新冠後遺症（長新冠）
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請謹記，大多數營養素不具藥物療效。對於缺乏某些營養素的人士，服食補充劑是有效的方法，否則無效。

缺鐵^[25]

缺鐵是疲勞的常見原因，特別是女性。某些疾病還可能會導致缺鐵程度加劇。簡單的血液測試可檢查是否缺鐵，例如鐵蛋白水平測試。缺鐵可以通過靜脈注射或口服鐵劑來改善。

維生素 D^[27]

維生素 D 是支持免疫系統的關鍵營養素，並具有抗炎作用。維生素 D 主要是由陽光對皮膚的作用所產生，因此在隔離和生病期間，維生素 D 含量可能會下降。由於維生素 D 是脂溶性，容易累積在體內，因此易於測量其水平並相應作出補充。每天補充 2,000 國際單位（IU）對成年人來說是安全的。

缺鋅^[27],[28]

缺鋅問題在全球常見，亦是免疫力低下的公認原因。 一般來說，蛋白質食品含鋅量普遍較多，所以低蛋白飲食是有風險的，而且對鋅的需求也會隨着感染而增加。長期過度攝入鋅會導致缺銅，每天 30 毫克鋅的攝取量，持續 3 至 6 個月還算是安全。

缺硒^[27]

在領康醫療，我們通常看到患者體內硒水平低。硒是免疫系統必需的營養素之一。低硒情況對居於低硒地區的人來說很常見。堅果和種子只有在含硒的土壤生長時才含有硒。補充劑量通常是每天 200 微克，以硒代氨基酸形式吸收更好。

奧米加 3 脂肪酸^[30]

已知存在於魚油和一些植物油中具有抗炎作用。它們減少炎症信息分子，甚至可以穩定肥大細胞。每天服用 2 克優質魚油已被證明可以減輕炎症。

益生菌^[31]

我們的文章曾提及關於益生菌的抗炎作用。每天服用益生菌可以改善免疫系統功能。

許多新冠後遺症患者有肥大細胞活化綜合症的症狀^[35]。想了解更多，我們在這裡有一篇文章。 與體位性心動過速一樣，肥大細胞活化綜合症是一種廣泛的現象，不限於新冠後遺症。治療目標是針對過量的組織胺，抗組織胺藥能阻止組織胺釋放。

許多新冠後遺症和慢性疲勞的患者表現出體位性心動過速的體徵和症狀。也就是說，由於自主神經系統紊亂，患者的心率增加或血壓可能會下降（不能靠意識控制）。體位性心動過速相當普遍，據估計，在美國有超過一百萬的體位性心動過速患者，因此有這方面的治療經驗。

槲皮素

這是一種天然類黃酮，可減少肥大細胞中組織胺的釋放，其作用方式與肥大細胞穩定劑如色甘酸類似。它通常與維他命 C 和菠蘿蛋白酶一起配製以增加吸收。

薑黃素

這是一種天然存在的抗炎化合物，已被廣泛用作自然療法。有增強吸收的配方可供選擇。相對醫用抗炎藥而言，薑黃素的主要好處是沒有胃潰瘍等腸道副作用。

氟伏沙明

已有文獻提出抗抑鬱藥氟伏沙明作為治療新冠的方法^[33]。任何類型的慢性疾病患者，特別是有神經系統症狀和疲勞的患者，通常會服用抗抑鬱藥物作為管理疾病的一部分。SSRI 類抗抑鬱藥氟伏沙明是 sigma-1 受體的刺激劑，具有抗炎作用。如果本身需要抗抑鬱藥，有持續炎症的新冠患者可以考慮使用氟伏沙明。

褪黑激素

這是一種眾所周知用於改善失眠和倒時差的補充劑，並且可以廣泛使用。人類的褪黑激素由松果體和線粒體產生。除了誘導睡眠，褪黑激素具有很強的抗氧化和抗炎作用，還可以穩定肥大細胞^[34]。通常使用的劑量是每天 6 至 10 毫克。褪黑激素是安全的，常見副作用是增加做夢。

新冠重症死亡率降低的原因之一是使用皮質類固醇。在最初的醫院試驗中，使用了地塞米松。在門診患者中，更常用的是潑尼松。類固醇是強大的抗炎藥，但它們也會抑制對感染的正常免疫反應。此外，如果長期服用，可以抑制腎上腺皮質類固醇的正常產生。當出現炎症時，可短期使用潑尼松治療新冠後遺症，但應在醫療監督下進行。

