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},
"code": "C93.1",
"name": "Хронический моноцитарный лейкоз",
"icd_name": "Хронический моноцитарный лейкоз",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
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],
"periodicity": 1,
"slug": "c93.1_hronicheskiy_monocitarnyy_leykoz",
"lead": "опухолевый процесс со значительным увеличением содержания моноцитарных клеток при нормальном или невысоком лейкоцитозе",
"description": "",
"etiology": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Причины хронического моноцитарного лейкоза неизвестны. </span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Единой теории, объясняющей возникновение опухолей системы крови, не существует. </span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наиболее признанной в настоящее время является вирусно-генетическая теория. </span><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Согласно ей, особые вирусы (известно 15 видов таких вирусов) внедряются в организм человека и при воздействии предрасполагающих факторов, вызывающих срыв иммунитета, проникают внутрь незрелых клеток костного мозга. </span><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Это препятствует созреванию клеток и вызывает их частое деление.</span></p>\r\n<p><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Роль наследственности в возникновении опухолей системы крови не вызывает сомнений, так как эти заболевания чаще встречаются в некоторых семьях, а также у людей с нарушениями структуры хромосом (носители наследственной информации). </span></p>\r\n<p><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Предрасполагающие факторы.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Физические: ионизирующая радиация, рентгеновское облучение (например, при нарушении техники безопасности на атомных электростанциях или при лечении рентгеновским облучением опухолей кожи).</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Химические:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">производственные – лаки, краски и др. (могут проникать в организм человека через кожу, при вдыхании или поступать с пищей и водой);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">лекарственные – длительное применение солей золота (при лечении заболеваний суставов), некоторых антибиотиков и др.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\">Биологические:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">вирусы;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">кишечные инфекции;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">туберкулез (инфекционное заболевание человека и животных, вызываемое особым видом микроорганизмов – микобактериями – и поражающее преимущественно легкие, кости и почки);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хирургические вмешательства;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">стрессы. </span></li>\r\n</ul>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В патогенезе хронического лимфолейкоза значимая роль принадлежит иммунологическим механизмам – об этом свидетельствует его частое сочетание с аутоиммунной гемолитической анемией и тромбоцитопенией, коллагенозами. Вместе с тем, у большинства больных хроническими лейкозами причинно значимых факторов выявить не удается.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Предполагаемый диагноз устанавливается на основании анализа гемограммы, с результатами которой пациент должен быть немедленно направлен к врачу-гематологу. Для подтверждения диагноза проводится:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Общий анализ крови. Типичные для хронического миелоидного лейкоза изменения включают: анемию, присутствие единичных миелобластов и гранулоцитов на разной стадии дифференцировки; в период бластного криза количество бластных клеток увеличивается более чем на 20%. При хроническом лимфолейкозе определяющими гематологическими признаками выступают выраженный лейкоцитоз и лимфоцитоз, наличие лимфобластов и клеток Боткина-Гумпрехта.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пункции и биопсии. С целью определения морфологии опухолевого субстрата показано выполнение стернальной пункции, трепанобиопсии, биопсии лимфоузлов. В пунктате костного мозга при хроническом миелолейкозе увеличено количество миелокариоцитов за счет незрелых клеток гранулоцитарного ряда; в трепанобиоптате определяется замещение жировой ткани миелоидной. При хроническом лимфоидном лейкозе миелограмма характеризуется резким усилением лимфоцитарной метаплазии.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инструментальные исследования. Для оценки выраженности лимфопролиферативного синдрома применяются УЗИ лимфатических узлов, селезенки, рентгенография грудной клетки, лимфосцинтиграфия, МСКТ брюшной полости и ряд других.