Cov kab mob lymphocytic leukemia yog ib yam kab mob uas lub cev tsim cov qe ntshav dawb ntau dhau. Ib qho teeb meem zoo sib xws tshwm sim feem ntau hauv cov neeg tom qab 60 xyoo. Tus kab mob no qeeb heev thiab tej zaum yuav tsis muaj tsos mob tshwm sim thawj ob peb xyoos.
Lymphocytic leukemia yog qhov txawv ntawm qhov kev loj hlob ntawm cov hlwb malignant. Nyob rau hauv cov chav kawm ntawm xws li ib tug pathology, lub hauv paus yog kev puas tsuaj rau cov pob txha pob txha, thiab lub hauv paus zaub mov rau qhov no yog cov leukocytes tsim nyob rau hauv nws.
Tus kab mob no tseem tsis tau paub. Ntau tus kws kho mob ntseeg hais tias tus kab mob yog caj ces nyob rau hauv cov xwm. Nws yog ib qho tseem ceeb kom paub txog tus kab mob kom raws sij hawm, txhawm rau kuaj xyuas thiab kho tom ntej.
Tus yam ntxwv ntawm tus kab mob
Lymphocytes yog ib hom leukocytes uas koom nrog lub luag haujlwm ntawm kev tiv thaiv kab mob. Kev noj qab haus huv lymphocytes degenerate rau hauv plasma cell thiab tsim cov tshuaj immunoglobulins. Cov tshuaj tiv thaiv no raug tshem tawmtshuaj lom, kab mob kab mob, neeg txawv teb chaws rau tib neeg lub cev.
Cov kab mob lymphocytic leukemia (ICD-10 code - C91.1) yog cov kab mob qog ntawm cov hlab ntshav. Thaum lub sij hawm tus kab mob no, leukemic lymphocytes tsis tu ncua thiab sib sau ua ke nyob rau hauv cov pob txha pob txha, spleen, ntshav, siab, thiab lymph nodes. Nws yuav tsum tau muab sau tseg tias qhov siab dua tus nqi ntawm cell division, qhov ntau aggressive lub pathology.
Cov kab mob lymphocytic leukemia yog ib yam kab mob uas feem ntau cuam tshuam rau cov neeg laus. Feem ntau tus kab mob no maj mam thiab yuav luag asymptomatically. Nws raug pom zoo los ntawm kev sib tsoo thaum kawm txog kev kuaj ntshav dav dav. Nyob rau hauv tsos, lymphocytes txawv txav tsis txawv ntawm ib txwm sawv daws yuav, txawm li cas los xij, lawv qhov tseem ceeb ua haujlwm tsis zoo.
Tus neeg mob tsis kam mus rau cov kab mob txo qis. Qhov ua rau tus kab mob no tseem tsis tau paub meej, tab sis kev kis tus kab mob thiab cov kab mob genetic predisposition yog suav tias yog qhov ua rau hnyav dua.
Flow Stages
Txhawm xaiv cov kev kho kom zoo tshaj plaws, nrog rau kev txiav txim siab txog qhov kev mob tshwm sim ntawm tus kab mob, muaj ntau theem ntawm cov kab mob lymphocytic leukemia. Thaum pib ntawm txoj kev loj hlob ntawm tus kab mob, tsuas yog lymphocytosis yog txiav txim nyob rau hauv lub laboratory nyob rau hauv cov ntshav. Qhov nruab nrab, cov neeg mob uas muaj theem no nyob ntau dua 12 xyoos. Qib ntawm kev pheej hmoo yog suav tias tsawg.
Nyob rau theem 1, qhov nce hauv cov qog nqaij hlav koom nrog lymphocytosis, uas tuaj yeem txiav txim siab palparously lossis instrumentally. Lub sijhawm nruab nrablub neej yog mus txog 9 xyoo, thiab qhov kev pheej hmoo yog nruab nrab.
Nyob rau theem 2, ntxiv rau lymphocytosis, thaum kuaj tus neeg mob, splenomegaly thiab hepatomegaly tuaj yeem txiav txim siab. Qhov nruab nrab, cov neeg mob nyob txog 6 xyoo.
