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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
「瘦瘦丸」升級版問世！口服減重藥能否取代瘦瘦針
司美格魯肽口服錠（瘦瘦丸）與仿製藥陸續上市，2026年成為減重藥物大眾化的轉折點。醫師指出口服與針劑在適應症、效果與成本上仍有差異，短期內難以完全互相取代。
脂肪肝沒症狀不代表沒病！醫師：把握早期評估時間
脂肪肝早期常無明顯症狀，卻可能默默進展為肝纖維化甚至肝硬化。醫師提醒代謝性脂肪肝與肥胖、糖尿病、高血脂密切相關，建議及早以非侵入性檢查評估肝臟健康。
全世界直腸癌都在年輕化！4大危險因子你中了幾項
大腸直腸癌明顯年輕化，部分患者僅30多歲。肥胖、缺乏運動、紅肉與加工肉品攝取過多、家族史為主要危險因子，呼籲民眾及早篩檢並調整飲食與生活型態。
青壯年也要小心大腸癌！公費篩檢擴大升級至45歲
2026年大腸癌糞便潛血公費篩檢年齡下修至45至74歲，具家族史者40歲起即可受檢；並推動「胃腸同篩」，符合資格者可同時檢測幽門桿菌，雙重防護大腸癌與胃癌。
NIH最新研究揭開延長GLP-1減重藥效的關鍵機制
研究指出停用司美格魯肽一年後體重平均反彈約三分之二。最新研究嘗試突破GLP-1減重停滯期，強調藥物仍須搭配飲食與生活型態調整，才能維持長期成效。
頂尖期刊
NEJM 近期研究
Zanidatamab with and without Tislelizumab in HER2-Positive Gastroesophageal Cancer
In this open-label phase 3 trial, untreated HER2-positive advanced gastroesophageal adenocarcinoma patients received zanidatamab-tislelizumab-chemotherapy, zanidatamab-chemotherapy, or trastuzumab-chemotherapy. Both zanidatamab arms achieved longer progression-free survival (median 12.4 vs 8.1 months). Zanidatamab-tislelizumab-chemotherapy also prolonged overall survival (26.4 vs 19.2 months; HR 0.72). Diarrhea was the most common grade 3+ adverse event.
第三期試驗中，未治療的HER2陽性晚期胃食道腺癌患者隨機接受zanidatamab加tislelizumab併化療、zanidatamab併化療或trastuzumab併化療。兩組zanidatamab的無惡化存活期較長（中位12.4 vs 8.1個月）；zanidatamab加tislelizumab併化療的整體存活期也延長（26.4 vs 19.2個月）。腹瀉為最常見的嚴重副作用。
Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia
In this Bayesian adaptive platform trial, adults with methicillin-susceptible S. aureus bacteremia were randomized to cefazolin or an antistaphylococcal penicillin (flucloxacillin/cloxacillin). 90-day mortality was 15.0% with cefazolin vs 17.0% (probability of noninferiority 99.2%). Acute kidney injury was less frequent with cefazolin (13.9% vs 19.6%), supporting cefazolin as a comparable, safer option.
此貝氏自適應平台試驗將甲氧西林敏感金黃色葡萄球菌菌血症成人隨機分配至cefazolin或抗葡萄球菌青黴素。90天死亡率為15.0%對17.0%（非劣性機率99.2%），且cefazolin的急性腎損傷較少（13.9%對19.6%），顯示cefazolin為療效相當且更安全的選擇。
Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage
This cluster-randomized phase 3 trial assigned 44 air medical bases to prehospital transfusion with whole blood or blood components in trauma patients with hemorrhagic shock. 30-day mortality was 25.9% with whole blood vs 20.5% with components (adjusted OR 1.24; not significant). Whole blood did not lower mortality versus component therapy.
