或腸道感染，應盡速檢查。
手搖飲稽查：知名連鎖店腸桿菌科超標140倍 食藥署共裁罰105萬
食藥署9月17日公布「現場調製飲品及冰品稽查專案」結果，查核387家、抽驗448件，6件不合格；台北一家青山分店檢出腸桿菌科1400 CFU/ml（限量10），另有咖啡因標示不符、食品逾期、未投保產品責任險等違規，合計裁罰105萬元。
頂尖期刊
NEJM 近期研究
Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal (EPoS II)
In this European noninferiority trial, 10,799 patients with high-risk adenomas were randomized to first surveillance colonoscopy at 5 years or 3 years after polyp removal. At the 5.5-year interim analysis, cumulative colorectal cancer incidence was 0.77% with 5-year surveillance versus 0.82% with 3-year surveillance, meeting noninferiority. Cancer stage distribution and colorectal cancer deaths did not differ substantially between groups.
歐洲八國非劣性試驗納入10,799名高風險腺瘤（≥10 mm、高度異生、絨毛狀或3–10顆）病人，隨機分配息肉切除後5年或3年做第一次追蹤大腸鏡。5.5年期中分析顯示，5年組大腸癌累積發生率0.77%、3年組0.82%，達非劣性；分期分布與大腸癌死亡無明顯差異，支持放寬追蹤間隔。
Blinatumomab for Replacing Chemotherapy in Pediatric Acute Lymphoblastic Leukemia
In this randomized trial of 709 children with newly diagnosed high-risk B-cell ALL, replacing two consolidation chemotherapy cycles with blinatumomab increased estimated 4-year event-free survival from 70.3% to 83.0% (hazard ratio 0.51). Treatment-related infections fell from 69.4% to 23.9%, and life-threatening adverse events were fewer, although neurotoxic events were more frequent with blinatumomab.
709名新診斷高風險B細胞ALL兒童隨機分組，以兩個週期 blinatumomab 取代傳統化療。中位追蹤2.9年，4年無事件存活率由70.3%提升至83.0%（HR 0.51）；治療相關感染從69.4%降至23.9%，危及生命不良事件也較少，但神經毒性事件較多（12.0% vs 3.2%）。
Tambotatug Pelitecan in Small-Cell Lung Cancer after Platinum-Based Therapy (TAISHAN-302)
In this phase 3 trial, 451 patients with small-cell lung cancer progressing after platinum-based therapy were randomized to tambotatug pelitecan, a B7-H3-targeting antibody-drug conjugate, or topotecan. Median overall survival was 13.3 versus 9.4 months (hazard ratio 0.46), progression-free survival 7.4 versus 2.8 months, and objective response 59.1% versus 9.7%, with fewer grade 3 or higher adverse events.
451名鉑類治療後惡化的小細胞肺癌病人隨機接受 B7-H3 標靶 ADC 藥物 tambotatug pelitecan 或 topotecan。中位整體存活13.3 vs 9.4個月（HR 0.46），無惡化存活7.4 vs 2.8個月，客觀反應率59.1% vs 9.7%，且≥3級不良事件反而較少（55.4% vs 77.9%）。
頂尖期刊
Lancet 近期研究
Efficacy and safety of mitapivat in adults with transfusion-dependent α- or β-thalassaemia (ENERGIZE-T): phase 3 trial
ENERGIZE-T randomized 258 adults with transfusion-dependent α- or β-thalassaemia across 19 countries to oral mitapivat 100 mg twice daily or placebo for 48 weeks. Transfusion reduction response occurred in 30% versus 13% (adjusted difference 18 percentage points). Common adverse events included headache, upper respiratory infection, insomnia, diarrhoea and fatigue; no deaths occurred, supporting mitapivat as the first oral disease-modifying therapy.
ENERGIZE-T 於19國納入258名輸血依賴型α或β地中海型貧血成人，隨機接受口服丙酮酸激酶活化劑 mitapivat 或安慰劑48週。輸血量減少反應率30% vs 13%（差異18個百分點，p=0.0003）；常見副作用為頭痛、上呼吸道感染、失眠、腹瀉，無死亡，為首個口服疾病修飾療法。
Catheter ablation for symptomatic atrial fibrillation (PVI-SHAM-AF): a randomised, double-blind, sham-controlled trial
In this double-blind sham-controlled trial, 262 patients with symptomatic paroxysmal or persistent atrial fibrillation were randomized 2:1 to catheter ablation or a sham procedure. At 6 months, AFEQT quality-of-life scores improved substantially in both groups (61.3 to 81.1 versus 59.2 to 74.9), with a nonsignificant between-group difference of 2.6 points. Ablation did not demonstrate superiority over sham for symptom-related quality of life.
