äʹҹ Ӥѭо Եҧ Դҡ÷ըӹǹʹᴧŧ 觤ҡҡ˹ ѺԵҧԴͪҧ ԴǤ ҡҡ Ҥ繤 ҡáҡ ҹ ѡҡäҧѧ
äʹͤԴ ǢͧѺԵԷ мԴҧ˹觷Ƿء ˭ͤ٧ ѧҨǢͧѺä աä 纻 Ѻغѵ˵ѹ˵ʹ й鹡 ¤ѡҺҵͧ¨ҡäʹ ҡӤѭ褹çҺ Եҧ ʹ͡ Ѻ͵ͧ 㹻Ѩغѹäʹǹ˭öѡ¢Ҵ ҧ¡ѡդسҾԵբ
ѺҨ֧ԹҧҷçҺѲʶ 㹫ٹԨ ѧ ٹԵԷҡا ;ٴ¡Ѻᾷþ ᾷǪҭҧԵԷ ǡѺͧ س
ԤջѭͧäʹաШѴШ աôѡἹҧ 繡ôѡзҧҧúǧ 觻ѨغѹͧҡդջѭǡѺäʹҡ äմ äʹ͡Դ äǢͧѺԴԢͧʹ äʹҨ˵بҡѹ ԴͧҡԴԢͧǴ 㹻Ѩغѹաҡ Ҩçҹصˡ ԵѳëԸա÷ҧصˡҡ §ѵ лѵ 觵ҧ ҹѺҡ 㹪ԵШѹ ҡա§ ҨԴäʹ·ҧա ҧҡѴਹ ˹¢ͧҧ
-秵ͧ
äʹ 2 ѡ á äʹµç 繤ԴԢͧʹ ˵بҡʹͧ ǤաҧʹԴ ըӹǹҡһ ǹա辺¡Ҥ äкҡ͡ʴҧʹԴ 辺ҡʹǢͧѺͺءк դԴԴ鹡Ѻкк˹ ռšзԴԴԷҧʹ ¹ŧҧʹҨҡù餹çҺ 秡˭ ǡҨçҺŴͧԵҧ ҵǨ秴ѧ 繵鹔
..չҡٴ֧´ͧäͧ á äʹµç ǡѹҡش äкʹ 觷辺·ش 秵ͧ (Lymphoma) 秷Դյͧ ǢͧѺкͧ ҡӤѭͧ ͧ ͧ ˻ ѡ Т˹պ ͧͧǧ͡ 仡ʹʹ˭ ʹѺ´ ҨҴҡú ˹Һ ͺ˹͡ Ҩյͧ˹պ Һ ͧҨ 秵ͧʹ չ㹪ͧʹ Ҩ价ͺتͧͧ չ㹷ͧ ҡӤѭ աҡ÷յͧ ͧҨ仡ʹʹͧԴԡШ价ͺتͧҧ ͡ҡҨҡ÷Ш ˹ѡŴ ˧͡Դ 繵
...秵ͧ кʹ辺ҡѹѺ˹ 㹻Ѩغѹäöѡ 餹 դسҾԵբ 㹤ҧ¡öѡ¢Ҵ
٤-ʹ
äͧ äʹ ٤ ٤¤秢ͧʹǷԴ䢡д١ ¨աӹǹͧ Ẻ ҧش ʹ 2 Դ ԴºѹЪԴѧ ҡеѡɳТͧ秷辺 Դºѹ秷աӹǹҡ ·ҹ ѧ繵 ǹԴѧ 秷ӹǹöԭ繵 訹֧ش
...äʹԴҧ ººʹǡѺԴԢͧçҹ çҹԵԹҫ觢ǹâͧüԵԹ 4 5 鹵 ʹºѹ秷ԴԢͧ鹵 1 աӹǹͧԹҷѧ㹢鹵 1 ԭ֧鹷 2, 3 , 4 Թ仢鹷 1 çҹӹǹҡ ҼԵԹ鹷 1 ͧԹçҹ 仢 çҹͧҡ秵 öԵ Թһ ѧҤʹºѹ ʹ䢡д١ ҧʹᴧ ʹ ʹ Ԩըӹǹ ֧ʹԹŧ Եҧ äԴͧ ӹǹʹ ʹ͡Դ ֧ҡ÷عç äʹǪԴºѹ ¡ªԵ 2-3 ѧҡԹԨä 㹻Ѩغѹöѡä