Nyob rau theem 3, hemoglobin poob qis, thiab tseem muaj cov lymphocytosis tsis tu ncua thiab nce qhov loj ntawm cov qog ntshav. Lub neej expectancy ntawm tus neeg mob yog mus txog 3 xyoos.
Thaum qib 4 nce mus, thrombocytopenia koom nrog tag nrho cov kev tshwm sim no. Qhov kev pheej hmoo ntawm qhov no yog siab heev, thiab qhov nruab nrab lub neej expectancy ntawm cov neeg mob yog tsawg tshaj li ib xyoos thiab ib nrab.
Kev faib kab mob
Tus kab mob lymphocytic leukemia (ICD-10 code - C91.1) tau muab faib ua ob peb pawg, raws li cov qe ntshav dab tsi pib sib faib sai heev thiab yuav luag tsis tuaj yeem tswj tau. Nws yog los ntawm qhov ntsuas no uas tus kab mob tau muab faib ua:
- megakaryocytic leukemia;
- monocyte;
- myeloid leukemia;
- erythromyelosis;
- macrophage;
- lymphocytic leukemia;
- erythremia;
- mast cell;
- hair cell.
Qhov mob hnyav hnyav yog qhov tshwm sim los ntawm kev nce qeeb hauv leukocytosis thiab lymphocytes. Qhov nce hauv cov qog ntshav yog qhov tsis tseem ceeb thiab tsis muaj ntshav qab zib thiab cov tsos mob ntawm kev qaug dab peg. Tus neeg mob qhov mob yog qhov txaus siab heev. Kev kho tshwj xeeb tsis tas yuav tsum tau ua, tus neeg mob tsuas yog pom zoo kom ua raws li kev xav tau ntawm kev so thiab kev ua haujlwm, kom noj zaub mov noj qab haus huv uas muaj cov vitamins. Pom zoomuab tus cwj pwm phem, zam kev mob ntshav qab zib.
Progressive form of chronic lymphocytic leukemia yog hais txog cov classic thiab yog tus cwj pwm los ntawm qhov tseeb tias qhov nce ntawm cov leukocytes tshwm sim tsis tu ncua, txhua hli. Lymph nodes maj mam nce thiab pom cov tsos mob ntawm intoxication, tshwj xeeb, xws li:
- fever;
- tsis muaj zog;
- poob phaus;
- tawm hws ntau dhau.
Nrog rau qhov nce ntxiv ntawm cov leukocytes, cov tshuaj kho mob tshwj xeeb raug sau tseg. Nrog rau kev kho kom raug, nws muaj peev xwm ua tiav qhov kev zam mus ntev. Daim ntawv qog yog tus yam ntxwv los ntawm qhov tseeb tias leukocytosis hauv cov ntshav yog qhov tsis tseem ceeb. Hauv qhov no, muaj qhov nce ntawm tus po, lymph nodes, tonsils. Rau kev kho mob, cov chav kawm ua ke ntawm kws khomob raug sau tseg, nrog rau kev kho hluav taws xob.
Splenomegalic hom mob lymphocytic leukemia (raws li ICD-10 - C91.1) yog tus cwj pwm los ntawm cov leukocytosis nruab nrab, cov qog ntshav me me, thiab tus po loj. Kev kho hluav taws xob tau muab rau kev kho mob, thiab thaum mob hnyav, kev tshem tawm tus po yog qhia.
Cov pob txha pob txha ntawm cov kab mob lymphocytic mob qog noj ntshav tau qhia me ntsis hauv cov poov xab thiab cov qog ntshav. Kev kuaj ntshav qhia pom lymphocytosis, txo qis hauv platelets sai, cov qe ntshav liab, thiab cov qe ntshav dawb noj qab haus huv. Tsis tas li ntawd, muaj ntau los ntshav thiab ntshav ntshav. Rau kev kho mob, ib chav kawm ntawm kws khomob tau sau tseg.