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На ранней доклинической стадии лечение неэффективно, поэтому больные подлежат динамическому наблюдению. Общережимные мероприятия предполагают исключение физических перегрузок, стрессов, инсоляции, электропроцедур и теплолечения; полноценное витаминизированное питание, длительные прогулки на свежем воздухе.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В развернутом периоде миелолейкоза назначается химиотерапевтическое лечение (бусульфан, митобронитол, гидроксимочевина и др.), при выраженной спленомегалии проводится облучение селезенки. Подобная тактика, хоть и не приводит к полному излечению, но существенно тормозит прогрессирование болезни и позволяет отсрочить наступление бластного криза. Кроме медикаментозной терапии, при хроническом миелоцитарном лейкозе используются процедуры лейкафереза. В ряде случаев излечение достигается с помощью трансплантации костного мозга.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При переходе хронического миелолейкоза в терминальную стадию назначается высокодозная полихимиотерапия. В среднем после установления диагноза больные хроническим миелолейкозом живут 3-5 лет, в отдельных случаях – 10-15 лет. Также проводится цитостатическая терапия (хлорбутин, циклофосфамид), иногда в сочетании со стероидной терапией, облучением лимфоузлов, селезенки, кожи. При значительном увеличении селезенки выполняется спленэктомия. Применяется трансплантация стволовых клеток, однако ее эффективность еще требует подтверждения.</span></p>",
"prevention": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Первичная профилактика хронического моноцитарного лейкоза (то есть до возникновения заболевания):</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">соблюдение техники безопасности на производстве с целью снижения контакта с потенциально опасными химическими веществами (лаки, краски и др.) и источниками ионизирующего излучения (радиации);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">укрепление защитных сил организма для снижения заболеваемости простудными и прочими инфекционными заболеваниями (например, закаливание, прогулки на свежем воздухе, здоровое питание с достаточным содержанием овощей и фруктов и др.).</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Вторичная профилактика (то есть после возникновения заболевания) заключается в регулярных профилактических осмотрах населения с целью наиболее раннего выявления у них признаков заболевания.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Все симптомы хронического моноцитарного лейкоза объединены в несколько синдромов (устойчивая совокупность симптомов, объединенных единым развитием).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиперпластический, или пролиферативный (связанный с ростом опухоли):</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боль и тяжесть в левой верхней части живота (увеличение селезенки) встречается у половины больных;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">увеличение лимфоузлов обычно незначительное или отсутствует;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боль и тяжесть в правой верхней части живота (увеличение печени) отмечается редко;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боли в костях (разрастание костного мозга) выявляется при длительном течении заболевания.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\"> Интоксикационный (отравление организма продуктами распада опухоли). Развивается при большой массе опухоли. Симптомы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">выраженная общая слабость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">утомляемость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">снижение массы тела;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">потливость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">повышение температуры тела. </span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анемический (то есть за счет снижения уровня гемоглобина – особого вещества эритроцитов (красных клеток крови), переносящего кислород):</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">слабость, снижение работоспособности;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">головокружение;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">обморочные состояния;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">шум в ушах, мелькание «мушек» перед глазами;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">одышка (учащенное дыхание) и сердцебиение при незначительной физической нагрузке;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">колющие боли в грудной клетке.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Геморрагический (наличие кровоизлияний и кровотечений за счет снижения количества тромбоцитов – кровяных пластинок, склеивание которых обеспечивает начальный этап свертывания крови):</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">подкожные и подслизистые (например, в полости рта) кровоизлияния;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">десневые, носовые и другие кровотечения.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Иммунодефицитный (синдром инфекционных осложнений). Присоединение любых инфекций связано с недостаточным образованием нормальных лейкоцитов (белых клеток крови), обеспечивающих защиту от микроорганизмов. </span></p>",
