diff --git "a/CMeEE_train.json" "b/CMeEE_train.json"
new file mode 100644--- /dev/null
+++ "b/CMeEE_train.json"
@@ -0,0 +1,445778 @@
+[
+ {
+ "text": "（5）房室结消融和起搏器植入作为反复发作或难治性心房内折返性心动过速的替代疗法。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "房室结消融"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "起搏器植入"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "反复发作或难治性心房内折返性心动过速"
+ }
+ ]
+ },
+ {
+ "text": "（6）发作一次伴血流动力学损害的室性心动过速（ventriculartachycardia），可接受导管消融者。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "血流动力学损害的室性心动过速"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "ventriculartachycardia"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "pro",
+ "entity": "导管消融"
+ }
+ ]
+ },
+ {
+ "text": "4.第三类（1）无症状性WPW综合征患者，年龄小于5岁。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "无症状性WPW综合征"
+ }
+ ]
+ },
+ {
+ "text": "（2）室上性心动过速可用常规抗心律失常药物控制，年龄小于5岁。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "室上性心动过速"
+ }
+ ]
+ },
+ {
+ "text": "（3）非持续性，不考虑为无休止性的阵发性室性心动过速（即一次监视数小时或任何一小时记录的心电图条带几乎均可出现），心室功能正常。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "非持续性，不考虑为无休止性的阵发性室性心动过速"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "心电图"
+ }
+ ]
+ },
+ {
+ "text": "（4）非持续性室上性心动过速，不需其他治疗和（或）症状轻微。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "非持续性室上性心动过速"
+ }
+ ]
+ },
+ {
+ "text": "第十章胸膜疾病小儿胸膜疾病以胸膜炎最为常见，多继发于肺部感染，原发性或其他原因所致者较少见。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "胸膜疾病"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "小儿胸膜疾病"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "胸膜炎"
+ }
+ ]
+ },
+ {
+ "text": "第一节胸膜炎胸膜炎（pleurisy）分为三种：干性胸膜炎、浆液性胸膜炎和化脓性胸膜炎。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "胸膜炎"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "胸膜炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "pleurisy"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "干性胸膜炎"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "浆液性胸膜炎"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "化脓性胸膜炎"
+ }
+ ]
+ },
+ {
+ "text": "一、干性胸膜炎干性胸膜炎（dryorplasticpleurisy）又称纤维素性胸膜炎，常与肺部细菌感染有关，亦可发生于急性上呼吸道疾病过程中。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "干性胸膜炎"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "干性胸膜炎"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "dryorplasticpleurisy"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "纤维素性胸膜炎"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "肺部细菌感染"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "急性上呼吸道疾病"
+ }
+ ]
+ },
+ {
+ "text": "结缔组织疾病如风湿热患儿亦可发生。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "结缔组织疾病"
+ }
+ ]
+ },
+ {
+ "text": "深呼吸及咳嗽时疼痛加剧。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "深呼吸及咳嗽时疼痛加剧"
+ }
+ ]
+ },
+ {
+ "text": "病程早期可闻胸膜摩擦音在全部呼吸期间均可听到。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "闻胸膜摩擦音"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "在全部呼吸期间均可听到"
+ }
+ ]
+ },
+ {
+ "text": "胸部X线透视和胸片可见患侧膈呼吸运动减弱肋膈角变钝流行性胸痛和带状疱疹前驱期的胸痛及肋骨骨折相鉴别。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "胸部X线透视"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "胸片"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "患侧膈呼吸运动减弱"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "肋膈角变钝"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "流行性胸痛"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "带状疱疹前驱期的胸痛"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "肋骨骨折"
+ }
+ ]
+ },
+ {
+ "text": "同时应分析胸膜炎的原因，注意肺部有无炎症，并进行必要的检查，尤其注意排除结核病。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "胸膜炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "如非肺炎病例，宜用宽大胶布条紧缠患部以减少其呼吸动作或给镇咳剂抑制咳嗽。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "宽大胶布条紧缠患部"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "镇咳剂"
+ }
+ ]
+ },
+ {
+ "text": "肺炎患儿则不宜采用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "第十三节狂犬病狂犬病（rabies）又称恐水症（hydrophobia），是由狂犬病毒引起的中枢神经系统急性传染病，为人畜共患的自然疫源性疾病。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "狂犬病"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "狂犬病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "rabies"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "恐水症"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "hydrophobia"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "mic",
+ "entity": "狂犬病毒"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "中枢神经系统急性传染病"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "自然疫源性疾病"
+ }
+ ]
+ },
+ {
+ "text": "临床上以恐水、怕风、咽肌痉挛、进行性瘫痪为特征，病死率极高。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "恐水"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "怕风"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "咽肌"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "咽肌痉挛"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "瘫痪"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "进行性瘫痪"
+ }
+ ]
+ },
+ {
+ "text": "【病原和流行病学】狂犬病病毒（rabiesvirus）属弹状病毒科狂犬病病毒属。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "rabiesvirus"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "mic",
+ "entity": "弹状病毒"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ }
+ ]
+ },
+ {
+ "text": "病毒基因为单负链RNA。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "病毒基因"
+ }
+ ]
+ },
+ {
+ "text": "狂犬病病毒能在多种细胞中生长，但绝大多数毒株不引起细胞病变（长期传代培养适应后才出现），故常采用免疫酶技术或动物接种试验检测病毒增殖。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "免疫酶技术"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "pro",
+ "entity": "动物接种试验"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "在狂犬患者和动物神经细胞内存在狂犬病病毒特有的胞质内包涵体，又称内基小体（Negribodies）。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ }
+ ]
+ },
+ {
+ "text": "病毒对理化因素抵抗力较低，56℃30分钟或100℃2分钟、强酸、强碱、甲醛、升汞、脂溶剂、季铵类化合物都能很快杀灭之；紫外线和直射阳光可迅速降低病毒活力。",
+ "entities": [
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "狂犬病的传染源主要是犬，其次是猫和狼，其他野生动物如狐、浣熊、吸血蝙蝠也能传播本病。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "狂犬病"
+ }
+ ]
+ },
+ {
+ "text": "患病或带毒动物唾液中有大量病毒，通过咬伤、抓伤和舔伤皮肤黏膜而侵入，偶经食入带毒肉类而感染。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "皮肤黏膜"
+ }
+ ]
+ },
+ {
+ "text": "人群普通易感，被病犬咬伤而未预防接种者发病率为10%～70%，病死率近100%。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "咬伤"
+ }
+ ]
+ },
+ {
+ "text": "狂犬病在全球2/3的国家和地区流行。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "狂犬病"
+ }
+ ]
+ },
+ {
+ "text": "我国在20世纪50年代发病率很低，近几年随着“宠物热”的升温，发病率逐年增高，近5年全国狂犬病年疫报人数由160人（1996年）上升至899人（2001年），年死亡人数由140人（1996年）上升至862人（2001年）。",
+ "entities": [
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "狂犬病"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制和病理改变】狂犬病病毒的靶细胞是神经细胞和肌细胞。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "神经细胞"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肌细胞"
+ }
+ ]
+ },
+ {
+ "text": "侵入后先在局部神经末梢或在附近肌细胞中增殖后再侵入神经末梢，沿周围传入神经轴索上行至脊髓前背根神经大量增殖，然后侵入脊髓和中枢神经系统，主要侵犯脑干、基底节、海马回及小脑等处神经元，引起弥漫性脑脊髓病变；再沿传出神经侵入各组织器官继续复制。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "局部神经末梢"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肌细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "神经末梢"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "传入神经轴索"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "脊髓前背根神经"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "脊髓"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "脑干"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "基底节"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "海马回及小脑"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "神经元"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 100,
+ "type": "dis",
+ "entity": "弥漫性脑脊髓病变"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 107,
+ "type": "bod",
+ "entity": "传出神经"
+ }
+ ]
+ },
+ {
+ "text": "由于迷走神经、舌咽神经核及舌下神经核受损伤，可发生呼吸肌及吞咽肌痉挛。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "迷走神经"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "舌咽神经核"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "舌下神经核"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "呼吸肌"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "吞咽肌"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "呼吸肌及吞咽肌痉挛"
+ }
+ ]
+ },
+ {
+ "text": "交感神经受累时，可致唾液分泌和出汗增多。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "交感神经"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "交感神经受累"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "唾液"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "汗"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "唾液分泌和出汗增多"
+ }
+ ]
+ },
+ {
+ "text": "延髓和脊髓受损，则可引起各种类型的瘫痪。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "延髓"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "脊髓"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "延髓和脊髓受损"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "瘫痪"
+ }
+ ]
+ },
+ {
+ "text": "最终因脑实质损伤导致呼吸和循环衰竭而死亡。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "脑实质损伤"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "呼吸和循环衰竭"
+ }
+ ]
+ },
+ {
+ "text": "病毒侵入靶细胞的机制与病毒结合乙酰胆碱受体或其他受体有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "乙酰胆碱受体"
+ }
+ ]
+ },
+ {
+ "text": "病毒抗原诱导的特异性中和抗体、特异性细胞免疫及其分泌的细胞因子，特别是干扰素在抗狂犬病病毒免疫中起重要作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "病毒抗原"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "干扰素"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ }
+ ]
+ },
+ {
+ "text": "主要病理改变为脑实质和脑膜水肿、充血，微小血管出血，尤以大脑海马、延髓、脑桥、小脑和咬伤部位相应的背根节及脊髓段最为严重。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "脑实质"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "脑膜"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "脑实质和脑膜水肿、充血"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "微小血管"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "微小血管出血"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "大脑海马"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "延髓"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "脑桥"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "小脑"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "背根节"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "脊髓段"
+ }
+ ]
+ },
+ {
+ "text": "显微镜下见神经细胞空泡形成，透明变性和染色体分解小神经胶质细胞浸润，血管周围单核细胞及浆细胞浸润。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "equ",
+ "entity": "显微镜"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "神经细胞"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "神经细胞空泡"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "透明变性"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "染色体"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "染色体分解"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "小神经胶质细胞"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "小神经胶质细胞浸润"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "血管周围单核细胞"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "浆细胞"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "血管周围单核细胞及浆细胞浸润"
+ }
+ ]
+ },
+ {
+ "text": "70%～80%患者的神经细胞质中可发现内基小体，呈圆形或卵圆形，直径3～10μm，由狂犬病病毒核糖核蛋白聚集而成，有特异性诊断价值。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "神经细胞质"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "70%～80%患者的神经细胞质中可发现内基小体，呈圆形或卵圆形，直径3～10μm"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 51,
+ "type": "mic",
+ "entity": "狂犬病病毒核糖核蛋白"
+ }
+ ]
+ },
+ {
+ "text": "影响潜伏期的因素为年龄（儿童较短）、伤口部位（头面部发病早）、伤口性质（深咬伤较短）和入侵病毒的数量、毒力及宿主防御机制等。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "头面部"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "（一）前驱期持续1～4天，常有低热、头痛、乏力、咽痛、腹痛、烦躁等。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "低热"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "头痛"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "乏力"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "咽痛"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "烦躁"
+ }
+ ]
+ },
+ {
+ "text": "继之对强光、高声等刺激敏感而有咽喉紧迫感，进食时咽喉肌轻度痉挛，但尚能吞咽。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "咽喉"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "对强光、高声等刺激敏感而有咽喉紧迫感"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "咽喉肌"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "进食时咽喉肌轻度痉挛"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "尚能吞咽"
+ }
+ ]
+ },
+ {
+ "text": "约80%的患者伤口局部及其神经通路上有放射性疼痛、麻木、痒及感觉异常。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "伤口局部及其神经通路上有放射性疼痛、麻木、痒及感觉异常"
+ }
+ ]
+ },
+ {
+ "text": "（二）兴奋期反射性咽喉痉挛逐渐加重，当饮水，甚至听到讲水、看到水及咽水动作，或风、光、声、烟刺激也会引起咽喉部严重痉挛，出现典型的恐水症。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "咽喉"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "咽喉痉挛逐渐加重"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "咽喉部"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "当饮水，甚至听到讲水、看到水及咽水动作，或风、光、声、烟刺激也会引起咽喉部严重痉挛"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "恐水症"
+ }
+ ]
+ },
+ {
+ "text": "常伴呼吸肌痉挛而发生呼吸困难，全身肌张力高，颈部强硬。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "呼吸肌"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "呼吸肌痉挛"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "呼吸困难"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "全身肌"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "全身肌张力高"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "颈部"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "颈部强硬"
+ }
+ ]
+ },
+ {
+ "text": "常出现躁狂与昏睡交替。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "躁狂"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "昏睡交替"
+ }
+ ]
+ },
+ {
+ "text": "发作时暴躁异常；发作间歇期则较安静，语言清晰。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "暴躁异常"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "间歇期则较安静，语言清晰"
+ }
+ ]
+ },
+ {
+ "text": "由于交感神经亢进，有大汗、心率增快、血压升高、瞳孔扩大、唾液分泌增加等表现。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "交感神经"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "交感神经亢进"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "大汗"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "心率增快"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "血压升高"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "瞳孔"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "瞳孔扩大"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "唾液"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "唾液分泌增加"
+ }
+ ]
+ },
+ {
+ "text": "患者可高热39～40℃，神志大多清晰，部分患者有精神失常，可在发作中死于呼吸衰竭或循环衰竭。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "神志大多清晰"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "精神失常"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "循环衰竭"
+ }
+ ]
+ },
+ {
+ "text": "（三）麻痹期痉挛减少或停止，患者渐安静，逐步发生全身弛缓性瘫痪，尤以肢体软瘫多见。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "痉挛减少或停止"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "渐安静"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "瘫痪"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "逐步发生全身弛缓性瘫痪"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "肢体软瘫"
+ }
+ ]
+ },
+ {
+ "text": "感觉减退，反射消失，呼吸变慢而不齐，心搏微弱，血压下降，神志不清，最终因呼吸麻痹和循环衰竭而死亡。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "感觉减退"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "反射消失"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "呼吸变慢而不齐"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "心搏微弱"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "血压下降"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "神志不清"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "呼吸麻痹"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "循环衰竭"
+ }
+ ]
+ },
+ {
+ "text": "狂犬病整个病程3～5天，极少超过10天。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "狂犬病"
+ }
+ ]
+ },
+ {
+ "text": "极少见“麻痹型”病例，后者以高热、进行性麻痹为主，终至衰竭死亡，全病程约8～9天。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "进行性麻痹"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）血、尿常规及脑脊液白细胞总数轻至中度升高，亦可高达30×109/L，以中性粒细胞占优势，可达80%以上。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "血、尿常规"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "中性粒细胞"
+ }
+ ]
+ },
+ {
+ "text": "尿常规有轻度蛋白尿，偶有透明管型。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "尿常规"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "轻度蛋白尿"
+ }
+ ]
+ },
+ {
+ "text": "脑脊液压力在正常范围或稍增高，细胞数及蛋白量稍增多。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "脑脊液"
+ }
+ ]
+ },
+ {
+ "text": "（二）病原学检查1.病毒分离取患者唾液（病后4～24天）、脑脊液和尿沉渣（病后头2周内）或死后脑组织悬液接种敏感细胞，经检测病毒抗原鉴定病毒或脑内接种敏感动物，若接种动物在6～10天出现痉挛和麻痹或脑组织中找到内基小体即可诊断。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "病毒分离"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "唾液"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "尿沉渣"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 74,
+ "type": "pro",
+ "entity": "接种"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 94,
+ "type": "sym",
+ "entity": "痉挛"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 97,
+ "type": "sym",
+ "entity": "麻痹"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 101,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 108,
+ "type": "bod",
+ "entity": "内基小体"
+ }
+ ]
+ },
+ {
+ "text": "2.内基小体检查取死者脑组织或咬人动物脑组织（最好是脑室底部）印压涂片或病理切片，染色直接镜检或免疫荧光法检查内基小体，阳性率为70%～80%。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "内基小体检查"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "脑室底部"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "印压涂片"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "病理切片"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "染色直接镜检"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "免疫荧光法"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "内基小体"
+ }
+ ]
+ },
+ {
+ "text": "3.病毒抗原检测取患者唾液、咽-气管分泌物、尿沉渣、有神经原纤维的皮肤（常取颈部发际处）活检标本，用免疫荧光法或ELISA或ELISA夹心法检测病毒抗原，具有较高敏感性和特异性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "病毒抗原检测"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "唾液"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "咽-气管分泌物"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "尿沉渣"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "有神经原纤维的皮肤"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "颈部发际"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "活检标本"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "pro",
+ "entity": "免疫荧光法"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 60,
+ "type": "pro",
+ "entity": "ELISA"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 69,
+ "type": "pro",
+ "entity": "ELISA夹心法"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "mic",
+ "entity": "病毒抗原"
+ }
+ ]
+ },
+ {
+ "text": "4.中和抗体测定患者存活一周以上可用中和试验或ELISA法检测血清中和抗体，未接种过疫苗的患者抗体水平低；接种过疫苗的患者在出现症状后6～10天中和抗体水平快速增高，滴度可≥1∶5000（疫苗免疫不能达到此水平）。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "中和抗体测定"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "中和试验"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "ELISA法"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "疫苗"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "疫苗"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 95,
+ "type": "bod",
+ "entity": "疫苗"
+ }
+ ]
+ },
+ {
+ "text": "病程晚期脑脊液中检出高水平抗体（疫苗不能诱导）亦有诊断意义。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "疫苗"
+ }
+ ]
+ },
+ {
+ "text": "5.病毒RNA检查用斑点杂交法或RT-PCR法检测狂犬病病毒核衣壳序列，因有非特异性扩增带干扰，PCR产物需用Southern印迹法加以确认。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "病毒RNA检查"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "斑点杂交法"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "RT-PCR法"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "pro",
+ "entity": "PCR"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "Southern印迹法"
+ }
+ ]
+ },
+ {
+ "text": "确诊有赖于病原学检查或尸检脑组织发现内基小体。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "尸检"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "内基小体"
+ }
+ ]
+ },
+ {
+ "text": "（二）鉴别诊断1.破伤风（tetanus）有外伤史，潜伏期短，多为6～14天。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "破伤风"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "tetanus"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "外伤"
+ }
+ ]
+ },
+ {
+ "text": "有牙关紧闭，角弓反张，全身阵发性强直性肌痉挛，持续时间长；而无高度兴奋和恐水现象，预后也较好。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "牙关紧闭"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "角弓反张"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "全身阵发性强直性肌痉挛"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "无高度兴奋和恐水现象"
+ }
+ ]
+ },
+ {
+ "text": "但须注意，狂犬患者被咬伤时，也可同时感染破伤风。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "狂犬"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "咬伤"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "破伤风"
+ }
+ ]
+ },
+ {
+ "text": "2.其他病毒所致脑炎和脑膜炎有神志改变，甚至昏迷，此与狂犬病患者神志清楚、惊恐不安的情况不同。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "其他病毒所致脑炎和脑膜炎"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "神志改变"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "昏迷"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "狂犬病"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "神志清楚"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "惊恐不安"
+ }
+ ]
+ },
+ {
+ "text": "可通过脑脊液变化和病原学检查区别。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "脑脊液"
+ }
+ ]
+ },
+ {
+ "text": "【预防和治疗】（一）控制和消灭传染源加强犬等管理，野犬应尽量捕杀，家犬应登记，注射疫苗。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "控制和消灭传染源"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "加强犬等管理"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "注射疫苗"
+ }
+ ]
+ },
+ {
+ "text": "狂犬应立即击毙，焚毁或深埋，不可剥皮。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "狂犬应立即击毙，焚毁或深埋，不可剥皮"
+ }
+ ]
+ },
+ {
+ "text": "一时不能肯定为狂犬者，应隔离观察10天，取击毙或隔离期死亡动物的脑组织作病原学检查。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "隔离观察10天"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "取击毙或隔离期死亡动物的脑组织作病原学检查"
+ }
+ ]
+ },
+ {
+ "text": "以20%肥皂水或0.1%苯扎溴铵彻底冲洗伤口至少半小时；再用白酒或70%乙醇、碘酊涂擦几次，以清除局部的病毒。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "肥皂水"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "苯扎溴铵"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "白酒"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "dru",
+ "entity": "乙醇"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "碘酊"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "涂擦"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "除非伤及大血管需要紧急止血外，3天内不必包扎或缝合伤口。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "大血管"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "紧急止血"
+ }
+ ]
+ },
+ {
+ "text": "（三）疫苗接种疫苗接种是预防和控制狂犬病的重要措施之一。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "疫苗接种"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "疫苗接种"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "狂犬病"
+ }
+ ]
+ },
+ {
+ "text": "1.狂犬病病毒疫苗目前主要使用细胞培养疫苗，包括：①人二倍体细胞狂犬疫苗（humandiploidcell，HDCV）：免疫原性强，不良反应很少，注射次数少，但制备困难，价格昂贵；②原代地鼠肾细胞狂��病疫苗：效力在2.5IU以上，使用安全；③精制Vero狂犬病疫苗：免疫原性和不良反应与①相似，但价格低。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "狂犬病病毒疫苗"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "疫苗"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "人二倍体细胞狂犬疫苗"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 52,
+ "type": "dru",
+ "entity": "humandiploidcell"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "dru",
+ "entity": "HDCV"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 102,
+ "type": "dru",
+ "entity": "原代地鼠肾细胞狂犬病疫苗"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 131,
+ "type": "dru",
+ "entity": "精制Vero狂犬病疫苗"
+ }
+ ]
+ },
+ {
+ "text": "其他有精制鸡胚狂犬病疫苗、精制鸭胚狂犬病疫苗和原代牛肾细胞狂犬病疫苗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "精制鸡胚狂犬病疫苗"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "精制鸭胚狂犬病疫苗"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "原代牛肾细胞狂犬病疫苗"
+ }
+ ]
+ },
+ {
+ "text": "2.接触前免疫对象为有职业危险者、接触狂犬病病毒的实验室工作人员及和狂犬患者密切接触者。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "狂犬病病毒"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "狂犬"
+ }
+ ]
+ },
+ {
+ "text": "推荐0、28日二剂和0、7、28或0、28、56日三剂接种方案，每次1.0ml肌内注射或深皮下注射，或0.1ml皮内注射。",
+ "entities": [
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "肌内注射"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "深皮下注射"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "pro",
+ "entity": "皮内注射"
+ }
+ ]
+ },
+ {
+ "text": "3.接触后免疫WHO推荐的标准免疫方案（HDCV疫苗）为0、3、7、14和28日各肌内注射1ml，第90日再加强1次。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "HDCV疫苗"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "肌内注射"
+ }
+ ]
+ },
+ {
+ "text": "佐剂地鼠肾细胞疫苗建议采用2-2-1程序，即0日肌内注射2剂（2ml），第7日和第21日各肌内注射1ml。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "地鼠肾细胞疫苗"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "肌内注射"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "肌内注射"
+ }
+ ]
+ },
+ {
+ "text": "注射部位成人取三角肌，儿童注入腿前外侧。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "三角肌"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "腿前外侧"
+ }
+ ]
+ },
+ {
+ "text": "不宜接种于臂部。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "臂部"
+ }
+ ]
+ },
+ {
+ "text": "（四）注射免疫血清WHO推荐，在接种疫苗同时注射人狂犬病免疫球蛋白（HRIG），剂量为20IU/kg（马狂犬病免疫球蛋白剂量为40IU/kg）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "注射免疫血清"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "接种疫苗"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "人狂犬病免疫球蛋白"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dru",
+ "entity": "HRIG"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "马��犬病免疫球蛋白"
+ }
+ ]
+ },
+ {
+ "text": "先做皮试，阴性者一次肌内注射或一半剂量在伤口周围浸润注射，另半量肌内注射。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "皮试"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "肌内注射"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "肌内注射"
+ }
+ ]
+ },
+ {
+ "text": "皮试阳性者需行脱敏处理（0.05ml稀释20倍，0.05ml稀释10倍，0.1ml，0.2ml，0.5ml，不稀释抗血清分别皮下注射，每次观察15分钟）后方可注射。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "皮试"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "脱敏处理"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "皮下注射"
+ }
+ ]
+ },
+ {
+ "text": "补充水电解质及热量，纠正酸碱平衡失调，维护心血管及呼吸功能。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "补充水电解质及热量，纠正酸碱平衡失调"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "维护心血管及呼吸功能"
+ }
+ ]
+ },
+ {
+ "text": "兴奋期狂躁时可交替应用多种镇静剂，甚至应用吗啡或全身麻醉。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "吗啡"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "全身麻醉"
+ }
+ ]
+ },
+ {
+ "text": "咽喉痉挛不能控制导致窒息时可气管切开，间歇正压给氧。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "咽喉"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "咽喉痉挛不能控制"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "气管切开"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "间歇正压给氧"
+ }
+ ]
+ },
+ {
+ "text": "脑水肿时给脱水剂。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "脑"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "脑水肿"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "脱水剂"
+ }
+ ]
+ },
+ {
+ "text": "麻痹期可用呼吸循环兴奋剂、给氧或人工辅助呼吸。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "麻痹"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "呼吸循环兴奋剂"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "给氧"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "人工辅助呼吸"
