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},
"code": "C90",
"name": "Множественная миелома и злокачественные плазмоклеточные ново образования",
"icd_name": "Множественная миелома и злокачественные плазмоклеточные ново образования",
"gender": 0,
"age_min": 40,
"age_max": 100,
"cause": [
"3"
],
"periodicity": 1,
"slug": "c90_mnozhestvennaya_mieloma_i_zlokachestvennye_plazmokletochnye_novo_obrazovaniya",
"lead": "злокачественный онкопроцесс в структурах костного мозга",
"description": "<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;\">Миелома — одна из форм хронического лимфобластного лейкоза, для которой характерно поражение костного мозга, разрушение костной ткани и выработка однотипных иммуноглобулинов. Это онкопатология крови, затрагивающая плоские кости, позвоночник и почки. </span></p>",
"etiology": "<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;\">Заболевание возникает вследствие мутации в ДНК В-лимфоцитов. Точные причины изменения генетического материала не установлены. К возможным предрасполагающим факторам относят:</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;\">Пожилые люди (возраст от 60-70 лет и старше).</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;\">Лишний вес, ожирение.</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;\">Облучение (в том числе и с медицинской целью) в прошлом.</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;\">Работа с ядами, токсинами, химикатами, инсектицидами на вредных производствах.</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;\">Синдром приобретённого иммунодефицита (например, ВИЧ).</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;\">Аутоиммунные нарушения (системная красная волчанка, тиреоидит, ревматоидный артрит).</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;\">Наследственная предрасположенность.</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<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;\">Перерождение клеток лимфоидного ростка в миелому начинается в процессе дифференцировки зрелых B-лимфоцитов на уровне проплазмоцитов и сопровождается стимуляцией определенного их клона. Ростовым фактором миеломных клеток служит интерлейкин-6. При миеломной болезни обнаруживаются плазмоциты различной степени зрелости с чертами атипизма, отличающиеся от нормальных большим размером (>40 мкм), бледной окраской, многоядерностью (нередко 3-5 ядер) и наличием нуклеол, бесконтрольным делением и длительным сроком жизни.</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;\">Разрастание миеломной ткани в костном мозге приводит к деструкции кроветворной ткани, угнетению нормальных ростков лимфо- и миелопоэза. В крови снижается количество эритроцитов, лейкоцитов и тромбоцитов. Миеломные клетки не способны полноценно выполнять иммунную функцию из-за резкого снижения синтеза и быстрого разрушения нормальных антител. Факторы опухоли дезактивируют нейтрофилы, снижают уровень лизоцима, нарушают функции комплемента.</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: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Локальная деструкция костей связана с замещением нормальной костной ткани пролиферирующими миеломными клетками и стимуляцией остеокластов цитокинами. Вокруг опухоли формируются очаги растворения костной ткани (остеолиза) без зон остеогенеза. Кости размягчаются, становятся ломкими, значительное количество кальция выходит в кровь. Парапротеины, поступая в кровяное русло, частично депонируются в различных органах (сердце, легких, ЖКТ, дерме, вокруг суставов) в виде амилоида.</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;\">На ранних стадиях заболевание диагностируют случайно, обычно в рамках скринингового обследования по поводу анемии. Подозрение на миелому возникает при выявлении отклонений в картине общего (снижение уровня гемоглобина и увеличение СОЭ) и биохимического анализа крови (гиперкальциемия и гиперпротеинемия, сочетающаяся со снижением концентрации альбумина).</span></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 подозрении на множественную миелому проводят комплексное обследование, которое включает следующие мероприятия:</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;\">физикальный осмотр с пальпаторным исследованием болезненных зон;</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;\">рентгенографию скелета;</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;\">лабораторную диагностику (общий анализ крови и мочи, биохимия крови, электрофоретическую идентификацию белка крови и мочи и др.);</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;\">позитронно-эмиссионную томографию (для определения локализации и размеров опухолей);</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;\">КТ и МРТ костей, суставов и внутренних органов;</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;\">биопсию костного мозга (отражает плазматизацию костного мозга, что является важным диагностическим критерием). </span></li>\r\n</ul>\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\"> </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\"> </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;\">Основаниями для постановки диагноза выступают следующие критерии: плазматизация костного мозга более 10%, наличие моноклонального белка в крови и моче в сочетании с поражением внутренних органов, гиперкальциемией, анемией и обнаружением очагов разрежения костной ткани или диффузного остеопороза.</span></p>\r\n<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;\">Патологию дифференцируют с доброкачественной моноклональной гаммапатией и другими онкологическими заболеваниями (лимфолейкемия, лимфома, костные метастазы опухолей внутренних органов и пр.)</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;\">Стратегия лечения миеломы зависит от размеров опухолевого очага, вида и стадии онкопроцесса.</span></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;\">Основные лечебные методики:</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;\">Химиотерапия. Введение лекарственных препаратов препятствует делению опухолевых клеток или разрушает их.</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;\">Иммунотерапия. Активно применяют синтетические средства (идентичные интерферону человека), стимулирующие иммунную систему.</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;\">Лучевая терапия (радиотерапия). Опухоль уничтожается с помощью ионизирующего излучения.</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;\">Трансплантация стволовых клеток. У больного с генерализованной плазмоцитомой или подходящего донора забирают часть стволовых клеток, подвергая их заморозке. После химио- или радиотерапии пациенту трансплантируют здоровые стволовые клетки. Такой метод увеличивает продолжительность жизни.</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;\">Симптоматическая терапия – направлена на устранение конкретной симптоматики (антибиотикотерапия, лечение анемии).</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<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;\">Специфических методов профилактики развития множественной миеломы не существует. С учетом факторов риска превентивные меры включают в себя:</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;\">ведение здорового образа жизни;</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;\">рациональное питание и контроль массы тела;</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;\">сведение к минимуму контактов с токсическими веществами и ионизирующим излучением.</span></li>\r\n</ul>\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\"> </p>\r\n<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;\">Лицам с неблагоприятным семейным анамнезом рекомендуется регулярно проходить профилактические обследования. Людям старше 50 лет стоит ежегодно сдавать общий и биохимический анализы крови.</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;\">Существует 2 формы состояния – бессимптомная и симптоматическая. Бессимптомный вариант определяется лабораторными показателями. Для симптоматической формы характерна следующая клиническая картина:</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;\">Дискомфорт, ноющие боли в костях скелета.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Развитие остеопороза, проявлениями которого являются снижение костной плотности, частые переломы.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Нарушение функции почек, желудка, легких из-за скопления большого количества кальция в органы из-за разрушения костей.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Постоянная субфебрильная температура (37,5° С), приступы озноба.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Частые простудные инфекции. Ослабленный иммунитет связан с нарушенной выработкой здоровых иммуноглобулинов.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Увеличивается вязкость крови за счет повышенного уровня белковых фракций. Возникают риск как тромбозов, так и кровотечений.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Упадок сил, выраженная мышечная слабость.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Необъяснимое снижение веса.</span></li>\r\n</ul>",
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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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},
"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": "",
"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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