# 護理師準備為一名漢族且新發三叉神經痛的病人開始 carbamazepine。治療前最重要的檢查是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391742&lang=zh-tw  
> language: zh-TW  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## 題目

護理師準備為一名漢族且新發三叉神經痛的病人開始 carbamazepine。治療前最重要的檢查是什麼？

## 選項

1. HLA-B*1502 基因檢測 **✔ 正確答案**
2. 血清鈉
3. 全血球計數（CBC）
4. 肝功能檢查

**正確答案: 1**

## 解析

正解 (2): HLA-B*1502與carbamazepine誘發的Stevens-Johnson症候群（SJS）及毒性表皮壞死鬆解症（TEN）高度相關；此等位基因在漢族、泰國及其他東南亞族群較常見。FDA要求開始前篩檢。帶因者應改用其他抗癲癇藥。(1) CBC用於長期監測再生不良性貧血，但不是啟用前的關鍵篩檢。(3,4) 鈉與肝功能是治療中監測項目，不是致命過敏反應的預篩。

## 深入解析

記憶提示 Carbamazepine = “C for Chinese screening”：亞洲族群先查HLA-B*1502。HLA-B*5701則是abacavir的類似藥物基因門檻。

## 臨床情境

情境 42歲漢族女性，因三叉神經痛，醫囑 carbamazepine 200 mg PO BID。過去未使用過抗癲癇藥。

## 重要概念

- **HLA-B*1502** — 與carbamazepine誘發SJS/TEN高度相關的基因標記；高風險族群開始前需篩檢。
- **Stevens-Johnson症候群** — 伴隨表皮剝離的嚴重黏膜皮膚反應，可致命；carbamazepine是高風險誘因之一。
- **藥物基因體篩檢** — 用基因檢測預測嚴重藥物反應並個別化治療；高風險族群使用carbamazepine前篩檢HLA-B*1502是標準例。

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