德國與波蘭9個中心262名有症狀心房顫動病人，以2:1隨機接受導管消融或假手術，雙盲追蹤6個月。兩組 AFEQT 生活品質分數皆明顯改善（61.3→81.1 vs 59.2→74.9），組間差異僅2.6分（p=0.36），消融未顯示優於假手術，顯示安慰劑效應在症狀改善中扮演重要角色。
頂尖期刊
JAMA 近期研究
Liquid Biopsies for Cancer: A Translational Science Review
This review summarizes circulating tumor DNA applications: guiding molecularly targeted therapy in lung, colorectal and breast cancer, monitoring treatment response, and detecting minimal residual disease. Post-treatment ctDNA detection strongly predicts recurrence; in colorectal cancer, molecular relapse was detected about 8.7 months earlier than imaging. Optimal testing timing, management of ctDNA-positive imaging-negative patients, and cost-effectiveness remain unresolved.
本回顧整理循環腫瘤DNA（ctDNA）在肺癌、大腸癌、乳癌的臨床應用：指引標靶治療選擇、監測治療反應與偵測微量殘留疾病。治療後ctDNA陽性與復發及較差存活強烈相關；大腸癌中分子復發比影像早約8.7個月被發現。最佳檢測時機、影像陰性但ctDNA陽性的處置及成本效益仍待釐清。
High-Dose Intravenous Vitamin C and Mortality and Organ Dysfunction in Severe Burn Injury: The VICTORY Randomized Clinical Trial
In this international phase 3 trial, 238 adults with deep burns covering at least 20% body surface area were randomized to intravenous vitamin C 50 mg/kg every 6 hours for 96 hours or placebo. The composite of 28-day mortality and persistent organ dysfunction occurred in 40.8% versus 29.7%, and 28-day mortality was higher with vitamin C (15.0% vs 7.6%), prompting early termination for futility and possible harm.
24個燒傷中心238名體表面積≥20%深度燒傷成人，隨機接受高劑量靜脈維生素C（50 mg/kg每6小時、共96小時）或安慰劑。28天死亡或持續器官功能障礙複合終點40.8% vs 29.7%，28天死亡率15.0% vs 7.6%（RR 1.96），試驗因無效且可能有害而提前中止。
Integrated Telehealth Rehabilitation and Quality of Life in Mechanically Ventilated Adults: A Randomized Clinical Trial
This stepped-wedge cluster randomized trial in 20 Brazilian public hospitals enrolled 1916 adults with acute hypoxemic respiratory failure requiring invasive ventilation. A telehealth-based rehabilitation program spanning ICU, ward and 2 months post-discharge modestly improved 90-day EQ-5D-3L utility (0.16 vs 0.12), reduced 90-day mortality (71.8% vs 78.3%) and shortened mechanical ventilation duration (9.9 vs 15.5 days).
巴西20家公立醫院階梯式叢集隨機試驗，納入1916名需插管的急性低血氧呼吸衰竭成人。涵蓋ICU、病房到出院後2個月的遠距復健方案，使出院90天EQ-5D-3L效用值略升（0.16 vs 0.12），90天死亡率下降（71.8% vs 78.3%），呼吸器使用天數縮短（9.9 vs 15.5天）。
Prognostic Value of Blood-Based P-Tau217 Levels for Progression to Cognitive Impairment
Pooling 2684 cognitively unimpaired older adults from 6 cohorts with median 5.4-year follow-up, each 1-SD increase in baseline plasma p-tau217 raised the hazard of progression to cognitive impairment by 38%, independent of amyloid PET. Participants with high and very high p-tau217 had 24% and 38% absolute 5-year risk, respectively, and faster cognitive decline, supporting p-tau217 for prognostic model development.
彙整北美、日本、澳洲6個世代2684名認知正常長者，中位追蹤5.4年。基線血漿p-tau217每升高1個標準差，進展至認知障礙風險增加38%，且獨立於類澱粉PET。p-tau217高與極高者5年絕對風險分別為24%與38%，認知下降也較快，支持作為預後模型與試驗設計依據。
頂尖期刊
Gastroenterology 近期研究
Faecalibacterium prausnitzii EXL01 Strain for the Prevention of Multiple-Recurrent Clostridioides difficile Infection
In a murine CDI model and a multicenter open-label phase 1 trial of six adults with at least three C. difficile episodes, oral Faecalibacterium prausnitzii EXL01 given for 8 weeks after vancomycin was safe, and 83.3% remained recurrence-free at week 8, comparable to matched FMT cohorts. Engraftment correlated with restored secondary bile acid and butyrate production, supporting function-targeted precision microbiome therapy.