阿托伐他汀

一種用於治療新冠後遺症 ^[35] 的他汀類降膽固醇藥物。除了阻斷肝臟膽固醇的製造外，他汀類藥物還具有很強的抗炎作用。他汀類藥物被廣泛使用，因此長期使用也安全。由於他汀類藥物還會阻斷能量產生所必需的輔酶 Q10 產生，以致他汀類藥物的副作用與新冠後遺症並無不同，即疲勞、腦霧和肌肉疼痛。輔酶 Q10 可以與阿托伐他汀一起作為補充劑服用。

低劑量納曲酮

低劑量納曲酮（LDN）已被提議作為新冠和新冠後遺症的潛在治療方法。納曲酮是一種鴉片拮抗劑，即它可以阻斷海洛英、嗎啡和芬太尼等鴉片製劑的作用。鴉片類藥物過量是鴉片類藥物濫用問題的國家常見死因，而納曲酮可用於鴉片類藥物過量的情況。

鴉片受體的天然刺激物是內啡肽，可充當止痛藥和抗炎藥。低劑量納曲酮在短時間內阻斷鴉片受體，刺激身體產生更多的內啡肽，從而增加它們的活性。

納曲酮片劑的常用劑量為 50 毫克，而低劑量納曲酮的常用劑量為 1 毫克至 4.5 毫克。這些低劑量納曲酮的作用實際上是增加天然內啡肽，刺激與藥物作用相同的鴉片受體。稍為增加內啡肽水平亦能起到抗炎和鎮痛的作用。

1. Centers for Disease Control and Prevention. (2021). ‘Post-COVID Conditions.’ CDC. 12 July 2021. Available at: <https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html> [Accessed 10 September 2021].

2. National Health Service. (2021). ‘Long-term effects of coronavirus (long COVID)’ NHS. 2 September 2021. Available at: <https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/> [Accessed 10 September 2021].

3. The World Health Organization. (2021). ‘Episode #47 - Post COVID-19 condition.’ WHO. 30 July 2021. Available at: <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-47---post-covid-19-condition> [Accessed 10 September 2021].

6. National Institute for Health and Care Excellence. (2020). ‘COVID-19 rapid guideline: managing the long-term effects of COVID-19’. NICE. 18 December 2020. Available at: <https://www.nice.org.uk/guidance/ng188> [Accessed 10 September 2021].

8. Kent J. Nielsen, Jesper Medom Vestergaard., et al. (2021). ‘Day by day symptoms following positive and negative PCR tests for SARS-CoV-2 in non-hospitalised health-care workers: a 90-day follow-up study’. International Journal of Infectious Diseases. March 03, 2021. Available at: <https://www.medrxiv.org/node/310296.external-links.html> [Accessed 10 September 2021].

20. Huang, Chaolin et al. (2021). ‘6-month consequences of COVID-19 in patients discharged from hospital: a cohort study’. The Lancet, Volume 397, Issue 10270, 220 - 232. 8 January 2021. Available at: <https://doi.org/10.1016/S0140-6736(20)32656-8> [Accessed 10 September 2021].

41. Groff, D., Sun, A., & Ssentongo, A. E. (2021). Short- and long-term rates of postacute sequelae of SARS-COV-2 infection. JAMA Network Open. October 13, 2021. Available at: <https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784918.> [Accessed November 22, 2021]

4. CUHK Faculty of Medicine. (2021). ‘CU Medicine Finds New Evidence for Link between Gut Microbiome and COVID-19 Severity Microbiome Imbalance Might Influence “Long COVID” Risk’. CUHK. 18 January 2021. Available at: <https://www.med.cuhk.edu.hk/press-releases/cu-medicine-finds-new-evidence-for-link-between-gut-microbiome-and-covid-19-severity-microbiome-imbalance-might-influence-long-covid-risk> [Accessed 10 September 2021].

5. Office for National Statistics. (2021). ‘Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021’. ONS. 1 April 2021. Available at: <https://www.ons.gov.uk/> [Accessed 10 September 2021].

9. Lam MH, Wing Y, Yu MW, et al. (2009). ‘Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up’. Arch Intern Med. 2009;169(22):2142–2147. 14 December 2009. Available at: <doi:10.1001/archinternmed.2009.384> [Accessed 10 September 2021].

10. Lee SH, Shin HS, Park HY, et al. (2019). ‘Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors'. Psychiatry Investig. 2019;16(1):59-64. 7 January 2019. Available at: <doi:10.30773/pi.2018.10.22.3> [Accessed 10 September 2021].

