淋巴肉瘤

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腰疼贫血反复感染helliph [复制链接]

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白癜风如何治 http://m.39.net/pf/a_7998441.html

本期由湖北省卫生健康委员会和湖北广播电视台联合策划。

对于大部分人来说,一谈起血液肿瘤,最先想到的就是白血病,韩剧里很多“生死恋”都因它而上演。但其实,还有一种血液病,它的发病率超过白血病,仅次于淋巴瘤,是血液系统第二大常见恶性肿瘤。很多患者的首发症状是腰疼、贫血、肾功能损害、反复感染……这些症状很难与血液病联系到一起,所以误诊、漏诊率非常高,85%的患者确诊时已是晚期!它就是——多发性骨髓瘤!今天我们就来聊一聊,如何识别善于“伪装”的骨髓瘤?精彩预告??

本期专家

医院院长

华中科技大学血液病学研究所所长

介绍:主任医师、二级教授、博士生导师。全国*协委员、国家重点学科带头人、教育部新世纪百千万人才、国家杰出青年科学基金获得者、国家科技进步二等奖获得者、全国创新争先奖、卫生部有突出贡献中青年专家、国务院*务特殊津贴获得者。在各种疑难血液病的临床诊治方面具有丰富经验,特别是对出、凝血疾病如难治ITP、易栓症等,恶性血液疾病如多发性骨髓瘤等具有较深造诣。

01

初次误诊率高达60%!你听说过多发性骨髓瘤吗?多发性骨髓瘤是一种起源于浆细胞的恶性肿瘤。正常的浆细胞会产生抗体,这种抗体在机体的免疫功能方面发挥着重要作用。当浆细胞成为恶性细胞时,它们就会变得具有多形性和不可控制地增长。从而对人体产生全方位、多系统的损害。多发性骨髓瘤是血液科的常见病和疑难病之一,且起病隐匿。再加上这一疾病的知晓率目前还是比较低,所以导致很多患者跑错科室,被漏诊、误诊,初次漏诊率高达60%,很多患者会首先就诊于骨科和肾内科等其他科室,诊断历程非常长,通常要4-6个月确诊。很多患者因此错过了最佳治疗时间,严重影响预后效果。

02

腰疼、贫血、肾功能损害、反复感染……有可能是骨髓瘤?一、腰疼骨痛≠骨病约75%的骨髓瘤患者因骨痛而就诊,约80%患者有不同程度的骨损害。骨头中有成骨细胞,还有破骨细胞,正常情况下,两者的代谢维持在一个平衡状态。当患有多发性骨髓瘤时,恶变的浆细胞会使钙、磷代谢发生变化,导致破骨细胞活动能力变强,成骨细胞活动能力下降。代谢平衡打破后,骨质被破坏,骨强度下降,很多患者就会出现骨痛。二、厌食恶心呕吐≠消化系统疾病多发性骨髓瘤会导致体内血钙水平增高,大量的钙质析出进入血液,排泄不出去,会出现高钙血症。高钙血症对人体损害严重,可引起头痛、厌食、恶心、呕吐、多尿、便秘,重者可致心律失常、嗜睡、意识模糊、谵妄或昏迷。三、肾功能异常≠肾病40%的患者会合并肾功能损害,部分会发展为急性肾功能衰竭,甚至需要做血液透析。恶变的浆细胞产生大量的单克隆抗体,就是M蛋白。M蛋白太多后,排泄不出去,堵塞肾小管,时间长了以后肾小球会出问题,进而损害肾功能。很多病人一开始往往在肾科就诊,甚至被当成肾病治疗,耽误时机,发展为肾衰竭。肾衰竭是骨髓瘤的重要并发症,与早期病死率增加有关,需要及时和适宜的干预治疗。四、乏力头晕脸色差≠内分泌疾病当恶变的浆细胞无限增殖,挤占了正常的骨髓空间,导致骨髓不能正常生成红细胞,甚至白细胞、血小板时,就会出现贫血。从而产生乏力、头晕、活动后心悸气短、面色苍白等表现。五、呼吸道感染≠呼吸道疾病恶性浆细胞分泌的M蛋白是没有免疫功能的,所以多发性骨髓瘤的患者往往免疫力低下,容易感染,感染后不易控制,控制后易复发,比如反复发作肺炎,或者出现带状疱疹等。

提问

确诊骨髓瘤要做哪些检查?