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},
"code": "C92",
"name": "Миелоидный лейкоз",
"icd_name": "Миелоидный лейкоз [миелолейкоз]",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c92_mieloidnyy_leykoz",
"lead": " это злокачественная опухоль миелоидного ростка крови, при которой быстро размножаются изменённые белые кровяные клетки. ",
"description": "Миелоидный лейкоз (МЛ) – это раковое заболевание крови, которое характеризуется большим содержанием аномальных незрелых лейкоцитов, размножающихся очень быстро. Этот тип лейкоза поражает 20% детей с раковыми заболеваниями крови. ",
"etiology": "<p>Точные причины возникновения миелоидного лейкоза неизвестны, но онкологи выделяют некоторые условия, которые способствуют повышению риска заболевания.</p>\r\n<p>Риски включают в себя унаследованные генетические проблемы, такие, как синдром Дауна, нейрофиброматоз, а также анемия Фанкони и прочие наследуемые патологии костного мозга. Ненаследуемые заболевания – миелодиспластический синдром и апластическая анемия, также могут увеличить риск развития острой лейкемии.МЛ чаще встречается у детей, которые были подвержены лучевой или химиотерапии, и является наиболее распространенным типом вторичного рака у детей.</p>\r\n<p>Если у одного из близнецов диагностировали лейкемию в возрасте до 6 лет, то вероятность развития миелоидного лейкоза у второго ребенка составляет 20-25%. Дети, имеющие сестер и братьев с лейкемией, заболевают в два раза чаще. Облучение во время беременности может вызвать заболевание у развивающегося плода. Некоторые экологические факторы также могут провоцировать лейкоз.</p>",
"pathogenesis": "",
"diagnostics": "<p>Полный анализ крови, назначающийся при первых признаках рака крови, дает врачу важную информацию о количестве нормальных клеток крови в организме, а также о том, насколько хорошо функционируют печень, селезенка и другие органы.</p>\r\n<p>Аспирация и биопсия необходимы для изучения костного мозга. Врач вводит иглу в большую кость, как правило, бедренную, и берет небольшое количество костного мозга для проверки его на наличие раковых клеток.</p>\r\n<p>Рентген, МРТ и УЗИ помогают обнаружить увеличение органов и исключить симптомы других заболеваний.</p>\r\n<p>Спинномозговая пункция – процедура для диагностики рака крови, при которой берется немного спинномозговой жидкости для исследования в лаборатории.</p>\r\n<p>Для идентификации подтипов МЛ проводятся хромосомные тесты. При этом для анализа ДНК берутся клетки крови и костного мозга.</p>",
"treatment": "<p>Миелоидный лейкоз прогрессирует быстро, поэтому своевременная диагностика играет особенно важную роль. Онкологи не выделяют промежуточных стадий МЛ, а характеризуют заболевание либо как вновь диагностированное, либо как находящееся в стадии ремиссии. Ремиссия – состояние, при котором нет никаких признаков присутствия болезни в организме.</p>\r\n<p>Лечение состоит из двух этапов. Первый этап, или фаза индукции, преследует цель убить как можно большее количество раковых клеток в организме и достигнуть состояния ремиссии. Второй этап, или фаза пост-ремиссии, предназначен для поддержания эффекта терапии и преодоления последствий лечения. I и II этапы могут включать несколько видов терапии, использующихся независимо или совместно друг с другом.</p>\r\n<p>Химиотерапия – это уничтожение раковых клеток специальными препаратами. Интерканальная терапия осуществляется через поясничный прокол и обеспечивает поступление лекарства непосредственно в спинномозговую жидкость, где может скапливаться большое количество пораженных лейкоцитов.</p>\r\n<p>В случае необходимости, после химиотерапии проводится трансплантация костного мозга. Новые здоровые стволовые клетки нужны для восстановления нормального состояния иммунной системы и крови.</p>",
"prevention": "",
"clinical_picture": "<p>Первые признаки рака крови нередко похожи на симптомы других заболеваний. Наблюдается <a href=\"/symptom/vyalost/\" title=\"Перейти на страницу симптома Вялость\">вялость</a>, появление небольших красных пятнышек на коже, <a href=\"/symptom/bol_v_kostyah/\" title=\"Перейти на страницу симптома Боль в костях\">боль в костях</a>, суставах и животе. У ребенка появляются безболезненные на ощупь комочки под кожей на шее, в паху и других местах расположения лимфатических узлов. При обнаружении таких симптомов необходимо немедленно обратиться к специалисту.</p>",
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