Prolymphocytic hom mob lymphocytic leukemia (raws li ICD-10 - C91.3) yog tus cwj pwm los ntawm qhov tseeb tias hauv cov neeg mobmuaj leukocytosis nce ntxiv nrog rau qhov nce ntxiv ntawm tus po. Nws tsis teb zoo rau kev kho mob.
Cov plaub hau ntawm tes ntawm tus kab mob yog ib daim ntawv tshwj xeeb uas leukemic pathological lymphocytes muaj cov yam ntxwv. Thaum lub sijhawm nws kawm, cov qog ntshav qog tsis hloov pauv, lub siab thiab tus po nce ntxiv, thiab cov neeg mob raug kev txom nyem los ntawm ntau yam kab mob, pob txha puas thiab los ntshav. Kev kho mob nkaus xwb yog tshem tus po thiab tshuaj kho mob.
Cov tsos mob tseem ceeb
Cov ntshav lymphocytic leukemia mob ntev heev, thiab cov tsos mob yuav tsis tshwm sim ntev, tsuas yog cov ntshav suav hloov pauv xwb. Tom qab ntawd maj mam muaj qhov txo qis ntawm cov hlau, uas ua rau muaj cov tsos mob ntawm anemia. Cov tsos mob thawj zaug tuaj yeem dhau los ua qhov tshwm sim ntawm leukemia, tab sis feem ntau lawv mus tsis pom. Ntawm cov cim tseem ceeb, ib tus tuaj yeem paub qhov txawv xws li:
- pallor ntawm daim tawv nqaij thiab mucous daim nyias nyias;
- tsis muaj zog;
- saw;
- dyspnea on exertion.
Ntxiv rau, qhov kub thiab txias tuaj yeem nce thiab poob phaus sai sai tuaj yeem pib. Ntau tus lymphocytes cuam tshuam rau cov pob txha pob txha thiab maj mam nyob hauv cov qog ntshav. Nws yog tsim nyog sau cia tias cov qog ntshav qog tau loj zuj zus thiab nyob twj ywm tsis mob. Lawv qhov sib xws yog me ntsis reminiscent ntawm mos khob noom cookie, thiab qhov ntau thiab tsawg tuaj yeem ncav cuag 10-15 cm. Lymph nodes tuaj yeem nyem cov kab mob tseem ceeb, ua rau cov hlab plawv thiab ua pa.ua tsis tiav.
Ua ke nrog cov qog nqaij hlav, tus po pib loj tuaj, thiab tom qab ntawd lub siab. Ob lub cev no feem ntau tsis loj hlob mus rau qhov loj, tab sis tej zaum yuav muaj kev zam.
Cov kab mob lymphocytic leukemia provokes ntau yam kev tiv thaiv kab mob. Pathological leukemic lymphocytes tso tseg tag nrho tsim cov tshuaj tiv thaiv, uas ua tsis txaus rau lub cev los tiv thaiv cov kab mob thiab ntau yam kab mob, qhov zaus ntawm kev nce siab. Cov kab mob ua pa feem ntau cuam tshuam, ua rau mob ntsws loj, pleurisy thiab mob ntsws.
Kab mob tso zis los yog kab mob ntawm daim tawv nqaij tsis tshua muaj tshwm sim. Lwm qhov laj thawj ntawm kev txo qis hauv kev tiv thaiv kab mob yog tsim cov tshuaj tiv thaiv rau nws tus kheej cov qe ntshav liab, uas provokes kev loj hlob ntawm hemolytic anemia, uas tshwm sim nws tus kheej nyob rau hauv daim ntawv ntawm jaundice.
Diagnostics
Txhawm rau kuaj xyuas tus mob lymphocytic leukorrosis, kuaj ntshav ua ntej. Nyob rau theem pib ntawm pathology, daim duab kho mob yuav hloov me ntsis. Qhov hnyav ntawm leukocytosis feem ntau nyob ntawm theem ntawm tus kab mob.