胡院长:一般需进行血尿蛋白电泳和免疫固定电泳,骨髓穿刺,影像学等检查可明确诊断。高危人群检查建议——40岁以上人群,如出现不明原因的骨痛、头晕、乏力、蛋白尿、水肿、反复感染等,在对应专科正规诊疗无效,需引起医院血液科检查。

03

自体移植打破治疗困境多发性骨髓瘤不再是绝症过去,多发性骨髓瘤曾一度缺乏有效治疗手段。近十几年来,随着医学技术的进步,化疗、靶向治疗、免疫治疗等新方法的涌现,骨髓瘤的疗效有很大提高。完全缓解率从5%提高到70%,平均生存期可以超过5年,早期的患者经过积极治疗以后中位生存期可以超过10年,甚至有患者能达到30年。多发性骨髓瘤是以化疗为主的一个多学科综合治疗,涉及靶向药治疗、自体造血干细胞移植、支持治疗等。对于适合移植的多发性骨髓瘤患者,会先通过化学药物进行诱导治疗,让患者达到一定的缓解程度后,再根据患者身体情况判断是否能够进行造血干细胞移植(就是把患者自己的造血干细胞拿出来做移植)进行巩固治疗。最后通过药物的巩固和维持治疗,尽可能延长患者的生存期。点击边框调出视频工具条amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;nbsp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;mpchecktextcontenteditable=amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;falseamp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;id=amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am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04

血液疾病的认知误区很“坏事”这些谣言你信了吗?说法一:住刚装修的房子易得恶性血液肿瘤。错误!新装修的房子,乳胶漆中的苯和大理石中的放射线,这两种有害物质与血液肿瘤具有一定的相关性。但现在的装修材料,环保等级有所提升,目前也没有明确证据表明,只要住了刚装修的房子,就会得血液肿瘤。建议新装修的房子多通通风再入住。孕妇、婴幼儿、老年人等体质较弱的人群不建议入住新装修的房子。说法二:血液肿瘤有遗传性。错误!有小部分血液肿瘤呈家族聚集性发病,直系亲属患病几率会比正常人有所增加,不过不是肯定会遗传的。说法三:患上肿瘤疾病要少摄入蛋白质,“饿死”癌细胞。错误!确实有一些传言“癌症不能吃糖、高蛋白、高营养,不能吃鸡……”,这些想“饿”死癌细胞的理论,都是不科学的。想饿死癌细胞,同时也是饿坏了好的免疫细胞,不利于患者的身体恢复。均衡营养合理膳食才是增强体质抵御疾病的正确之道。

多发性骨髓瘤患者的饮食禁忌:如合并肾脏问题,可以吃一些碱性的食物,减少尿蛋白对肾脏损伤,比如豆腐、牛奶、海带等。另外,要多喝水,让M蛋白都尿出去,减少在肾里的堆积,减少对肾小管的损伤。

说法四:患上恶性血液肿瘤最好少动,容易受伤出血。错误!这个说法也是比较片面的,适当运动,可以提高免疫力。不过需要提醒的是,多发性骨髓瘤患者免疫功能有缺陷,容易感染,所以要避免扎堆,预防交叉感染。年龄大的患者还要特别注意预防骨折。来源:荆楚大医生、湖北省卫生健康委员会、湖北广播电视台

往期回顾:

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抽脂≠减肥!33岁“网红”抽脂后感染去世,官方通报……

常吃碘盐和海鲜,会导致甲状腺结节?甚至甲状腺癌?!

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