[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-115-1-basic-medicine-026":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":33,"lastmod":63},"基礎醫學","basic-medicine","基礎醫學(包括解剖學、生理學、病理學、藥理學、微生物學與免疫學)",{"id":8,"webId":9,"year":10,"session":11,"subject":4,"number":12,"stem":13,"options":14,"answer":19,"answerNote":20,"images":21,"explanation":22,"explanationDeep":23,"topics":24,"freq":11},"nurse-115-1-基礎醫學-026","nurse-115-1-basic-medicine-026",115,1,26,"下列何種疾病會出現 Barts 氏血紅素（Hb Barts）？",{"A":15,"B":16,"C":17,"D":18},"甲型地中海型貧血（α-thalassemia）","鐮刀型貧血（sickle cell anemia）","遺傳性球狀紅血球症（hereditary spherocytosis）","缺鐵性貧血（iron deficiency anemia）","A",null,[],"本題考點是血紅素異常型與貧血病因的配對。Hb Barts 是由四條 γ 鏈組成的四聚體，只有在 α 鏈基因嚴重缺損、γ 鏈找不到 α 鏈配對時才會堆積，因此它是甲型地中海型貧血的標誌，尤以四個 α 基因全缺的胎兒水腫型最典型，故選 A。鐮刀型貧血是 β 鏈第六個胺基酸由麩胺酸換成纈胺酸形成 HbS，屬結構質變而非鏈數失衡。遺傳性球狀紅血球症的缺陷在紅血球膜骨架蛋白，血紅素組成本身正常。缺鐵性貧血是血基質合成原料不足，呈微小低色素紅血球，電泳不會出現異常血紅素帶。","地中海型貧血的核心病生理是「鏈失衡」：正常成人血紅素為 α2β2，胎兒為 α2γ2。α 鏈是所有時期都必需的，一旦大量缺失，胎兒期過剩的 γ 鏈就自聚成 γ4（Hb Barts），出生後過剩的 β 鏈自聚成 β4（Hb H）。所以記法是「α 缺 → 胎兒期 Barts、之後 Hb H」；β 缺則相反，α 鏈過剩但不會形成穩定四聚體，而是沉積傷害紅血球前驅細胞，造成無效造血。臨床設計此考點是因台灣為地中海型貧血高盛行區，新生兒與孕前篩檢常以血紅素電泳加上 MCV 偏低、鐵質正常來鑑別，避免誤補鐵。可連結概念：MCV、鐵質四項、Hb H disease、胎兒水腫。",[25,27,29,31],{"term":26,"count":11},"Hb Barts(γ4 四聚體)",{"term":28,"count":11},"甲型地中海型貧血",{"term":30,"count":11},"血紅素電泳",{"term":32,"count":11},"紅血球膜骨架缺陷",[34,38,43,48,53,58],{"webId":35,"stem":36,"number":37,"year":10,"session":11},"nurse-115-1-basic-medicine-027","下列何種病毒不會造成慢性肝炎？",27,{"webId":39,"stem":40,"number":41,"year":42,"session":11},"nurse-106-1-basic-medicine-023","下列何者抑制泌乳素分泌？",23,106,{"webId":44,"stem":45,"number":46,"year":42,"session":47},"nurse-106-2-basic-medicine-037","下列何種疾病的發生與抽菸的關係最少？",37,2,{"webId":49,"stem":50,"number":51,"year":52,"session":47},"nurse-107-2-basic-medicine-075","白色念珠菌（C. albicans）的結構及生理特性，下列何者錯誤？",75,107,{"webId":54,"stem":55,"number":56,"year":57,"session":11},"nurse-109-1-basic-medicine-039","下列何者最不可能引起左心衰竭（left heart failure）？",39,109,{"webId":59,"stem":60,"number":61,"year":62,"session":11},"nurse-110-1-basic-medicine-073","下列何種器官移植，較可能發生移植體對抗宿主疾病（graft-versus-host disease; GVHD）？",73,110,"2026-08-06",1787299087722]