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style=\"font-size: 15px;\">慢性淋巴细胞白血病（Chronic Lymphocytic Leukemia，CLL）是一种发生于血液和骨髓的恶性肿瘤，主要表现为异常的B淋巴细胞逐渐增多，并在血液、骨髓、淋巴结和脾脏等部位积聚。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">CLL通常进展较慢，有些患者在确诊时没有明显症状，可能是在体检或常规血液检查中偶然发现。随着疾病进展，部分患者可能出现淋巴结肿大、肝脾肿大、疲劳、发热、盗汗、体重下降或容易感染等表现。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">CLL并不意味着确诊后一定需要马上治疗。对于没有明显症状、疾病相对稳定的患者，医生可能会建议定期复查和观察；当疾病进展并达到治疗指征时，再根据患者的具体情况选择合适的治疗方案。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","⚕️","2026-09-14",{"key":90,"title":91,"html":92,"icon":93,"updatedAt":88},"cause","病因与危险因素","\u003Cp>\u003Cspan style=\"font-size: 15px;\">CLL的确切病因目前尚不完全清楚。研究发现，CLL的发生与B淋巴细胞中的一些遗传和分子改变有关，这些改变使异常B淋巴细胞不能正常死亡，并逐渐在体内积聚。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">一些因素可能与CLL发病风险增加有关：\u003C\u002Fspan>\u003C\u002Fp>\u003Cul class=\" list-paddingleft-2\" style=\"list-style-type: disc;\">\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">年龄：CLL更常见于老年人，年轻人相对少见。\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">家族史：如果近亲中有人患有CLL或其他血液系统恶性肿瘤，发生CLL的风险可能有所增加。\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">性别：CLL在男性中的发病率高于女性。\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">部分环境或职业暴露：一些环境和职业相关暴露可能与CLL风险增加有关，但具体影响仍在研究中。\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">需要注意的是，存在危险因素并不意味着一定会患CLL。很多CLL患者也没有明确的危险因素。\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","🧬",{"key":95,"title":96,"html":97,"icon":98,"updatedAt":88},"symptom","症状表现","\u003Cp>\u003Cspan style=\"font-size: 15px;\">很多CLL患者在疾病早期没有明显症状。随着疾病发展，可能出现：\u003C\u002Fspan>\u003C\u002Fp>\u003Cul class=\" list-paddingleft-2\" style=\"list-style-type: disc;\">\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">持续疲劳、乏力\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">发热\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">夜间大量出汗\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">不明原因的体重下降\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">颈部、腋窝或腹股沟等部位淋巴结肿大\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">肝脏或脾脏增大\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">反复或较严重的感染\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">容易出现瘀青或出血\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">气短\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">吃少量食物后就有饱腹感\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">这些表现也可能由其他疾病引起，仅凭症状不能判断是否患有CLL，需要结合相关检查进行诊断。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","📋",{"key":100,"title":101,"html":102,"icon":103,"updatedAt":88},"exam","检查方式","\u003Cp>\u003Cspan style=\"font-size: 15px;\">如果血液检查发现淋巴细胞持续异常升高，或出现其他疑似CLL的表现，可能需要进一步检查。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>血液检查 \u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>血常规可以了解白细胞、红细胞和血小板的数量及变化。CLL患者通常可发现外周血淋巴细胞数量增多，部分患者还可能伴有贫血或血小板减少。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>流式细胞术和免疫表型检查\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Flow cytometry and immunophenotyping examine specific markers on the surface of lymphocytes. These tests can help determine whether abnormal lymphocytes are CLL cells and distinguish CLL from other blood disorders.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>骨髓检查 \u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">部分患者可能需要进行骨髓穿刺和\u002F或骨髓活检，了解CLL细胞在骨髓中的情况。但骨髓检查并不是所有CLL患者确诊时都必须进行的检查。是否需要进行，需要结合具体情况判断。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>遗传和分子检测 \u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>通过对CLL细胞进行染色体、基因和分子检测，可以进一步了解疾病的生物学特征。