於小鼠模型與多中心開放性第一期試驗中，6名至少3次困難梭菌感染的成人在 vancomycin 前置後口服 F. prausnitzii EXL01 八週，無治療相關嚴重不良事件，第8週83.3%未復發，與配對FMT世代相當。菌株定殖與次級膽酸及丁酸恢復相關，支持以功能為標的的精準微菌療法。
Gastrointestinal Disorders in Scleroderma
This review covers gastrointestinal involvement in systemic sclerosis, which affects the esophagus in about 90% of patients and produces dysphagia, reflux, gastroparesis, gastric antral vascular ectasia, pseudo-obstruction, small intestinal bacterial overgrowth, constipation and fecal incontinence. Impaired motility from smooth-muscle atrophy and fibrosis is central; symptoms correlate poorly with pathology, and management largely extrapolates from non-scleroderma evidence.
本回顧整理全身性硬化症的腸胃道侵犯，約90%病人食道受累，表現為吞嚥困難、胃食道逆流、胃輕癱、胃竇血管擴張、假性腸阻塞、小腸細菌過度生長、便秘與糞失禁。平滑肌萎縮與纖維化導致的蠕動障礙是核心機轉；症狀與病理相關性差，治療多引用非硬皮症證據，需高度警覺並個別化處置。
Clonal Lymphocyte Expansions and JAK-STAT Pathway Mutations Define a Pathogenic Continuum Driving Resistance to Gluten-Free Diet in Celiac Disease
Using single-cell transcriptomic, genomic and TCR profiling of duodenal biopsies and blood from patients with type 1 and type 2 refractory celiac disease, the authors show malignant RCD2 lymphocytes are heterogeneous and that JAK inhibitors can select drug-resistant clones in vitro. In RCD1, clonal T-cell expansions with JAK-STAT-enhancing mutations were identified, suggesting a shared pathogenic continuum and caution against JAK inhibitor monotherapy.
研究以單細胞轉錄體、基因體與TCR分析第一型與第二型頑固型乳糜瀉的十二指腸切片與血液。RCD2惡性淋巴球具高度腫瘤內異質性，體外JAK抑制劑可篩選出抗藥克隆；RCD1亦發現帶有增強JAK-STAT路徑突變的克隆T細胞擴增。兩者可能共享克隆演化機轉，提示JAK抑制劑單一治療的風險。
Pre-Crohn's Disease Stool From Discordant Siblings Promotes the Development of Colitis in Germ-Free Mice
Germ-free mice were colonized with stool from 12 sibling pairs in which one sibling later developed Crohn's disease. After T-cell transfer colitis induction, recipients of pre-Crohn's stool showed greater weight loss, fecal lipocalin-2 and histologic damage than recipients of healthy sibling stool. Forty fecal metabolites differed, and sphingolipids correlated with colitis in both humans and mice, demonstrating pre-diagnostic microbiome alterations with inflammatory potential.
研究將12對不一致手足（一人日後罹患克隆氏症）的糞便移植至無菌鼠，再以T細胞轉移誘發腸炎。接受「發病前」糞便的小鼠體重減輕更多、糞便lipocalin-2與組織損傷更嚴重；40種糞便代謝物有差異，鞘脂類在人與鼠皆與腸炎相關，證實診斷前數年腸道菌相已具致炎潛能。
頂尖期刊
Hepatology 近期研究
Lactulose with or without TeleTai-Chi for the prevention of falls: A sequential multiple assignment randomized controlled trial (LiveSMART)
In this 24-week SMART trial of 230 adults with cirrhosis and portal hypertension without prior overt hepatic encephalopathy, lactulose reduced injurious falls (3.5% vs 8.5%) and non-injurious falls (15.0% vs 26.5%) versus non-use, with a win ratio of 2.3. Sequential lactulose followed by TeleTai-Chi was superior to enhanced usual care (win ratio 2.7) on a hierarchical composite of death, falls and encephalopathy.
