# 一名克隆氏症個案開始使用硫唑嘌呤。哪一項基線檢查對決定起始劑量並避免嚴重骨髓抑制最重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391821&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名克隆氏症個案開始使用硫唑嘌呤。哪一項基線檢查對決定起始劑量並避免嚴重骨髓抑制最重要？

## 選項

1. 維生素D濃度
2. TPMT（硫嘌呤 S-甲基轉移酶）活性或基因型，並檢查 CBC、LFT 與病毒性肝炎血清學 **✔ 正確答案**
3. BNP 檢測
4. 血脂檢查

**正確答案: 2**

## 解析

正確（2）：TPMT缺乏（低活性同合子約佔0.3%）會導致硫唑嘌呤累積，造成嚴重且可能致命的骨髓抑制。基因型/表型可指引用量或避免使用。也需基線CBC、LFT與病毒性肝炎血清學；亞洲族群考慮NUDT15。（1、3、4）與thiopurine安全性無關。

## 深入解析

記憶提示 硫唑嘌呤/6-MP開始前先測TPMT；亞洲血統還要想到NUDT15。

## 臨床情境

情境 42歲女性克隆氏症，開始使用硫唑嘌呤。治療前評估。

## 重要概念

- **硫唑嘌呤** — 普林類似物免疫抑制劑；代謝為活性代謝物6-MP。
- **TPMT 酵素** — 代謝thiopurine的酵素；缺乏型基因會增加毒性。
- **NUDT15 基因** — 在亞洲族群中影響可能比TPMT更大的藥物基因。

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