解密楊桃：與腎臟的糾葛

The Secret of Star Fruit and Kidney

楊桃為慢性腎臟病患者之禁忌水果，國內、外多篇病例報告提出慢性腎臟病患者在食用楊桃產品後，導致噁心嘔吐、急性腎衰竭併發症，以及無法抑制的打嗝和癲癇發作等神經症狀，嚴重者甚至死亡。本文根據文獻，歸納楊桃對於腎臟的致病機轉為二：草酸堆積致使草酸腎病變、急性腎衰竭；同時神經毒素－Caramboxin持續累積及吸收後，通過血腦障壁影響中樞神經系統傳導物質平衡，使得神經過度興奮而導致神經官能症狀，如：意識混亂及癲癇發作，目前主要以血液透析或血液灌流為治療方法，但治療指引尚未建立。除了慢性腎臟病患，腎功能正常的人也可能因食用楊桃而出現病症；故無論腎功能正常與否，在食用楊桃除了注意食用量外，後續也須留意是否有不適症狀出現，若有則應及早就醫治療避免病情迅速惡化。同時，醫師若發現慢性腎臟病患者主訴無法抑制的打嗝、噁心嘔吐或失眠等症狀時，需特別留意是否與食用楊桃有關。

Star fruit (Averrhoa carambola) is considered a taboo for patients with chronic kidney disease (CKD). According to various previous studies, CKD patients suffered from intractable hiccup, vomiting, oxalate nephropathy, acute renal failure, seizure and coma after having star fruits. Two substances, oxalate and caramboxin, have been identified in the literature as the causes of star fruitinduced symptoms. Oxalate results in nephrotoxicity, which can also be triggered by caramboxin. The star fruit-induced symptoms usually become less severe after hemodialysis or hemoperfusion. There is no protocol to treat the star fruit-induced disease yet. Both patients with CKD and people with normal renal function could become ill after consuming star fruits. However, the amount of star fruits needed to result in nephrotoxicity or neurotoxicity and proper administration remain understudied in the literature. Therefore, in treating patients with hiccup, vomiting, mental confusion and seizure, especially those diagnosed as CKD, physicians and health professionals should pay attention to whether they have eaten star fruits.