美國四中心24週序貫多重分配隨機試驗，納入230名有門脈高壓但無明顯肝性腦病變的肝硬化成人。使用lactulose者受傷性跌倒3.5% vs 8.5%、非受傷性跌倒15.0% vs 26.5%（勝率比2.3）；lactulose接續遠距太極相較加強常規照護，在死亡/移植、跌倒與腦病變的階層複合終點上更優（勝率比2.7）。
Shear wave elastography demonstrates similar risk stratification performance to vibration-controlled transient elastography in FIB-4-based two-step algorithms for MASLD
Among 2817 MASLD patients who underwent same-session VCTE and SWE, AGA- and EASL-based two-step algorithms using SWE stratified liver-related event risk (subdistribution hazard ratios up to 18.9 for high-risk groups). Time-dependent AUCs through 60 months were 0.770 vs 0.775 (AGA) and 0.804 vs 0.805 (EASL) for SWE vs VCTE, with strong correlation (rho 0.713), indicating comparable predictive performance without formal equivalence.
2817名同一次檢查同時接受FibroScan（VCTE）與剪力波彈性成像（SWE）的MASLD病人，依AGA與EASL兩階段流程分層。SWE分層可有效區分肝臟相關事件風險（高風險組sHR達18.9）；60個月時間相依AUC分別為0.770 vs 0.775（AGA）、0.804 vs 0.805（EASL），兩者相關性強（ρ=0.713），預測表現相當。
A First-in-Human study of AHB-137, an unconjugated antisense oligonucleotide, in healthy subjects and patients with chronic hepatitis B
This phase 1 study evaluated AHB-137, an unconjugated antisense oligonucleotide targeting all HBV mRNAs, in 40 healthy volunteers and 24 virally suppressed HBeAg-negative chronic hepatitis B patients. Adverse events were mainly mild injection-site reactions and headache, with no serious treatment-related events. Pharmacokinetics were dose-proportional with a 150-220 hour half-life; HBsAg declined 0.7-1.0 log10 IU/mL, and three patients achieved HBsAg loss at least once.
第一期試驗評估針對所有HBV mRNA的非接合反義寡核苷酸AHB-137，納入40名健康受試者與24名病毒抑制中的HBeAg陰性慢性B肝病人。不良事件多為輕度注射部位反應與頭痛，無嚴重治療相關事件；藥動學呈劑量比例、半衰期150–220小時。HBsAg平均下降0.7–1.0 log，3名病人曾達HBsAg消失。
BEACON-HCC: Best evidence and North American consensus on treatment allocation for hepatocellular carcinoma
Through a modified Delphi process, 20 North American experts across hepatology, oncology, surgery, radiology and radiation oncology developed BEACON-HCC, a treatment allocation framework incorporating intrahepatic tumor burden, vascular invasion, adverse prognostic markers, external beam radiation, radioembolization and systemic-locoregional combinations. In 29 real-world cases, expert decisions showed 96.6% concordance with BEACON-HCC versus 72.4% with BCLC 2025.
20位北美肝臟科、腫瘤科、外科、放射科與放射腫瘤專家以修正式Delphi法建立BEACON-HCC治療分配框架，納入肝內腫瘤負荷、血管侵犯、不良預後標記，並整合體外放射、放射栓塞與全身合併局部治療。29例真實病例中，專家決策與BEACON-HCC一致率96.6%，與BCLC 2025僅72.4%。
主題專區
糖尿病・代謝 近期研究
Calorie-Restricted DASH, Carbohydrate-Restricted, and Low-Purine Diets for Weight Loss and Urate Control in Men With Overweight or Obesity and Hyperuricemia: A Randomized Trial
In this 12-week randomized trial, 102 men with overweight or obesity and hyperuricemia followed calorie-restricted carbohydrate-restricted, DASH or low-purine balanced diets. Mean weight loss was 8.47 kg (9.3%) with no between-group difference, and serum urate reductions (-0.89, -0.79, -0.50 mg/dL) did not differ significantly. DASH had higher adherence and less lean mass loss; a transient week-1 urate rise coincided with early gout flares.
102名過重或肥胖合併高尿酸男性隨機接受限熱量（20–25 kcal/kg理想體重）的低碳水、DASH或低普林均衡飲食12週。平均減重8.47 kg（9.3%），三組無差異；血尿酸下降分別為-0.89、-0.79、-0.50 mg/dL亦無顯著差異。DASH順從性較高、軟瘦體重流失較少；第1週尿酸短暫上升並伴隨痛風急性發作高峰。
The Management of Type 1 Diabetes in Adults: The Updated 2026 Consensus Report by the ADA and EASD
This 2026 ADA/EASD consensus report updates the 2021 guidance on managing type 1 diabetes in adults, emphasizing integration of new technologies such as automated insulin delivery, incorporating new evidence and therapies including interventions to delay stage 3 type 1 diabetes, and broadening scope to screening for long-term complications and management of obesity and cardiovascular risk factors, while retaining psychosocial care and self-management education as core elements.