此叢集隨機第三期試驗將44個空中救護基地分派給創傷出血性休克病人於院前輸注全血或血品成分。30天死亡率全血組為25.9%，成分組為20.5%（校正OR 1.24，未達顯著）。結果顯示全血並未較成分輸血降低死亡率。
頂尖期刊
Lancet 近期研究
Elecoglipron, an oral small molecule GLP-1 receptor agonist in adults with obesity or overweight (VISTA): a phase 2 randomised trial
In this phase 2 dose-ranging trial (sites including Taiwan), 310 adults with obesity/overweight without diabetes received once-daily oral elecoglipron or placebo. At week 26, mean weight change ranged from -2.6% (5 mg) to -10.5% (75 mg) versus -0.6% with placebo; up to 88.8% achieved ≥5% weight loss. GI adverse events were most common.
此第二期劑量探索試驗（含台灣試驗點）納入310名無糖尿病的肥胖或過重成人，每日口服elecoglipron或安慰劑。第26週體重平均變化由-2.6%（5mg）至-10.5%（75mg），安慰劑僅-0.6%；最高達88.8%達成≥5%減重。腸胃道副作用最常見。
Perioperative serplulimab with neoadjuvant chemotherapy versus chemotherapy in PD-L1-positive gastric cancer (ASTRUM-006): a phase 3 study
In this phase 3 trial, 588 patients with resectable PD-L1-positive (CPS≥5) gastric/gastro-oesophageal junction adenocarcinoma received neoadjuvant serplulimab or placebo plus SOX chemotherapy, then adjuvant therapy. Event-free survival was significantly longer with serplulimab in the ITT population (not reached vs 35.9 months; HR 0.73) with a better safety profile.
此第三期試驗納入588名可手術切除的PD-L1陽性（CPS≥5）胃或胃食道交界腺癌病人，於術前接受serplulimab或安慰劑併SOX化療，再行輔助治療。意向治療族群中serplulimab的無事件存活期顯著延長（未達中位 vs 35.9個月；HR 0.73），且安全性較佳。
頂尖期刊
JAMA 近期研究
Lifestyle and Metformin Interventions and Risk of Multimorbidity in Adults With Prediabetes
Long-term follow-up of the Diabetes Prevention Program (1173 adults with prediabetes) examined multimorbidity (≥2 of 15 chronic conditions). Intensive lifestyle intervention was associated with lower multimorbidity risk versus placebo (HR 0.79), persisting even when diabetes was excluded; metformin showed no significant difference (HR 0.91).
糖尿病預防計畫的長期追蹤（1173名糖尿病前期成人）評估多重慢性病（15項中≥2項）。密集生活型態介入相較安慰劑可降低多重慢性病風險（HR 0.79），即使排除糖尿病仍成立；二甲雙胍則無顯著差異（HR 0.91）。
Bispecific Antibody Ivonescimab Added to Chemotherapy in EGFR-Variant NSCLC: The HARMONi-A Trial
In this phase 3 China trial, 322 patients with EGFR-variant nonsquamous NSCLC progressing after EGFR-TKI received ivonescimab (anti-PD-1/VEGF bispecific) or placebo plus chemotherapy. Ivonescimab improved overall survival (median 16.8 vs 14.1 months; HR 0.74). Grade 3+ adverse events were more frequent with ivonescimab (67.1% vs 54.7%).
此中國第三期試驗納入322名EGFR-TKI治療後惡化的EGFR變異非鱗狀非小細胞肺癌病人，接受ivonescimab（抗PD-1/VEGF雙特異性抗體）或安慰劑併化療。ivonescimab延長整體存活期（中位16.8 vs 14.1個月；HR 0.74），但嚴重副作用較多（67.1% vs 54.7%）。
An AI-Based OCT System to Detect Diabetic Macular Edema: A Validation and Noninferiority Randomized Trial
An AI-OCT system was integrated into a diabetic retinopathy screening pathway in Hong Kong. In validation it achieved 98.8% sensitivity and 90.7% specificity for DME. In the RCT (276 patients), adding AI-OCT cut the false-positive referral rate from 69.1% to 24.1% without missing any DME cases.