...ǹԴѧ 㹡üԵԹ 5 鹵 ҼԵ件֧鹷 4 ö͡ к͡ äʹǪԴѧ ҡè֧ҡ ҨǨͺºѧԭѾ (ǨآҾ) µǨʹ з褹ҧ ʹǷʹѧШµҧ зѺ ͧ ǡҴͧ Ҵͧͧ 誹Դ äʹǪԴѧҡä繤 㹻Ѩغѹöѡ աþѲҵ㹡ѡäʹѧ Դ CML äʹԴҡõչԴԫ觡е鹷ԴʹǷӹǹ 㹻ѨغѹաüԵҷѺ㹡üԵõչ 㹡 Tynosine Kinase Inhibitor ҹջԷҾ㹡ѡ ¤Ҥᾧҡ ѧͧҵʹԵ ҡشäСѺ
䢡д١ Դ Multiple Myeloma
ʹ辺ѹѺ 䢡д١¡ Multiple Myeloma (ŵ ) ԴҡԴԢͧ¡Ҿ 觾˹ҷ㹡ҧԺʹ Ѻáе鹨ҡਹ ǢͧѺкԤѹ äҡҡ Եҧ Ǵд١ ҧҡ ˡԴǡաд١ѡ ҧ ҧҴҡëҡ÷٧ ͺҧǴд١ ǡǹ˭áԵᾷ äд١ ʹҹ ҨԹԨҹҹ
äͤԴԢͧʹ
кʹٴ 秵ͧ ʹ ŵ 㹻Ѩغѹդ˹㹡ѡҡ աù äʧäʧ 鹵㹡ѡ зҧäʧҹش 餹դسҾԵբ ä秷ǷԴ ҡѹ оҡش
...չäʹ Ӥѭо Եҧ Դҡ÷ըӹǹʹᴧŧ ҡҡ˹ ѺԵҧԴͪҧ ԵҧԴ ҡҡ Ҥ繤 ҡáФ Դ ѧ
...˵آͧԵҧҧ ˹ աҧʹᴧŴŧ ͧ ա÷ʹᴧ աʹ 駹繨ҡäúҧ鹡Ѻ ԵҧԴǪҧ ԵҧԴǴ ѻǤѧʺ´ 觨͡ʺ 3 4 ҵ Դҡ ˹ ǡ¡ºѹ ˵ҨԴҡʹ͡ ʹ͡¹͡ѡջѭ㹡ԹԨ ҧʹ͡ ʹ͡㹪ͧͧҧͧ ᾷԹԨͧ ͧ͡١ͤҧʺغѵ˵աáᷡͧҹ¨ᵡ ժ͡絫ʵᵡ ʹ͡ ҹʹ͡ ҳʹʹŴŧ ѹԵ ҨҡêͤԴ
˭ա ǡʹᴧᵡ ǡҨԴҡҴ ѡ繼 äҧѹء ҡʺ´ҵʹ äԴ͡ԹҺҧҧ ѡ Ƿʹᴧᵡ ʹᴧᵡ зҡëմ մ çҺ ҧ٧
...äͧҨ ʫ ¡źԹ (Hb H disease) ǡ繸ʫªԴ˹觫ҡù ˹ҵѡա¹ŧ ˹ҵẺ ҨռǫմԴ˹ äԴԴ鹨 ʹᴧᵡҧǴ Եҧ
...ä ԴҡѧͧʹᴧԴ ä Hereditary spherocytosis ǡҨҴʹᴧᵡºѹ
ä ԴҡԺʹʹᴧ Ժʹ仨Ѻʹᴧ աᵡ¢ͧʹᴧ ¡ ä Autoimmune hemolytic anemia ѡ㹼˭ԧ
ԵҧԴѧ ҡä繤 ˵ط辺 Դҡ աʹѧ ԴâҴҵ ÷ʹ͡ѧ ѡԴҡʹ͡ҡҧԹ ä秡 ˭ Դմǧ ҨԴҡʹ͡ҡͧʹ ҡͧ͡١ 㹡ԹԨԵҧѧҡâҴҵ 繵ͧ˵ش ʹ͡ҡ˹