+ }
+ ]
+ },
+ {
+ "text": "三、核素检查放射性核素检查（简称核素检查），是利用放射性核素对疾病进行检查和对脏器功能进行测定的方法，已广泛应用于小儿肾脏疾病的诊断和病理生理研究，有以下常用的方法应用于临床。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "核素检查"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "放射性核素检查"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "核素检查"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "脏器"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "小儿肾脏疾病"
+ }
+ ]
+ },
+ {
+ "text": "（一）肾动态显像和GRF、ERPF测定静脉注射由肾小球滤过或肾小管上皮细胞分泌而不被回吸收的显像剂（如99mTc-DTPA、131I-邻碘马尿酸和99mTc-EC等）后，用γ相机快速连续采集包括双肾和部分膀胱区域的放射性影���，可以依次观察到显像剂随血流灌注肾动脉和肾血管床的情况，然后是迅速聚集在肾实质，继而逐渐由肾实质流向肾盏、肾盂，最后经输尿管而达膀胱的整个过程，该检查提供两侧肾脏血流、肾功能和尿路是否通畅等多方面的信息，并可定量计算出双肾的GFR和ERPF。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "肾动态显像"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "GRF、ERPF测定"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "静脉注射"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肾小管上皮细胞"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dru",
+ "entity": "显像剂"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 60,
+ "type": "dru",
+ "entity": "99mTc-DTPA"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 71,
+ "type": "dru",
+ "entity": "131I-邻碘马尿酸"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 80,
+ "type": "dru",
+ "entity": "99mTc-EC"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "equ",
+ "entity": "γ相机"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 98,
+ "type": "bod",
+ "entity": "双肾"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 103,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 111,
+ "type": "pro",
+ "entity": "放射性影像"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 122,
+ "type": "dru",
+ "entity": "显像剂"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 125,
+ "type": "bod",
+ "entity": "血流"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 130,
+ "type": "bod",
+ "entity": "肾动脉"
+ },
+ {
+ "start_idx": 148,
+ "end_idx": 150,
+ "type": "bod",
+ "entity": "肾实质"
+ },
+ {
+ "start_idx": 157,
+ "end_idx": 159,
+ "type": "bod",
+ "entity": "肾实质"
+ },
+ {
+ "start_idx": 162,
+ "end_idx": 163,
+ "type": "bod",
+ "entity": "肾盏"
+ },
+ {
+ "start_idx": 165,
+ "end_idx": 166,
+ "type": "bod",
+ "entity": "肾盂"
+ },
+ {
+ "start_idx": 171,
+ "end_idx": 173,
+ "type": "bod",
+ "entity": "输尿管"
+ },
+ {
+ "start_idx": 176,
+ "end_idx": 177,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 191,
+ "end_idx": 192,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 196,
+ "end_idx": 196,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 200,
+ "end_idx": 201,
+ "type": "bod",
+ "entity": "尿路"
+ },
+ {
+ "start_idx": 221,
+ "end_idx": 222,
+ "type": "bod",
+ "entity": "双肾"
+ },
+ {
+ "start_idx": 224,
+ "end_idx": 226,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 228,
+ "end_idx": 231,
+ "type": "ite",
+ "entity": "ERPF"
+ }
+ ]
+ },
+ {
+ "text": "本法十分灵敏，当血浆BUN＞36mmol/L（100mg/dl）和Scr＞800μmol/dl（10mg/dl），仍可使泌尿系显影。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "血浆BUN"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "泌尿系显影"
+ }
+ ]
+ },
+ {
+ "text": "已成为GFR的“金标准”。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "动态肾显影还可作为肾血管性高血压的初筛方法，肾血管性高血压多为单侧肾动脉狭窄，典型表现为患侧肾血流灌注不良肾静态显像静脉注射能够聚集并滞留在肾实质内的显像剂（如99mTc-DMSA和99mTc-GH等），取后位进行肾区静态显像，所得影像即为肾实质影像。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "���态肾显影"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "肾血管性高血压"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "肾血管性高血压"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "单侧肾动脉狭窄"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "患侧肾血流灌注不良"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 57,
+ "type": "pro",
+ "entity": "肾静态显像"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 77,
+ "type": "dru",
+ "entity": "显像剂"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 89,
+ "type": "dru",
+ "entity": "99mTc-DMSA"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 98,
+ "type": "dru",
+ "entity": "99mTc-GH"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 112,
+ "type": "pro",
+ "entity": "肾区静态显像"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 122,
+ "type": "bod",
+ "entity": "肾实质"
+ }
+ ]
+ },
+ {
+ "text": "当血浆BUN＞18mmol/L（50mg/dl），Scr＞440μmol/L（5mg/dl）时，本法仍可显示残余的肾组织，较IVP灵敏。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "血浆BUN"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "IVP"
+ }
+ ]
+ },
+ {
+ "text": "肾静态显像和动态显像是所有显像技术（包括静脉肾盂造影、肾动脉造影、X线计算机体层扫描以及超声检查等）中最直观者，能直接显示肾实质全影，因此十分有利于观察肾脏的位置、形态和大小。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "肾静态显像"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "动态显像"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "静脉肾盂造影"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "肾动脉造影"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "X线计算机体层扫描"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "超声检查"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "肾脏"
+ }
+ ]
+ },
+ {
+ "text": "对先天性肾畸形，如蹄铁形肾（horseshoekidney）、孤立肾（singlekidney）、双肾一侧融合（unilateralfusion）、重复肾（duplicationofthekidney）和先天性肾盂输尿管连接部狭窄（pelviuretericobstruction）等，本法可一目了然，并可了解局部的功能状态。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "horseshoekidney"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "singlekidney"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "unilateralfusion"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 114,
+ "type": "dis",
+ "entity": "先天性肾盂输尿管连接部狭窄"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 139,
+ "type": "dis",
+ "entity": "pelviuretericobstruction"
+ }
+ ]
+ },
+ {
+ "text": "用本法显影受肾功能的影响很小，有人估计，只要残留肾功能在3%以上，本法即可勉强显影。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肾"
+ }
+ ]
+ },
+ {
+ "text": "肾静态显像观察到急性肾盂肾炎患儿肾瘢痕的阳性率达50%左右，瘢痕征的表现为肾影中单个或多个局部放射性缺损或减低区，多位于上下极，典型者呈楔形，宽面向外，使整个肾影变形。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "肾静态显像"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "急性肾盂肾炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "肾瘢痕"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "瘢痕征的表现为肾影中单个或多个局部放射性缺损或减低区，多位于上下极，典型者呈楔形，宽面向外，使整个肾影变形"
+ }
+ ]
+ },
+ {
+ "text": "本法的阳性率比超声检查和IVP高1倍左右。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "超声检查"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "IVP"
+ }
+ ]
+ },
+ {
+ "text": "由于瘢痕征并不全是真正的组织坏死后纤维化，而仍有较多的缺血和炎症成分，故可以由功能性肾静态显像发现，而难以被形态学检查法发现。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "瘢痕征"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "缺血"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "炎症"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "pro",
+ "entity": "形态学检查法"
+ }
+ ]
+ },
+ {
+ "text": "尿路感染患儿有肾瘢痕，说明感染已定位于肾实质，可作为小儿肾盂肾炎的诊断参考指标，对预后、正确治疗和疗效观察有重要意义。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "尿路感染"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "肾瘢痕"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "小儿肾盂肾炎"
+ }
+ ]
+ },
+ {
+ "text": "由于瘢痕的上述性质，经过积极治疗可见缩小甚至消退。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "瘢痕"
+ }
+ ]
+ },
+ {
+ "text": "肾动态显像的肾实质影像和排出影像也可见到瘢痕肾多样异常表现，但因影像质量不如肾静态显像，故为诊断肾瘢痕应首选肾静态显像，动态显像仅有参考价值。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "瘢痕肾多样异常"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "肾瘢痕"
+ }
+ ]
+ },
+ {
+ "text": "（三）膀胱输尿管尿反流（vesicoureteralreflux，VUR）显像膀胱尿反流显像分直接和间接两种方法。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "膀胱输尿管尿反流（vesicoureteralreflux，VUR）显像"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "膀胱尿反流显像"
+ }
+ ]
+ },
+ {
+ "text": "直接法是将99mTcO4-148MBq（4mCi）经导尿管注入膀胱内，然后用生理盐水缓缓灌注，待膀胱充盈完全后用力排尿，在此过程中，用γ相机以1～2秒一帧的速度连续照相，无论在充盈期或γ相机，输尿管或肾内有放射性出现，即可诊断为膀胱尿反流。",
+ "entities": [
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "equ",
+ "entity": "导尿管"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 112,
+ "type": "equ",
+ "entity": "γ相机"
+ }
+ ]
+ },
+ {
+ "text": "间接法则是在进行肾肾动态显像很少时，令受检者尽量憋住尿，然后用力排尿，在此过程中用γ相机快速照相，也可观察有无膀胱输尿管反流的存在和程度。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "则是在进行肾"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "肾动态显像"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "尿"
+ }
+ ]
+ },
+ {
+ "text": "核素法和X线法对膀胱尿反流的诊断率大致相同，且二者有约80%的X线法性，对���度反流为100%。",
+ "entities": [
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "pro",
+ "entity": "X线法"
+ }
+ ]
+ },
+ {
+ "text": "针对X线法的使受检患儿性腺的辐射吸收剂量较大的突出的缺点，核素法所致小儿性腺的辐射吸收剂量明显要低，仅为上述剂量的1/100左右。",
+ "entities": [
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "核素法"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "性腺"
+ }
+ ]
+ },
+ {
+ "text": "第十三节尿道下裂尿道下裂是一种尿道发育畸形，即尿道开口在阴茎腹侧正常尿道口近端至会阴部的途径上小儿泌尿生殖系统最常见的畸形之一。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "尿道发育畸形"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "会阴部"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "尿道开口在阴茎腹侧正常尿道口近端至会阴部的途径上"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "小儿泌尿生殖系统"
+ }
+ ]
+ },
+ {
+ "text": "近来，由于环境污染、农作物大量使用化肥和促生长剂，尿道下裂在欧美报道有上升之势。",
+ "entities": [
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "尽管在尿道下裂的手术治疗上已经有了非常大的进步，但无论从医生的角度还是患儿或其父母的角度，尿道下裂的治疗结果远不如人意。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "【胚胎学】胚胎第6周时，尿生殖窦的腹侧出现一个突起，称为生殖结节。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "尿生殖窦"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "生殖结节"
+ }
+ ]
+ },
+ {
+ "text": "在生殖结节的尾侧正中线上有一条浅沟，称为尿道沟。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "生殖结节"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "尿道沟"
+ }
+ ]
+ },
+ {
+ "text": "尿道沟两侧隆起部分为尿生殖褶。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "尿道沟"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "尿生殖褶"
+ }
+ ]
+ },
+ {
+ "text": "男性在双氢睾酮的作用下，生殖结节增长形成阴茎，尿生殖窦的下段伸入阴茎并开口于尿道沟，以后尿道沟两侧的尿生殖褶由近端向远端相互融合，形成尿道，此时尿道外口移到阴茎头冠状沟部。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "双氢睾酮"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "生殖结节"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "尿生殖窦"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "尿道沟"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "尿道沟"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "尿生殖褶"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "阴茎头冠状沟部"
+ }
+ ]
+ },
+ {
+ "text": "在阴茎头顶部，外胚层向内生长出一个细胞索，以后细胞索中央与尿道沟相通，使尿道外口移到阴茎头顶端。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "阴茎头顶部"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "细胞索"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "细胞索"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "尿道沟"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "尿道外口"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "阴茎头顶端"
+ }
+ ]
+ },
+ {
+ "text": "第12周时，阴茎头处形成皮肤反折，称为包皮。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "阴茎头"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "皮肤反折"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "包皮"
+ }
+ ]
+ },
+ {
+ "text": "生殖结节内的间质分化为阴茎海绵体及尿道海绵体。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "生殖结节"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "间质"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "阴茎海绵体"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "尿道海绵体"
+ }
+ ]
+ },
+ {
+ "text": "在胚胎期由于内分泌的异常或其他原因导致尿道沟融合不全时，即形成尿道下裂。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "内分泌的异常或其他原因导致尿道沟融合不全"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "由于尿道远端的形成处于最后阶段，所以尿道口位于阴茎体远端的尿道下裂占比例最大。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "尿道远端"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "阴茎体"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "【病因】1.基因遗传尿道下裂发病有一定的家族倾向，但所涉及的基因或染色体的具体情况尚不清楚。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "基因"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "染色体"
+ }
+ ]
+ },
+ {
+ "text": "我们碰到数例父子或兄弟，特别是孪生兄弟同患此病的，有报道10%患儿的父亲及15%患儿的兄弟中有尿道下裂。",
+ "entities": [
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "2.激素影响从胎睾中产生的激素影响男性外生殖器的形成。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "胎睾"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "激素"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "外生殖器"
+ }
+ ]
+ },
+ {
+ "text": "由绒毛膜促性腺激素刺激睾丸间质细胞（leydigcells）��孕期第8周开始产生睾酮，再转化形成双氢睾酮。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "绒毛膜促性腺激素"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "睾丸间质细胞"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "leydigcells"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "睾酮"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "双氢睾酮"
+ }
+ ]
+ },
+ {
+ "text": "外生殖器的发育受双氢睾酮的调节。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "外生殖器"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "双氢睾酮"
+ }
+ ]
+ },
+ {
+ "text": "睾酮产生不足、过迟，或者睾酮转化成双氢睾酮的过程出现异常均可导致生殖器畸形。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "睾酮"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "双氢睾酮"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "睾酮产生不足、过迟，或者睾酮转化成双氢睾酮的过程出现异常均可导致生殖器畸形"
+ }
+ ]
+ },
+ {
+ "text": "尿道下裂常伴发于隐睾、两性畸形就与此相关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "隐睾"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "两性畸形"
+ }
+ ]
+ },
+ {
+ "text": "母亲孕前、孕期的激素应用对胎儿生殖系统的发育也有一定的影响。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "激素"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】尿道下裂的临床表现非常有特点，①尿道开口异位尿道异位开口于从正常尿道口近端至会阴部的任何部位部分尿道口有轻度狭窄因其表面有一层非常薄的黏膜样组织不完全覆盖所致有时尿道的一段海绵体缺如，其壁菲薄尿线一般向后，故患儿常取蹲位排尿，尿道口位于阴茎体近端时更明显阴茎向腹侧弯曲，主要因尿道口远端的尿道板纤维组织增生阴茎腹侧和尿道壁各层组织缺乏以及阴茎海绵体背、腹两侧不对称所致包皮堆积于背侧，阴茎头腹侧包皮未能在中线融合包皮系带缺如，全部包皮转至阴茎背侧，呈帽状堆积尿道口位置尿道下裂分为四型，阴茎头型、阴茎体型、阴茎阴囊型和会阴型（图12-8）。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "尿道开口异位"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "会阴部"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "尿道异位开口于从正常尿道口近端至会阴部的任何部位"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "部分尿道口有轻度狭窄"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 84,
+ "type": "sym",
+ "entity": "因其表面有一层非常薄的黏膜样组织不完全覆盖所致"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "海绵体"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 101,
+ "type": "sym",
+ "entity": "有时尿道的一段海绵体缺如，其壁菲薄"
+ },
+ {
+ "start_idx": 119,
+ "end_idx": 121,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 126,
+ "type": "bod",
+ "entity": "阴茎体"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 132,
+ "type": "sym",
+ "entity": "尿线一般向后，故患儿常取蹲位排尿，尿道口位于阴茎体近端时更明显"
+ },
+ {
+ "start_idx": 133,
+ "end_idx": 139,
+ "type": "sym",
+ "entity": "阴茎向腹侧弯曲"
+ },
+ {
+ "start_idx": 144,
+ "end_idx": 146,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 150,
+ "end_idx": 154,
+ "type": "bod",
+ "entity": "尿道板纤维"
+ },
+ {
+ "start_idx": 141,
+ "end_idx": 158,
+ "type": "sym",
+ "entity": "主要因尿道口远端的尿道板纤维组织增生"
+ },
+ {
+ "start_idx": 159,
+ "end_idx": 160,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 164,
+ "end_idx": 166,
+ "type": "bod",
+ "entity": "尿道壁"
+ },
+ {
+ "start_idx": 175,
+ "end_idx": 180,
+ "type": "bod",
+ "entity": "阴茎海绵体背"
+ },
+ {
+ "start_idx": 159,
+ "end_idx": 189,
+ "type": "sym",
+ "entity": "阴茎腹侧和尿道壁各层组织缺乏以及阴茎海绵体背、腹两侧不对称所致"
+ },
+ {
+ "start_idx": 190,
+ "end_idx": 191,
+ "type": "bod",
+ "entity": "包皮"
+ },
+ {
+ "start_idx": 198,
+ "end_idx": 200,
+ "type": "bod",
+ "entity": "阴茎头"
+ },
+ {
+ "start_idx": 190,
+ "end_idx": 211,
+ "type": "sym",
+ "entity": "包皮堆积于背侧，阴茎头腹侧包皮未能在中线融合"
+ },
+ {
+ "start_idx": 212,
+ "end_idx": 213,
+ "type": "bod",
+ "entity": "包皮"
+ },
+ {
+ "start_idx": 221,
+ "end_idx": 222,
+ "type": "bod",
+ "entity": "包皮"
+ },
+ {
+ "start_idx": 225,
+ "end_idx": 226,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 212,
+ "end_idx": 234,
+ "type": "sym",
+ "entity": "包皮系带缺如，全部包皮转至阴茎背侧，呈帽状堆积"
+ },
+ {
+ "start_idx": 235,
+ "end_idx": 237,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 240,
+ "end_idx": 243,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 249,
+ "end_idx": 252,
+ "type": "dis",
+ "entity": "阴茎头型"
+ },
+ {
+ "start_idx": 254,
+ "end_idx": 257,
+ "type": "dis",
+ "entity": "阴茎体型"
+ },
+ {
+ "start_idx": 259,
+ "end_idx": 263,
+ "type": "dis",
+ "entity": "阴茎阴囊型"
+ },
+ {
+ "start_idx": 265,
+ "end_idx": 267,
+ "type": "dis",
+ "entity": "会阴型"
+ }
+ ]
+ },
+ {
+ "text": "有些病例其阴茎弯曲非常严重，尿道开口仍可位于阴茎远端患儿甚至还可站立解尿，但一旦术中将纤维索带组织松解，尿道口即会退至阴茎近端尿道下裂的分型【伴发畸形】尿道下裂最常见的伴发畸形为腹股沟斜疝及睾丸下降不全，各占10%左右。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "有些病例其阴茎弯曲非常严重，尿道开口仍可位于阴茎远端"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "患儿甚至还可站立解尿"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "纤维索"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "尿道口"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "但一旦术中将纤维索带组织松解，尿道口即会退至阴茎近端"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 100,
+ "type": "sym",
+ "entity": "伴发畸形为腹股沟斜疝及睾丸下降不全"
+ }
+ ]
+ },
+ {
+ "text": "尿道下裂越严重，伴发畸形的发生率也越高重，伴发畸形的发生率也越高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "尿道下裂越严重，伴发畸形的发生率也越高"
+ }
+ ]
+ },
+ {
+ "text": "尿道下裂患儿伴发上尿路畸形的发生率1%～3%不等，如肾盂输尿管连接部梗阻及重复畸形等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "伴发上尿路畸形的发生率1%～3%不等"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "肾盂输尿管连接部梗阻"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "重复畸形"
+ }
+ ]
+ },
+ {
+ "text": "也有少数病人合并肛门直肠畸形。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "合并肛门直肠畸形"
+ }
+ ]
+ },
+ {
+ "text": "【诊断及鉴别诊断】尿道下裂的诊断由于其外观的特征性改变，并不困难，一望可知。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "关键是应明确尿道下裂可能是某些严重泌尿生殖系畸形如两性畸形的表现。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "泌尿生殖系畸形"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "两性畸形"
+ }
+ ]
+ },
+ {
+ "text": "尤其是比较严重的尿道下裂，畸形伴发率高，要注意鉴别有无性别异常。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "对外生殖器表现模棱两可的、尿道下裂伴隐睾的都要首先进行染色体检查；如明确为男性的46XY，则先行睾丸下降固定，同时进行性腺活检。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "外生殖器"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "伴隐睾"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "染色体检查"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 62,
+ "type": "pro",
+ "entity": "先行睾丸下降固定，同时进行性腺活检"
+ }
+ ]
+ },
+ {
+ "text": "如为睾丸，但发育很差，加之阴茎发育很小的情况，要和家属商讨，考虑做成女性为好。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "睾丸"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "但发育很差"
+ }
+ ]
+ },
+ {
+ "text": "【手术治疗】手术行尿道成形是尿道下裂唯一的治疗方法。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "手术行尿道成形"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "手术要求达到完全矫正阴茎下弯、尿道正位开完全矫正阴茎下弯、尿道正位开口于阴茎头、能站立排尿以及成年后能进行正常性生活的目的术方法有200多种，但至今尚无一种满意的被所有医师接受的术式。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "阴茎"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "阴茎头"
+ }
+ ]
+ },
+ {
+ "text": "相对来说比较常用的手术方法有尿道口前移龟头成形术（meata尿道口前移龟头成形术ndgmeataladvancementandglanuloplastyincorporatedprocedure或FMAGPIFlapMathieu，Filp-Flap尿道成形术la加盖岛状皮瓣尿道成形术成形onlayislandflap尿道成形术皮内板横行岛状皮瓣尿道成形术包皮内板横行岛状皮瓣尿道成形术十年Duckett术多的在无阴茎下弯的尿道下裂中应用尿道板纵切卷管尿道成形术（也尿道板纵切卷管尿道成形术。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "龟头成形术"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "尿道口前移龟头成形术"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 96,
+ "type": "pro",
+ "entity": "meataladvancementandglanuloplastyincorporatedprocedure"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 103,
+ "type": "pro",
+ "entity": "MAGPI"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 114,
+ "type": "pro",
+ "entity": "Mathieu"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 129,
+ "type": "pro",
+ "entity": "Filp-Flap尿道成形术"
+ },
+ {
+ "start_idx": 132,
+ "end_idx": 142,
+ "type": "pro",
+ "entity": "加盖岛状皮瓣尿道成形术"
+ },
+ {
+ "start_idx": 145,
+ "end_idx": 164,
+ "type": "pro",
+ "entity": "onlayislandflap尿道成形术"
+ },
+ {
+ "start_idx": 179,
+ "end_idx": 193,
+ "type": "pro",
+ "entity": "包皮内板横行岛状皮瓣尿道成形术"
+ },
+ {
+ "start_idx": 196,
+ "end_idx": 203,
+ "type": "pro",
+ "entity": "Duckett术"
+ },
+ {
+ "start_idx": 213,
+ "end_idx": 216,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 234,
+ "end_idx": 245,
+ "type": "pro",
+ "entity": "尿道板纵切卷管尿道成形术"
+ }
+ ]
+ },
+ {
+ "text": "波士顿儿Snodgrass术尿道下裂尿道成形术的50%是采用此方尿道成形术特点是手术简单，尿道外口美观，并发症低。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "Snodgrass术"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "尿道下裂"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "尿道成形术"
+ }
+ ]
+ },
+ {
+ "text": "手术的主要并发症包括：尿瘘、尿道狭窄、尿道憩室形成尿瘘、尿道狭窄、尿道憩室形成、阴茎弯曲及阴茎扭转总体发生率约有30%左右其总体发生率约有30%左右尚难有效解决。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "尿瘘"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "尿道狭窄"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "尿瘘、尿道狭窄、尿道憩室形成、阴茎弯曲及阴茎扭转"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "其总体发生率约有30%左右"
+ }
+ ]
+ },
+ {
+ "text": "由于尿道下裂患儿多不能如正常地站立解尿，容易造成其心理负担，影响心理发育，现多主张早期手术。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "尿道下裂"
+ }
+ ]
+ },
+ {
+ "text": "第七篇感染性疾病第一章感染性疾病的诊断要则感染性疾病是指由病原微生物感染机体引起的一类疾病，这些病原微生物包括细菌、病毒、支原体、衣原体、立克次体、真菌、螺旋体、原虫和蠕虫等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "感染性疾病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "感染性疾病"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "感染性疾病"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "mic",
+ "entity": "支原体"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "mic",
+ "entity": "衣原体"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "mic",
+ "entity": "立克次体"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 75,
+ "type": "mic",
+ "entity": "真菌"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 82,
+ "type": "mic",
+ "entity": "原虫"
+ }
+ ]
+ },
+ {
+ "text": "其范畴远远超过以往定义的“传染病”，如外科的感染疾病、术后感染，耳鼻喉科的中耳炎和鼻窦炎，以及内科的呼吸道感染、肠道感染疾病等都属感染性疾病。",
+ "entities": [
+ {
+ "start_idx": 65,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "医院内感染是相对于社区感染而言的概念，也属感染性疾病范畴。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "感染性疾病有其特异的病原微生物，因此病原学诊断尤为重要，是确诊的主要依据。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "感染性疾病的诊断过程中，要充分注意以下环节。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "如伤寒杆菌只可能在早期伤寒患者的血中发现，1周以后才能从患者粪便中查到此菌。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "伤寒杆菌"
+ }
+ ]
+ },
+ {
+ "text": "2.标本采集的最有价值部位是感染所在部位，如肺炎的标本应该是真正从下呼吸道取得的痰。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "三、周围肺动脉狭窄自肺动脉瓣以后的肺动脉管道狭窄可发生于从主干至肺内动脉的各段，单发或多发，大多伴有其他畸形如肺动脉瓣狭窄，室间隔缺损、法洛四联症及主动脉瓣上狭窄（supravalvularaorticstenosis）等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "周围肺动脉狭窄"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "肺动脉管道狭窄"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "主干"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肺内动脉"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "肺动脉瓣狭窄"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "法洛四联症"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "主动脉瓣上狭窄"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 108,
+ "type": "dis",
+ "entity": "supravalvularaorticstenosis"
+ }
+ ]
+ },
+ {
+ "text": "肺动脉的管腔狭窄依其部位可分为四型：①主干或其左右支；②主干分叉部，并延伸至左右支；③周围分支多发的梗阻；④主干及其周围分支狭窄。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "肺动脉的管腔狭窄"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "周围分支多发的梗阻"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "主干及其周围分支狭窄"
+ }
+ ]
+ },
+ {
+ "text": "狭窄部可能产生连续性杂音，尤其伴有左向右分流使肺动脉血流增多者。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肺动脉血流"
+ }
+ ]
+ },
+ {
+ "text": "心导管可能发现在肺动脉的管道某部前后有明显压差，肺动脉造影可以看到狭窄的部位；为了避免狭窄部被重叠影像掩盖，必须用轴向位置方能将全貌暴露出来。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "equ",
+ "entity": "心导管"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "肺动脉造影"
+ }
+ ]
+ },
+ {
+ "text": "随着患儿的成长，狭窄可越趋严重，到青春期心排量大增时尤著；再者许多手术如法洛四联症，心内畸形纠正后右心室出路仍受本病的阻挡，应考虑解除的措施。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "心"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "法洛四联症"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "心内畸形"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "右心室"
+ }
+ ]
+ },
+ {
+ "text": "四、超声检查应用实时B型超声波或三维实时超声。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "超声检查"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "B型超声波"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "三维实时超声"
+ }
+ ]
+ },
+ {
+ "text": "进食一定量液体时，能够有效地观察到胃窦、胃体、幽门以及十二指肠的动态运动情况，并可将胃排空情况量化。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "胃窦"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "胃体"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "幽门"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "十二指肠"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "胃"
+ }
+ ]
+ },
+ {
+ "text": "常用功能指标有：①收缩频率；②收缩幅度；③运动指数；④幽门开放时间；⑤胃十二指肠运动协调性；⑥十二指肠、胃反流征观察。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "运动指数"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "ite",
+ "entity": "幽门开放时间"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 44,
+ "type": "ite",
+ "entity": "胃十二指肠运动协调性"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "十二指肠"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "胃"
+ }
+ ]
+ },
+ {
+ "text": "对胃的排空功能检查，能准确测量胃的半排空和完全排空时间。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "胃"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "胃"
+ }
+ ]
+ },
+ {
+ "text": "具体方法：给被检查者一定量的37℃的液体，然后每10分钟测量胃体、胃底及胃窦部前后径、上下径大小和面积，计算出胃窦、胃体面积减少的速度，从而得出胃排空和半排空时间。",
+ "entities": [
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "胃体"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "胃底"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "胃窦部前后径"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "胃窦"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "胃体"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "胃"
+ }
+ ]
+ },
+ {
+ "text": "国内已采用B超对小儿厌食、胃炎及功能性消化不良分别检测。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "B超"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "小儿厌食"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "胃炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "功能性消化不良"
+ }
+ ]
+ },
+ {
+ "text": "本方法准确可靠，重复性好，但技术要求高，适于观察液体排空，但不能确切显示固体胃排空。",
+ "entities": [
+ {
+ "start_idx": 38,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "胃"
+ }
+ ]
+ },
+ {
+ "text": "四、手术技术的特殊性1.儿童肾移植常发生移植物大小和髂窝的空隙不成比例，需将移植肾置入腹膜后、盲肠后以及腹腔内。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "儿童肾移植"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "髂窝"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "腹膜"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "盲肠"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "腹腔"
+ }
+ ]
+ },
+ {
+ "text": "体重＞20kg的儿童移植手术方法与成人相同。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "儿童移植手术"
+ }
+ ]
+ },
+ {