ADA與EASD發布2026年成人第一型糖尿病管理共識，更新2021版內容，重點強化新科技整合（自動胰島素輸注等），納入延緩第3期第一型糖尿病發病的介入、新療法與新證據，並擴大至長期併發症篩檢、肥胖與心血管風險因子管理；心理社會照護與自我管理衛教仍為核心。
Maternal and Neonatal Complications in Pregnant Women With Polyendocrine Metabolic Ovarian Syndrome: A Nested Prospective Cohort Study
In a nested cohort of 3645 pregnant women at risk of hyperglycemia within an international gestational diabetes trial, PMOS (PCOS) prevalence was 17.1%. PMOS was independently associated with early gestational diabetes (adjusted OR 1.37), a composite of adverse neonatal outcomes (aOR 1.28), neonatal special care admission (aOR 1.32), and slightly shorter gestation and birth length, with no interaction by BMI or ethnicity.
在一項國際妊娠糖尿病治療試驗中，3645名高血糖風險孕婦的巢式前瞻世代顯示PMOS（PCOS）盛行率17.1%。PMOS獨立與早發妊娠糖尿病（aOR 1.37）、新生兒不良結果複合終點（aOR 1.28）、新生兒加護／特殊照護入住（aOR 1.32）及較短妊娠週數相關，且與BMI、種族無交互作用，提示需及早辨識與監測。
主題專區
慢性腎臟病（CKD） 近期研究
Initial Changes in eGFR during Treatment with Balcinrenone and Dapagliflozin: An Exploratory Analysis of the MIRO-CKD Trial
In the phase 2 MIRO-CKD trial, 324 adults with CKD (eGFR 25-60, UACR 100-5000 mg/g) received balcinrenone/dapagliflozin 15/10 mg, 40/10 mg, or dapagliflozin alone. The combination caused a modest, reversible acute eGFR dip at week 4 (-0.6 and -1.7 mL/min/1.73 m2 vs dapagliflozin). Larger acute dips were associated with greater UACR and blood pressure reductions, and adverse event rates were low and unrelated to the dip.
MIRO-CKD第二期試驗324名CKD成人（eGFR 25–60、UACR 100–5000 mg/g）隨機接受balcinrenone/dapagliflozin 15/10、40/10 mg或單用dapagliflozin。合併治療於第4週出現輕微且可逆的急性eGFR下降（-0.6與-1.7），停藥4週後恢復；急性下降幅度越大者UACR與收縮壓降幅越大，嚴重不良事件少且與eGFR變化無關。
Glucosuria as a Marker of Adherence to Sodium-Glucose Cotransporter 2 Inhibitors and Clinical Outcomes in Real-World Practice
Using Optum real-world data (2014-2023), SGLT2 inhibitor use was associated with 18-fold higher odds of glucosuria on urinalysis. Among 45,711 patients prescribed SGLT2 inhibitors, 58% showed glucosuria within 6 months; after weighting, glucosuria was associated with lower all-cause mortality (HR 0.78), heart failure hospitalization (HR 0.87) and end-stage kidney disease (HR 0.73), with no association with fractures as a negative control.
分析Optum真實世界資料（2014–2023），使用SGLT2抑制劑者尿液常規出現尿糖的機率高18倍。45,711名處方SGLT2i的病人中58%於6個月內出現尿糖（代表服藥）；加權後尿糖者全因死亡（HR 0.78）、心衰竭住院（HR 0.87）與末期腎病（HR 0.73）風險較低，骨折陰性對照無差異。
Complement in Kidney Disease: Core Curriculum 2026
This core curriculum reviews the complement cascade as a driver of kidney inflammation and summarizes FDA-approved complement inhibitors for five renal indications: atypical hemolytic uremic syndrome, C3 glomerulopathy, immune-complex membranoproliferative glomerulonephritis, ANCA-associated vasculitis and IgA nephropathy. It covers ongoing trials of new anticomplement agents, complement biomarkers in plasma, urine and tissue, and practical laboratory evaluation for nephrologists.
本核心課程回顧補體級聯作為腎臟發炎驅動因子的角色，整理美國FDA已核准補體抑制劑的五種腎臟適應症：非典型溶血性尿毒症候群、C3腎絲球病變、免疫複合體膜增生性腎絲球腎炎、ANCA血管炎與IgA腎病變，並說明進行中的新藥試驗、血漿／尿液／組織補體生物標記與臨床實驗室評估要點。
歷史紀錄