11. Paterson RW, Brown RL, Benjamin L, et al. (2020). ‘The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings’. Brain. 2020;143(10):3104-3120. 1 October 2020. Available at: <doi:10.1093/brain/awaa240> [Accessed 10 September 2021].

12. Fridman S, Bres Bullrich M, Jimenez-Ruiz A, et al. (2020). ‘Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases. Neurology’. 2020;95(24):e3373-e3385. 15 September 2020. Available at: <doi:10.1212/WNL.0000000000010851> [Accessed 10 September 2021].

13. Paniz-Mondolfi A, Bryce C, Grimes Z, et al. (2020). ‘Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)’. J Med Virol. 2020;92(7):699-702. July 2020. Available at: <doi:10.1002/jmv.25915> [Accessed 10 September 2021].

14. Shoucri SM, Purpura L, DeLaurentis C, et al. (2021). ‘Characterising the long-term clinical outcomes of 1190 hospitalised patients with COVID-19 in New York City: a retrospective case series’. BMJ Open 2021;11:e049488. 1 June 2021. Available at: <doi: 10.1136/bmjopen-2021-049488> [Accessed 10 September 2021].

15. Weng, Jingrong et al. (2021). ‘Gastrointestinal sequelae 90 days after discharge for COVID-19’. The Lancet Gastroenterology & Hepatology, Volume 6, Issue 5, 344 - 346. 9 March 2021. Available at: <https://doi.org/10.1016/S2468-1253(21)00076-5> [Accessed 10 September 2021].

18. Sweed, D., Abdelsameea, E., Khalifa, E.A. et al. (2021). ‘SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore’. Egypt Liver Journal 11, 64. 31 July 2021. Available at: <https://doi.org/10.1186/s43066-021-00123-6> [Accessed 10 September 2021].

19. Klaus W. Lange. (2021). ‘Coronavirus disease 2019 (COVID-19) and global mental health’. Global Health Journal. 13 February 2021. Available at: <https://doi.org/10.1016/j.glohj.2021.02.004.> [Accessed 10 September 2021].

21. Zhao YM, Shang YM, Song WB, et al. (2020). ‘Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery’. EClinicalMedicine. 2020;25:100463. 25 August 2020. Available at: <doi:10.1016/j.eclinm.2020.100463> [Accessed 10 September 2021].

22. Shah AS, Wong AW, Hague CJ, et al. (2020). ‘A prospective study of 12-week respiratory outcomes in COVID-19-related hospitalisations’. Thorax 2021;76:402-404. 3 December 2020. Available at: <https://thorax.bmj.com/content/76/4/402> [Accessed 10 September 2021].

23. Benjamin Bowe, Yan Xie, Evan Xu, Ziyad Al-Aly. (2021). ‘Kidney Outcomes in Long COVID’. American Society of Nephrology. 1 September 2021. Available at: <https://doi.org/10.1681/ASN.2021060734> [Accessed 10 September 2021].

25. OT&P Healthcare. (2020, March 27). Is anaemia making me tired? OT&P – Internationally Accredited Medical Clinics in Hong Kong. Retrieved October 5, 2021, from https://www.otandp.com/blog/is-iron-deficiency-anaemia-causing-my-fatigue.

26. Vimaleswaran, K. S., Forouhi, N. G., &amp; Khunti, K. (2021, March 4). Vitamin D and covid-19. The BMJ. Retrieved October 5, 2021, from https://www.bmj.com/content/372/bmj.n544.

27. OT&P Healthcare. (2021, August 9). How nutrition and lifestyle can improve immunity against viral infections. OT&P – Internationally Accredited Medical Clinics in Hong Kong. Retrieved October 5, 2021, from https://www.otandp.com/blog/how-nutrition-and-lifestyle-can-improve-immunity-against-viral-infections.

28. Kumssa, D. B., Joy, E. J. M., Ander, E. L., Watts, M. J., Young, S. D., Walker, S., &amp; Broadley, M. R. (2015, June 22). Dietary calcium and zinc deficiency risks are decreasing but remain prevalent. Nature News. Retrieved October 5, 2021, from https://www.nature.com/articles/srep10974.

29. U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - selenium. NIH Office of Dietary Supplements. Retrieved October 5, 2021, from https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/.

30. PC;, C. (n.d.). Omega-3 fatty acids and inflammatory processes: From molecules to man. Biochemical Society transactions. Retrieved October 5, 2021, from https://pubmed.ncbi.nlm.nih.gov/28900017/.