+ "text": "＜20kg的小儿取腹正中切口入腹腔，游离盲肠，将供肾移植于腹膜后，肾动、静脉分别与主动脉、腔静脉（或髂总动、静脉）吻合，成人供肾体积相对较大时，须将肾脏横置于右侧腹腔内，肾血管与腹部大血管吻合。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "腹正"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "腹腔"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "盲肠"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "腹膜"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "肾动、静脉"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "腔静脉"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "髂总动"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "腹腔"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 87,
+ "type": "bod",
+ "entity": "肾血管"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "腹部大血管"
+ }
+ ]
+ },
+ {
+ "text": "2.儿童肾移植（＜5岁）吻合技术需顾及儿童器官的生长过程，至少有半圈采用间断缝合，对边连续缝合进行吻合。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "儿童肾移植"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "器官"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "间断缝合"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "连续缝合"
+ }
+ ]
+ },
+ {
+ "text": "3.在开放移植肾血流时需考虑婴幼儿心搏出量及收缩压，当不能满足成人供肾血流动力学要求，应尽快输血100～200ml，保持患儿的足够��容量；当阻断主动脉进行血管吻合时，可继发酸中毒，宜给予5%NaHCO31～2ml/kg。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "心搏出量"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "收缩压"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "输血"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "ite",
+ "entity": "血容量"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 100,
+ "type": "dru",
+ "entity": "NaHCO3"
+ }
+ ]
+ },
+ {
+ "text": "4.移植前切除双肾的对象经血透不能控制的恶性高血压、慢性肾盂肾炎或多囊肾合并感染不易控制时建议移植前切除双肾。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "移植"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "切除双肾"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "血透"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "恶性高血压"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "慢性肾盂肾炎"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "多囊肾合并感染"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "移植"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "pro",
+ "entity": "切除双肾"
+ }
+ ]
+ },
+ {
+ "text": "对进展迅速的肾小球肾炎，因血循环中存在抗肾小球基底膜抗体，为防止移植后复发，亦应切除病肾，待血循环中抗体消失6个月后再行肾移植手术。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "抗肾小球基底膜"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "pro",
+ "entity": "移植"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "肾移植手术"
+ }
+ ]
+ },
+ {
+ "text": "5.下尿路异常的矫正先天性泌尿道畸形患儿在肾移植前应检查膀胱功能，如膀胱输尿管反流伴肾积水，应施行肾、全输尿管切除术。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "尿路异常"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "先天性泌尿道畸形"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "膀胱输尿管反流伴肾积水"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 57,
+ "type": "pro",
+ "entity": "肾、全输尿管切除术"
+ }
+ ]
+ },
+ {
+ "text": "膀胱有慢性炎症以及神经性膀胱病变，应移植前切除膀胱并在腹膜后形成回盲袋代膀胱。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "慢性炎症"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "神经性膀胱病变"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "移植"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "切除膀胱"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "腹膜"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "膀胱"
+ }
+ ]
+ },
+ {
+ "text": "二、爽身粉吸入婴幼儿使用爽身粉、痱子粉时误吸所致。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "爽身粉吸入"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "爽身粉"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "痱子粉"
+ }
+ ]
+ },
+ {
+ "text": "多含有矽酸镁或其他矽酸盐。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "矽酸镁"
+ }
+ ]
+ },
+ {
+ "text": "吸入肺部后造成细支气管阻塞间质性肺炎、肺纤维变性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "细支气管阻塞"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "间质性肺炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "肺纤维变性"
+ }
+ ]
+ },
+ {
+ "text": "开始为干咳，以后有痰有低热。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "开始为干咳"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "以后有痰"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "有低热"
+ }
+ ]
+ },
+ {
+ "text": "有的表现反复呼吸道感染两肺听诊可闻及干湿啰音呛咳、气喘、进行性呼吸困难、发绀等，未经处理可在1～2天内死亡。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "反复呼吸道感染"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "两肺听诊可闻及干湿啰音"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "呛咳"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "气喘"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "进行性呼吸困难"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "发绀"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "未经处理可在1～2天内死亡"
+ }
+ ]
+ },
+ {
+ "text": "胸部X线表现中下肺野有条索状、小片状、斑点状或网状阴影病程长、出现纤维化时，表现两下肺野细小网状影。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "胸部X线"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "中下肺野有条索状、小片状、斑点状或网状阴影"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "病程长"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "出现纤维化"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "两下肺野细小网状影"
+ }
+ ]
+ },
+ {
+ "text": "合并感染时可有片絮状阴影。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "合并感染时可有片絮状阴影"
+ }
+ ]
+ },
+ {
+ "text": "以对症处理为主，急性大量吸入者可采用支气管镜下冲洗，立即在高湿度下吸氧。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "支气管镜下冲洗"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "高湿度下吸氧"
+ }
+ ]
+ },
+ {
+ "text": "早期使用肾上腺皮质激素可减轻炎症反应。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "肾上腺皮质激素"
+ }
+ ]
+ },
+ {
+ "text": "七、异基因造血干细胞移植的植入证据1.异性间移植时可通过性染色体获得证据。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "异基因造血干细胞移植"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "异性间移植"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "染色体"
+ }
+ ]
+ },
+ {
+ "text": "2.同性别异基因移植者可以通过DNA指纹证据。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "同性别异基因移植"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "DNA"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "指"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "指"
+ }
+ ]
+ },
+ {
+ "text": "二、病理性黄疸新生儿病理性黄疸是新生儿早期除胆红素代谢的特点外，同时有使黄疸加重的疾病或致病因素存在。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "病理性黄疸"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "病理性黄疸"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "胆红素"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "但广义的病理性黄疸还包括已过生理性黄疸时期而血清胆红素仍超过正常水平者。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "病理性黄疸"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "生理性黄疸"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "血清胆红素"
+ }
+ ]
+ },
+ {
+ "text": "部分病理性黄疸可致中枢神经系统受损，产生胆红素脑病。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "病理性黄疸"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "胆红素脑病"
+ }
+ ]
+ },
+ {
+ "text": "我国新生儿高胆的发病率各家报道不一，为9.1%～50.0%，甚至更高。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "高胆"
+ }
+ ]
+ },
+ {
+ "text": "1997年，徐放生等统计164所医院共收治患病新生儿39621例，其中黄疸患儿13918例，占患病新生儿总数的35.13%；高胆红素血症患儿共收治10365例，占患病新生儿总数的26.16%，黄疸患儿的74.47%；发生胆红素脑病216例，为高胆患儿的2.08%。",
+ "entities": [
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "高胆红素血症"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 97,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 114,
+ "type": "dis",
+ "entity": "胆红素脑病"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 122,
+ "type": "dis",
+ "entity": "高胆"
+ }
+ ]
+ },
+ {
+ "text": "新生儿黄疸有下列情况之一时要考虑病理性黄疸：①生后24小时内出现黄疸，血清胆红素＞102μmol/L（6mg/dl）；②足月儿血清胆红素＞220.6μmol/L（12.9mg/dl），早产儿＞255μmol/L（15mg/dl）；③血清结合胆红素＞34μmol/L（2mg/dl）；④血清胆红素每天上升＞85μmol/L（5mg/dl）；⑤黄疸持续时间较长，超过2～4周，或进行性加重。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "病理性黄疸"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "血清胆红素"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "血清胆红素"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 122,
+ "type": "bod",
+ "entity": "血清结合胆红素"
+ },
+ {
+ "start_idx": 142,
+ "end_idx": 146,
+ "type": "bod",
+ "entity": "血清胆红素"
+ },
+ {
+ "start_idx": 170,
+ "end_idx": 171,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "新生儿病理性黄疸按发病机制可分为红细胞破坏增多（溶血性、肝前性）、肝脏胆红素代谢功能低下（肝细胞性）和胆汁排出障碍（梗阻性、肝后性）三类。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "病理性黄疸"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "肝脏胆红素"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "肝细胞性"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "胆汁"
+ }
+ ]
+ },
+ {
+ "text": "按实验室测定总胆红素和结合胆红素浓度的增高程度可分为高未结合胆红素血症和高结合胆红素血症，如两者同时存在则称混合性高胆红素血症。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "胆红素"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "结合胆红素"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "高未结合胆红素血症"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "高结合胆红素血症"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "混合性高胆红素血症"
+ }
+ ]
+ },
+ {
+ "text": "（一）高未结合胆红素血症引起的原因有：①胆红素产生过多：如母婴血型不合、遗传性球形红细胞增多症、红细胞酶的缺陷（如G-6-PD、丙酮酸激酶、己糖激酶等）、血管外溶血、红细胞增多症等；②肝细胞摄取和结合低下：如肝脏酶系统功能不全引起的黄疸、甲状腺功能低下、进食减少等；③肠-肝循环增加：如胎粪排出延迟等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "高未结合胆红素血症"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "胆红素"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "遗传性球形红细胞增多症"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "红细胞酶"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "G-6-PD"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "丙酮酸激酶"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "己糖激酶"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 88,
+ "type": "dis",
+ "entity": "溶血、红细胞增多症"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "肝细胞"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 106,
+ "type": "bod",
+ "entity": "肝脏酶"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 117,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 119,
+ "end_idx": 121,
+ "type": "bod",
+ "entity": "甲状腺"
+ },
+ {
+ "start_idx": 127,
+ "end_idx": 130,
+ "type": "sym",
+ "entity": "进食减少"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 136,
+ "type": "bod",
+ "entity": "肠-肝"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 140,
+ "type": "sym",
+ "entity": "肠-肝循环增加"
+ }
+ ]
+ },
+ {
+ "text": "1.新生儿溶血病因母子血型不合而引起的同族免疫性溶血称为新生儿溶血病���hemolyticdiseaseofnewborn）。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "新生儿溶血病"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "新生儿溶血病"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "hemolyticdiseaseofnewborn"
+ }
+ ]
+ },
+ {
+ "text": "ABO血型不合者较Rh不合多见，大多数母亲为O型，子为A或B型，本病可见于第一胎，可能因其母孕前已受其他原因的刺激，如寄生虫感染，注射伤寒疫苗、破伤风或白喉抗毒素等，均可使机体发生初发免疫反应，当怀孕时再次刺激机体产生免疫抗体，即可通过胎盘进入胎儿引起溶血（详见本章第16节）。",
+ "entities": [
+ {
+ "start_idx": 76,
+ "end_idx": 80,
+ "type": "pro",
+ "entity": "白喉抗毒素"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 119,
+ "type": "bod",
+ "entity": "胎盘"
+ },
+ {
+ "start_idx": 126,
+ "end_idx": 127,
+ "type": "sym",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "2.母乳性黄疸其特征为新生儿以母乳喂养后不久即出现黄疸，可持续数周到数月，而其他方面正常。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "母乳性黄疸"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "母乳"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "20世纪60年代，文献报道发生率为1%～2%，随着对母乳性黄疸的认识的提高，从20世纪80年代报道的发生率有逐年上升的趋势。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "母乳性黄疸"
+ }
+ ]
+ },
+ {
+ "text": "其发生的原因目前认为主要是因为新生儿胆红素代谢的肠-肝循环增加有关,早发型母乳喂养性黄疸的预防和处理：鼓励尽早喂奶。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "新生儿胆红素"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肠-肝"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "早发型母乳喂养性黄疸"
+ }
+ ]
+ },
+ {
+ "text": "晚发型母乳性黄疸，血清胆红素＜257μmol/L（15mg/dl）时不需停母乳；＞257μmol/L（15mg/dl）时暂停母乳3天，＞342μmol/L（20mg/dl）时则加光疗，一般不需用清蛋白或血浆治疗。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "晚发型母乳性黄疸"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "血清胆红素"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "母乳"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "母乳"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "pro",
+ "entity": "光疗"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 104,
+ "type": "pro",
+ "entity": "清蛋白或血浆治疗"
+ }
+ ]
+ },
+ {
+ "text": "（二）高结合胆红素血症新生儿结合胆红素增高的疾病，其临床均以阻塞性黄疸为特征，即皮肤、巩膜黄染，大便色泽变淡或呈灰白色如油灰状，小便深黄，肝脾大及肝功能损害等，亦称之为肝炎综合征。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "高结合胆红素血症"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "胆红素"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "阻塞性黄疸"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "皮肤、巩膜黄染，大便色泽变淡或呈灰白色如油灰状"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "sym",
+ "entity": "小便深黄"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "肝脾"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "肝"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 77,
+ "type": "sym",
+ "entity": "肝脾大及肝功能损害"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 88,
+ "type": "dis",
+ "entity": "肝炎综合征"
+ }
+ ]
+ },
+ {
+ "text": "1.新生儿肝炎多数为胎儿在宫内由病毒感染所致，国际上所指的CROTCHS或TORCH感染（即巨细胞病毒、风疹病毒、弓形虫、柯萨奇和其他肠道病毒、单纯疱疹和乙肝病毒、HIV以及其他病毒）均可为新生儿肝炎的病因。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "新生儿肝炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "胎儿"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "CROTCHS"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "TORCH感染"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "mic",
+ "entity": "巨细胞病毒"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 55,
+ "type": "mic",
+ "entity": "风疹病毒"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "mic",
+ "entity": "弓形虫"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "mic",
+ "entity": "柯萨奇"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 70,
+ "type": "mic",
+ "entity": "肠道病毒"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "mic",
+ "entity": "单纯疱疹"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 80,
+ "type": "mic",
+ "entity": "乙肝病毒"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 84,
+ "type": "mic",
+ "entity": "HIV"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 99,
+ "type": "dis",
+ "entity": "新生儿肝炎"
+ }
+ ]
+ },
+ {
+ "text": "感染可经胎盘传给胎儿或在通过产道娩出时被感染。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "胎盘"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "产道"
+ }
+ ]
+ },
+ {
+ "text": "常在生后1～3周或更晚出现黄疸，经过一般处理后好转，病程约4～6周。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "2.胆道闭锁其病因尚不清楚，发病率在亚洲比白种人为高，多在生后2周始显黄疸并呈进行性加重，粪色由浅黄转为白色，肝脏进行性增大，边缘硬而光滑；肝功能以结合胆红素升高为主。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "胆道闭锁"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "粪色由浅黄转为白色"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "肝脏进行性增大"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "肝"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 78,
+ "type": "bod",
+ "entity": "胆红素"
+ }
+ ]
+ },
+ {
+ "text": "3.代谢性疾病由先天性代谢障碍所引起的一类疾病，部分可以在新生儿期间出现黄疸。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "代谢性疾病"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "（三）混合性高胆红素血症感染是引起混合性高胆红素血症的重要原因，细菌和病毒都可引起黄疸。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "混合��高胆红素血症"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "混合性高胆红素血症"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "患儿多伴有发热或体温不升、食欲缺乏、呼吸不规则、嗜睡和烦躁不安等症状。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "体温不升"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "食欲缺乏"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "呼吸不规则"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "烦躁不安"
+ }
+ ]
+ },
+ {
+ "text": "表5-5、5-5示新生儿黄疸干预标准，主要针对非结合胆红素升高引起的黄疸（中华医学会儿科学分会新生儿学组，2000年9月）。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "胆红素"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "表5-2不同出生时龄的足月新生儿黄疸干预推荐标准注：括号内数值为mg/dl，1mg/dl=17.1μmol/L表5-3不同胎龄/出生体重的早产儿黄疸干预推荐标准注：括号内数值为mg/dl，1mg/dl=17.1μmol/L（朱建幸何振娟）",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "dis",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "第六节肺液的转运和清除（一）胎肺液和肺发育胎儿肺内上皮细胞分泌肺液（又称肺管腔液，以别于肺血管外水含量），充盈于气道和潜在肺泡，对于肺的宫内发育至关重要。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "胎肺液"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肺内上皮细胞"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "肺管腔液"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "潜在肺泡"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "肺"
+ }
+ ]
+ },
+ {
+ "text": "肺液量由妊娠中期的4～6ml/kg增加到近足月的20ml/kg，并在出生前下降到6～10ml/kg。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "肺液量"
+ }
+ ]
+ },
+ {
+ "text": "当胎儿血供由胎盘转为宫外呼吸时，首先需要将肺液清除，以利于肺泡扩张和气体交换。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "胎盘"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "宫外"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "在正常呼吸建立后，肺液在充气的成熟肺泡腔���非常少，可能只有0.5～1ml/kg，主要作为电解质、肺表面活性物质的承载与交换基质。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肺泡腔"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "电解质"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "羊膜早破可能导致肺液显著减少，或膈疝使肺组织发育受外来压迫，均可造成肺泡发育延迟或停顿，为肺发育不良（hypoplasia）或不发育（agenesis）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "羊膜早破"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "膈疝"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "肺泡发育延迟或停顿"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 75,
+ "type": "sym",
+ "entity": "肺发育不良（hypoplasia）或不发育（agenesis）"
+ }
+ ]
+ },
+ {
+ "text": "肺液与淋巴液、血浆的电解质、蛋白成分不同（表8-8），反映出肺液不是血浆或淋巴液的漏出或浓缩。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "淋巴液"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "电解质"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "蛋白"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "淋巴液"
+ }
+ ]
+ },
+ {
+ "text": "表8-3胎羊肺液、淋巴液和血浆成分比较（二）肺淋巴管肺淋巴管形成网络，分布于肺血管周围的结缔组织间质中，主要为肺泡外间质内，为水分子和大分子的回流通路。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肺淋巴管"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肺淋巴管"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "结缔组织间质"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "肺泡外间质"
+ }
+ ]
+ },
+ {
+ "text": "其中包括大量淋巴细胞和血液有形成分。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "血液"
+ }
+ ]
+ },
+ {
+ "text": "液体主要借助肺泡壁和肺泡间质之间的压力差作为推进动力，且流量随间质内液量增多而增加。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肺泡壁"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺泡间质"
+ }
+ ]
+ },
+ {
+ "text": "而肺间质也沿外周肺泡向肺门部呈压力下降趋势，以保持微血管滤出液的回流。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肺间质"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺门部"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "微血管滤出液"
+ }
+ ]
+ },
+ {
+ "text": "滤出液先顺此压力梯度转移到大血管和气道周围结缔组织中，经淋巴管系统有效地回流过量液体。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "滤出液"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "大血管"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "结缔组织"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "淋巴管系统"
+ }
+ ]
+ },
+ {
+ "text": "当滤出液量超过了淋巴回流能力时，液体先在肺门及大血管鞘积聚，形成肺水肿早期血管周围液体“袖口”特征。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "淋巴"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "肺门"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "大血管鞘"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "肺水肿"
+ }
+ ]
+ },
+ {
+ "text": "在间质和肺泡水肿时，淋巴回流代偿能力丧失。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 1,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "间质和肺泡水肿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "淋巴"
+ }
+ ]
+ },
+ {
+ "text": "（三）水的跨壁转运肺泡上皮细胞、毛细血管内皮细胞和间质基质是肺泡和间质液体转运的主要屏障。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肺泡上皮细胞"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "毛细血管内皮细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "间质基质"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "间质"
+ }
+ ]
+ },
+ {
+ "text": "间质中的透明质酸、硫酸蛋白聚糖、清蛋白、内皮细胞多糖成分间相互作用，调节内皮细胞屏障对水的通透性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "间质"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "透明质酸"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "硫酸蛋白聚糖"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "清蛋白"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "内皮细胞多糖"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "内皮细胞"
+ }
+ ]
+ },
+ {
+ "text": "肺泡上皮细胞端面的离子通道、水通道、基底面的钠-钾ATP酶（钠泵）对钠、钾、氯离子的转运，使水分由肺泡向肺间质和血管转移。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肺泡上皮细胞"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "钠-钾ATP酶"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "钠泵"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "血管"
+ }
+ ]
+ },
+ {
+ "text": "第四节IgA肾病IgA肾病（IgAnephropathy）是1968年由Berger首先描述的，以系膜增生及系膜区显著弥漫的IgA沉积为特征的一组肾小球疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "IgAnephropathy"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 66,
+ "type": "sym",
+ "entity": "膜增生及系膜区显著弥漫的IgA沉积"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "肾小球疾病"
+ }
+ ]
+ },
+ {
+ "text": "本节主要介绍原发性IgA肾病，继发性IgA肾病请参阅各有关章节。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "原发性IgA肾病"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "继发性IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "现有的流行病学资料均是以同期肾活体组织检查乃至肾脏病住院人数作参照对象统计得来的。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "肾脏病"
+ }
+ ]
+ },
+ {
+ "text": "中华儿科学会肾脏病学组统计全国20个单位，1979～1994年共2315例肾活检标本中，IgA肾病168例，占7.3%。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肾脏病"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "肾活检"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "该病在年长儿及成人中更多见，在原发性肾小球疾病肾活体组织检查中，IgA肾病在北美占10%左右，欧洲10%～30%，亚太地区最高，我国为30%，日本甚至高达50%。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "原发性肾小球疾病"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "由于肾组织内有IgA、C3或/和IgA、IgG的沉积，因此IgA肾病是一种免疫复合物性肾炎，其发病与IgA免疫异常密切相关，目前有关研究已深入到IgA分子结构水平。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "肾组织"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "C3"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "IgG"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "免疫复合物性肾炎"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "IgA免疫异常"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "IgA"
+ }
+ ]
+ },
+ {
+ "text": "（一）免疫球蛋白A的结构与特征IgA是一种重要的免疫球蛋白，约占血清总免疫球蛋白的15.2%，80%的血清IgA是以单体四条链的形式出现，单体间的连接靠二硫键和J链稳定。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "免疫球蛋白A"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "免疫球蛋白"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "血清总免疫球蛋白"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "血清IgA"
+ }
+ ]
+ },
+ {
+ "text": "依α重链抗原性不同，将IgA分为2个血清型，即IgA1和IgA2。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "IgA1"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "IgA2"
+ }
+ ]
+ },
+ {
+ "text": "IgA1是血清中的主要亚型，占80%～90%，IgA2仅占10%～20%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "IgA1"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "IgA2"
+ }
+ ]
+ },
+ {
+ "text": "IgA1绞链区比IgA2长1倍，IgA2又可分为IgA2m（1）和IgA2m（2），尽管血清IgA2浓度仅及IgA1的1/4，但分泌液中IgA2浓度与IgA1相等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "IgA1"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "IgA2"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "IgA2"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "IgA2"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "血清IgA2"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "IgA1"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 108,
+ "type": "bod",
+ "entity": "分泌液"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 112,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 123,
+ "end_idx": 126,
+ "type": "bod",
+ "entity": "IgA1"
+ }
+ ]
+ },
+ {
+ "text": "在IgA2m（1）结构中，α链与轻链间无二硫键，靠非共价键连接，但轻链间及α链间则由二硫链相连接。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "IgA2"
+ }
+ ]
+ },
+ {
+ "text": "分泌型IgA与血清型不同，它是一个二聚体分子，带一个J链和另一个外分泌成分（SC）组成（IgA）2-J-SC复合物。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "分泌型IgA"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "IgA"
+ }
+ ]
+ },
+ {
+ "text": "而血清型则是（IgA）2-J组成。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "IgA"
+ }
+ ]
+ },
+ {
+ "text": "J链由137个氨基酸构成，分子量1500，是一种酸性糖蛋白，含8个胱氨酸残基，6个与链内二硫链形成有关，而2个与α链的连接有关。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "氨基酸"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "酸性糖蛋白"
+ }
+ ]
+ },
+ {
+ "text": "已知α链的C末端有18个额外的氨基酸残基，J链是通过与α链的C端的第2个半胱氨酸残基与α链相连的。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "氨基酸"
+ }
+ ]
+ },
+ {
+ "text": "SC是由黏膜组织或分泌腺体中的上皮细胞合成的，通过二硫键同人SIgA的两个单体IgA中的一个相连接，SC是由549～558个氨基酸组成的多肽链，分子量约7万，糖基含量高达20%。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "黏膜组织"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "腺体"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "SIgA"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "氨基酸"
+ }
+ ]
+ },
+ {
+ "text": "其多肽链上有5个同源区，每个同源区由104、114个氨基酸组成，这些同源区在立体结构上与Ig相似。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "氨基酸"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "Ig"
+ }
+ ]
+ },
+ {
+ "text": "SIgA的构型可能是：①一种堆加起来的Y型排列；②末端对末端的排列，两个IgA通过Fcα区相连接，组成双Y字形结构。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "SIgA"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "IgA"
+ }
+ ]
+ },
+ {
+ "text": "局部组织浆细胞产生的（IgA）2-J通过：①与上皮细胞基底侧表面的SC结合后，形成IgA-J-SC，转送到一个囊泡中的顶端表面而分泌出去；②（IgA）2-J经淋巴管进入血液循环，同肝细胞表面的SC结合而清除，再经肝细胞的囊泡机制而转送入胆道，并最终进入肠道。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "组织浆细胞"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "SC"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "IgA-J-SC"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "囊泡"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "淋巴管"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 85,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 92,
+ "type": "bod",
+ "entity": "肝细胞"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 97,
+ "type": "bod",
+ "entity": "SC"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 108,
+ "type": "bod",
+ "entity": "肝细胞"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 111,
+ "type": "bod",
+ "entity": "囊泡"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 119,
+ "type": "bod",
+ "entity": "胆道"
+ },
+ {
+ "start_idx": 126,
+ "end_idx": 127,
+ "type": "bod",
+ "entity": "肠道"
+ }
+ ]
+ },
+ {
+ "text": "血清IgA末端相互连接可形成末端开放的多聚体，而且一个明显的特征是多聚体大小的异质性，血清中IgA有20%是以多聚体形或存在的，且沉降系数为10S、13S及15S不等，此外IgA有易于同其他蛋白质形成复合物的倾向，这都是由于α链的氨基酸残基极易于形成分子间的二硫键。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "血清IgA"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 97,
+ "type": "bod",
+ "entity": "蛋白质"
+ },
+ {
+ "start_idx": 115,
+ "end_idx": 117,
+ "type": "bod",
+ "entity": "氨基酸"
+ }
+ ]
+ },
+ {
+ "text": "（二）IgA在肾小球系膜区的沉积在IgA肾病中，IgA沉积的方式与肾小球的病理变化是相平行的。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肾小球系膜"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肾小球"
+ }
+ ]
+ },
+ {
