# 一名HER2陽性乳癌個案開始trastuzumab。哪一項基線與追蹤評估是必要的？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391868&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名HER2陽性乳癌個案開始trastuzumab。哪一項基線與追蹤評估是必要的？

## 選項

1. 每日INR
2. 每月皮膚切片
3. 基線LVEF（echo或MUGA）並每3個月追蹤LVEF；trastuzumab會造成可逆性心毒性，anthracycline曝露會放大風險 **✔ 正確答案**
4. 每日尖峰流速

**正確答案: 3**

## 解析

正確（2）：Trastuzumab（抗HER2）會造成可逆性心肌病變，尤其在anthracycline後或併用時。需基線與每3個月LVEF監測。若LVEF絕對下降≥16%或低於機構門檻需暫停；與anthracycline不同，停藥後常可恢復。（1、3、4）無關。

## 深入解析

記憶提示 Trastuzumab看HER2也看心臟；心毒性常比doxorubicin更可逆。

## 臨床情境

情境 48歲女性HER2+乳癌，曾接受anthracycline，現在開始trastuzumab。

## 重要概念

- **Trastuzumab（Herceptin）** — 用於HER2+乳癌/胃癌的抗HER2單株抗體；可能造成可逆心毒性。
- **LVEF監測** — 治療期間與之後，基線加每3個月追蹤。
- **可逆性心毒性** — Trastuzumab心毒性通常停藥後改善，與anthracycline不同。

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