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"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
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"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": "",
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},
"code": "C91",
"name": "Лимфолейкоз",
"icd_name": "Лимфоидный лейкоз [лимфолейкоз]",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "c91_limfoleykoz",
"lead": "Лейкоз, при котором источником опухолевого процесса является клетка-предшественник лимфопоэза",
"description": "Лимфолейкоз является злокачественным поражением, возникающим в лимфатической ткани. Характеризуется оно накоплением опухолевых лимфоцитов в лимфоузлах, в периферической крови и в костном мозге. Острая форма лимфолейкоза ранее относилась к «детским» заболеваниям ввиду подверженности ему преимущественно пациентов в возрасте двух-четырех лет. В настоящее время лимфолейкоз наблюдается чаще среди взрослых.",
"etiology": "<ul class=\"list list-description\">\r\n<li>Единой теории, объясняющей возникновение опухолей крови, не существует.</li>\r\n<li>Наиболее признанной в настоящее время является вирусно-генетическая теория.\r\n<ul class=\"list list-description-2\">\r\n<li>Согласно ей, особые вирусы (известно 15 видов таких вирусов) внедряются в организм человека и при воздействии предрасполагающих факторов, вызывающих срыв иммунитета (защитных сил организма), проникают внутрь незрелых клеток костного мозга или лимфоузлов, вызывая их частое деление без созревания.</li>\r\n<li>Роль наследственности в возникновении опухолей крови не вызывает сомнений, так как эти заболевания чаще встречаются в некоторых семьях, а также у людей с нарушениями структуры хромосом (носителей наследственной информации). </li>\r\n</ul>\r\n</li>\r\n</ul>\r\n<full></full>\r\n<p>Предрасполагающие факторы.<br /><br /></p>\r\n<ul class=\"list list-description\">\r\n<li>Физические: ионизирующая радиация, рентгеновское облучение (например, при нарушении техники безопасности на атомных электростанциях или при лечении рентгеновским облучением опухолей кожи).</li>\r\n</ul>\r\n<ul class=\"list list-description\">\r\n<li>Химические:\r\n<ul class=\"list list-description-2\">\r\n<li>производственные – лаки, краски и др. (могут проникнуть в организм человека через кожу, при вдыхании или поступить с пищей и водой); </li>\r\n<li>лекарственные – длительное применение солей золота (при лечении заболеваний суставов), некоторых антибиотиков и др.</li>\r\n</ul>\r\n</li>\r\n</ul>\r\n<ul class=\"list list-description\">\r\n<li>Биологические:\r\n<ul class=\"list list-description-2\">\r\n<li>вирусы;</li>\r\n<li>кишечные инфекции;</li>\r\n<li>туберкулез (инфекционное заболевание человека и животных, вызываемое особым видом микроорганизмов – микобактериями, поражающее преимущественно легкие, кости и почки);</li>\r\n<li>хирургические вмешательства;</li>\r\n<li>стрессы.</li>\r\n</ul>\r\n</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<ul class=\"list list-description\">\r\n<li>Анализ анамнеза заболевания и жалоб (когда (как давно) появились общая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, колющие боли в грудной клетке, боли и тяжесть в левом подреберье, <a href=\"/symptom/uvelichenie_limfaticheskih_uzlov/\" title=\"Перейти на страницу симптома Увеличение лимфатических узлов\">увеличение лимфоузлов</a> и др., с чем пациент связывает возникновение этих симптомов).</li>\r\n<li>Анализ анамнеза жизни. Есть ли у пациента какие-либо хронические заболевания, отмечаются ли наследственные заболевания, имеет ли пациент вредные привычки, принимал ли длительно какие-нибудь препараты, выявлялись ли у него опухоли, контактировал ли он с токсическими (отравляющими) веществами. </li>\r\n<li>Физикальный осмотр. Определяется цвет кожных покровов (возможна бледность, появление кровоизлияний). При пальпации (прощупывании) определяется <a href=\"/symptom/uvelichenie_limfaticheskih_uzlov/\" title=\"Перейти на страницу симптома Увеличение лимфатических узлов\">увеличение лимфоузлов</a>. При перкуссии (простукивании) выявляется <a href=\"/symptom/uvelichenie_pecheni/\" title=\"Перейти на страницу симптома Увеличение печени\">увеличение печени</a> и селезенки. Пульс может быть учащенным, артериальное давление — сниженным. <full></full></li>\r\n<li>Анализ крови. Может определяться снижение количества эритроцитов (красных клеток крови, норма 4,0-5,5х109г/л), уменьшение уровня гемоглобина (особого соединения внутри эритроцитов, переносящего кислород, норма 130-160 г/л). Цветной показатель (отношение уровня гемоглобина, умноженного на 3, к первым трем цифрам количества эритроцитов) обычно остается нормальным: в норме этот показатель 0,86-1,05. Количество лейкоцитов (белых клеток крови, норма 4-9х109г/л) может быть повышенным (чаще всего), нормальным или сниженным. Определяется повышение содержания лимфоцитов (особого вида лейкоцитов). Появляются тени Боткина-Гумпрехта (ядра раздавленных стеклом (при изготовлении мазка крови) нестойких опухолевых лимфоцитов). Количество тромбоцитов (кровяных пластинок, склеивание которых обеспечивает начальный этап свертывания крови) остается нормальным или становится сниженным (норма 150-400х109г/л).