+ "text": "系膜区的IgA沉积伴随系膜增生，毛细血管上的沉积则伴随血管内皮的改变。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "系膜"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "毛细血管"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "血管内皮"
+ }
+ ]
+ },
+ {
+ "text": "引起IgA沉积的病���因素有：①抗原从黏膜处进入体内并刺激IgA免疫系统，抗原成分范围很广，包括微生物及食物（卵白蛋白、牛血清白蛋白、酪蛋白和胶）等；②IgA免疫反应异常导致高分子量的多聚IgA形成；③结合抗原的多聚IgA通过静电（λ链）、受体（FcaR）或与纤维连接蛋白结合而沉积于肾脏，已发现血清中IgA-纤维连接蛋白复合物是IgA肾病的特征；④其他IgA清除机制（如肝脏）的受损或饱和。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "IgA免疫系统"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "mic",
+ "entity": "微生物"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 97,
+ "type": "sym",
+ "entity": "IgA免疫反应异常导致高分子量的多聚IgA形成"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 142,
+ "type": "sym",
+ "entity": "结合抗原的多聚IgA通过静电（λ链）、受体（FcaR）或与纤维连接蛋白结合而沉积于肾脏"
+ },
+ {
+ "start_idx": 147,
+ "end_idx": 148,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 150,
+ "end_idx": 162,
+ "type": "bod",
+ "entity": "IgA-纤维连接蛋白复合物"
+ },
+ {
+ "start_idx": 164,
+ "end_idx": 168,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 176,
+ "end_idx": 178,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 185,
+ "end_idx": 186,
+ "type": "bod",
+ "entity": "肝脏"
+ }
+ ]
+ },
+ {
+ "text": "现有的研究表明，IgA肾病中在肾小球内沉积的IgA主要是多聚的λ-IgA1，IgA肾病患者的血清IgA1、多聚IgA和λ-IgA1水平均可见增高。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "λ-IgA1"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "血清IgA1"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "多聚IgA"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "λ-IgA1"
+ }
+ ]
+ },
+ {
+ "text": "患者B细胞存在β-1，3半乳糖基转移酶（β-1，3GT）的缺陷，导致IgA1绞链区O型糖基化时，末端链接的半乳糖减少，这一改变可能影响IgA1与肝细胞上的寡涎酸蛋白受体（ASGPR）结合而影响IgA的清除，而且能增加其与肾脏组织的结合而沉积。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "B细胞"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "β-1，3半乳糖基转移酶"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "β-1，3GT"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "IgA1"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "IgA1"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "肝细胞"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "寡涎酸蛋白受体"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 95,
+ "type": "bod",
+ "entity": "ASGPR"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 104,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 119,
+ "type": "bod",
+ "entity": "肾脏组织"
+ }
+ ]
+ },
+ {
+ "text": "Harper等采用原位杂交技术研究发现IgA肾病肠道黏膜表达合成多聚IgA的必需成分J链mRNA水平降低，而骨髓则升高。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肠道黏膜"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "多聚IgA"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "J链mRNA"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "骨髓"
+ }
+ ]
+ },
+ {
+ "text": "此外，扁桃体PIgA1产生也增多。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "扁桃体PIgA1"
+ }
+ ]
+ },
+ {
+ "text": "由于扁桃体PIgA产量远低于黏膜及骨髓，因此，沉积在肾组织中的PIgA1可能主要来源于骨髓而非扁桃体及黏膜。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "扁桃体PIgA"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肾组织"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "PIgA1"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "扁桃体"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "黏膜"
+ }
+ ]
+ },
+ {
+ "text": "（三）IgA肾病的免疫异常对IgA肾病体液及细胞免疫的广泛研究，表明IgA肾病患者存在免疫异常，包括：1.自身抗体Fornesier等已在肾病病人血清中发现有针对肾脏系膜细胞胞浆大分子成分的抗体。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "体液"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "免疫异常"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "肾病"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "肾脏系膜细胞胞浆"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "抗体"
+ }
+ ]
+ },
+ {
+ "text": "此外还有针对基底膜Ⅰ、Ⅱ、Ⅲ型胶原纤维、层黏蛋白及Gliadin等成分的抗体。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "基底膜Ⅰ、Ⅱ、Ⅲ型胶原纤维"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "层黏蛋白"
+ }
+ ]
+ },
+ {
+ "text": "在部分病人血液中还发现IgA型抗中性粒细胞胞浆抗体（IgA-ANCA）。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "IgA型抗中性粒细胞胞浆抗体"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "IgA-ANCA"
+ }
+ ]
+ },
+ {
+ "text": "IgA肾病接受同种肾移植后，在移植肾中重新出现IgA肾病病理改变者高达40%～50%，这些资料均说明自身抗体在IgA肾病的发病中起重要作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "移植肾"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "2.细胞免疫研究表明，细胞免疫功能的紊乱也在IgA肾病发病中起重要作用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "细胞免疫功能的紊乱"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "IgA特异性抑制T细胞活性的下降导致B淋巴细胞合成IgA的增加。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "IgA特异性抑制T细胞活性的下降导致B淋巴细胞合成IgA的增加"
+ }
+ ]
+ },
+ {
+ "text": "T辅助细胞（Th）数在IgA肾病活动期也增高，因此活动期时Th/Ts增高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "T辅助细胞"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "Th"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "Th/Ts"
+ }
+ ]
+ },
+ {
+ "text": "具有IgA特异性受体的T细胞称为Tα细胞，Tα细胞具有增加IgA产生的作用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "IgA特异性受体的T细胞"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "Tα细胞"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "Tα细胞"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "IgA"
+ }
+ ]
+ },
+ {
+ "text": "有人发现IgA肾病尤其是表现为肉眼血尿的患者Tα明显增多，Tα辅助细胞明显增多导致了IgA合成的增多。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "Tα"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "Tα辅助细胞"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "IgA"
+ }
+ ]
+ },
+ {
+ "text": "3.细胞因子与炎症介质许多细胞因子参与了免疫系统的调节，包括淋巴因子、白介素（interleukin，IL）、肿瘤坏死因子以及多肽生长因子，这些细胞因子对于行使正常的免疫功能起重要作用，在异常情况下也会导致细胞因子网络的失调，从而产生免疫损伤。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "细胞因子"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "炎症介质"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "细胞因子"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "免疫系统"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "淋巴因子"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "白介素"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "interleukin"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "IL"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "肿瘤坏死因子"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "多肽生长因子"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "细胞因子"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 106,
+ "type": "bod",
+ "entity": "细胞因子"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 120,
+ "type": "sym",
+ "entity": "免疫损伤"
+ }
+ ]
+ },
+ {
+ "text": "在肾小球系膜细胞增生的过程中，细胞因子与炎症介质（补体成分MAC、IL1、MCP-1及活性氧等）发挥着重要作用。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肾小球系膜细胞"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "细胞因子"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "炎症介质"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "补体成分MAC"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "IL1"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "MCP-1"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "活性氧"
+ }
+ ]
+ },
+ {
+ "text": "4.免疫遗传已有家族成员先后患IgA肾病的报道，提示遗传因素在IgA肾病中有重要作用。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "IgA肾病相关的HLA抗原位点也报道不一，欧美以Bw35，日本和我国以DR4多见，也有报道我国北方汉族以DRW12最多见，此外还有与B12、DR1以及IL-RN.2等位基因、ACED/D基因型相关的报道。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "HLA抗原"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "Bw35"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "DR4"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "DRW12"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "bod",
+ "entity": "B12"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "DR1"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 109,
+ "type": "bod",
+ "entity": "IL-RN.2等位基因"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 119,
+ "type": "bod",
+ "entity": "ACED/D基因型"
+ }
+ ]
+ },
+ {
+ "text": "【病理】光镜表现为肾小球系膜增生，程度从局灶、节段性增生到弥漫性系膜增生不等。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "equ",
+ "entity": "光镜"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "肾小球系膜增生，程度从局灶、节段性增生到弥漫性系膜增生不等"
+ }
+ ]
+ },
+ {
+ "text": "部分系膜增生较重者可见系膜插入，形成节段性双轨。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "部分系膜增生较重者可见系膜插入，形成节段性双轨"
+ }
+ ]
+ },
+ {
+ "text": "有时还见节段性肾小球硬化毛细血管塌陷及球囊粘连。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "有时还见节段性肾小球硬化"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "毛细血管塌陷及球囊粘连"
+ }
+ ]
+ },
+ {
+ "text": "个别病变严重者可出现透明样变和全球硬化，个别有毛细血管管袢形成Masson染色可见系膜区大量嗜复红沉积物，这些沉积物具有诊断价值。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "病变严重者可出现透明样变和全球硬化"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "毛细血管管袢"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "个别有毛细血管管袢形成"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "Masson染色"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "可见系膜区大量嗜复红沉积物"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "沉积物"
+ }
+ ]
+ },
+ {
+ "text": "Ⅰ、Ⅲ、Ⅳ型胶原及层黏蛋白、纤维结合蛋白在IgA肾病肾小球毛细血管袢的表达明显增加，Ⅰ、Ⅲ型胶原在系膜区表达也明显增加多数患者肾小管基底膜Ⅳ型胶原表达也增加电镜下主要为不同程度的系膜细胞和基质增生，在系膜区有较多的电子致密物沉积，有些致密物也可沉积于内皮下。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "Ⅰ、Ⅲ、Ⅳ型胶原"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "层黏蛋白"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "纤维结合蛋白"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "肾小球毛细血管袢"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "胶原"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "Ⅰ、Ⅲ型胶原在系膜区表达也明显增加"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "肾小管基底膜Ⅳ型胶原"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 77,
+ "type": "sym",
+ "entity": "多数患者肾小管基底膜Ⅳ型胶原表达也增加"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 79,
+ "type": "equ",
+ "entity": "电镜"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 97,
+ "type": "sym",
+ "entity": "不同程度的系膜细胞和基质增生"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 127,
+ "type": "sym",
+ "entity": "在系膜区有较多的电子致密物沉积，有些致密物也可沉积于内皮下"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】本病多见于年长儿童及青年，男女比为2∶1，起病前多常有上呼吸道感染的诱因，也有由腹泻及泌尿系感染等诱发的报告。",
+ "entities": [
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "上呼吸道感染"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "泌尿系感染"
+ }
+ ]
+ },
+ {
+ "text": "也有些患儿表现为血尿和蛋白尿，此时血尿既可为发作性肉眼血尿，也可为镜下血尿，蛋白尿多为轻-中度。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "发作性肉眼血尿"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "镜下血尿"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "蛋白尿"
+ }
+ ]
+ },
+ {
+ "text": "高血压是IgA肾病病情恶化的重要标志，多数伴有肾功能的迅速恶化。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "肾功能的迅速恶化"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）免疫学检查约1/4～1/2病人血IgA增高，主要是多聚体IgA的增多；约1/5～2/3患儿血中可检出IgA循环免疫复合物和/或IgG循环免疫复合物；少数患者有抗“O”滴度升高；补体C3、C4多正常。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "免疫学检查"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "血IgA增高"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "多聚体IgA的增多"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "血中可检出IgA循环免疫复合物和/或IgG循环免疫复合物"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 96,
+ "type": "sym",
+ "entity": "抗“O”滴度升高"
+ },
+ {
+ "start_idx": 98,
+ "end_idx": 101,
+ "type": "bod",
+ "entity": "补体C3"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 110,
+ "type": "bod",
+ "entity": "C4"
+ }
+ ]
+ },
+ {
+ "text": "IgA型类风湿因子以及IgA型ANCA也时常为阳性，有人认为血中升高的IgA-纤维结合蛋白复合物是IgA肾病的特征性改变，有较高诊断价值。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "IgA型类风湿因子"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "IgA型ANCA"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 30,
+ "type": "ite",
+ "entity": "血"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "IgA-纤维结合蛋白复合物"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "（二）免疫病理肾脏免疫病理是确诊IgA肾病唯一关键的依据。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "有人进行皮肤免疫病理检查发现，20%～50%病人皮肤毛细血管壁上有IgA、C3及备解素的沉积，Bene等报告皮肤活体组织检查的特异性和敏感性分别为88%和75%。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "皮肤免疫病理检查"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "皮肤毛细血管壁"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "C3"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "备解素"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 67,
+ "type": "pro",
+ "entity": "皮肤活体组织检查"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】（一）诊断年长儿童反复发作性肉眼血尿并多有上呼吸道或肠道感染的诱因，应考虑本病；表现为单纯镜下血尿或肉眼血尿或伴中等度蛋白尿时，也应怀疑IgA肾病，争取尽早肾活体组织检查。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "反复发作性肉眼血尿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "上呼吸道或肠道感染"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "单纯镜下血尿"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 65,
+ "type": "sym",
+ "entity": "中等度蛋白尿"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 88,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ }
+ ]
+ },
+ {
+ "text": "以肾病综合征、急进性肾炎综合征和高血压伴肾功能不全为表现者也应考虑本病，确诊有赖肾活体组织检查。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "肾病综合征"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "急进性肾炎综合征"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "高血压伴肾功能不全"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "��活体组织检查"
+ }
+ ]
+ },
+ {
+ "text": "（二）WHO对本病的病理分级Ⅰ级：光镜大多数肾小球正常，少数部位有轻度系膜增生伴/不伴细胞增生小管和间质损害。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "膜"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "光镜大多数肾小球正常，少数部位有轻度系膜增生伴/不伴细胞增生"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "小管"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "间质"
+ }
+ ]
+ },
+ {
+ "text": "Ⅱ级：少于50%的肾小球有系膜增生，罕有硬化、粘连和小新月体，称轻微病变，无小管和间质损害局灶节段乃至弥漫性肾小球系膜增宽伴细胞增生偶有粘连和小新月体局灶节段性肾小球肾炎。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "新月体"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "小管"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "间质"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "少于50%的肾小球有系膜增生，罕有硬化、粘连和小新月体，称轻微病变，无小管和间质损害"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 65,
+ "type": "sym",
+ "entity": "局灶节段乃至弥漫性肾小球系膜增宽伴细胞增生"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "新月体"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "偶有粘连和小新月体"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 84,
+ "type": "dis",
+ "entity": "局灶节段性肾小球肾炎"
+ }
+ ]
+ },
+ {
+ "text": "偶有局灶性间质水肿和轻度炎症细胞浸润全部肾小球示明显的弥漫性系膜增生和硬化伴不规则分布的、不同程度的细胞增生少于50%的肾小球有粘连和新月体弥漫性系膜增生性肾小球肾炎。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "局灶性间质水肿"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "轻度炎症细胞浸润"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "全部肾小球示明显的弥漫性系膜增生和硬化"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "伴不规则分布的、不同程度的细胞增生"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "新月体"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 69,
+ "type": "sym",
+ "entity": "少于50%的肾小球有粘连和新月体"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "弥漫性系膜增生性肾小球肾炎"
+ }
+ ]
+ },
+ {
+ "text": "有明显的小管萎缩和间质炎症。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "小管萎缩"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "间质炎症"
+ }
+ ]
+ },
+ {
+ "text": "小管和间质的损害较Ⅳ级更严重。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "间质"
+ }
+ ]
+ },
+ {
+ "text": "（一）一般治疗儿童最多见的临床类型是反复发作性的肉眼血尿，且大多有诱因如急性上呼吸道感染等，因此要积极控制感染，清除病灶，注意休息。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "急性上呼吸道感染"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "pro",
+ "entity": "清除病灶"
+ }
+ ]
+ },
+ {
+ "text": "（二）肾上腺皮质激素及免疫抑制剂对于以肾病综合征或急进性肾炎综合征起病的患儿，应予以皮质激素及免疫抑制剂治疗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "肾上腺皮质激素"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "免疫抑制剂"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "肾病综合征"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "急进性肾炎综合征"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dru",
+ "entity": "皮质激素"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 51,
+ "type": "dru",
+ "entity": "免疫抑制剂"
+ }
+ ]
+ },
+ {
+ "text": "Kabayashi曾回顾性研究二组病人，一组为29例，蛋白尿＞2g/d，泼尼松治疗1～3年，随访2～4年，结果表明早期的激素治疗（Ccr在70ml/min以上时）对于稳定肾功能及延缓疾病进展有益。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "ite",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "泼尼松"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 63,
+ "type": "pro",
+ "entity": "激素治疗"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 85,
+ "type": "bod",
+ "entity": "肾"
+ }
+ ]
+ },
+ {
+ "text": "对另一组18例蛋白尿1～2g/d的IgA肾病也采用皮质激素治疗，同时以42例使用双嘧达莫及吲哚美辛的IgA患者作对照，治疗组在稳定肾功能及降压蛋白尿方面明显优于对照组。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "ite",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "皮质激素治疗"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "双嘧达莫"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "dru",
+ "entity": "吲哚美辛"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 73,
+ "type": "ite",
+ "entity": "蛋白尿"
+ }
+ ]
+ },
+ {
+ "text": "Lai等报告了一个前瞻性随机对照试验结果，17例患者每日服用泼尼松4个月，与17例对照组相比，平均观察38个月，两组内生肌酐清除率无显著差异，泼尼松治疗对轻微病变的肾病综合征患者，可明显提高缓解率，但有一定不良反应。",
+ "entities": [
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "泼尼松"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "ite",
+ "entity": "肌酐清除率"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 73,
+ "type": "dru",
+ "entity": "泼尼松"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 86,
+ "type": "sym",
+ "entity": "肾病综合征"
+ }
+ ]
+ },
+ {
+ "text": "这一研究提示泼尼松治疗对于IgA肾病是有益的。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "泼尼松"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "有人报道一组对成人IgA肾病的对照研究以考察硫唑嘌呤和泼尼松的疗效。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "成人IgA肾病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "硫唑嘌呤"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "泼尼松"
+ }
+ ]
+ },
+ {
+ "text": "66例病人使用硫唑嘌呤和泼尼松，结果表明其在减慢IgA肾病进展方面，与48例未接受该治疗的对照组比较是有益的。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "硫唑嘌呤"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "泼尼松"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "有关应用环孢霉素的报道较少，Lai等曾应用环孢素A进行了一个随机、单盲对照试验，治疗组及对照组各12例，患者蛋白尿大于1.5g/d，并有肌酐清除率减退［Ccr（77±6）ml/min］，予环孢素A治疗12周，使血浆浓度水平控制在50～100ng/ml。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "环孢霉素"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "环孢素A"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "ite",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 72,
+ "type": "ite",
+ "entity": "肌酐清除率"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 97,
+ "type": "dru",
+ "entity": "环孢素A"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 108,
+ "type": "ite",
+ "entity": "血浆浓度"
+ }
+ ]
+ },
+ {
+ "text": "结果显示蛋白排泄显著减少，同时伴随着血浆肌酐清除率提高，但这些变化在终止治疗后则消失。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "蛋白"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "血浆肌酐清除率"
+ }
+ ]
+ },
+ {
+ "text": "总之，免疫抑制剂在治疗IgA肾病方面的功效仍有待评价。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "免疫抑制剂"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "Woo和Wallker分别观察了环磷酰胺、华法林、双嘧达莫及激素的联合治疗效果，结果与对照组相比，在治疗期间可以降低蛋白尿并稳定肾功能，但随访2～5年后，肾功能保护方面与对照组相比较无明显差异。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dru",
+ "entity": "环磷酰胺"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "华法林"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "双嘧达莫"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "激素"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "联合治疗"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "ite",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 66,
+ "type": "ite",
+ "entity": "肾功能"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "ite",
+ "entity": "肾功能"
+ }
+ ]
+ },
+ {
+ "text": "（三）免疫球蛋白在一组开放的前瞻性的研究中，Rostoker等人采用大剂量免疫球蛋白静脉注射，每日1次，每次2g/kg，连用3个月，然后改为16.5%免疫球蛋白肌肉注射，每次0.35ml/kg，每半月1次，连用6个月，结果发现，治疗后尿蛋白排泄由5.2g/d降至2.2g/d，血尿及白细胞尿消失，肾小球滤过率每月递减速率由-3.78ml/min减慢至0。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "免疫球蛋白"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "免疫球蛋白"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "静脉注射"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 79,
+ "type": "dru",
+ "entity": "免疫球蛋白"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "pro",
+ "entity": "肌肉注射"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 119,
+ "type": "ite",
+ "entity": "尿蛋白"
+ },
+ {
+ "start_idx": 138,
+ "end_idx": 139,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 141,
+ "end_idx": 144,
+ "type": "sym",
+ "entity": "白细胞尿"
+ },
+ {
+ "start_idx": 148,
+ "end_idx": 153,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ }
+ ]
+ },
+ {
+ "text": "（四）鱼油IgA肾病患者缺乏必需脂肪酸，而鱼油（fishoil）可补充必需脂肪酸，从而防止早期的肾小球损害。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "脂肪酸"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "fishoil"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "脂肪酸"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "肾小球"
+ }
+ ]
+ },
+ {
+ "text": "鱼油富含长链ω-3-多聚不饱和脂肪酸、EPA（eicosapentaenoicacid）及DHA，这些物质可代替花生四烯酸，作为脂氧化酶和环氧化酶的底物而发挥作用，改变膜流动性，降低血小板聚集。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "花生四烯酸"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "脂氧化酶"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "环氧化酶"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "膜"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "血小板"
+ }
+ ]
+ },
+ {
+ "text": "早在1984年Hamazaki收集20例IgA肾病患者做了初步研究，治疗组接受鱼油治疗1年，肾功能维持稳定，而未接受鱼油的对照组，则显示血浆肌酐清除率的降低。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "ite",
+ "entity": "肾功能"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 74,
+ "type": "ite",
+ "entity": "血浆肌酐清除率"
+ }
+ ]
+ },
+ {
+ "text": "共收集55例病人，每日口服12g鱼油为治疗组，51例病人服橄榄油为对照组，所选病例中68%的基础血肌酐值增高，初始观察终点是血肌酐上升＞50%，结果为在治疗期间（2年），鱼油组仅6%的病人进展到观察终点，而对照组达33%，每年血肌酐的增高速率在治疗组为0.03mg/dl，对照组为0.14mg/dl。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "橄榄油"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 64,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 86,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 115,
+ "type": "ite",
+ "entity": "血肌酐"
+ }
+ ]
+ },
+ {
+ "text": "4年后的终末期肾病发生率，对照组为40%，治疗组则为10%，结果有统计学显著意义，没有病人因不良反应而停止治疗。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "终末期肾病"
+ }
+ ]
+ },
+ {
+ "text": "表明鱼油可减慢GFR的下降率。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "该作者在1999年又报道了上述病例远期随访结果，表明早期并持续使用鱼油可明显延缓高危IgA肾病患者的肾衰竭出现时间。",
+ "entities": [
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "鱼油"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "肾衰竭"
+ }
+ ]
+ },
+ {
+ "text": "（五）其他Copp最近组织了一个为期6年的前瞻多中心双盲随机对照研究，以探讨长效服用贝那普利（benazepril），0.2mg/（kg•d），对中等程度蛋白尿、肾功能较好的儿童和青年IgA肾病患者的治疗功效，试验于2004年已完成。",
+ "entities": [
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dru",
+ "entity": "贝那普利"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "benazepril"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "ite",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 83,
+ "type": "ite",
+ "entity": "肾功能"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 96,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "以往有人采用苯妥英钠5mg/（kg•d）治疗IgA肾病，发现可降低血清中IgA及多聚IgA水平，且血尿发作次数减少，但循环免疫复合物未减低，且远期疗效不肯定，近年已很少使用。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "苯妥英钠"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "IgA"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "多聚IgA"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 65,
+ "type": "dru",
+ "entity": "循环免疫复合物"
+ }
+ ]
+ },
+ {
+ "text": "（六）透析及肾移植对终末期肾衰患者可行透析及移植治疗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "透析"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "终末期肾衰"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "透析"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "移植治疗"
+ }
+ ]
+ },
+ {
+ "text": "【预后】成人IgA肾病10年后约15%进展到终末肾功衰竭，20年后升至25%～30%。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "终末肾功衰竭"
+ }
+ ]
+ },
+ {
+ "text": "儿童IgA肾病预后好于成人，Yoshikawa报道20年后10%进展到终末肾衰竭。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "终末肾衰竭"
+ }
+ ]
+ },
+ {
+ "text": "影响预后的因素很多，重度蛋白尿、高血压、肾小球硬化以及间质小管病变严重均是预后不良的指标；男性也易于进展；肉眼血尿与预后的关系尚存争议。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "重度蛋白尿"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "间质小管病变严重"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ }
+ ]
+ },
+ {
+ "text": "据报道，IgA肾病患者从肾功能正常起每年GFR的减低速度为1～3ml/min，而表现为肾病综合征的IgA肾病病人GFR递减率为9ml/min。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "肾功能"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "肾病综合征"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "GFR递减率"
+ }
+ ]
+ },
+ {
+ "text": "合并高血压时，GFR减低速度更是高达每年12ml/min，因此，控制血压和蛋白尿在IgA肾病治疗中至关重要。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "IgA肾病"
+ }
+ ]
+ },
+ {
+ "text": "第四节黏多糖病【概述】黏多糖病（mucopolysaccharidosis，MPS）是一组遗传性溶酶体贮积症，因降解各种黏多糖所需的溶酶体酶缺陷，造成不能完全降解的黏多糖在溶酶体中贮积，并有大量黏多糖从尿中排出。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "mucopolysaccharidosis"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "MPS"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "遗传性溶酶体贮积症"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "黏多糖"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "溶酶体酶"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 104,
+ "type": "sym",
+ "entity": "不能完全降解的黏多糖在溶酶体中贮积，并有大量黏多糖从尿中排出"
+ }
+ ]
+ },
+ {
+ "text": "根据临床表现和不同的酶缺陷，可将MPS分为Ⅰ～Ⅶ型，除MPSⅡ型为X连锁隐性遗传外，其余均属常染色体隐性遗传。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "MPS"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "Ⅰ～Ⅶ型"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "MPSⅡ型"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "常染色体"
+ }
+ ]
+ },
+ {
+ "text": "MPS各型之间存在明显的遗传异质性，我国以MPSⅡ型和Ⅰ型最为常见，症状最为典型。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "MPS"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "MPSⅡ型"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "Ⅰ型"
+ }
+ ]
+ },
+ {
+ "text": "【病理生理和发病机制】黏多糖是结缔组织细胞间的主要成分，广泛存在于各种细胞内。",
+ "entities": [
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "细胞内"
+ }
+ ]
+ },
+ {
+ "text": "黏多糖是带阴性电荷的多聚物，重要的黏多糖有硫酸皮肤素（dermatansulfate，DS）、硫酸肝素（heparansulfate，HS）、硫酸角质素（keratansulfate，KS）、硫酸软骨素（chondroitinsulfate，CS）及透明质酸（hyaluronicacid，HA）等，前3种是黏多糖病的主要病理性黏多糖。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "黏多糖"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "黏多糖"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "硫酸皮肤素"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "dermatansulfate"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "DS"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "硫酸肝素"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "heparansulfate"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "HS"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "硫酸角质素"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 90,
+ "type": "bod",
+ "entity": "keratansulfate"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "KS"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 100,
+ "type": "bod",
+ "entity": "硫酸软骨素"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 119,