Tsis tas li, nyob rau hauv cov kab mob lymphocytic leukemia, kev kuaj ntshav qhia tias tsis muaj cov qe ntshav liab thiab hemoglobin. Xws li kev ua txhaum cai tuaj yeem tshwm sim los ntawm lawv qhov kev hloov pauv los ntawm cov qog hlwb los ntawm cov pob txha pob txha. Cov theem ntawm platelets nyob rau hauv thawj theem ntawm cov kab mob feem ntau tseem nyob rau hauvCov qauv, txawm li cas los xij, raws li cov txheej txheem pathological txhim kho, lawv cov lej poob qis.
Kom paub meej qhov kev kuaj mob, kev kuaj xyuas xws li:
- biopsy ntawm cov qog nqaij hlav cuam tshuam;
- pob txha pob txha puncture;
- kev txiav txim siab ntawm qib ntawm immunoglobulins;
- cellular immunophenotyping.
Kev tshuaj xyuas ntawm tes ntawm cov ntshav thiab cov pob txha tso cai rau koj los txiav txim siab cov cim tiv thaiv kab mob ntawm tus kab mob txhawm rau txhawm rau tshem tawm lwm yam kab mob thiab ua kom muaj kev cuam tshuam txog nws txoj kev kawm.
Txoj kev kho mob
Tsis zoo li ntau lwm cov txheej txheem malignant, mob qog ntshav qog ntshav qog ntshav tsis tau kho thaum pib. Hauv paus, kev kho mob pib thaum cov tsos mob ntawm kev loj hlob ntawm tus kab mob tshwm sim, uas yuav tsum muaj xws li:
- nce nrawm ntawm cov lej ntawm cov leukocytes hauv cov ntshav;
- kev loj hlob tseem ceeb ntawm cov qog nqaij hlav;
- nce ntshav ntshav, thrombocytopenia;
- nthuav dav ntawm tus po;
- tshwm sim ntawm kev qaug cawv.
Txoj kev kho yog xaiv tus kheej nkaus xwb, raws li cov ntaub ntawv kuaj mob raug thiab tus neeg mob tus yam ntxwv. Yeej, txoj kev kho yog tsom rau kev tshem tawm cov teeb meem. Los ntawm nws tus kheej, tus kab mob no tseem kho tsis tau.
Chemodrugs yog siv rau hauv qhov tsawg kawg nkaus ntawm cov tshuaj lom thiab feem ntau raug muab los ua kom tus neeg mob lub neej ntev thiab tshem tawm cov tsos mob tsis zoo. Cov neeg mobyuav tsum nyob rau hauv kev saib xyuas nruj ntawm hematologist-oncologist. Kev kuaj ntshav yuav tsum tau ua 1-3 zaug hauv 6 lub hlis. Yog tias tsim nyog, tshwj xeeb kev txhawb nqa kev kho cytostatic raug sau tseg.
Kev Tiv Thaiv Kev Tiv Thaiv
Kev kho mob ntawm cov qog ntshav qog ntshav qog ntshav ntev yog ua tiav tom qab txheeb xyuas tag nrho cov teeb meem tshwm sim, tsim daim ntawv, theem thiab kuaj mob. Kev ua raws li kev noj zaub mov thiab kev kho tshuaj yog qhia. Yog tias tus kab mob hnyav heev, yuav tsum tau hloov cov pob txha pob txha, vim qhov no yog tib txoj hauv kev ua kom tiav kev kho kom tiav.
Thaum pib ntawm tus kab mob no, kev soj ntsuam hauv tsev kho mob tau qhia, thiab yog tias tsim nyog, tus kws kho mob tau sau tshuaj tua kab mob. Thaum kis tau tus kab mob, yuav tsum tau siv tshuaj tua kab mob thiab tshuaj tua kab mob. Nyob rau hauv lub hlis tom ntej, ib chav kawm ntawm chemotherapy yog qhia, tsom rau kev tshem tawm sai ntawm cov qog nqaij hlav cancer ntawm lub cev. Kev kho hluav taws xob yog siv thaum koj xav tau kom txo qhov loj ntawm cov qog sai sai thiab tsis muaj txoj hauv kev los kho nws nrog tshuaj kho mob.
siv tshuaj kho mob
Kev tshuaj xyuas ntawm cov kab mob lymphocytic mob qog noj ntshav hauv tsib caug feem pua ntawm cov neeg mob tau zoo, vim tias vim yog kev kho kom raug, tus neeg mob txoj kev noj qab haus huv tuaj yeem ua tau zoo. Ntau tus neeg mob hais tias nrog kev siv tshuaj khomob hauv thawj theem, lub neej tuaj yeem txuas ntxiv thiab nws qhov zoo tuaj.