例如，\u003Cstrong>del(17p)、TP53基因异常以及IGHV突变状态\u003C\u002Fstrong>等信息，可以帮助医生进行风险评估，并为治疗方案的选择提供参考。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","🩺",{"key":105,"title":106,"html":107,"icon":108,"updatedAt":88},"treatment","治疗方式","\u003Cp>\u003Cspan style=\";\">CLL的治疗需要综合考虑是否存在治疗指征、疾病特点、遗传和分子特征，以及患者的年龄、身体状况和既往治疗等因素。\u003C\u002Fspan>并不是所有CLL患者确诊后都需要立即开始治疗。\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cstrong>观察等待 \u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\";\">\u003Cbr\u002F>\u003C\u002Fspan>\u003Cspan style=\";\">对于疾病处于早期、没有明显症状或暂时没有治疗指征的患者，可以先进行定期随访，而不是立即治疗，这种方式通常称为“观察等待”。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\";\">观察期间一般会定期进行血液检查和身体检查，了解疾病是否发生变化。\u003C\u002Fspan>观察等待并不等于不管疾病，而是在医生评估和随访下，根据疾病变化选择合适的治疗时机。\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cstrong>靶向治疗\u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>\u003Cspan style=\";\">靶向治疗是目前CLL重要的治疗方式之一。这类药物主要针对CLL细胞生长和存活所依赖的特定信号通路发挥作用。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\";\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\";\">目前CLL常用的靶向药物包括\u003C\u002Fspan>\u003Cstrong>\u003Cspan style=\";\">BTK抑制剂、BCL-2抑制剂\u003C\u002Fspan>\u003C\u002Fstrong>\u003Cspan style=\";\">等。具体选择需要结合患者的疾病特征、基因和分子检测结果、身体状况以及既往治疗情况综合判断。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cstrong>免疫治疗\u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\";\">\u003Cbr\u002F>\u003C\u002Fspan>\u003Cspan style=\";\">部分治疗可以通过识别CLL细胞表面的特定靶点，帮助免疫系统攻击肿瘤细胞。\u003C\u002Fspan>例如，抗CD20单克隆抗体可以根据患者的具体情况单独使用，或与其他药物联合使用。\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cstrong>化疗和化学免疫治疗\u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\";\">\u003Cbr\u002F>\u003C\u002Fspan>\u003Cspan style=\";\">过去，化疗和化学免疫治疗曾是CLL的重要治疗方式。随着靶向药物的发展，目前许多患者的治疗选择已经发生变化。\u003C\u002Fspan>对于部分患者，医生仍可能根据疾病特点和个人情况考虑化疗或化学免疫治疗。\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cstrong>放疗\u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\";\">\u003Cbr\u002F>\u003C\u002Fspan>\u003Cspan style=\";\">放疗通常不是CLL的主要治疗方式。在部分情况下，如果明显增大的淋巴结或脾脏引起疼痛、压迫等症状，可以考虑使用局部放疗帮助缓解症状。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Ch3>\u003Cstrong>造血干细胞移植\u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>\u003Cspan style=\";\">造血干细胞移植（HSCT）并不是大多数CLL患者的常规治疗方式。\u003C\u002Fspan>对于少数高危、难治或经过多种治疗后仍无法获得理想疾病控制的患者，医生可能会综合评估是否考虑异基因造血干细胞移植。是否适合移植，需要综合考虑疾病风险、既往治疗效果、年龄、身体状况以及供者等多方面因素。\u003C\u002Fp>","💊",{"author":84,"reviewedBy":84,"lastReviewed":84,"datePublished":84,"citations":110,"disclaimer":84},[111,114,117,120],{"title":112,"url":113},"National Cancer Institute (NCI). Chronic Lymphocytic Leukemia Treatment (PDQ®)–Patient Version.","https:\u002F\u002Fwww.cancer.gov\u002Ftypes\u002Fleukemia\u002Fpatient\u002Fcll-treatment-pdq",{"title":115,"url":116},"National Cancer Institute (NCI). Chronic Lymphocytic Leukemia Treatment (PDQ®)–Health Professional Version.","https:\u002F\u002Fwww.cancer.gov\u002Ftypes\u002Fleukemia\u002Fhp\u002Fcll-treatment-pdq",{"title":118,"url":119},"American Cancer Society (ACS). Tests for Chronic Lymphocytic Leukemia (CLL).","https:\u002F\u002Fwww.cancer.org\u002Fcancer\u002Ftypes\u002Fchronic-lymphocytic-leukemia\u002Fdetection-diagnosis-staging\u002Fhow-diagnosed.html",{"title":121,"url":122},"American Cancer Society (ACS). Treating Chronic Lymphocytic Leukemia (CLL).","https:\u002F\u002Fwww.cancer.org\u002Fcancer\u002Ftypes\u002Fchronic-lymphocytic-leukemia\u002Ftreating.html",false,1789384105993]