香港將AI-OCT系統整合進糖尿病視網膜病變篩檢流程。驗證階段對黃斑部水腫的敏感度達98.8%、特異度90.7%。隨機試驗（276人）顯示加入AI-OCT可將偽陽性轉診率由69.1%降至24.1%，且未漏診任何黃斑部水腫個案。
Digoxin in Patients With Symptomatic Rheumatic Heart Disease: A Randomized Clinical Trial
This India-based trial randomized 1769 patients with symptomatic rheumatic heart disease to digoxin or placebo. The composite of all-cause death or new/worsening heart failure occurred in 31.4% with digoxin vs 35.5% with placebo (HR 0.82). Digoxin reduced heart-failure events with little toxicity risk.
此印度試驗將1769名有症狀風濕性心臟病人隨機分配至digoxin或安慰劑。全因死亡或新發/惡化心衰竭的複合結果，digoxin組為31.4%、安慰劑組35.5%（HR 0.82）。digoxin可減少心衰竭事件且毒性風險低。
頂尖期刊
Gastroenterology 近期研究
TIM3 signaling in effector T cells acts as an immunometabolic switch to suppress intestinal inflammation
Using TIM3-deficient mice and human IBD samples, researchers showed TIM3 functions as an immunometabolic regulator, suppressing adenosine deaminase and the purine degradation pathway to keep effector T cells exhausted. Galectin-9 treatment ameliorated experimental colitis, suggesting TIM3 activation as a strategy for chronic intestinal inflammation.
研究以TIM3缺失小鼠及人類發炎性腸病檢體證實，TIM3作為免疫代謝調節因子，可抑制腺苷脫胺酶與嘌呤降解路徑，使效應T細胞維持耗竭狀態。以galectin-9治療可改善實驗性結腸炎，顯示活化TIM3為治療慢性腸道發炎的潛在策略。
Validated early detection metrics reduce the population requiring liver fibrosis screening
Using NHANES and four general-population cohorts, refined fibrosis-screening criteria targeted only 10-22% of adults (vs 60-76% under current guidelines) while raising the prevalence of significant fibrosis among those screened and keeping risk low in non-eligible individuals. In UK Biobank, those meeting criteria had ~6-fold higher 10-year cirrhosis risk.
研究運用NHANES與四個一般人群世代，精煉後的肝纖維化篩檢標準僅鎖定10–22%成人（現行指引為60–76%），同時提高受篩者顯著纖維化盛行率，並維持未受篩者低風險。英國生物樣本庫中符合標準者10年肝硬化風險約高出6倍。
AGA Clinical Practice Update on Risk Stratification and Emerging Surveillance Strategies for Hepatocellular Carcinoma
This AGA Expert Review provides Best Practice Advice on HCC surveillance: semiannual ultrasound plus AFP remains preferred; surveillance benefits cirrhosis (any etiology) and selected chronic HBV. Novel blood-based biomarkers (e.g., GALAD) and multicancer panels are not yet recommended for routine surveillance. Preventing cirrhosis is the best strategy.
此AGA專家審查提供肝癌監測最佳實務建議：仍以每半年超音波加甲型胎兒蛋白為首選；監測對各病因肝硬化及部分慢性B肝病人有益。新型血液生物標記（如GALAD）與多癌篩檢套組尚不建議常規使用。預防肝硬化為最佳策略。
Pathology-Driven Epithelial Sulfide Loss Reprograms the Redox Proteome and Triggers Barrett's Esophagus
Using proteomics across squamous, GERD-exposed, and metaplastic esophageal epithelium, researchers identified epithelial protein persulfidation (regulated by hydrogen sulfide) as a key regulator of Barrett's esophagus. GERD-induced sulfide loss accelerated metaplasia, while sulfide donors reversed it, identifying sulfide metabolism as a druggable driver of Barrett's pathogenesis.