Եҧѧ辺աä˹ ʫ 觤ѡҡõ ԵҧѺͧ ͧ յѺ СԭԺԴ ˹ҵ¹мǤ äʹᴧᵡѧ ռŷ䢡д١ҺҧʹᴧҪ յѺҡ÷ա÷ʹᴧԴ ոҵеҧ ˹ѧդ ҹ äʫ öѡ¢Ҵ¡û١䢡д١ 觶ѡá 3 á ¢Ҵͺ繵
͡ҡ Եҧѧ ҨԴҡѧ âҴͧҡ·ҹѡʴ ŵԵѹ 12 ä㹡Myelodysplastic MDS 觾㹤٧ ͡¹Ǥºѹ
ԵҧԴҡԴԢͧ䢡д١辺 ä䢡д١äԵҧоʵԡ ä䢡д١ҧʹ ҡ÷Եҧ ʹ͡Դ ·ԵҧԴẺºѹ ѧ ѡҡ 1-2 䢡д١ҧʹᴧҧ ҧʹʹ´
äʹ͡Դ
ʹ͡ ҨԴҡ˵зԴҡ÷դԴԢͧ䡡ʹ ǹ˭Դҡʹ͡зҳ 80 90 % ա 10 - 20 % ԴҡԴԢͧ䡡ʹ ҨԴҡԴԷҧѹ辺 ¡ä ѡ硼 ҡõѴ ѴԹ ˡҨը ҡ÷Ӥѭ ʹ͡㹢
...ǡѹ ʹ͡äҧѹ羺 ըӹǹʹ 辺·شäʹ ITP ԴҡҧҧԤѹ价ʹͧͧ äǡѺä SLE ·ҧҧԤѹҷͷТͧͧ Ѻ Ҩ繡Ѻʹᴧ ʹ ʹ ˹ѧ 繵
...ǡҴ¡ ͧ辺ä秵ͧ辺äʹѧ㹢ҧ
...ش¤ ǡʹʹպѹ 觨ҡҧâ鹡Ѻʹʹպѹ˹ ʹʹ㨵պѹ ʹʹشѹ 繵鹔
ػѡɳФäʹçҺ
ѡɳҡâͧҨäʹ ˹觤 մ ˹§ ӡԨѵûШѹ˹ ;ҫմҡõǨʹҧͧԺѵԡԴҡѾ ͧ ҡâͧõԴ ͧҡʹǵ ʹ͡˹ѧ ʹ͡ÿѹ ʹ͡ҡԴ ʹ͡ҡ˹ ա յͧ ѡ ˹պ Ҩ ա㹷ͧ äʹѺԹԨ
Եͧѡäʹ
ҧ äʹҡ Ҩäʹµç äк ҡ÷ҧʹ ٹԵԷҡا ٹѡäʹçҺ͡ ˹Ҥµѹ͡§ ·ᾷǪҭջʺó٧㹡ôŤ ¡úԡâͧҤ ԹԨäҧǴ ѡҧѹǧ çҺҹ Фҹ ·ᾷǪҭջʺó٧ ᾷäʹ ᾷäʹ оҸᾷ ᾷ֡ҷءк ͧԺѵԡ÷ҵðҹšõǨǴ ٹ١鹡Դҡʹ䢡д١ öѡҼ´¡û١ͧ觵ѡҷçҺ
...աʹǹСͺͧʹʹ٧ աõǨѴͧʹ繾 ʹäҧ ʹᴧ աáͧʹ͡仡 ͻͧѹԴԺʹ ŴõԴ cytomegalovirus Ш鹡ʹҡԨҤ Ŵ͡ԴԺʹ ͡ҡ ҧٹѧѲѡҾͧԡҵðҹ觢 ¡¹ ҹԪҪվСý֡ͺ ѺᾷоҺ͡¹ ٹʺó㹡ѡ觢
...äʹѡ ҧä¢Ҵ ҧäѡǷ餹դسҾԵբ ѡҵá Ŵ¹ ѧ鹷ҹҵǨآҾ Ǩʹ繻Шҧ»Ф
...Ըշշش ûͧѹԴä ҡöͧѹ ҹèѺԹԨµá šѡҨдշش
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