[{"data":1,"prerenderedAt":67},["ShallowReactive",2],{"q-nurse-115-2-basic-medicine-044":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":36,"lastmod":66},"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":27},"nurse-115-2-基礎醫學-044","nurse-115-2-basic-medicine-044",115,2,44,"下列何種自體免疫疾病是由免疫複合物媒介（第三型過敏反應）？",{"A":15,"B":16,"C":17,"D":18},"第一型糖尿病","類風濕性關節炎","多發性硬化症","亞急性細菌性心內膜炎","D",null,[],"本題考點是過敏反應四型分類中第三型免疫複合物型的代表疾病。第三型反應的機轉是抗原與 IgG 或 IgM 結合成可溶性免疫複合物,沉積於血管壁、腎絲球或關節滑膜,活化補體並吸引嗜中性球釋出溶酶體酵素造成組織傷害;亞急性細菌性心內膜炎因心內膜上持續存在的菌體抗原刺激,血中形成大量循環免疫複合物並沉積於腎絲球與皮膚小血管,是經典的免疫複合物媒介病變,故選 D。選項 A 的第一型糖尿病由自體反應性 T 細胞破壞 β 細胞,屬第四型。選項 C 的多發性硬化症由 T 細胞媒介中樞髓鞘破壞,亦屬第四型。選項 B 的類風濕性關節炎雖有類風濕因子形成的免疫複合物參與,但教科書多同時強調 T 細胞媒介的滑膜發炎,分類上並非單純第三型,故非本題最佳答案。","四型分類先背骨架再處理灰色地帶。第一型:IgE 與肥大細胞,即刻型(過敏性休克、氣喘、過敏性鼻炎)。第二型:IgG 或 IgM 直接攻擊細胞或基質抗原(自體免疫溶血性貧血、免疫性血小板低下、Graves 病、重症肌無力、Goodpasture 症候群、輸血反應)。第三型:可溶性免疫複合物沉積(系統性紅斑性狼瘡、鏈球菌感染後腎絲球腎炎、血清病、Arthus 反應、多發性動脈炎、亞急性細菌性心內膜炎相關腎炎)。第四型:T 細胞或巨噬細胞媒介的延遲型(結核菌素試驗、接觸性皮膚炎、移植排斥、第一型糖尿病、多發性硬化症)。第二型與第三型的關鍵區別在抗原位置:固定在細胞或組織上的抗原走第二型,可溶性抗原在循環中結合成複合物再沉積走第三型,這一句話可解掉大半題目。臨床線索上第三型常見補體 C3、C4 下降(被消耗)與血管炎樣皮膚病灶。需誠實指出的侷限是類風濕性關節炎在不同教科書可能被歸入第三型或第三與第四型混合,本題以官方答案的亞急性細菌性心內膜炎為單一最典型的免疫複合物病。",[25,28,31,32,34],{"term":26,"count":27},"第三型過敏反應",3,{"term":29,"count":30},"免疫複合物沉積",1,{"term":18,"count":30},{"term":33,"count":30},"第四型 T 細胞媒介反應",{"term":35,"count":30},"過敏反應四型分類",[37,41,46,51,56,61],{"webId":38,"stem":39,"number":40,"year":10,"session":11},"nurse-115-2-basic-medicine-045","金黃色葡萄球菌（Staphylococcus aureus）若懸浮於人類的血漿中會促進纖維蛋白（fibrin）形成引發凝血，與下列那一種毒素最相關？",45,{"webId":42,"stem":43,"number":44,"year":45,"session":11},"nurse-106-2-basic-medicine-011","下列何者的內襯上皮不是單層柱狀？",11,106,{"webId":47,"stem":48,"number":49,"year":50,"session":30},"nurse-107-1-basic-medicine-025","下列何者含有血睪丸障壁（blood-testis barrier）？",25,107,{"webId":52,"stem":53,"number":54,"year":55,"session":30},"nurse-108-1-basic-medicine-063","關於腸泌素類似物（incretin minetics）的敘述，下列何者錯誤？",63,108,{"webId":57,"stem":58,"number":59,"year":60,"session":11},"nurse-109-2-basic-medicine-027","男性心血管疾病發生率高於非更年期女性，主要是下列何種因素導致此現象？",27,109,{"webId":62,"stem":63,"number":64,"year":65,"session":11},"nurse-110-2-basic-medicine-061","下列何種藥物可預防或減輕因使用 Aspirin 造成之消化性潰瘍？",61,110,"2026-08-06",1787299017826]