研究以蛋白體分析比較鱗狀、胃食道逆流暴露與化生食道上皮，發現由硫化氫調控的上皮蛋白過硫化是巴瑞特食道的關鍵調節因子。逆流引起的硫化物流失加速化生，補充硫化物供體可逆轉，顯示硫化物代謝為可藥物介入的致病驅動因子。
頂尖期刊
Hepatology 近期研究
H4K12 lactylation drives TREM2high macrophages differentiation in liver fibrosis
Integrated multi-omics of human and mouse fibrotic livers showed TGF-β-activated glycolysis raises histone H4K12 lactylation at the TREM2 promoter, driving differentiation of pro-fibrotic TREM2high scar-associated macrophages via a TREM2/LDHA/H4K12la feedback loop. Disrupting this pathway mitigated liver fibrosis, offering a novel therapeutic target.
對人類與小鼠纖維化肝臟的多體學分析顯示，TGF-β活化的糖解作用提高TREM2啟動子上的組蛋白H4K12乳酸化，透過TREM2/LDHA/H4K12la正回饋環驅動促纖維化的TREM2高表現疤痕相關巨噬細胞分化。阻斷此路徑可減輕肝纖維化，提供新治療標的。
Beyond second-line therapy: Strategic sequencing of systemic treatments in advanced hepatocellular carcinoma
This review integrates phase II/III and real-world data (>4000 patients) on sequencing therapy after first-line immunotherapy in advanced HCC. Tyrosine kinase inhibitors remain effective (median OS ~10-11 months), with liver function determining eligibility. The CUSE framework reframes sequencing as an adaptive, patient-centered process beyond second line.
本綜述整合超過4000名病人的二三期與真實世界資料，探討晚期肝癌一線免疫治療後的治療排序。酪胺酸激酶抑制劑仍具療效（中位整體存活約10–11個月），肝功能決定治療資格。CUSE架構將排序重新定義為以病人為中心、可調整且超越二線的歷程。
Outcomes of Y90-radioembolization as downstaging to liver transplantation in HCC with tumoral portal vein thrombosis
Across 5 Italian centers, 240 HCC patients with tumoral portal vein thrombosis received TARE; 25.4% achieved sustained downstaging and 15.4% underwent transplant. Transplant was associated with markedly lower cancer-related death (60-month incidence 15.8% vs 45.2%; sHR 0.221), with 5-year post-transplant survival of 61.6%.
義大利5家中心收治240名合併腫瘤性門靜脈栓塞的肝癌病人接受放射栓塞，25.4%達持續降期、15.4%最終接受移植。移植與顯著較低的癌症相關死亡相關（60個月累積發生率15.8% vs 45.2%；sHR 0.221），移植後5年存活率達61.6%。
Non-transcriptional activity of IRF3 promotes liver fibrosis and stress granule assembly via a dsRNA-TLR3-dependent pathway
In mouse fibrosis models and human stellate cells, the non-transcriptional activity of IRF3 was a key driver of hepatic fibrogenesis. TGF-β-induced endogenous double-stranded RNA triggered TLR3-dependent assembly of IRF3-containing stress granules, central to stellate cell activation. Stress granules were detected in fibrotic human livers.
在小鼠纖維化模型與人類肝星狀細胞中，IRF3的非轉錄活性是肝纖維生成的關鍵驅動因子。TGF-β誘導的內源性雙股RNA觸發TLR3依賴的含IRF3壓力顆粒組裝，為星狀細胞活化的核心，且於人類纖維化肝臟中可偵測到壓力顆粒。
主題專區
糖尿病・代謝 近期研究
Precision Prescribing of SGLT2 Inhibitors for Primary Prevention of Heart Failure in Type 2 Diabetes (SABRE model)
The SABRE model combines individual heart-failure risk with the SGLT2i hazard ratio to estimate personalized 5-year HF benefit in T2D patients without ASCVD, HF, or CKD. Validated in UK data (57,368 initiators), SGLT2i lowered new HF risk by 30%; predicted absolute benefit ranged widely, enabling more targeted prescribing.