+ "type": "bod",
+ "entity": "chondroitinsulfate"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 122,
+ "type": "bod",
+ "entity": "CS"
+ },
+ {
+ "start_idx": 125,
+ "end_idx": 128,
+ "type": "bod",
+ "entity": "透明质酸"
+ },
+ {
+ "start_idx": 130,
+ "end_idx": 143,
+ "type": "bod",
+ "entity": "hyaluronicacid"
+ },
+ {
+ "start_idx": 145,
+ "end_idx": 146,
+ "type": "bod",
+ "entity": "HA"
+ },
+ {
+ "start_idx": 154,
+ "end_idx": 157,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 164,
+ "end_idx": 166,
+ "type": "bod",
+ "entity": "黏多糖"
+ }
+ ]
+ },
+ {
+ "text": "这些多糖都是直链杂多糖，由不同的双糖单位连接而成，包括N-乙酰氨基己糖和糖醛酸或者己糖组成。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "多糖"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "双糖"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "N-乙酰氨基己糖"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "糖醛酸"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "己糖"
+ }
+ ]
+ },
+ {
+ "text": "每个氨基葡糖聚糖直链约由50～100个分子组成，许多直链又同时与一条蛋白质肽链结合，形成更大分子量的聚合体。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "氨基葡糖聚糖直链"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "蛋白质肽链"
+ }
+ ]
+ },
+ {
+ "text": "结缔组织便是由这类聚合体所形成。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "结缔组织"
+ }
+ ]
+ },
+ {
+ "text": "这种多糖链的降解必须在溶酶体中进行。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "多糖链"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "溶酶体"
+ }
+ ]
+ },
+ {
+ "text": "正常溶酶体中含有许多种糖苷酶、硫酸脂酶和乙酸转移酶，不同的黏多糖需不同的溶酶体酶进行降解。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "溶酶体"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "糖苷酶"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "硫酸脂酶"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "乙酸转移酶"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "黏多糖"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "溶酶体酶"
+ }
+ ]
+ },
+ {
+ "text": "已知有10余种溶酶体酶参与其降解过程。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "溶酶体酶"
+ }
+ ]
+ },
+ {
+ "text": "其中任何一种酶的缺陷都会造成氨基葡糖聚糖链分解障碍，积聚在溶酶体内，尿中排出增加。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "氨基葡糖聚糖链分解障碍，积聚在溶酶体内，尿中排出增加"
+ }
+ ]
+ },
+ {
+ "text": "各型黏多糖病的酶缺陷（表14-14）。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "黏多糖病"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】黏多糖是结缔组织的主要成分，因此黏多糖代谢异常累及全身器官，患者一般出生时正常，随年龄增大，临床症状逐渐明显，其共同特征是在出生一年左右出现生长落后。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "黏多糖"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "结缔组织"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "黏多糖代谢异常"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "在出生一年左右出现生长落后"
+ }
+ ]
+ },
+ {
+ "text": "关节进行性畸变，有爪形手、椎体发育不良呈扁平，短颈，鸡胸，肋下缘外突，脊柱后凸或者侧凸，早期出现肝、脾肿大，耳聋，心脏增大等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "关节"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肋下缘"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "脊柱"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "关节进行性畸变，有爪形手、椎体发育不良呈扁平，短颈，鸡胸，肋下缘外突，脊柱后凸或者侧凸，早期出现肝、脾肿大，耳聋，心脏增大等"
+ }
+ ]
+ },
+ {
+ "text": "表14-19黏多糖病的分型、酶的缺陷和累积的代谢产物目前对引起黏多糖病的酶缺陷都已鉴定，共分为6大型。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "酶缺陷"
+ }
+ ]
+ },
+ {
+ "text": "1.黏多糖病I-H型（Hurler综合征）本型是最严重的一种类型，常在10岁左右死亡，病因为缺乏α-L-艾杜糖醛酸苷酶，导致硫酸皮肤素和硫酸肝素在体内积聚，全身脏器如角膜、软骨、骨骼、皮肤、心肌内膜及血管结缔组织等均受累。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "黏多糖病I-H型"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "Hurler综合征"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "常在10岁左右死亡"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "α-L-艾杜糖醛酸苷酶"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "硫酸皮肤素"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "硫酸肝素"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "脏器"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "角膜"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 87,
+ "type": "bod",
+ "entity": "软骨"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "bod",
+ "entity": "骨骼"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 98,
+ "type": "bod",
+ "entity": "心肌内膜"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 105,
+ "type": "bod",
+ "entity": "血管结缔组织"
+ }
+ ]
+ },
+ {
+ "text": "末梢血白细胞、淋巴细胞可见到异染的大小不等，形态不同的深染颗粒，有时呈空泡状，尿排出大量酸性黏多糖（（＞100mg/24h，正常为3～25mg/24h）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 75,
+ "type": "sym",
+ "entity": "末梢血白细胞、淋巴细胞可见到异染的大小不等，形态不同的深染颗粒，有时呈空泡状，尿排出大量酸性黏多糖（（＞100mg/24h，正常为3～25mg/24h）"
+ }
+ ]
+ },
+ {
+ "text": "本病是常染色体隐性遗传病，α-L-艾杜糖醛酸苷酶基因已被鉴定，位于染色体4p16.3，有14个外显子，并在其中发现了不少基因突变。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "常染色体隐性遗传病"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "α-L-艾杜糖醛酸苷酶基因"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "染色体4p16.3"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "外显子"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "基因突变"
+ }
+ ]
+ },
+ {
+ "text": "临床表型与基因型分析发现，α-L-艾杜糖醛酸苷酶基因突变导致酶活性严重缺乏者称为黏多糖病I-H型，如在编码区70，或402出现终止密码。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "α-L-艾杜糖醛酸苷酶基因突变"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "ite",
+ "entity": "酶活性"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "黏多糖病I-H型"
+ }
+ ]
+ },
+ {
+ "text": "基因突变导致酶活性中度或轻度下降者，在临床上分类为黏多糖病I-S型。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "基因突变"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "酶活性"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "黏多糖病I-S型"
+ }
+ ]
+ },
+ {
+ "text": "2.黏多糖病I-S型（Scheie综合征）原先分类为黏多糖病V型，属中等度严重类型黏多糖病，遗传类型和致病基因同黏多糖病I-H型。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "黏多糖病I-S型"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "Scheie综合征"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "黏多糖病V型"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "黏多糖病I-H型"
+ }
+ ]
+ },
+ {
+ "text": "智能发育正常，临床症状一般在5岁后出现。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "智能发育正常，临床症状一般在5岁后出现"
+ }
+ ]
+ },
+ {
+ "text": "3.黏多糖病Ⅱ型（Hunter综合征）临床重型与黏多糖I-H型相似，在2～6岁起病，有特殊面容和骨骼畸形，但脊椎无鸟嘴样畸形。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "黏多糖病Ⅱ型"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "Hunter综合征"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "黏多糖I-H型"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "在2～6岁起病，有特殊面容和骨骼畸形，但脊椎无鸟嘴样畸形"
+ }
+ ]
+ },
+ {
+ "text": "无角膜混浊。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "无角膜混浊"
+ }
+ ]
+ },
+ {
+ "text": "本型为X连锁隐性遗传，病因是艾杜糖醛酸硫酸酯酶缺陷，使硫酸皮肤素和硫酸肝素代谢障碍。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "艾杜糖醛酸硫酸酯酶"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "硫酸皮肤素"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "硫酸肝素"
+ }
+ ]
+ },
+ {
+ "text": "致病基因已克隆，位于染色体Xq28区，在脆性X综合征区域附近，有9个外显子，基因分析发现较多病人有大片段缺失，其他形式有点突变、小片段缺失或插入。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "染色体Xq28区"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "脆性X综合征"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "外显子"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "基因分析"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "较多病人有大片段缺失，其他形式有点突变、小片段缺失或插入"
+ }
+ ]
+ },
+ {
+ "text": "有严重病变，如在核苷酸1129位上插入22个碱基或有基因缺失者病情较重，基因有点突变者相对属轻型临床表现。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "核苷酸1129位"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "碱基"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "基因缺失"
+ }
+ ]
+ },
+ {
+ "text": "4.黏多糖病Ⅲ型（Sanfilippo综合征）临床可分为4种亚型，分别由4种不同的酶缺陷所引起。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "黏多糖病Ⅲ型"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "Sanfilippo综合征"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "酶缺陷"
+ }
+ ]
+ },
+ {
+ "text": "上述4种酶都是硫酸肝素降解所需要的酶，因此，当这些酶缺乏时均引起硫酸肝素在体内积聚，同时尿中排出量增加。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "硫酸肝素"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "酶缺乏"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "硫酸肝素"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "尿"
+ }
+ ]
+ },
+ {
+ "text": "本病4型均为常染色体隐性遗传性疾病，导致硫酸肝素在体内积聚。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "常染色体隐性遗传性疾病"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "硫酸肝素"
+ }
+ ]
+ },
+ {
+ "text": "ⅢD型的致病基因葡糖胺-6-硫酸酯酶已克隆，位于染色体12q14。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "ⅢD型"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "葡糖胺-6-硫酸酯酶"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "染色体12q14"
+ }
+ ]
+ },
+ {
+ "text": "5.黏多糖病Ⅳ型（Morquio综合征）临床特征与黏多糖病I-H型相似，但无智能障碍。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "黏多糖病Ⅳ型"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "Morquio综合征"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "黏多糖病I-H型"
+ }
+ ]
+ },
+ {
+ "text": "两种亚型都属常染色体隐性遗传性疾病。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "常染色体隐性遗传性疾病"
+ }
+ ]
+ },
+ {
+ "text": "N-乙酰半乳糖胺-6-硫酸酯酶的全长cDNA已克隆，基因定位于染色体16q24.3，并在此基因上发现了一些突变位点。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "N-乙酰半乳糖胺-6-硫酸酯酶"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "cDNA"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "染色体16q24.3"
+ }
+ ]
+ },
+ {
+ "text": "β-半乳糖酶基因也已克隆，定位于染色体3q21.33，并找到了突变位点。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "β-半乳糖酶基因"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "染色体3q21.33"
+ }
+ ]
+ },
+ {
+ "text": "6.黏多糖病Ⅵ型（Maroteaux-Lamy综合征）临床表现同黏多糖病I-H型相似，但无智能落后。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "黏多糖病Ⅵ型"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "Maroteaux-Lamy综合征"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "黏多糖病I-H型"
+ }
+ ]
+ },
+ {
+ "text": "尿中排出大量硫酸皮肤素，致病基因为芳基硫酸酯酶B，基因定位于染色体5q13-13q14，属常染色体隐性遗传性疾病。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "尿中排出大量硫酸皮肤素"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "芳基硫酸酯酶B"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "染色体5q13-13q14"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "常染色体隐性遗传性疾病"
+ }
+ ]
+ },
+ {
+ "text": "7.黏多糖病Ⅶ型临床表现同黏多糖病I-H型，但个体轻重程度不一，变异较大，轻者可无智能落后，本型为常染色体隐性遗传性疾病，因β-葡萄糖醛酸酶缺乏，导致4/6硫酸软骨素在体内沉积。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "黏多糖病Ⅶ型"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "黏多糖病I-H型"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "常染色体隐性遗传性疾病"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "β-葡萄糖醛酸酶缺乏"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "硫酸软骨素"
+ }
+ ]
+ },
+ {
+ "text": "基因定位于染色体7q21.11，有12个外显子。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "染色体7q21.11"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "外显子"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】1.尿黏多糖测定通常用甲苯胺蓝法做定性试验，患者尿液呈阳性反应。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "尿黏多糖测定"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "甲苯胺蓝法"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "尿液呈阳性反应"
+ }
+ ]
+ },
+ {
+ "text": "2.骨骼X线检查骨质较疏松，骨皮质变薄，颅骨增大蝶鞍增大后凸或侧凸，椎体呈楔形或扁平，胸、腰椎体前下缘呈鱼唇样前突或呈鸟嘴突肋骨脊柱端细小胸骨端增宽飘带状，掌骨短粗，基底变尖，指骨远端窄圆，腕骨骨化成熟延迟。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "骨质较疏松"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "骨皮质变薄"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "颅骨"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "颅骨增大"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "蝶鞍"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "蝶鞍增大"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "后凸或侧凸"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "腰椎体"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "胸、腰椎体前下缘呈鱼唇样前突或呈鸟嘴突"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "肋骨脊柱"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 68,
+ "type": "sym",
+ "entity": "肋骨脊柱端细小"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "胸骨"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "胸骨端增宽"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "sym",
+ "entity": "飘带状"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "掌骨短粗"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 86,
+ "type": "sym",
+ "entity": "基底变尖"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "指骨远端窄圆"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 102,
+ "type": "sym",
+ "entity": "腕骨骨化成熟延迟"
+ }
+ ]
+ },
+ {
+ "text": "3.醋酸纤维薄膜电泳可以区分尿中排出黏多糖的种类，并进行分型。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "醋酸纤维薄膜电泳"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "黏多糖"
+ }
+ ]
+ },
+ {
+ "text": "4.酶学分析通过测定外周血白细胞，成纤维细胞中的特异性酶活性，以及尿中排出的黏多糖类型，可以对黏多糖病分型。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "酶学分析"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "外周血白细胞"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "成纤维细胞"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 29,
+ "type": "ite",
+ "entity": "特异性酶活性"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "黏多糖"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "黏多糖病"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】1.根据临床特殊面容和体征、X线片表现以及尿黏多糖阳性，可以作出诊断。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "特殊面容"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "尿黏多糖阳性"
+ }
+ ]
+ },
+ {
+ "text": "2.家族史中有黏多糖病人对早期诊断有帮助。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "黏多糖"
+ }
+ ]
+ },
+ {
+ "text": "本病应与佝偻病、先天性甲状腺功能减低症、粘脂病各型、甘露糖贮积病以及GM1神经节苷脂沉积病等鉴别，这些疾病临床表现与黏多糖病相似，但尿中黏多糖排量不增加。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "佝偻病"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "先天性甲状腺功能减低症"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "粘脂病各型"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "甘露糖贮积病"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "GM1神经节苷脂沉积病"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "黏多糖病"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 75,
+ "type": "sym",
+ "entity": "尿中黏多糖排量不增加"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】目前对各型黏多糖病无病因治疗方法，可做一些对症处理。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "黏多糖病"
+ }
+ ]
+ },
+ {
+ "text": "【预后】本组未治疗病例随年龄增大而病情加重，出现进行性智能障碍，骨、关节症状加重肺炎或心脏病，少数类型可存活至成人。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "进行性智能障碍"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "骨"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "关节"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "骨、关节症状加重"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "心脏病"
+ }
+ ]
+ },
+ {
+ "text": "参考文献1.彭文伟.传染病学.第3版.北京：人民卫生出版社，19922.杨永弘.小儿细菌性肺炎及其病原学诊断.中华儿科杂志，1992，30（4）：2563.杨永弘.儿科细菌感染性疾病及其病原学诊断中的几个问题.中华儿科杂志，1993，31（1）：66-684.朱忠勇.实用医学检验学.北京：人民军医出版社，19925.李苏利.临床微生物检验的快速诊断技术研究进展.当代医学，2009，16：15-15",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "传染病"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "细菌性肺炎"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 90,
+ "type": "dis",
+ "entity": "细菌感染性疾病"
+ },
+ {
+ "start_idx": 165,
+ "end_idx": 167,
+ "type": "mic",
+ "entity": "微生物"
+ },
+ {
+ "start_idx": 171,
+ "end_idx": 176,
+ "type": "pro",
+ "entity": "快速诊断技术"
+ }
+ ]
+ },
+ {
+ "text": "四、Addis计数Addis计数是测定夜间12小时尿液中有形成分的数量，可以定量地反映尿中细胞及管型的数量。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "Addis计数"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "Addis计数"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "尿液"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 43,
+ "type": "ite",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "ite",
+ "entity": "细胞"
+ }
+ ]
+ },
+ {
+ "text": "正常参考值为管型0～5000个/12h尿，红细胞0～50万个/12h尿，白细胞0～100万个/12h尿。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "管型"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "ite",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 50,
+ "type": "ite",
+ "entity": "尿"
+ }
+ ]
+ },
+ {
+ "text": "收集3小时尿再计算出1小时尿有形成分排泄率也可定量反映尿改变。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "尿"
+ }
+ ]
+ },
+ {
+ "text": "成人正常值为红细胞：男＜3万个/h，女＜4万/h；白细胞：男＜7万个/h，女＜14万个/h，小儿正常值为成人的1～2倍。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "白细胞"
+ }
+ ]
+ },
+ {
+ "text": "第十四节流行性出血热流行性出血热（epidemichemorrhagicfever，EHF）是由汉坦病毒引起的自然疫源性疾病。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "流行性出血热"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "流行性出血热"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "epidemichemorrhagicfever"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "EHF"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "mic",
+ "entity": "汉坦病毒"
+ }
+ ]
+ },
+ {
+ "text": "临床上以发热、出血、周围循环衰竭及肾脏损害为特征。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "周围循环衰竭"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "肾脏损害"
+ }
+ ]
+ },
+ {
+ "text": "【病原和流行病学】汉坦病毒（hantaviruses，HVs）归类为布尼亚病毒科汉坦病毒属。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "汉坦病毒"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "hantaviruses"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "mic",
+ "entity": "HVs"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "mic",
+ "entity": "布尼亚病毒"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "mic",
+ "entity": "汉坦病毒"
+ }
+ ]
+ },
+ {
+ "text": "其中9个主要型别为汉滩型（hantaanvirus，HTNV）、汉城型（SEOV）、普马拉型（PUUV）、希望山型（PHV）、泰国型（ThAIV）、印度型（TPMV）、多布拉伐-贝尔格莱德型（DOBV）、无名病毒型（SNV）和纽约型（NYV）。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "汉滩型"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 24,
+ "type": "mic",
+ "entity": "hantaanvirus"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "mic",
+ "entity": "HTNV"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "汉城型"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "SEOV"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "mic",
+ "entity": "普马拉型"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "mic",
+ "entity": "PUUV"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "mic",
+ "entity": "希望山型"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "mic",
+ "entity": "PHV"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 65,
+ "type": "mic",
+ "entity": "泰国型"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 71,
+ "type": "mic",
+ "entity": "ThAIV"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "mic",
+ "entity": "印度型"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "mic",
+ "entity": "TPMV"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 94,
+ "type": "mic",
+ "entity": "多布拉伐-贝尔格莱德型"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 99,
+ "type": "mic",
+ "entity": "DOBV"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 105,
+ "type": "mic",
+ "entity": "无名病毒"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 110,
+ "type": "mic",
+ "entity": "SNV"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 115,
+ "type": "mic",
+ "entity": "纽约型"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 119,
+ "type": "mic",
+ "entity": "NYV"
+ }
+ ]
+ },
+ {
+ "text": "我国目前仅发现汉滩型和汉城型，其宿主分别为黑线姬鼠和褐家鼠。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "mic",
+ "entity": "汉滩型"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "mic",
+ "entity": "汉城型"
+ }
+ ]
+ },
+ {
+ "text": "病毒基因由3个负链RNA环状分子组成，外被核衣壳和包膜。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "病毒基因"
+ }
+ ]
+ },
+ {
+ "text": "包膜含血凝素抗原，在病毒黏附、穿入和脱衣壳中起重要作用。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "病毒可在多种细胞或细胞株中生长，但致细胞病变的作用较弱，其生长缓慢，病毒滴度一般在接种后7～14天达高峰。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "接种"
+ }
+ ]
+ },
+ {
+ "text": "病毒对外环境抵抗力不强，75%乙醇、乙醚等脂溶剂、0.5%碘酒、戊二醛、酸（pH3～5）、56℃30分钟、紫外线可使之灭活。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "乙醇"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "dru",
+ "entity": "乙醚"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "碘酒"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "戊二醛"
+ }
+ ]
+ },
+ {
+ "text": "带病毒的鼠类是主要传染源和储存宿主。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "病毒有多种传播途径，以动物源传播为主，即人接触带病毒动物排泄物而感染；带毒排泄物形成的气溶胶能经呼吸道感染人体；其他如消化道及虫媒（寄生虫与带毒动物身上的螨类叮咬人体）传播也已证明，罕见人与人之间传播的报道。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "呼吸道感染"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 68,
+ "type": "mic",
+ "entity": "寄生虫"
+ }
+ ]
+ },
+ {
+ "text": "已报道全球有78个国家和地区的人和动物感染汉坦病毒，我国疫情最重，占发病人数的90%以上，1997～1999年全国年报告病例达4.1万～4.6万余，2000年和2001年分别为35810和33872例。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "mic",
+ "entity": "汉坦病毒"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制和病理】EHF的发病机制并不十分明了。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "EHF"
+ }
+ ]
+ },
+ {
+ "text": "一般认为，早期损伤是病毒直接致病作用所致，晚期则是病毒介导的免疫性损伤。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "免疫性损伤"
+ }
+ ]
+ },
+ {
+ "text": "HVs的组织细胞嗜性广泛，血管内皮细胞和多种免疫细胞如T细胞、B细胞、单核/巨噬细胞、脑胶质细胞及肝库普弗细胞等为其靶细胞。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "HVs"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "血管内皮细胞"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "T细胞"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "B细胞"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "单核/巨噬细胞"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "脑胶质细胞"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "肝库普弗细胞"
+ }
+ ]
+ },
+ {
+ "text": "病毒侵入人体后，首先累及单核-吞噬细胞系统，病毒入血致短暂病毒血症后出现全身广泛微血管损伤，表现为微血管充血、水肿、变性和坏死。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "单核-吞噬细胞系统"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "病毒血症"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "微血管"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "全身广泛微血管损伤"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "微血管"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "微血管充血、水肿、变性和坏死"
+ }
+ ]
+ },
+ {
+ "text": "血管通透性增加，血浆大量外渗，致有效循环血量减少。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "血管通透性增加"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "血浆大量外渗"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "有效循环血量减少"
+ }
+ ]
+ },
+ {
+ "text": "肾血流量减少和其滤过率下降，经刺激肾素-血管紧张素-醛固酮系统分泌增多导致少尿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "肾血流量减少和其滤过率下降"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肾素-血管紧张素-醛固酮系统"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "少尿"
+ }
+ ]
+ },
+ {
+ "text": "肾缺血致肾小管上皮坏死，加上肾间质水肿使肾小管狭窄甚至闭塞，加重少尿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "肾缺血"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肾小管上皮"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "肾小管上皮坏死"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "肾间质"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "肾间质水肿"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "肾小管狭窄甚至闭塞"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "少尿"
+ }
+ ]
+ },
+ {
+ "text": "大量免疫复合物沉积于血管和肾小球基底膜，参与血管壁和肾脏损伤机制。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肾小球基底膜"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "大量免疫复合物沉积于血管和肾小球基底膜"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "血管壁"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "肾脏损伤"
+ }
+ ]
+ },
+ {
+ "text": "患者早期血中IgE明显增高，并可检出自身抗体，提示存在Ⅰ型和Ⅱ型变态反应。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "血中IgE明显增高"
+ }
+ ]
+ },
+ {
+ "text": "最近研究显示，患者免疫细胞增生活跃，CD8+T细胞增加，NK细胞活性增强，认为细胞免疫在病毒清除和致病机制中起双重作用。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "免疫细胞"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "免疫细胞增生活跃"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "CD8+T细胞增加"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "NK细胞"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "NK细胞活性增强"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "典型病理改变为多发性出血、严重渗出和水肿及灶状坏死和细胞浸润。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "多发性出血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "严重渗出"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "灶状坏死"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "细胞浸润"
+ }
+ ]
+ },
+ {
+ "text": "肾脏病变广泛，髓质充血、出血；肾小管上皮肿胀、变性、坏死；内皮脱落；包膜紧张可至肾破裂；全尿路均可出血。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "肾脏病变"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "髓质"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "髓质充血、出血"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肾小管上皮"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "肾小管上皮肿胀、变性、坏死"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "内皮脱落"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "包膜"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "包膜紧张可至肾破裂"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "尿路"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "全尿路均可出血"
+ }
+ ]
+ },
+ {
+ "text": "心脏以右心房病变多见，心壁细胞变性、浸润及出血；纤维断裂。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "右心房"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "右心房病变"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "心壁细胞"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "心壁细胞变性、浸润及出血"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "纤维断裂"
+ }
+ ]
+ },
+ {
+ "text": "脑垂体肿大，前叶明显充血、出血和坏死。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "脑垂体"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "前叶"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "脑垂体肿大，前叶明显充血、出血和坏死"
+ }
+ ]
+ },
+ {
+ "text": "腹膜后胶冻样水肿为本病所特有。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "腹膜"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "腹膜后胶冻样水肿"
+ }
+ ]
+ },
+ {
+ "text": "（一）发热期相当于病毒血症期。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "病毒血症"
+ }
+ ]
+ },
+ {
+ "text": "血及尿中有病毒存在，故有传染性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "主要表现有：1.发热及中毒症状几乎均有发热，多急起，体温可达38～40℃，以弛张热、稽留热型为多，热程一般3～7天。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "中毒"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "弛张热"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "稽留热"
+ }
+ ]
+ },
+ {
+ "text": "常伴三痛症：头痛、腰痛及眼眶痛。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "头痛"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "腰痛"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "眼眶痛"
+ }
+ ]
+ },
+ {
+ "text": "由于脑膜及脑实质血管充血、水肿及出血，引起剧烈头痛。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "脑膜"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "脑实质血管"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "脑膜及脑实质血管充血、水肿及出血"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "剧烈头痛"
+ }
+ ]
+ },
+ {
+ "text": "腰痛和肾区叩痛与肾充血、水肿、包膜紧张及腹膜后水肿有关；眼眶痛系眼球周围软组织水肿出血引起眶压增高所致。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "腰痛"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "肾区"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "肾区叩痛"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "肾充血"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "包膜"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "包膜紧张"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "腹膜"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "腹膜后水肿"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "眼眶痛"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "眼球周围软组织"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "眼球周围软组织水肿出血"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "眶压增高"