31. OT&P Healthcare. (2021, September 14). Gut Microbiota and Covid-19. OT&P – Internationally Accredited Medical Clinics in Hong Kong. Retrieved October 5, 2021, from https://www.otandp.com/blog/gut-microbiota-and-covid-19.

32. Mast Cell Activation Syndrome (MCAS). American Academy of Allergy Asthma & Immunology. (n.d.). Retrieved October 5, 2021, from https://www.aaaai.org/conditions-treatments/related-conditions/mcas.

33. Sukhatme, V. P., Reiersen, A. M., Vayttaden, S. J., &amp; Sukhatme, V. V. (1AD, January 1). Fluvoxamine: A review of its mechanism of action and its role in covid-19. Frontiers. Retrieved October 5, 2021, from https://www.frontiersin.org/articles/10.3389/fphar.2021.652688/full.

34. Tarocco, A., Caroccia, N., Morciano, G., Wieckowski, M. R., Ancora, G., Garani, G., & Pinton, P. (2019, April 8). Melatonin as a master regulator of cell death and inflammation: Molecular mechanisms and clinical implications for newborn care. Nature News. Retrieved October 5, 2021, from https://www.nature.com/articles/s41419-019-1556-7.

35. I-RECOVER Management Protocol for Long Haul COVID-19 Syndrome (LHCS) | Front Line COVID-19 Critical Care Alliance. (2021, August 11). Retrieved October 5, 2021, from https://covid19criticalcare.com/covid-19-protocols/i-recover-protocol/.

36. Molderings, G. J., Brettner, S., Homann, J., &amp; Afrin, L. B. (2011, March 22). Mast cell activation disease: A concise practical guide for diagnostic workup and therapeutic options. Journal of Hematology &amp; Oncology. Retrieved October 5, 2021, from https://jhoonline.biomedcentral.com/articles/10.1186/1756-8722-4-10.

37. Weiler CR; Austen KF; Akin C; Barkoff MS; Bernstein JA; Bonadonna P; Butterfield JH; Carter M; Fox CC; Maitland A; Pongdee T; Mustafa SS; Ravi A; Tobin MC; Vliagoftis H; Schwartz LB; (n.d.). AAAAI Mast Cell Disorders Committee Work Group Report: Mast cell activation syndrome (MCAS) diagnosis and management. The Journal of Allergy and Clinical Immunology. Retrieved October 5, 2021, from https://pubmed.ncbi.nlm.nih.gov/31476322/.

38. Raj, S. R., Arnold, A. C., Barboi, A., Claydon, V. E., Limberg, J. K., Lucci, V.-E. M., Numan, M., Peltier, A., Snapper, H., Vernino, S., &amp; American Autonomic Society. (2021, June). Long-Covid Postural Tachycardia Syndrome: An American Autonomic Society Statement. Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society. Retrieved October 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976723/.

39. Dani, M., Dirksen, A., Taraborrelli, P., Torocastro, M., Panagopoulos, D., Sutton, R., &amp; Lim, P. B. (2021, January). Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clinical medicine (London, England). Retrieved October 5, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850225/.

40. GrubbMD, B. P., Grubb, B. P., Blair P. Grubb From the Cardiology Department of Medicine, &amp; Grubb, C. to B. P. (2005, June 7). Neurocardiogenic Syncope and Related Disorders of Orthostatic Intolerance. Circulation. Retrieved October 5, 2021, from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.482018?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%2B%2B0pubmed&amp;.

42. Alexander, S. (2021, November 17). Ivermectin: Much more than you wanted to know. Astral Codex Ten. Retrieved November 22, 2021, from https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted

7. Buonsenso, D., Munblit, D., De Rose, C., Sinatti, D., Ricchiuto, A., Carfi, A. and Valentini, P. (2021). ‘Preliminary evidence on long COVID in children’. Acta Paediatrica, 110: 2208-2211. 09 April 2021. Available at: <https://onlinelibrary.wiley.com/doi/10.1111/apa.15870> [Accessed 10 September 2021].

16. Öcal Demir et al. (2021). ‘SARS-CoV-2 associated multisystem inflammatory syndrome in children (MIS-C). A single center's experience’. Minerva Pediatrics. 23 April 2021. Available at: <https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/pt/covidwho-1200473> [Accessed 10 September 2021].

17. Rubens J H, Akindele N P, Tschudy M M, Sick-Samuels A C. (2021). ‘Acute covid-19 and multisystem inflammatory syndrome in children’. BMJ 2021; 372 :n385. 1 March 2021. Available at: <doi:10.1136/bmj.n385> [Accessed 10 September 2021].