慢性白血病转急性白血病

2025-02-19 04:40:36
推荐回答(4个)
回答1:

病情分析:
 急性白血病:发病急骨髓和外周血中主要是原始细胞,若不治疗病人常于半年内死亡.根据白血病细胞的类型临床上又分为急性淋巴细胞性白血病(ALL) 和急性非淋巴细胞性白血病(ANLL)两大类,每类又有几型.目前国内外通用的分型如下:①ANLL分为7型 即粒细胞白血病未分化型(M1) , 粒细胞白血病部分分化型 (M2), 早幼粒细胞型(M3)粒-单核细胞型(M4),单核细胞型(M5),红白血病(M6)巨核细胞型(M7);②ALL分为L1 ,L2和L3型,近年来又根据细胞的免疫学特点分为T B,前B,普通型和未分化型.我国白血病发病率约3.0~4.0/10万.在恶性肿瘤死亡率中,白血病在男女性中分别居第6和第8位,而在35岁以下人群中居首位.急性白血病多于慢性.成人急性白血病中以ANLL最多见,儿童中则以急性淋巴细胞白血病(acute lymphocytic leukemia,ALL)较多见;在我国慢性白血病中以慢性髓细胞白血病(chronic myeloid leukemia,CML)多见,而欧美国家则以慢性淋巴细胞白血病(chronic lymphocytic leukemia,CLL)常见.
意见建议:
1.治疗原则:总的治疗原则是消灭白血病细胞群体和控制白血病细胞的大量增生,解除因白血病细胞浸润而引起的各种临床表现. 
  2.支持治疗 (1)注意休息:高热,严重贫血或有明显出血时,应卧床休息.进食高热量,高蛋白食物,维持水,电解质平衡. (2)感染的防治:严重的感染是主要的死亡原因,因此防治感染甚为重要.病区中应设置“无菌”病室或区域,以便将中性粒细胞计数低或进行化疗的人隔离.注意口腔,鼻咽部,肛门周围皮肤卫生,防止粘膜溃疡,糜烂,出血,一旦出现要及时地对症处理.食物和食具应先灭菌.口服不吸收的抗生素如庆大毒素,粘菌素和抗霉菌如制霉菌素,万古霉素等以杀灭或减少肠道的细菌和霉菌.对已存在感染的患者,治疗前作细菌培养及药敏试验,以便选择有效抗生素治疗.一般说来,真菌感染可用制霉菌素,克霉唑,咪康唑等;病毒感染可选择Ara-c,病毒唑.粒细减少引起感染时可给予白细胞,血浆静脉输入以对症治疗. (3)纠正贫血:显著贫血者可酌情输注红细胞或新鲜全血;自身免疫性贫血可用肾上腺皮质激素,丙酸睾丸酮或蛋白同化激素等. (4)控制出血:对白血病采取化疗,使该病得到缓解是纠正出血最有效的方法.但化疗缓解前易发生血小板减少而出血,可口服安络血预防之.有严重的出血时可用肾上腺皮质激素,输全血或血小板.急性白血病(尤其是早粒),易并发DIC,一经确诊要迅速用肝素治疗,当DIC合并纤维蛋白溶解时,在肝素治疗的同时,给予抗纤维蛋白溶解药(如对羧基苄胺,止血芳酸等).必要时可输注新鲜血或血浆. (5)高尿酸血症的防治:对白细胞计数很高的病人在进行化疗时,可因大量白细胞被破坏,分解,使血尿酸增高,有时引起尿路被尿酸结石所梗阻,所以要特别注意尿量,并查尿沉渣和测定尿酸浓度,在治疗上除鼓励病人多饮水外,要给予嘌呤醇10mg/kg?d,分三次口服,连续5~6天;当血尿酸>59um01/L时需要大量输液和碱化尿液. 
  3.化学治疗:化疗是治疗急性白血病的主要手段,因化疗副作用大,因此化疗期间及化疗后应同时用“脱毒的红豆杉药材”以降低其副作用,同时长期服用达到防止复发转移的目的.化疗可分为缓解诱导和维持治疗两个阶段,其间可增加强化治疗,巩固治疗和中枢神经预防治疗等.缓解诱导是大剂量多种药物联用的强烈化疗,以求迅速大量杀伤白血病细胞,控制病情,达到完全缓解,为以后的治疗打好基础.所谓完全缓解,是指白血病的症状,体征完全消失,血象和骨髓象基本上恢复正常,急性白血病末治疗时,体内白血病细胞的数量估计为5×1010~13;,经治疗而达到缓解标准时体内仍有相当数量的白血病细胞,估计在108~109以下,且在髓外某些隐蔽之处仍可有白血病细胞的浸润.维持治疗量一系列的小剂量较缓和的治疗方案进行较长时间的延续治疗,目的在于巩固由缓解诱导所获得的完全缓解,并使病人长期地维持这种“无病”状态而生存,最后达到治愈.巩固治疗是在维持治疗以后.维持治疗以前,在病人许可的情况,再重复缓解诱导方案.强化治疗是在维持治疗的几个疗程中间再重复原缓解诱导的方案.中枢神经预防性治疗宜在诱导治疗出现缓解后立即进行,以避免和减少中枢神经系统白血病发生,一个完整的治疗方案应遵循上述原则进行. 

回答2:

化疗控制纠正指征,配合中药保护脏腑功能,减小化疗危害,调理改善造血机制。

回答3:

现代医学以化疗、输血及骨髓移植为主,这些方法治标不治本,长期应用会产生许多毒副作用,食欲不振,厌食、恶心呕吐等胃肠道症状是化疗后最常见的毒副作用,化疗后自身抵抗力低下,易引起各种感染,反过来感染又会加重原发病,这样一来就会形成恶性循环,使病情进一步发展致慢粒加速期及急变期。石家庄燕赵血液病肾病研究院中医中药治疗慢性粒细胞白血病,可提供患者的具体病情来咨询

回答4:

慢粒白血病急变后预后极差,建议积极治疗。请问患者现在是如何治疗的?

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