+ }
+ ]
+ },
+ {
+ "text": "患者常有口渴、食欲下降、恶心、呕吐和腹痛、腹泻。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "口渴"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "食欲下降"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "大便可带黏血。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "大便可带黏血"
+ }
+ ]
+ },
+ {
+ "text": "重患者可有嗜睡或兴奋不安、谵语等。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "兴奋不安"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "谵语"
+ }
+ ]
+ },
+ {
+ "text": "2.毛细血管损害包括：①三红症：眼结膜、颜面、颈及上胸部明显充血潮红，呈酒醉貌；②出血：软腭、球结膜、腋下和胸背皮肤见针尖大小出血点，呈特征性搔抓样或条痕样排列。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "毛细血管"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "毛细血管损害"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "眼结膜"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "颜面"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "颈"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "上胸部"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "眼结膜、颜面、颈及上胸部明显充血潮红"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "酒醉貌"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "软腭"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "球结膜"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "腋下"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "胸背皮肤"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "软腭、球结膜、腋下和胸背皮肤见针尖大小出血点，呈特征性搔抓样或条痕样排列"
+ }
+ ]
+ },
+ {
+ "text": "重症见大片皮肤瘀斑，血尿、呕血及便血，束臂试验强阳性；③渗出：常见球结膜和眼睑水肿，面部、四肢亦可肿胀，可有腹水。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "大片皮肤瘀斑"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "呕血"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "便血"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "束臂试验强阳性"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "球结膜"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "眼睑"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "球结膜和眼睑水肿"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "面部"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "四肢"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "面部、四肢亦可肿胀"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "有腹水"
+ }
+ ]
+ },
+ {
+ "text": "3.肾脏损害蛋白尿为最常见的早期表现之一，可有血尿和尿量减少。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "肾脏损害"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "尿量减少"
+ }
+ ]
+ },
+ {
+ "text": "（二）低血压休克期发热后期（一般在病后4～6天）或退热同时可有血压下降甚至休克，呈现“热退症更重”的特点。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "低血压休克"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "退热"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "血压下降"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "休克"
+ }
+ ]
+ },
+ {
+ "text": "表现为：低血压：收缩压下降，脉压变小、脉快而弱、球结膜水肿，尿少，烦躁不安等；②休克：收缩压低于9.3kPa，脉压小于2.6kPa。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "低血压"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "收缩压"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "收缩压下降"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "脉压"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "脉压变小"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "脉快而弱"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "球结膜"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "球结膜水肿"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "尿少"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "烦躁不安"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "收缩压"
+ }
+ ]
+ },
+ {
+ "text": "脉细弱或扪不到，球结膜水肿更重，出现明显消化道及精神神经症状。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "脉细弱或扪不到"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "球结膜"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "球结膜水肿更重"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "消化道及精神神经症状"
+ }
+ ]
+ },
+ {
+ "text": "尿少、蛋白尿及出血症状更明显。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "尿少"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "出血"
+ }
+ ]
+ },
+ {
+ "text": "（三）少尿期多发生于病程第5～8天，持续约2～5天。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "少尿"
+ }
+ ]
+ },
+ {
+ "text": "症状以急性肾衰竭为主，表现为尿毒症、酸中毒、电解质紊乱、高血容量综合征（表现为脉搏洪大，静脉充血、水肿、血红蛋白下降等）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "急性肾衰竭"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "尿毒症"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "电解质紊乱"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "高血容量综合征"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "脉搏洪大"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "静脉充血"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 55,
+ "type": "ite",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "血红蛋白下降"
+ }
+ ]
+ },
+ {
+ "text": "前述各期的症状可加重，可因颅内压增高出现烦躁、谵妄甚至昏迷、抽搐等。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "颅内压"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "颅内压增高"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "烦躁"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "谵妄"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "昏迷"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "抽搐"
+ }
+ ]
+ },
+ {
+ "text": "（四）多尿期于病程第9～14天进入多尿期，持续1～2周，可分为移行阶段（尿量从少尿增至正常尿量）、多尿早期和多尿后期。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "ite",
+ "entity": "尿量"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "多尿"
+ }
+ ]
+ },
+ {
+ "text": "在前二阶段，氮质血症仍逐日上升，症状可继续加重。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "氮质血症"
+ }
+ ]
+ },
+ {
+ "text": "进入多尿后期，患者症状逐渐减轻，氮质血症好转，酸中毒和高血容量得以纠正。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "氮质血症"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "酸中毒和高血容量得以纠正"
+ }
+ ]
+ },
+ {
+ "text": "若过度利尿，失水、失盐，加之继发感染或出血等可诱发第二次休克或再次肾衰竭。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "继发感染"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "肾衰竭"
+ }
+ ]
+ },
+ {
+ "text": "尿量减少至肾功能恢复，症状体征消失，各种化验逐渐正常。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "ite",
+ "entity": "尿量"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "尿量减少"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "肾功能恢复"
+ }
+ ]
+ },
+ {
+ "text": "小儿出血热临床经过与成人基本相似，但5个病期经过不完全，临床表现除消化道症状明显外，其他症状与体征较成人轻，预后较好。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "小儿出血热"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "消化道症状明显"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）常规检查1.血常规检查白细胞总数于病程第3～4天开始增高，15×109～30×109/L，少数高达50×109/L以上。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "血常规"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "白细胞总数"
+ }
+ ]
+ },
+ {
+ "text": "早期中性粒细胞增高,核左移，可见中毒颗粒和类白血病反应；病程第5～8天后淋巴细胞增高;异淋出现于病程早期。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "中性粒细胞"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "中性粒细胞增高"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "核左移"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "类白血病"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "淋巴细胞增高"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "异淋"
+ }
+ ]
+ },
+ {
+ "text": "血红蛋白因血液浓缩而升高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "血红蛋白因血液浓缩而升高"
+ }
+ ]
+ },
+ {
+ "text": "血小板有不同程度下降，DIC时下降更明显。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "血小板"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "血小板有不同程度下降"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "DIC"
+ }
+ ]
+ },
+ {
+ "text": "2.尿常规蛋白尿是出血热肾损害的最早征象。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "尿常规"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "出血热肾损害"
+ }
+ ]
+ },
+ {
+ "text": "还可有血尿及管型尿。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "管型尿"
+ }
+ ]
+ },
+ {
+ "text": "少数病例尿中出现膜状物，为凝血块、蛋白和脱落上皮细胞的混合物。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "尿中出现膜状物"
+ }
+ ]
+ },
+ {
+ "text": "尿中溶菌酶、N-乙酰氨基糖苷酶（NAG）亦可阳性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "溶菌酶"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "N-乙酰氨基糖苷酶"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "mic",
+ "entity": "NAG"
+ }
+ ]
+ },
+ {
+ "text": "（二）血生化检查发热晚期血尿素氮及肌酐开始升高,少尿及多尿早期达高峰，常见代谢性酸中毒合并呼吸性碱中毒。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "血生化检查"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "血尿素氮"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "血尿素氮及肌酐开始升高"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "少尿"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "代谢性酸中毒"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "呼吸性碱中毒"
+ }
+ ]
+ },
+ {
+ "text": "血钠、氯、钙在全病程均降低,磷、镁、铁升高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "ite",
+ "entity": "血钠"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "血钠、氯、钙在全病程均降低"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "磷、镁、铁升高"
+ }
+ ]
+ },
+ {
+ "text": "血钾在发热及休克期降低，少尿期升高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "ite",
+ "entity": "血钾"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "血钾在发热及休克期降低，少尿期升高"
+ }
+ ]
+ },
+ {
+ "text": "心肌受损时，血清肌酸磷酸激酶、乳酸脱氢酶和肌红蛋白升高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "心肌受损"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "血清肌酸磷酸激酶"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "乳酸脱氢酶"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肌红蛋白"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "血清肌酸磷酸激酶、乳酸脱氢酶和肌红蛋白升高"
+ }
+ ]
+ },
+ {
+ "text": "（三）病原学检查病毒分离及鉴定取患者急性期血液、尿液或尸检材料制成10%悬液，接种于敏感单层细胞上，由于CPE不典型，需用免疫荧光法测定细胞内特异性抗原而检出病毒。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "病毒分离及鉴定"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "尿液"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "接种"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "免疫荧光法"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "2.病毒抗原检测最早采用免疫荧光法检测组织细胞中的病毒抗原，早期患者白细胞中病毒抗原检出率达90%以上。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "病毒抗原检测"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "免疫荧光法"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "mic",
+ "entity": "病毒抗原"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "mic",
+ "entity": "病毒抗原"
+ }
+ ]
+ },
+ {
+ "text": "用免疫酶技术检测患者血和体液中病毒抗原敏感性低，早期标本阳性率不足20%，但用于组织内病毒抗原检测，阳性率可达100%。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "免疫酶技术"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "体液"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "mic",
+ "entity": "病毒抗原"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "病毒抗原检测"
+ }
+ ]
+ },
+ {
+ "text": "3.特异性抗体测定特异性IgM出现早，感染1周后达高峰，维持半年左右，是近期感染的指标；双份血清特异性IgG≥4倍增高有确诊价值。",
+ "entities": [
+ {
+ "start_idx": 46,
+ "end_idx": 53,
+ "type": "ite",
+ "entity": "血清特异性IgG"
+ }
+ ]
+ },
+ {
+ "text": "检测方法有免疫荧光法和ELISA法，将重组病毒抗原用于ELISA检测，敏感性提高。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "免疫荧光法"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "ELISA法"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "mic",
+ "entity": "病毒抗原"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 33,
+ "type": "pro",
+ "entity": "ELISA检测"
+ }
+ ]
+ },
+ {
+ "text": "4.病毒基因检测用原位杂交法和RT-PCR技术可检测组织细胞内病毒基因片段。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "病毒基因检测"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "原位杂交法"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "RT-PCR技术"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "病毒基因"
+ }
+ ]
+ },
+ {
+ "text": "后者还是对汉坦病毒分离物进行基因分型的可靠方法之一。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "汉坦病毒"
+ }
+ ]
+ },
+ {
+ "text": "根据流行病学资料如在流行季节；发病前两个月内有疫区居住或逗留史；临床上有发热和中毒症状，充血、出血、渗出体征，以及肾损害三大主征和病程发展的五期经过，实验室检查有典型血、尿常规和血生化改变可作出临床诊断。",
+ "entities": [
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "中毒"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "充血"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "渗出"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "sym",
+ "entity": "肾损害"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 87,
+ "type": "ite",
+ "entity": "血、尿常规"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 91,
+ "type": "ite",
+ "entity": "血生化"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "血、尿常规和血生化改变"
+ }
+ ]
+ },
+ {
+ "text": "以发热为主症者，应与流感、钩端螺旋体病、败血症等相鉴别；以休克为主症者应与暴发型流脑、败血症休克、中毒型菌痢等区别；以出血为主症者应与伤寒肠出血，血小板减少性紫癜等相鉴别；以肾功能损害少尿为主症者，应与肾小球肾炎和其他原因引起的急性肾功能不全区别。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "流感"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "钩端螺旋体病"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "暴发型流脑"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "败血症休克"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "中毒型菌痢"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "伤寒肠出血"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "血小板减少性紫癜"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 87,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "肾功能损害少尿"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 105,
+ "type": "dis",
+ "entity": "肾小球肾炎"
+ },
+ {
+ "start_idx": 114,
+ "end_idx": 120,
+ "type": "dis",
+ "entity": "急性肾功能不全"
+ }
+ ]
+ },
+ {
+ "text": "另外，小儿流行性出血热还应与登革出血热（Denguehemorrhagicfever）相鉴别：①登革出血热是由伊蚊传播登革病毒所致，在海南及广东流行。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "小儿流行性出血热"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "登革出血热"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "Denguehemorrhagicfever"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "登革出血热"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "mic",
+ "entity": "登革病毒"
+ }
+ ]
+ },
+ {
+ "text": "②临床上以发热、多形性皮疹、多器官较大量出血为特征。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "多形性皮疹"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "多器官较大量出血"
+ }
+ ]
+ },
+ {
+ "text": "病程中可有休克但无肾损害。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "无肾损害"
+ }
+ ]
+ },
+ {
+ "text": "目前国内外已成功研制出3类疫苗，即纯化乳鼠脑灭活疫苗、细胞培养灭活疫苗和基因工程重组载体（活）疫苗。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "疫苗"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "纯化乳鼠脑灭活疫苗"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "细胞培养灭活疫苗"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 48,
+ "type": "dru",
+ "entity": "基因工程重组载体（活）疫苗"
+ }
+ ]
+ },
+ {
+ "text": "纯化乳鼠脑灭活疫苗Ⅲ期临床防病效果观察，保护率为96%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "纯化乳鼠脑灭活疫苗"
+ }
+ ]
+ },
+ {
+ "text": "两株细胞培养灭活疫苗，即金黄地鼠细胞（GHKC）和长爪沙鼠肾细胞（MGKC）灭活疫苗的Ⅲ期临床预防效果观察，前者保护率为97.63%；后者达95.27%。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "金黄地鼠细胞（GHKC）和长爪沙鼠肾细胞（MGKC）灭活疫苗"
+ }
+ ]
+ },
+ {
+ "text": "疫苗的应用将会大大降低我国EHF的发病率。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "EHF"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】（一）综合疗法应做好“三早一就”（早发现、早休息、早治疗及就近治疗），以液体疗法为主，辅以对症治疗。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "早发现、早休息、早治疗及就近治疗"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "pro",
+ "entity": "液体疗法"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "对症治疗"
+ }
+ ]
+ },
+ {
+ "text": "1.发热期治疗卧床休息，给以高热量、高维生素、易消化的食物。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "卧床休息"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "给以高热量、高维生素、易消化的食物"
+ }
+ ]
+ },
+ {
+ "text": "高���以物理降温为主，体温过高、中毒症状重者给予地塞米松，每次0.2～0.4mg/kg，每4～6小时一次，疗程2～3天或热退即停。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "物理降温"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "体温过高"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "中毒"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "地塞米松"
+ }
+ ]
+ },
+ {
+ "text": "出血明显可用酚磺乙胺、云南白药或维生素K。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "云南白药"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dru",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "呕吐不能进食者，给予静脉补液和止吐剂。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "静脉补液"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "止吐剂"
+ }
+ ]
+ },
+ {
+ "text": "发生DIC时，可尽早试用肝素，低分子右旋糖酐及丹参注射液有抗凝作用，均可应用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "DIC"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "肝素"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "低分子右旋糖酐"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "丹参注射液"
+ }
+ ]
+ },
+ {
+ "text": "2.低血压休克期治疗①补充血容量：按早期、快速、适量的原则，液体一般按3∶1的晶胶比例，先晶体后胶体，酌情补钾、钙。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "低血压休克"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "补充血容量"
+ }
+ ]
+ },
+ {
+ "text": "本期因血液浓缩，不宜用全血；②纠正酸中毒：1.4%～2.5%碳酸氢钠静脉注射或静脉滴注，至酸中毒纠正为止；③强心剂应用：在血容量基本补足情况下，心率仍快则可给予毛花苷丙或毒毛花苷K；④血管活性药物应用：血容量补足，血压仍不稳定者可选用血管活性药物，如多巴胺、间羟胺、异丙基肾上腺素或山莨菪碱等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "碳酸氢钠静脉注射或静脉滴注"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "强心剂"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "ite",
+ "entity": "心率"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dru",
+ "entity": "毛花苷丙"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 89,
+ "type": "dru",
+ "entity": "毒毛花苷K"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 97,
+ "type": "dru",
+ "entity": "血管活性药物"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 105,
+ "type": "sym",
+ "entity": "血容量补足"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 108,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 122,
+ "type": "dru",
+ "entity": "血管活性药物"
+ },
+ {
+ "start_idx": 125,
+ "end_idx": 127,
+ "type": "dru",
+ "entity": "多巴胺"
+ },
+ {
+ "start_idx": 129,
+ "end_idx": 131,
+ "type": "dru",
+ "entity": "间羟胺"
+ },
+ {
+ "start_idx": 133,
+ "end_idx": 139,
+ "type": "dru",
+ "entity": "异丙基肾上腺素"
+ },
+ {
+ "start_idx": 141,
+ "end_idx": 144,
+ "type": "dru",
+ "entity": "山莨菪碱"
+ }
+ ]
+ },
+ {
+ "text": "3.少尿期治疗（包括移行阶段和多尿早期）本期主要稳定机体内环境，加强利尿，促进肾功能恢复。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "少尿"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "加强利尿"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "肾"
+ }
+ ]
+ },
+ {
+ "text": "（1）稳定机体内环境：①控制氮质血症：给以高糖、高维生素、低蛋白饮食，维持热量；②严格限制入量：每日液体入量=［前一日尿量+每日不显性失水+吐泻丢失量］-内生水量；③维持电解质和酸碱平衡。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "氮质血症"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "以高糖、高维生素、低蛋白饮食，维持热量"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "严格限制入量"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 92,
+ "type": "pro",
+ "entity": "维持电解质和酸碱平衡"
+ }
+ ]
+ },
+ {
+ "text": "（2）促进利尿：可用呋塞米等利尿剂和血管扩张剂如多巴胺等。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "利尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "呋塞米"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "利尿剂"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "血管扩张剂"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "多巴胺"
+ }
+ ]
+ },
+ {
+ "text": "（3）导泻和放血：有高血容量综合征时，可口服甘露醇粉剂、50%硫酸镁、中药大黄等导泻；出现心衰、肺水肿可考虑放血。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "导泻"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "放血"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "高血容量综合征"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "甘露醇粉剂"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "硫酸镁"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "中药大黄"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "导泻"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "心衰"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "肺水肿"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "pro",
+ "entity": "放血"
+ }
+ ]
+ },
+ {
+ "text": "（4）透析疗法：凡有明显氮质血症、高血钾、高血容量综合征者，可采用腹膜或血液透析治疗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "透析"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "氮质血症"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "高血钾"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "高血容量综合征"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "腹膜或血液透析"
+ }
+ ]
+ },
+ {
+ "text": "4.多尿期治疗主要保持水、电解质平衡，防止继发感染。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "多尿"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "保持水、电解质平衡"
+ }
+ ]
+ },
+ {
+ "text": "随着尿量的增加适当补充液体和电解质，防止第二次肾衰竭，补液以口服为主。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "补充液体和电解质"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "肾衰竭"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "口服"
+ }
+ ]
+ },
+ {
+ "text": "蛋白质宜逐步增加，以防止多尿性氮质血症。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "蛋白质宜逐步增加"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "多尿性氮质血症"
+ }
+ ]
+ },
+ {
+ "text": "5.恢复期治疗补充营养，逐步恢复活动。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "补充营养"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "逐步恢复活动"
+ }
+ ]
+ },
+ {
+ "text": "6.其他对症治疗肾破裂时及时手术治疗；高血容量综合征、高血钾、心衰、肺水肿、呼吸衰竭、中枢神经并发症及腔道出血时及时采取有力抢救措施。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "肾破裂"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "高血容量综合征"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "高血钾"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "心衰"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "肺水肿"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "中枢神经"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "中枢神经并发症"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "腔道"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "腔道出血"
+ }
+ ]
+ },
+ {
+ "text": "（二）抗病毒治疗1.利巴韦林（ribavirin）是我国学者首先找到的抗汉坦病毒药物，早期应用（病程头4天内）效佳。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "利巴韦林"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "ribavirin"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "抗汉坦病毒药物"
+ }
+ ]
+ },
+ {
+ "text": "有两种治疗方案：①大剂量疗法：首剂33mg/kg，以后16mg/kg，6小时一次，连续4天，第5～7天8mg/kg，8小时一次，静脉滴注，可将病死率降至＜2%。",
+ "entities": [
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "pro",
+ "entity": "静脉滴注"
+ }
+ ]
+ },
+ {
+ "text": "副作用有可逆性骨髓抑制和红细胞减少。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "可逆性骨髓抑制"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "红细胞减少"
+ }
+ ]
+ },
+ {
+ "text": "②小剂量疗法：按10～15mg/（kg•d）或700～750mg/d静脉滴注，疗程3天，可改善症状，降低病死率，无不良反应。",
+ "entities": [
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "静脉滴注"
+ }
+ ]
+ },
+ {
+ "text": "但患者体内病毒是否被清除尚未证实。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "此外，利巴韦林治疗汉坦病毒肺综合征（HPS）无明显疗效，可能与该病进展快速有关。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "利巴韦林"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "汉坦病毒肺综合征"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "HPS"
+ }
+ ]
+ },
+ {
+ "text": "2.干扰素体外有抗病毒作用，体内疗效尚在评价中。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "干扰素"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "第二节面肩肱型肌营养不良面肩肱型肌营养不良（facioscapulohumeraldystrophy，FSHD）是常染色体显性遗传病，发病率约为1∶20000。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "面肩肱型肌营养不良"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "面肩肱型肌营养不良"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "facioscapulohumeraldystrophy"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "FSHD"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "常染色体显性遗传病"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制】Wijmenga等首先证实，FSHD基因定位于4号染色体上，进一步的研究还表明定位于4q35。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "FSHD基因"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "4号染色体"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "4q35"
+ }
+ ]
+ },
+ {
+ "text": "1992年，研究发现经EcoR1酶切后的片段中，用特异性探针（p13E-11）可检测到一个比正常人群短的DNA片段。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "EcoR1酶"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "equ",
+ "entity": "特异性探针"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "equ",
+ "entity": "p13E-11"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "DNA"
+ }
+ ]
+ },
+ {
+ "text": "约85%～95%临床诊断为FSHD患者（无论是家族性还是散发性），都证实有短片段存在。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "许多研究表明，4q35区的缺失越大（形成的短片段越小），临床表现越严重。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "4q35"
+ }
+ ]
+ },
+ {
+ "text": "虽然4q35短片段与FSHD的关系已明确，但精确的基因定位或这种缺陷影响的基因还未明确，缺失与疾病的确切关系至今未明。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "4q35"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "位置变异效应假说认为，此区域的串联重复序列缺失可能影响邻近基因（包括FSHD基因）的表达。",
+ "entities": [
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "一些FSHD患者在缺失��点邻近区域有重组现象，支持了以上假说。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "因此目前研究已转向确立4号染色体上邻近FSHD区域的基因及其特性。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "4号染色体"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "另外，一些FSHD的家族患者与4号染色体无关，这说明其具有遗传异质性。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "FSHD"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "4号染色体"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】本病患者肌无力主要累及面肌及肩胛肌群。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肌无力"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "面肌"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肩胛肌群"
+ }
+ ]
+ },
+ {
+ "text": "面肌主要累及眼轮匝肌和口轮匝肌，常为非对称性，患者出现奇怪的扭曲笑容，口角处出现凹陷无法撅嘴面部表情抑郁、平淡当要求患者吹口哨时，嘴唇常特征性地呈横向或水平位患者不能完全闭紧眼睛眼睑很容易睁开肩胛带肌肉包括背阔肌、斜方肌、菱形肌以及前锯肌。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "面肌"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "眼轮匝肌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "口轮匝肌"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "扭曲笑容"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "口角"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "口角处出现凹陷"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "嘴"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "无法撅嘴"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "面部"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "面部表情抑郁、平淡"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "嘴唇"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 78,
+ "type": "sym",
+ "entity": "当要求患者吹口哨时，嘴唇常特征性地呈横向或水平位"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "眼睛"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "患者不能完全闭紧眼睛"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "bod",
+ "entity": "眼睑"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 95,
+ "type": "sym",
+ "entity": "眼睑很容易睁开"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 100,
+ "type": "bod",
+ "entity": "肩胛带肌肉"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 105,
+ "type": "bod",
+ "entity": "背阔肌"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 109,
+ "type": "bod",
+ "entity": "斜方肌"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 113,
+ "type": "bod",
+ "entity": "菱形肌"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 118,
+ "type": "bod",
+ "entity": "前锯肌"
+ }
+ ]
+ },
+ {
+ "text": "静止时，患者表现为斜肩姿势肩膀前转肩胛骨上升前臂上移或外展时，肩胛骨常常向前外向转动活动障碍，尤其是那些需应用肩胛肌肉的活动，如爬树、挥动高尔夫球棒以及投掷垒球等。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肩"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "斜肩姿势"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肩"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "膀"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "肩膀前转"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肩胛骨"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "肩胛骨上升"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "肩胛骨"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "前臂上移或外展时，肩胛骨常常向前外向转动"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "活动障碍"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "肩胛肌肉"