Thaum tsis muaj kab mob sib kis, yog tias tus neeg mob hnub nyoog qis dua 70 xyoo, feem ntau sivkev sib xyaw ntawm cov tshuaj xws li Cyclophosphamide, Fludarabine, Rituximab. Nyob rau hauv rooj plaub ntawm kev ua siab ntev tsis zoo, yuav siv tau lwm yam tshuaj sib xyaw.
Rau cov neeg laus lossis thaum muaj cov kab mob sib kis, ntau qhov sib xyaw ua ke ntawm cov tshuaj tau sau tseg, tshwj xeeb, Obinutuzumab nrog Chlorambucil, Rituximab thiab Chlorambucil lossis Cyclophosphamide nrog Prednisolone. Nrog rau cov kev mob tsis tu ncua los yog rov qab ua dua, cov neeg mob tuaj yeem hloov txoj kev kho mob. Tshwj xeeb, nws tuaj yeem ua ke ntawm Idelalisib thiab Rituximab.
Cov neeg mob mob hnyav heev uas muaj mob hnyav heev tau raug sau tseg feem ntau yog kev kho mob monotherapy, tshwj xeeb yog cov tshuaj uas tau txais txiaj ntsig zoo. Piv txwv li, xws li Rituximab, Prednisolone, Chlorambucil.
Khoom noj khoom haus
Txhua tus neeg mob uas mob qog ntshav qog ntshav qog ntshav siab xav tau kev faib khoom kom zoo thiab ua haujlwm, nrog rau kev noj zaub mov kom raug. Kev noj zaub mov ib txwm yuav tsum tau tswj hwm los ntawm cov khoom tsiaj, thiab kev noj cov rog yuav tsum txwv. Nco ntsoov noj txiv hmab txiv ntoo tshiab, tshuaj ntsuab, zaub.
Nrog ntshav ntshav, cov zaub mov muaj hlau yuav pab tau kom normalize hematopoietic yam. Daim siab yuav tsum tsis tu ncua ntxiv rau cov zaub mov, nrog rau cov tshuaj vitamin.
Kev ntsuas tus neeg mob
Rau cov neeg mob feem ntau raug kev txom nyem los ntawm qhov teeb meem no, qhov tshwm sim tom qabkev kho mob zoo txaus. Nyob rau theem pib ntawm cov kab mob lymphocytic leukemia, lub neej expectancy yog ntau tshaj 10 xyoo. Ntau tus tuaj yeem ua yam tsis muaj kev kho tshwj xeeb. Txawm tias muaj tseeb hais tias tus kab mob no kho tsis tau, thawj theem tuaj yeem txuas ntxiv mus ntev. Kev kho mob feem ntau ua rau kev tshem tawm tsis tu ncua. Tsuas yog tus kws kho mob uas tuaj koom tuaj yeem muab kev kwv yees tau tseeb dua.
Muaj ntau cov txheej txheem niaj hnub kho. Cov tshuaj tshiab, ntau dua thiab cov kev kho mob tau tshwm sim txhua lub sijhawm. Cov tshuaj tshiab uas tau tshaj tawm hauv ob peb xyoos dhau los no tau pab txhim kho cov txiaj ntsig kev kho mob tau zoo.
Tsis muaj kev tiv thaiv tshwj xeeb ntawm lymphocytic leukemia. Kev noj tshuaj rau tus kheej tsuas tuaj yeem ua rau qhov xwm txheej hnyav zuj zus thiab tuaj yeem ua rau tus neeg mob tuag taus.