SABRE模型結合個人心衰竭風險與SGLT2i風險比，估算無動脈硬化心血管疾病、心衰竭或慢性腎病的第二型糖尿病人5年個人化心衰益處。英國資料（57,368名使用者）驗證顯示SGLT2i降低新發心衰風險30%，預測絕對益處差異大，有助更精準處方。
Time-restricted eating versus dietetic guidance on glycaemic outcomes in adults at risk of type 2 diabetes
In this Australian non-inferiority RCT, 247 adults at risk of T2D were assigned to a 9-hour time-restricted eating window or individualized dietetic guidance. At 4 months TRE was non-inferior for HbA1c change, but non-inferiority was not maintained at 12 months; absolute changes were small in both groups.
此澳洲非劣性隨機試驗將247名第二型糖尿病高風險成人分派至9小時限時進食或個人化飲食衛教。4個月時限時進食在糖化血色素變化上達非劣性，但12個月時不再維持；兩組的絕對變化皆很小。限時進食可作為飲食支援有限時的務實短期選擇。
High-intensity interval versus continuous moderate exercise on glycaemic decline in adults with type 1 diabetes
In this randomized crossover trial, 20 active adults with type 1 diabetes completed iso-mechanical high-intensity interval (HIIE) and continuous moderate exercise sessions. Glucose declined less during HIIE than continuous exercise, especially in the postabsorptive state, and HIIE reduced time spent in clinically relevant hypoglycemia over 24 hours.
此隨機交叉試驗中，20名活躍的第一型糖尿病成人完成等機械負荷的高強度間歇與持續中強度運動。高強度間歇運動期間血糖下降較少，尤其在空腹（吸收後）狀態，且24小時內顯著低血糖時間較少，顯示其對運動誘發低血糖具保護效果。
主題專區
慢性腎臟病（CKD） 近期研究
Comparison of Specific GLP-1 Receptor Agonists on Kidney Outcomes Among Patients With Type 2 Diabetes
This target trial emulation compared dulaglutide, exenatide, liraglutide, and semaglutide in T2D patients at moderate cardiovascular risk. No difference emerged for the primary kidney composite, but semaglutide was associated with lower risk of the secondary kidney-plus-death composite and lower mortality, suggesting it may be the preferred agent for kidney protection.
此目標試驗模擬比較dulaglutide、exenatide、liraglutide與semaglutide於中度心血管風險的第二型糖尿病人。主要腎臟複合結果無差異，但semaglutide與較低的次要腎臟加死亡複合結果及較低死亡率相關，顯示其可能為腎臟保護的優選藥物。
A Target Trial Emulation to Investigate Kidney Protection from Statin Initiation in Adults with Normal Kidney Function
Using Hong Kong EHR data with 449,595 matched pairs, statin initiation in adults with normal kidney function was associated with modestly lower risks of impaired kidney function (eGFR<60: HR 0.97), ≥30% and ≥50% eGFR decline, and all-cause mortality (HR 0.90), without increasing adverse kidney outcomes.
運用香港電子病歷449,595對配對資料，腎功能正常成人開始使用他汀與略低的腎功能受損風險（eGFR<60：HR 0.97）、≥30%與≥50% eGFR下降及全因死亡（HR 0.90）相關，且未增加不良腎臟結果，支持他汀具潛在腎臟保護益處。
Comprehensive geriatric assessment for frail older people with chronic kidney disease (GOAL trial)
This cluster-randomized trial across 15 Australian centers enrolled 240 frail older adults with moderate-to-severe CKD to a single outpatient comprehensive geriatric assessment plus usual care or usual care alone. At 3 months, goal attainment scores did not differ, and no secondary outcomes improved, not supporting routine single-episode outpatient CGA.
此澳洲15家中心的叢集隨機試驗納入240名中重度慢性腎病的衰弱老年人，分派接受單次門診全面老年評估加常規照護或僅常規照護。3個月時目標達成分數無差異，次要結果亦無改善，不支持常規採用單次門診全面老年評估。
歷史紀錄