+ }
+ ]
+ },
+ {
+ "text": "约有1/3的患者无症状，仅能依据体格检查进行诊断。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "体格检查"
+ }
+ ]
+ },
+ {
+ "text": "腹壁肌肉在疾病早期即可受累，但往往到疾病晚期才引起注意。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "腹壁肌肉"
+ }
+ ]
+ },
+ {
+ "text": "典型的表现是腹壁下部肌肉严重受累引起腹部突出Beevor征（患者在仰卧时屈曲颈部脐部可向上偶尔也会向下移动），它可作为可疑患者的一个早期表现，因为其他肌肉性疾病很少出现这种表现。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "腹壁"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "腹壁下部肌肉严重受累"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "引起腹部突出"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "Beevor征"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "颈部"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "在仰卧时屈曲颈部"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "脐部"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "脐部可向上"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "偶尔也会向下移动"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "肌肉性疾病"
+ }
+ ]
+ },
+ {
+ "text": "大腿远端前群肌常常受累最早、最严重行走时足部拖地明显的足下垂导致频繁的摔倒或者行走不稳。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "大腿"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "前群肌"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "大腿远端前群肌常常受累最早、最严重"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "足部"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "行走时足部拖地"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "足"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "明显的足下垂"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "导致频繁的摔倒"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "行走不稳"
+ }
+ ]
+ },
+ {
+ "text": "少数情况下，患者可出现较严重的骨盆肢带肌无力髋部屈肌和外展肌，造成早期相对较重的步态不稳。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "骨盆肢带肌"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "严重的骨盆肢带肌无力"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "髋部屈肌"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "外展肌"
+ }
+ ]
+ },
+ {
+ "text": "患者延髓肌、咽肌、眼外肌和呼吸肌一般不受累，吞咽功能不受影响没有明显肌肉外受累表现高频性耳聋以及视网膜血管异常在FSHD人群中的发病率正逐渐上升，但常无临床意义。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "延髓肌"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "咽肌"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "眼外肌"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "呼吸肌"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "吞咽功能"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "吞咽功能不受影响"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "没有明显肌肉外受累表现"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "高频性耳聋"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "视网膜血管异常"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "许多研究发现FSHD患者有发生房性心律紊乱实验室检查主要实验室指标如下：1.血清CK约75%患者血清CK升高，但常常为中度升高。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "FSHD"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "心律"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "房性心律紊乱"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "实验室检查"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "血清CK"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "pro",
+ "entity": "血清CK"
+ }
+ ]
+ },
+ {
+ "text": "2.肌电图大多数患者临床受累的肌肉出现明显的多相低振幅短时相的动作单位电位肌肉活体组织检查肌肉活体组织检查对于疑似FSHD，尤其是家族史不确切的患者至关重要。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "肌电图"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "肌肉出现明显的多相低振幅短时相的动作单位电位"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "肌肉活体组织检查"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "肌肉活体组织检查"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "常显示不同程度的改变，包括纤维直径的不同出现角形纤维中央核纤维坏死纤维再生纤维肥大纤维单核炎症细胞浸润明显的脂肪浸润和结缔组织增殖基因诊断基因检测不失为一种有用的诊断手段。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "纤维"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "纤维直径的不同"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "角形纤维"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "出现角形纤维"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "核纤维"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "中央核纤维"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "纤维"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "坏死纤维"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "纤维"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "再生纤维"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "纤维"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "肥大纤维"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "单核炎症细胞"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "单核炎症细胞浸润"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "脂肪浸润"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "结缔组织增殖"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 64,
+ "type": "sym",
+ "entity": "明显的脂肪浸润和结缔组织增殖"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "pro",
+ "entity": "基因诊断"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "pro",
+ "entity": "基因检测"
+ }
+ ]
+ },
+ {
+ "text": "FSHD的基因定位于4q35，4q35基因缺失具有较高的敏感性和特异性，通过检测可疑患者4q35短片段，基本可以作出诊断。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "FSHD"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "4q35"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "4q35"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "4q35"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】目前尚无特殊的治疗，支持治疗是主要治疗手段。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "支持治疗"
+ }
+ ]
+ },
+ {
+ "text": "由于受累的肌肉不同，患者容易出现肩部、背部、腹部及腿部疼痛保守治疗包括非甾体类抗炎药、适当的运动锻炼以及理疗可以缓解一些不适主诉。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肩部"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "背部"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "腿部"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "肩部、背部、腹部及腿部疼痛"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "保守治疗"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "非甾体类抗炎药"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "dru",
+ "entity": "理疗"
+ }
+ ]
+ },
+ {
+ "text": "定做的塑料踝-足矫正器，可以减轻足下垂伴有明显腹部或者下背部疼痛腰背紧身胸衣或腹带，为无力的腹部肌肉群提供支撑。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "equ",
+ "entity": "塑料踝-足矫正器"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "足"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "足下垂"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "背部"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "伴有明显腹部或者下背部疼痛"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 37,
+ "type": "equ",
+ "entity": "腰背紧身胸衣"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "equ",
+ "entity": "腹带"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "肌肉"
+ }
+ ]
+ },
+ {
+ "text": "目前尚无药物可改善FSHD患者的肌力或延缓疾病的进展。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "FSHD"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "肌力"
+ }
+ ]
+ },
+ {
+ "text": "曾有学者使用泼尼松治疗8例FSHD患者，但结果显示并无多大益处。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "泼尼松治疗"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "FSHD"
+ }
+ ]
+ },
+ {
+ "text": "【预后】肌无力发展呈下降型，首先累及面部肌肉然后下移至肩胛肌及肱肌最后影响骨盆肢带肌，对患者的寿命无明显影响。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "肌无力"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "发展呈下降型"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "面部"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "首先累及面部肌肉"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肩胛肌"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肱肌"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "然后下移至肩胛肌及肱肌"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "最后影响骨盆肢带肌"
+ }
+ ]
+ },
+ {
+ "text": "二、哮喘的诱因（一）呼吸道感染1.呼吸道病毒感染在婴幼儿期主要有呼吸道合胞病毒（RSV），其次为副流感病毒、流感病毒和腺病毒，其他如麻疹病毒、腮腺炎病毒、肠道病毒、脊髓灰质炎病毒偶尔可见。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "呼吸道病毒感染"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 38,
+ "type": "mic",
+ "entity": "呼吸道合胞病毒"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "mic",
+ "entity": "RSV"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "mic",
+ "entity": "副流感病毒"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "mic",
+ "entity": "流感病毒"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 69,
+ "type": "mic",
+ "entity": "麻疹病毒"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "mic",
+ "entity": "腮腺炎病毒"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 80,
+ "type": "mic",
+ "entity": "肠道病毒"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 88,
+ "type": "mic",
+ "entity": "脊髓灰质炎病毒"
+ }
+ ]
+ },
+ {
+ "text": "年长儿多见鼻病毒感染。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "鼻病毒感染"
+ }
+ ]
+ },
+ {
+ "text": "2.支原体感染由于婴幼儿免疫系统不成熟，支原体可以引起婴幼儿呼吸道慢性感染，若处理不恰当，可以导致反复不愈的咳嗽和喘息。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "支原体感染"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "免疫系统"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "支原体"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "婴幼儿呼吸道慢性感染"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "反复不愈的咳嗽和喘息"
+ }
+ ]
+ },
+ {
+ "text": "3.呼吸道局灶性感染慢性鼻窦炎、鼻炎、中耳炎、慢性扁桃体炎，是常见的儿童上呼吸道慢性局灶性病变，一方面可以引起反复的感染，另一方面又可以通过神经反射引起反复的咳喘，需要对这些病灶进行及时处理。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "呼吸道局灶性感染"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "慢性鼻窦炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "鼻炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "中耳炎"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "慢性扁桃体炎"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "儿童上呼吸道慢性局灶性病变"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "咳喘"
+ }
+ ]
+ },
+ {
+ "text": "（二）吸入过敏物质持续低浓度变应原吸入可以诱发慢性气道变应性炎症，促进气道高反应形成，但短时间吸入高浓度变应原可以诱发急性哮喘发作。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "慢性气道变应性炎症"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "急性哮喘"
+ }
+ ]
+ },
+ {
+ "text": "这类诱因诱发的哮喘发作较为突然，无上呼吸道感染症状，多数在环境中过敏原浓度较高的季节发作。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "无上呼吸道感染症状"
+ }
+ ]
+ },
+ {
+ "text": "（三）胃食管反流由于解剖结构的原因，也有医源性因素（如应用氨茶碱、β受体兴奋药等）可以引起胃食管反流，在婴幼儿尤为多见，它是导致喘息反复不愈的重要原因之一。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "胃食管反流"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "氨茶碱"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "β受体兴奋药"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "胃食管反流"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "喘息"
+ }
+ ]
+ },
+ {
+ "text": "临床上多表现为入睡中出现剧烈的咳嗽、喘息，平时有回奶或呕吐现象。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "入睡中出现剧烈的咳嗽"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "喘息"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "回奶"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "（四）其他吸入刺激性气体或剧烈运动、哭闹，以及油漆、煤烟、冷空气吸入均可作为非特异性刺激物诱发哮喘发作，其中油漆散发的气体可触发严重而持续的咳喘发作，应尽量避免。",
+ "entities": [
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "咳喘"
+ }
+ ]
+ },
+ {
+ "text": "剧烈运动、哭闹使呼吸运动加快，呼吸道温度降低或呼吸道内液体渗透压改变，而诱发哮喘发作。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "呼吸运动加快"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "哮喘"
+ }
+ ]
+ },
+ {
+ "text": "三、抗胆碱能药物正常人的气道有静态张力，主要受胆碱能神经（迷走神经）的控制。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "抗胆碱能药物"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "胆碱能神经"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "迷走神经"
+ }
+ ]
+ },
+ {
+ "text": "哮喘患儿可能由于气道上皮破坏，神经末梢暴露或其他原因，使胆碱能神经的张力及反射加强，是引起气道高反应的重要因素之一；临床常用的抗胆碱能药物主要为阿托品和溴化异丙托品。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "气道上皮"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "神经末梢"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "胆碱能神经"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 68,
+ "type": "dru",
+ "entity": "抗胆碱能药物"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "dru",
+ "entity": "阿托品"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 81,
+ "type": "dru",
+ "entity": "溴化异丙托品"
+ }
+ ]
+ },
+ {
+ "text": "阿托品为叔胺类复合物，脂溶性强，容易从黏膜吸收，可以口服给药；但由于其体内分布广泛，系统性不良反应较多；而且可以进入血脑屏障，引起疲劳、烦躁、头痛症状，目前已很少用于哮喘的治疗。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "阿托品"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "叔胺类复合物"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "口服给药"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "血脑屏障"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 72,
+ "type": "sym",
+ "entity": "疲劳、烦躁、头痛"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 84,
+ "type": "dis",
+ "entity": "哮喘"
+ }
+ ]
+ },
+ {
+ "text": "溴化异丙托品为季胺类化合物，水溶性强，不容易吸收，全身不良反应小，但局部作用强；而且对支气管平滑肌M受体的选择性强，对分泌腺的影响小，不易出现气道分泌物干结现象。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "溴化异丙托品"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "季胺类化合物"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "支气管平滑肌M受体"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "分泌腺"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "气道分泌物"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "不易出现气道分泌物干结现象"
+ }
+ ]
+ },
+ {
+ "text": "由于胆碱能神经在气道的分布不均匀，在大气道分布多，而在小气道分布少，因此应用抗胆碱药后，主要使大气道松弛；当大气道收缩明显时，才有一定的松弛作用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "胆碱能神经"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "大气道"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "小气道"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "抗胆碱药"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "大气道"
+ }
+ ]
+ },
+ {
+ "text": "β肾上腺素受体激动药则对大、小气道均有明显的松弛作用，这与抗胆碱药有所不同。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "β肾上腺素受体激动药"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "大、小气道"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "抗胆碱药"
+ }
+ ]
+ },
+ {
+ "text": "一般在哮喘治疗中抗胆碱药与β2受体激动剂合用而起到相互协同作用。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "抗胆碱药"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "β2受体激动剂"
+ }
+ ]
+ },
+ {
+ "text": "现有剂型为：①爱全乐pMDI：20μg/揿，1～2揿/次，3～4次/天；②爱全乐溶液：0.025%溶液，＜2岁0.5ml，＞2岁1ml，＜4次/天，喷射雾化吸入。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "爱全乐pMDI"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "爱全乐溶液"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 77,
+ "type": "pro",
+ "entity": "喷射雾化"
+ }
+ ]
+ },
+ {
+ "text": "第八节新生儿呕吐呕吐是新生儿期常见症状，是一系列复杂的神经反射活动。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "新生儿呕吐"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "新生儿胃容量小、胃呈横位、贲门括约肌发育不完善、幽门括约肌发育较好、肠道蠕动的神经调节功能较差，由于这些解剖生理特点，新生儿容易发生呕吐。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "胃"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "胃"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "贲门括约肌"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "幽门括约肌"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 67,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "【病因】（一）消化系统疾病各种消化系统疾病都可引起呕吐，主要有消化道先天畸形、梗阻、炎症、感染、出血、功能失调等。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "消化系统疾病"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "消化系统疾病"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "消化道先天畸形"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "梗阻"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "炎症"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "功能失调"
+ }
+ ]
+ },
+ {
+ "text": "1.消化系统功能紊乱如吞咽功能不协调、胃食管反流、贲门失弛缓症、幽门痉挛、胎粪性便秘、胎粪排出延迟等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "消化系统"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "吞咽功能不协调"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "胃食管反流"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "贲门失弛缓症"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "幽门痉挛"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "胎粪性便秘"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "胎粪排出延迟"
+ }
+ ]
+ },
+ {
+ "text": "2.消化道黏膜受刺激如咽下综合征、胃出血、应激性溃疡、牛奶过敏等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "消化道黏膜"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "咽下综合征"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "胃出血"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "应激性溃疡"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "牛奶过敏"
+ }
+ ]
+ },
+ {
+ "text": "3.消化系统感染及炎症如急性胃炎、急性肠炎、坏死性小肠结肠炎、腹膜炎等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "消化系统感染及炎症"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "急性胃炎"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "急性肠炎"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "坏死性小肠结肠炎"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "腹膜炎"
+ }
+ ]
+ },
+ {
+ "text": "4.消化道梗阻多数为先天畸形所致。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "消化道梗阻"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "先天畸形"
+ }
+ ]
+ },
+ {
+ "text": "少见疾病有嵌顿疝、肠套叠等。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "嵌顿疝"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肠套叠"
+ }
+ ]
+ },
+ {
+ "text": "（二）全身性疾病许多全身性疾病可引起呕吐，常见的有以下几方面：1.感染新生儿感染常引起呕吐，如败血症、呼吸道感染、泌尿系统感染等。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "新生儿感染"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "泌尿系统感染"
+ }
+ ]
+ },
+ {
+ "text": "2.颅内压增高引起颅内压增高的疾病多会导致呕吐，如中枢神经系统感染、脑水肿、脑积水、颅内出血、颅内肿瘤等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "颅内压增高"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "颅内压增高"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "中枢神经系统感染"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "脑水肿"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "脑积水"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "颅内肿瘤"
+ }
+ ]
+ },
+ {
+ "text": "3.先天性代谢性疾病一些先天性代谢性疾病由于代谢紊乱而导致呕吐，如氨基酸代谢疾病（高氨血症、苯丙酮尿症、甘氨酸血症）、糖代谢疾病（半乳糖血症、枫糖尿症）、肾上腺皮质增生症等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "先天性代谢性疾病"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "先天性代谢性疾病"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "氨基酸代谢疾病"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "高氨血症"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "苯丙酮尿症"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "甘氨酸血症"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "糖代谢疾病"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "半乳糖血症"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 74,
+ "type": "dis",
+ "entity": "枫糖尿症"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 84,
+ "type": "dis",
+ "entity": "肾上腺皮质增生症"
+ }
+ ]
+ },
+ {
+ "text": "（三）其他因素一些疾病因素也可引起新生儿呕吐。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "2.药物许多药物可引起消化道反应，发生呕吐，如红霉素、两性霉素B等。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "红霉素"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "两性霉素B"
+ }
+ ]
+ },
+ {
+ "text": "【临床特点】（一）溢乳和喂养不当1.溢乳新生儿溢乳比较常见，但溢乳没有神经反射参与，不属于真正的呕吐。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "溢乳"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "新生儿溢乳"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "溢乳"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "神经"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "溢乳的原因与食管弹力组织和肌肉发育不完善有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "溢乳"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "食管弹力组织"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肌肉"
+ }
+ ]
+ },
+ {
+ "text": "溢乳多发生在喂奶后不久，乳汁从口角边溢出，喂奶后体位改变可引起溢乳。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "溢乳"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "乳汁"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "溢乳"
+ }
+ ]
+ },
+ {
+ "text": "2.��养不当新生儿喂养不当非常多见，主要原因有：喂奶次数过于频繁，喂奶量太多，浓度不适合，牛乳太热或太凉，配方乳多变；奶嘴孔过大或过小，乳母乳头下陷；喂奶后平卧，体位多动。",
+ "entities": [
+ {
+ "start_idx": 68,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "乳母乳头"
+ }
+ ]
+ },
+ {
+ "text": "（二）与内科疾病有关的呕吐1.吞咽功能不协调喂奶时即呕吐，常伴有呛咳或吸入，一部分乳汁从鼻孔流出。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "鼻孔"
+ }
+ ]
+ },
+ {
+ "text": "2.胃食管反流（GER）是新生儿呕吐的常见原因，尤其是早产儿。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "新生儿呕吐"
+ }
+ ]
+ },
+ {
+ "text": "主要与新生儿食管下端括约肌较松弛、胃排空延迟、腹内压增高等因素有关。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "食管下端括约肌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "胃"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "腹内压"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "腹内压增高"
+ }
+ ]
+ },
+ {
+ "text": "常在喂奶后不久出现呕吐或表现为溢乳，呕吐物常为不带胆汁的奶液。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "溢乳"
+ }
+ ]
+ },
+ {
+ "text": "3.胃黏膜受刺激出生时咽下羊水或产道血液，刺激胃黏膜引起呕吐。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "羊水"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "未开奶前即可出现呕吐，开奶后呕吐加重，呕吐物为泡沫样黏液或带血性，用生理盐水洗胃1～2次，呕吐即可停止。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dru",
+ "entity": "生理盐水"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "洗胃"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "4.幽门痉挛为幽门神经肌肉功能暂时性失调所致，解剖结构无异常。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "幽门痉挛"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "幽门神经肌肉"
+ }
+ ]
+ },
+ {
+ "text": "呕吐常发生在生后2～3周，呈间隙性，可为喷射状，呕吐物不含胆汁，与幽门肥厚性狭窄较难鉴别，试用1∶1000阿托品可缓解。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 55,
+ "type": "dru",
+ "entity": "1∶1000阿托品"
+ }
+ ]
+ },
+ {
+ "text": "5.胎粪延迟排出正常新生儿在生后24小时内开始排胎粪，3天排完。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "胎粪延迟排出"
+ }
+ ]
+ },
+ {
+ "text": "6.感染性疾病肠道内感染或肠道外感染均可引起新生儿呕吐，常伴有感染表现如神萎��食欲缺乏，肠道内感染伴有腹泻、腹胀。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "感染性疾病"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肠道内感染"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "肠道外感染"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "新生儿呕吐"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "神萎"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "食欲缺乏"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "肠道内感染"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "腹胀"
+ }
+ ]
+ },
+ {
+ "text": "7.先天性代谢性疾病发生呕吐时间无规律性，一般呕吐较频繁和剧烈，常伴有其他代谢病的临床表现，如酸中毒、电解质紊乱、脱水、肝脾大等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "先天性代谢性疾病"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "电解质紊乱"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "肝脾"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "肝脾大"
+ }
+ ]
+ },
+ {
+ "text": "（三）与外科疾病有关的呕吐1.食管闭锁和食管气管瘘食管闭锁者第一次喂奶（或喂水）时即发生呕吐，伴食管气管瘘者喂奶时出现呼吸困难、青紫，肺部闻湿啰音，每次喂奶时均出现类似情况。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dep",
+ "entity": "外科"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "食管闭锁"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "食管气管瘘"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "食管闭锁"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "食管气管瘘者"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "呼吸困难"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "sym",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 72,
+ "type": "sym",
+ "entity": "肺部闻湿啰音"
+ }
+ ]
+ },
+ {
+ "text": "2.幽门肥厚性狭窄常于生后第2周左右开始出现呕吐，呕吐量多，呕吐物为乳汁或乳凝块，酸臭味，无胆汁。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "幽门肥厚性狭窄"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "胆汁"
+ }
+ ]
+ },
+ {
+ "text": "呕吐常呈进行性加重，伴脱水、电解质紊乱、营养不良。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "电解质紊乱"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "营养不良"
+ }
+ ]
+ },
+ {
+ "text": "腹部可见明显的胃型，右上腹可触及枣核大小的肿块。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "右上腹"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "肿块"
+ }
+ ]
+ },
+ {
+ "text": "3.十二指肠和小肠疾病患儿常有严重呕吐，呕吐物有绿色胆汁，位置较高者生后不久即呕吐，腹胀不明显，位置较低者呕吐出现晚一些，呕吐物为棕色粪便样物质，混有深色胆汁，腹胀明显，肠鸣音活跃，可见肠型、肠蠕动波。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "十二指肠"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "sym",
+ "entity": "腹胀明显"
+ }
+ ]
+ },
+ {
+ "text": "4.直肠肛门疾病一般先有腹胀，后出现呕吐，肠鸣音活跃，腹部平片显示肠腔扩张，多个液平。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "直肠肛门"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "肠鸣音活跃"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "肠腔扩张"
+ }
+ ]
+ },
+ {
+ "text": "先天性巨结肠患儿生后便秘，灌肠后腹胀减轻。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "先天性巨结肠"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "灌肠"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "腹胀"
+ }
+ ]
+ },
+ {
+ "text": "（四）呕吐所致的并发症新生儿呕吐时常发生一些并发症，需密切注意。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "1.窒息与猝死新生儿呕吐会使呕吐物进入呼吸道，发生窒息，如呕吐物多、没有及时发现可导致猝死。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "猝死"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "猝死"
+ }
+ ]
+ },
+ {
+ "text": "2.吸入综合征呕吐物进入气道可发生吸入性肺炎，出现咳嗽、呼吸困难，长时间反复吸入可使吸入性肺炎迁延不愈。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "吸入综合征"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "吸入性肺炎"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "咳嗽"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "呼吸困难"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "吸入性肺炎"
+ }
+ ]
+ },
+ {
+ "text": "3.呼吸暂停早产儿呕吐可发生呼吸暂停。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "呼吸暂停"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "呼吸暂停"
+ }
+ ]
+ },
+ {
+ "text": "4.出血剧烈呕吐可导致胃黏膜损伤，发生出血，呕吐物呈血性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "呕吐物呈血性"
+ }
+ ]
+ },
+ {
+ "text": "5.水电解质紊乱呕吐较频繁者，因丧失大量水分和电解质，导致水电解质平衡紊乱，患儿出现脱水、酸中毒、低钠血症等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "水电解质紊乱"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "低钠血症"
+ }
+ ]
+ },
+ {
+ "text": "【诊断与鉴别诊断】要详细询问病史，了解分娩时情况、发生呕吐的时间、呕吐特点、伴随症状等，仔细体格检查，初步考虑呕吐的定位和性质，并做进一步的检查，以明确诊断。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "（一）定位根据呕吐发生的时间、呕吐特点、呕吐物、是否有腹胀、肠型、便秘等情况，初步判断消化道疾病的位置。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "肠型"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "便秘"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "消化道疾病"
+ }
+ ]
+ },
+ {
+ "text": "1.上消化道呕吐出现时间早，呕吐物为乳汁或乳凝块，不含胆汁，腹胀不明显。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "上消化道"
+ }
+ ]
+ },
+ {
+ "text": "2.下消化道生后1～2天即呕吐，呕吐物含较多胆汁，腹胀不明显，提示病变在十二指肠或空肠上段。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "下消化道"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "腹胀不明显"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "十二指肠"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "空肠上段"
+ }
+ ]
+ },
+ {
+ "text": "如呕吐物含黄绿色粪便样物质，腹部有较细的肠型和肠蠕动，提示病变在空肠下段或回肠。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "空肠下段"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "回肠"
+ }
+ ]
+ },
+ {
+ "text": "而直肠病变的呕吐常发生在出生3天以后，呕吐物含棕色粪便样物质，腹胀明显，肠型较粗大，可触及粪块。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "直肠"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "腹胀明显"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "肠型"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "肠型较粗大"
+ }
+ ]
+ },
+ {
+ "text": "（二）定性为使呕吐原发病得到及时治疗，要鉴别是内科疾病还是外科疾病所致。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "dep",
+ "entity": "内科"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dep",
+ "entity": "外科"
+ }
+ ]
+ },
+ {