</li>\r\n<li>Анализ мочи. В моче может появляться кровь при развитии почечного кровотечения или кровотечения из мочевыводящих путей.</li>\r\n<li>Биохимический анализ крови. Определяется уровень холестерина (жироподобное вещество), глюкозы (простого углевода), креатинина (продукт распада белка), мочевой кислоты (продукт распада веществ из ядра клетки), электролитов (калий, натрий, кальций) для выявления сопутствующего поражения органов.</li>\r\n<li>Исследование костного мозга, полученного при помощи пункции (прокалывания с извлечением внутреннего содержимого) кости, чаще всего грудины (центральной кости передней поверхности грудной клетки, к которой крепятся ребра), позволяет оценить кроветворение (образование клеток ркови) и выявить характер опухоли крови. </li>\r\n<li>Трепанобиопсия (исследование костного мозга в его соотношении с окружающими тканями) выполняется при взятии на исследование столбика костного мозга с костью и надкостницей, обычно из крыла подвздошной кости (область таза человека, расположенная наиболее близко к коже) с помощью специального приборы – трепана. Наиболее точно характеризует состояние костного мозга.</li>\r\n<li>Исследование лимфоузлов проводится двумя путями:\r\n<ul class=\"list list-description-2\">\r\n<li>пункция (прокалывание подозрительного лимфоузла иглой шприца с забором содержимого) – малоинформативный метод;</li>\r\n<li>хирургическое удаление лимфоузла и его исследование – высоко информативный метод.</li>\r\n</ul>\r\n</li>\r\n</ul>\r\n<ul class=\"list list-description\">\r\n<li>Цитохимические реакции – окрашивание специальными красителями опухолевых клеток для определения их вида.</li>\r\n<li>Цитогенетическое исследование клеток костного мозга (метод выявления нарушений в хромосомах – особых структурах ядра клетки, состоящих из генов – носителей наследственной информации).</li>\r\n<li>Люмбальная пункция (взятие для исследования ликвора – спинномозговой жидкости) позволяет определить опухолевое поражение нервной системы.</li>\r\n<li>Ультразвуковое исследование (УЗИ) внутренних органов оценивает размеры печени, селезенки, почек, их структуру на предмет поражения опухолевыми клетками и наличия кровоизлияний.</li>\r\n<li>Рентгенография органов грудной клетки позволяет оценить состояние внутригрудных лимфоузлов, легких и сердца.</li>\r\n<li>Спиральная компьютерная томография (СКТ) – метод, основанный на проведении серии рентгеновских снимков на разной глубине – позволяет получить точное изображение исследуемых органов и оценить распространенность опухолевого процесса.</li>\r\n<li>Магнитно-резонансная томография (МРТ) – метод, основанный на выстраивании цепочек воды при воздействии на тело человека сильных магнитов – позволяет получить точное изображение исследуемых органов и оценить распространенность опухолевого процесса. </li>\r\n</ul>",
"treatment": "<p>Существует несколько подходов к лечению лимфолейкоза:</p>\r\n<ul type=\"square\">\r\n<li>Химиотерапия препаратом хлорбутин до недавнего времени являлась стандартным методом лечения хронического лимфолейкоза. В настоящее время доказана более эффективно использование новой группы препаратов, так называемых пуриновых аналогов, представителем которой является Флудара.</li>\r\n<li>К эффективным методам лечения хронического лимфолейкоза относят биоиммунотерапию с применением моноклональных антител. Введение этих препаратов позволяет селективно уничтожать опухолевые клетки, не повреждая здоровые ткани организма.</li>\r\n<li>При неудовлетворительной эффективности других методов лечения, может быть осуществлена высокодозная химиотерапия с трансплантацией кроветворных стволовых клеток.</li>\r\n<li>Лучевая терапия применяется в качестве вспомогательного метода лечения при наличии большой опухолевой массы.</li>\r\n<li>\" Удаление селезенки (спленэктомия) иногда показана при значительном увеличении этого органа.</li>\r\n</ul>\r\n<p>Выбор метода лечения - это очень важное решение, которое должно основываться на точных данных, касающихся диагноза, с учетом индивидуальных особенностей больного. Обсуждение вопросов лечения с больным и, по его желанию, с его близкими является неотъемлемым элементом утверждения общей программы лечения.</p>",
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