+ "text": "1.内科疾病呕吐症状不剧烈，呕吐次数不频繁，呕吐物常不含胆汁或粪便，有较明显的消化系统以外的症状和体征，常提示呕吐为内科疾病所致。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dep",
+ "entity": "内科"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "消化系统"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dep",
+ "entity": "内科"
+ }
+ ]
+ },
+ {
+ "text": "2.外科疾病呕吐出现早，频繁，较剧烈，呕吐物含胆汁、血液或粪便，伴脱水和电解质紊乱，常提示呕吐为外科疾病所致。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dep",
+ "entity": "外科"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "早，频繁，较剧烈，呕吐物含胆汁、血液或粪便"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "电解质紊乱"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "dep",
+ "entity": "外科"
+ }
+ ]
+ },
+ {
+ "text": "（三）进一步检查对呕吐原发病的位置和性质有初步判断后，应及时做进一步的检查，以明确诊断。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "1.消化道影像学检查对消化道先天畸形的诊断有很大的帮助。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "消化道影像学检查"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "消化道先天畸形"
+ }
+ ]
+ },
+ {
+ "text": "对胃食管反流，可做放射性核素检查。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "放射性核素检查"
+ }
+ ]
+ },
+ {
+ "text": "对胃十二指肠、小肠部位的先天畸形，钡餐���影可帮助诊断，须注意检查结束时应洗胃，将胃内钡剂洗出，防止呕吐时钡剂。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "胃十二指肠"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "先天畸形"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "钡餐造影"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "洗胃"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "胃"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "钡剂"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "dru",
+ "entity": "钡剂"
+ }
+ ]
+ },
+ {
+ "text": "2.中枢神经系统检查如怀疑中枢感染，应查脑脊液，对颅内出血或其他占位病变，应做头颅B超或CT检查。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "中枢神经系统检查"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "头颅B超"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "CT检查"
+ }
+ ]
+ },
+ {
+ "text": "3.血气分析及生化检查可了解患儿是否存在酸中毒、电解质紊乱。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "血气分析"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "生化检查"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "电解质紊乱"
+ }
+ ]
+ },
+ {
+ "text": "4.内分泌及遗传代谢病检查如已排除消化道、中枢神经等疾病，而患儿仍然频繁呕吐，应进一步做内分泌、代谢病方面检查，如血氨、血糖等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "内分泌及遗传代谢病检查"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "中枢神经"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "ite",
+ "entity": "血氨"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "血糖"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】（一）对症治疗1.禁食对一些病因未清楚、怀疑外科疾病、消化道出血，可先行禁食，以免加重病情，同时给予补液，保证营养供给。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "禁食"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "消化道出血"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "禁食"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "pro",
+ "entity": "补液"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "pro",
+ "entity": "营养供给"
+ }
+ ]
+ },
+ {
+ "text": "2.洗胃对咽下综合征可先洗胃，用温生理盐水，一般洗2～3次即可，如洗胃后仍呕吐，应考虑其他疾病。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "洗胃"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "咽下综合征"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "洗胃"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "温生理盐水"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "洗胃"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "3.胃肠减压对外科疾病、呕吐较频繁、腹胀者，可先行胃肠减压，缓解症状，同时做有关检查。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "胃肠减压"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "胃肠减压"
+ }
+ ]
+ },
+ {
+ "text": "4.解痉止吐对病因诊断为胃食管反流，可用胃动力制剂或解痉剂。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "解痉止吐"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "胃食管反流"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "胃动力制剂"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "解痉剂"
+ }
+ ]
+ },
+ {
+ "text": "5.体位对呕吐患儿，应提高头部和上身的体位，一般30°左右。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "6.纠正水、电解质紊乱呕吐导致水、电解质紊乱，应及时纠正。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "纠正水"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "（二）病因治疗1.手术对外科疾病需手术治疗，手术时机根据病情而定。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "dep",
+ "entity": "外科"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "手术治疗"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "手术"
+ }
+ ]
+ },
+ {
+ "text": "2.抗感染对消化道感染或其他部位感染所致者，应给抗生素治疗。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "抗感染"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "消化道感染"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "3.止血消化道出血者，可用维生素K1、酚磺乙胺等止血。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "止血"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "消化道出血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "维生素K1"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "酚磺乙胺"
+ }
+ ]
+ },
+ {
+ "text": "4.解除颅内高压脑水肿者用20%甘露醇每次0.5g/kg，每6～8小时1次，呋塞米每次0.5mg/kg，每天1～2次。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "解除颅内高压"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "脑水肿"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "20%甘露醇"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "呋塞米"
+ }
+ ]
+ },
+ {
+ "text": "颅内占位病变行手术治疗，脑积水行引流术。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "颅内"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "手术治疗"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "脑积水"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "引流术"
+ }
+ ]
+ },
+ {
+ "text": "十、L型菌肺炎L型菌肺炎是临床上难治性呼吸道感染的病原体之一。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "L型菌肺炎"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "L型菌肺炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ }
+ ]
+ },
+ {
+ "text": "患儿常有肺炎不能解释的迁延发热，或原发病已愈，找不到继续发热的原因。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "迁延发热"
+ }
+ ]
+ },
+ {
+ "text": "病情多不重，β-内酰胺类抗生素治疗无效。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "β-内酰胺类抗生素"
+ }
+ ]
+ },
+ {
+ "text": "X线改变无特异性，多呈间质性肺炎改变。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "ite",
+ "entity": "X线"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "间质性肺炎"
+ }
+ ]
+ },
+ {
+ "text": "三、各型结核的治疗方案（表7-7）表7-1各型结核的治疗方案",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "结核"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "结核"
+ }
+ ]
+ },
+ {
+ "text": "第六章风湿性疾病相关的实验室检查风湿性疾病（rheumaticdiseases）包含一大类慢性全身性疾病，人们认识这类疾病经历了漫长的实践、变迁过程。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "rheumaticdiseases"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "慢性全身性疾病"
+ }
+ ]
+ },
+ {
+ "text": "在命名上，西方与中国古代医学早有“风湿病”的名称，但两者在概念及内容上大相径庭，不可类比。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "风湿病"
+ }
+ ]
+ },
+ {
+ "text": "本章中“风湿性疾病”仅涉及现代医学的“风湿病”范畴。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "风湿病"
+ }
+ ]
+ },
+ {
+ "text": "西方医学中，经典称谓的风湿病泛指“以疼痛为核心的骨、关节及肌肉等慢性疾病”。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "风湿病"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "骨"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "关节"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "慢性疾病"
+ }
+ ]
+ },
+ {
+ "text": "至1941年Klemperer总结了系统性红斑狼疮和硬皮病经验以及Klinge的研究成果，认为风湿性疾病均为机体胶原组织病理损伤的结果，因此提出“胶原性疾病”的概念。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "系统性红斑狼疮"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "硬皮病"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "机体胶原组织"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "胶原性疾病"
+ }
+ ]
+ },
+ {
+ "text": "但后来多数人认为风湿性疾病并不仅限于累及胶原组织，它可以是更广泛的结缔组织损伤。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "胶原组织"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "结缔组织"
+ }
+ ]
+ },
+ {
+ "text": "为此Ehrich建议将“胶原性疾病”更名为“结缔组织病”，故此命名又沿用了几十年。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "胶原性疾病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "结缔组织病"
+ }
+ ]
+ },
+ {
+ "text": "至20世纪中后期，大量的临床研究与实验研究发现，在很多结缔组织病病人体内能检出针对自身抗原的自身抗体和与自身细胞反应的致敏淋巴细胞以及病变组织中有各种抗体，补体与免疫复合物沉积及免疫活性细胞浸润，因而主张将结缔组织病更名为“自身免疫性疾病”。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "结缔组织病"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "病变组织"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "补体"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 87,
+ "type": "bod",
+ "entity": "免疫复合物沉积"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 96,
+ "type": "dis",
+ "entity": "免疫活性细胞浸润"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 107,
+ "type": "dis",
+ "entity": "结缔组织病"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 118,
+ "type": "dis",
+ "entity": "自身免疫性疾病"
+ }
+ ]
+ },
+ {
+ "text": "20世纪末众多临床学家认为“结缔组织病”与“自身免疫性疾病”的命名强调了病理学与免疫学研究结果，但都不能全部涵盖风湿性疾病的特征，故主张仍使用风湿性疾病的名称。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "结缔组织病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "自身免疫性疾病"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "但现代风湿病概念已特指自身免疫耐受破坏后，发生自身免疫损伤的一类风湿性疾病。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "现代风湿病"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "它不包含外伤、代谢异常以及退行性变等许多经典风湿性疾病。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "外伤"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "代谢异常"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "风湿性疾病的病因并不十分清楚，遗传因素、感染因素以及免疫异常是公认的值得深入研究的方向。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "风湿性疾病往往因累及的器官不同而表现出由各种症状和体征组合的临床综合征。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "器官"
+ }
+ ]
+ },
+ {
+ "text": "“胶原性疾病”、“结缔组织病”以及“自身免疫性疾病”的命名均从不同角度反映了风湿性疾病的基本特征，这些命名有助于深入理解和研究风湿性疾病。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "胶原性疾病"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "结缔组织病"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "自身免疫性疾病"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "目前还缺乏针对各种风湿性疾病有特异性诊断价值的实验室检查项目，诊断主要依靠临床症状与实验室检查的综合分析，在除外其他疾病基础上，风湿性疾病的诊断才能成立。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 68,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "一、免疫学检查（一）免疫活化现象免疫活化现象有关的实验室检查结果是引导临床诊断风湿性疾病的简易途径：1.血清免疫球蛋白（immunoglobulin，Ig）Ig水平升高是风湿性疾病最常见的免疫活化现象，系统性红斑狼疮（SLE）、幼年特发性关节炎（JIA）、皮肌炎以及各种血管炎综合征均常有一种或几种免疫球蛋白显著升高B细胞增殖及分泌功能过度活化淋巴细胞表型分析免疫活化现象还可以在淋巴细胞表型分析检测发现CD3、CD4、CD8、CD16、CD19、CD20阳性细胞绝对数与相对数增加得到证实。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "免疫学检查"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "免疫活化现象"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "免疫活化现象"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "血清免疫球蛋白"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "immunoglobulin"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "Ig"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "Ig"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 89,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 99,
+ "type": "sym",
+ "entity": "免疫活化现象"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 107,
+ "type": "dis",
+ "entity": "系统性红斑狼疮"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 114,
+ "end_idx": 121,
+ "type": "dis",
+ "entity": "幼年特发性关节炎"
+ },
+ {
+ "start_idx": 123,
+ "end_idx": 125,
+ "type": "dis",
+ "entity": "JIA"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 130,
+ "type": "dis",
+ "entity": "皮肌炎"
+ },
+ {
+ "start_idx": 135,
+ "end_idx": 140,
+ "type": "dis",
+ "entity": "血管炎综合征"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 153,
+ "type": "bod",
+ "entity": "免疫球蛋白"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 157,
+ "type": "sym",
+ "entity": "免疫球蛋白显著升高"
+ },
+ {
+ "start_idx": 158,
+ "end_idx": 160,
+ "type": "bod",
+ "entity": "B细胞"
+ },
+ {
+ "start_idx": 158,
+ "end_idx": 171,
+ "type": "sym",
+ "entity": "B���胞增殖及分泌功能过度活化"
+ },
+ {
+ "start_idx": 172,
+ "end_idx": 175,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ },
+ {
+ "start_idx": 180,
+ "end_idx": 185,
+ "type": "sym",
+ "entity": "免疫活化现象"
+ },
+ {
+ "start_idx": 190,
+ "end_idx": 193,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ },
+ {
+ "start_idx": 224,
+ "end_idx": 231,
+ "type": "bod",
+ "entity": "CD20阳性细胞"
+ }
+ ]
+ },
+ {
+ "text": "3.免疫病理各脏器组织免疫病理学检测可见多种Ig、补体、抗原抗体复合物沉积病变区域或血管内外以及大量淋巴细胞的组织浸润补体检测测定补体活性及其中某些成分有助于判断几种风湿性疾病的活动性，尤其是对SLE有诊断意义。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "脏器组织"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "免疫病理学检测"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "Ig"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "补体"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "抗原抗体复合物沉积病变区域"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "组织"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "组织浸润"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "pro",
+ "entity": "补体检测"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "补体"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 99,
+ "type": "dis",
+ "entity": "SLE"
+ }
+ ]
+ },
+ {
+ "text": "C3、C4显著降低是补体消耗现象，也是免疫活化的标志。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "C3"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "C4"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "补体"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "免疫活化"
+ }
+ ]
+ },
+ {
+ "text": "一定要注意极少数原发性补体缺陷病以及与补体缺陷有关的风湿性疾病（表17-17）以上免疫活化现象仅是诊断各种风湿性疾病的提示指标。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "原发性补体缺陷病"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "补体缺陷有关的风湿性疾病"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "免疫活化现象"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "表17-13补体缺陷与风湿性疾病（二）自身抗体与抗核抗体谱理论上讲，检出自身抗体是自身免疫性疾病的直接证据。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "补体缺陷"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "自身免疫性疾病"
+ }
+ ]
+ },
+ {
+ "text": "最早人们发现了抗细胞核自身抗体（ANA），并成为诊断SLE的有力工具，随后发现ANA并非SLE特异性诊断抗体，干燥综合征、皮肌炎、关节炎以及混合性结缔组织病均见ANA阳性。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "抗细胞核自身抗体"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "ANA"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "ANA"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "干燥综合征"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "皮肌炎"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "关节炎"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "混合性结缔组织病"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "ANA"
+ }
+ ]
+ },
+ {
+ "text": "无任何临床症状的“健康人”也见低滴度ANA阳性（也可能是各种风湿病亚临床病人）。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "ANA"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "风湿病"
+ }
+ ]
+ },
+ {
+ "text": "近年研究成果发现依据针对不同细胞核成分可将抗核抗体分成多种抗核抗体亚类谱系，抗核抗体谱能更好地帮助临床鉴别诊断风湿性疾病。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "细胞核"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "但并不是所有抗核抗体亚类都具备非常高的特异性和敏感性。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "抗核抗体"
+ }
+ ]
+ },
+ {
+ "text": "1.类风湿因子（rheumatoidfactor，RF）属一种抗Ig稳定区（Fc）的自身抗体。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "类风湿因子"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "rheumatoidfactor"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "抗Ig稳定区（Fc）的自身抗体"
+ }
+ ]
+ },
+ {
+ "text": "虽然最先在类风湿关节炎病人血清中发现RF，但它在疾病中确切的病理及生理意义并未弄清。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "类风湿关节炎"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "RF"
+ }
+ ]
+ },
+ {
+ "text": "健康人血清中的RF为天然自身抗体，往往亲和力低，效价低，属IgM抗体，可能来自胚胎性免疫球蛋白基因。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "IgM抗体"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "胚胎性免疫球蛋白基因"
+ }
+ ]
+ },
+ {
+ "text": "由RF构成的免疫复合体还可以在滑膜液、滑膜组织中及皮肤溃疡、病变血管和吞噬细胞中检出。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "免疫复合体"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "滑膜液"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "滑膜组织"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "皮肤溃疡"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "病变血管"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "吞噬细胞"
+ }
+ ]
+ },
+ {
+ "text": "急、慢性感染，恶性肿瘤病人RF常呈阳性，甚至正常人也有低效价RF被检出，年龄越大阳性结果可能性越大。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "慢性感染"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "恶性肿瘤"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "RF"
+ }
+ ]
+ },
+ {
+ "text": "虽然检测RF对JIA诊断并非关键，但RF阳性JIA患儿常伴有严重、顽固的关节炎及血管炎，值得重视。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "JIA"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "RF阳性JIA"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "关节炎"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "血管炎"
+ }
+ ]
+ },
+ {
+ "text": "推测RF阳性JIA病人的发病机制可能与成人类风湿关节炎发病机制相同。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "RF阳性JIA"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "类风湿关节炎"
+ }
+ ]
+ },
+ {
+ "text": "2.隐匿性RF（hiddenrheumatoidfactor）沉降系数为19S，常规方法检测不出来，在血清中它与IgG结合在一起，用酸性凝胶滤过处理血清之后才能将其分离后再用ELISA方法测定。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "隐匿性RF"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "hiddenrheumatoidfactor"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "沉降系数"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "IgG"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 69,
+ "type": "dru",
+ "entity": "酸性凝胶"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 91,
+ "type": "pro",
+ "entity": "ELISA"
+ }
+ ]
+ },
+ {
+ "text": "有研究者发现65%～75%用经典方法检测RF阴性的JIA患儿隐匿性RF检测可能阳性。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "RF阴性的JIA"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "隐匿性RF检测"
+ }
+ ]
+ },
+ {
+ "text": "Moore等人认为这种隐匿性RF与JIA活动有关，因此有助于诊断和治疗观察。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "隐匿性RF"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "JIA"
+ }
+ ]
+ },
+ {
+ "text": "3.抗核抗体（antinuclearantibodies，ANAs）是与各种细胞核成分反应的自身抗体的总称，包括针对脱氧核糖核酸（DNA）、可提取的核蛋白（snENP）、核糖核酸（RNA）、组蛋白、酶及核仁等细胞核成分的抗体。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "antinuclearantibodies"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "ANAs"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "细胞核"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "脱氧核糖核酸"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "DNA"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "核蛋白"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "snENP"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "核糖核酸"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 92,
+ "type": "bod",
+ "entity": "RNA"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 97,
+ "type": "bod",
+ "entity": "组蛋白"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 99,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 102,
+ "type": "bod",
+ "entity": "核仁"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 106,
+ "type": "bod",
+ "entity": "细胞核"
+ }
+ ]
+ },
+ {
+ "text": "研究证明抗核抗体见于多种风湿性疾病，是筛查诊断SLE的指引性项目。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "SLE"
+ }
+ ]
+ },
+ {
+ "text": "几乎所有SLE病人，50%硬皮病，25%皮肌炎和超过50%小年龄JIA，如少关节型女性患儿及RF阳性多关节型患儿会有ANA阳性结果。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "硬皮病"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "皮肌炎"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "JIA"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "ANA"
+ }
+ ]
+ },
+ {
+ "text": "ANA阳性JIA常伴虹膜睫状体炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "ANA阳性JIA"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "虹膜睫状体炎"
+ }
+ ]
+ },
+ {
+ "text": "健康儿童也有2%～9%的人ANA阳性，有人通过5年随访也未见这些ANA阳性健康儿童发展成为风湿性疾病。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "ANA"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "ANA"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ }
+ ]
+ },
+ {
+ "text": "Miles和Isenberg（1993）发现在风湿性疾病病人的一、二级亲属中ANA阳性检出率较高。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "ANA"
+ }
+ ]
+ },
+ {
+ "text": "ANA滴度与临床症状间并无必然联系，但它有助于疾病随访。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "ANA"
+ }
+ ]
+ },
+ {
+ "text": "在细菌、病毒及真菌感染，甚至患恶性肿瘤时ANA也见阳性。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "真菌"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "恶性肿瘤"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "ANA"
+ }
+ ]
+ },
+ {
+ "text": "4.抗核抗体谱包括抗DNA抗体、抗组蛋白抗体、抗DNA组蛋白复合物抗体以及抗非组蛋白4种大类的自身抗体。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "抗DNA抗体"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "抗组蛋白抗体"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "抗DNA组蛋白复合物抗体"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "抗非组蛋白"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "自身抗体"
+ }
+ ]
+ },
+ {
+ "text": "目前国内普遍采用德国欧蒙试剂的抗核抗体谱检测，包括抗SS-A、抗SS-B、抗-Sm、抗Scl-70、抗Jo-1、抗Ro-52抗核小体抗体、抗组蛋白抗体、抗CNEPB、核糖体P蛋白抗体和抗nRNP/Sm等12种抗原的IgG抗体。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "德国欧蒙试剂"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "抗核抗体谱检测"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "抗SS-A"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "抗SS-B"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "抗-Sm"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "抗Scl-70"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "抗Jo-1"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "抗Ro-52抗核小体抗体"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "抗组蛋白抗体"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "抗CNEPB"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 90,
+ "type": "bod",
+ "entity": "核糖体P蛋白抗体"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 99,
+ "type": "bod",
+ "entity": "抗nRNP/Sm"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 111,
+ "type": "bod",
+ "entity": "IgG抗体"
+ }
+ ]
+ },
+ {
+ "text": "除抗dsDNA外，可提取核抗原（ENA）抗体中诊断意义较大的有抗-Sm、抗nRNP/Sm、抗SS-A、抗SS-B、抗Scl-70以及抗Jo-1六种自身抗体：①抗dsDNA：抗dsDNA抗体检测对诊断SLE具极高特异性（＞95%），且对SLE预后判断也有重要价值，但其敏感性只有30%～40%。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "抗dsDNA"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "核抗原（ENA）抗体"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "抗-Sm"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "抗nRNP/Sm"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "抗SS-A"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "抗SS-B"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "抗Scl-70"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "抗Jo-1"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "抗dsDNA"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 95,
+ "type": "pro",
+ "entity": "抗dsDNA抗体检测"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 101,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 119,
+ "type": "dis",
+ "entity": "SLE"
+ }
+ ]
+ },
+ {
+ "text": "高滴度抗dsDNA抗体不仅表明SLE的活动性，而且提示病变累及肾脏的可能性极大。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "高滴度抗dsDNA抗体"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肾脏"
+ }
+ ]
+ },
+ {
+ "text": "dsDNA抗体阳性率易受皮质激素和免疫抑制剂使用影响。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "dsDNA抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "皮质激素"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "免疫抑制剂"
+ }
+ ]
+ },
+ {
+ "text": "抗ssDNA抗体阳性率在SLE中高于抗dsDNA抗体，但其特异性不如后者；在其他AID，甚至病毒感染性疾病中也可见到抗ssDNA抗体阳性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "抗ssDNA抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "抗dsDNA抗体"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "AID"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "病毒感染性疾病"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "抗ssDNA抗体"
+ }
+ ]
+ },
+ {
+ "text": "②抗-Sm抗体：抗-Sm抗体也是SLE的标志性抗体，诊断特异性也超过95%，敏感性在40%左右。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "抗-Sm抗体"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "抗-Sm抗体"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "SLE"
+ }
+ ]
+ },
+ {
+ "text": "③抗nRNP/Sm：抗nRNP/Sm对混合性结缔组织病阳性率可达100%，但SLE及干燥综合征也有抗nRNP/Sm阳性检出。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "抗nRNP/Sm"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "抗nRNP/Sm"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "混合性结缔组织病"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "干燥综合征"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "抗nRNP/Sm"
+ }
+ ]
+ },
+ {
+ "text": "④抗SS-A及抗SS-B：抗SS-A和抗SS-B在干燥综合征中阳性检出率分别为75%和60%，但也见于SLE、硬皮病、皮肌炎以及关节炎等患者。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "抗SS-A"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "抗SS-B"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "抗SS-A"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "抗SS-B"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "干燥综合征"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "硬皮病"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "皮肌炎"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "关节炎"
+ }
+ ]
+ },
+ {
+ "text": "⑤抗Scl-70：抗Scl-70为硬皮病标志性抗体，但阳性率不足50%。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "抗Scl-70"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "抗Scl-70"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "硬皮病"
+ }
+ ]
+ },
+ {
+ "text": "⑥抗Jo-1：抗Jo-1见于多肌炎患者，阳性率仅25%～35%，常与合并肺间质纤维化有关。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "抗Jo-1"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "抗Jo-1"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "多肌炎"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "肺间质纤维化"
+ }
+ ]
+ },
+ {
+ "text": "5.其他细胞成分自身抗体这类抗体仅与专一的细胞成分反应，引起相应的细胞病变也较为局限，如：（1）抗细胞抗体：如抗淋巴细胞、红细胞、血小板及精子细胞抗体，引起临床所见淋巴细胞坏死性、增生性疾病及自身免疫性溶血症、血小板减少症和不孕症等疾病。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "抗细胞抗体"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "抗淋巴细胞"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "血小板"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "精子细胞抗体"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "淋巴细胞坏死"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 94,
+ "type": "dis",
+ "entity": "增生性疾病"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 103,
+ "type": "dis",
+ "entity": "自身免疫性溶血症"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 110,
+ "type": "dis",
+ "entity": "血小板减少症"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 114,
+ "type": "dis",
+ "entity": "不孕症"
+ }
+ ]
+ },
+ {
+ "text": "（2）抗细胞质抗体：如抗线粒体抗体、核糖体抗体及溶酶体抗体等，引起相应的病变。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "抗细胞质抗体"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "抗线粒体抗体"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "核糖体抗体"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "溶酶体抗体"
+ }
+ ]
+ },
+ {
+ "text": "（3）抗受体抗体：如抗乙酰胆碱受体及抗胰岛素受体抗体等所引起的自身免疫性神经传导性病变（自身免疫性重症肌无力）和胰腺等神经内分泌相关疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "抗受体抗体"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "抗乙酰胆碱受体"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "抗胰岛素受体抗体"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "自身免疫性神经传导性病变"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "自身免疫性重症肌无力"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "胰腺"
+ }
+ ]
+ },
+ {
+ "text": "（4）抗中性粒细胞胞浆抗体（ANCA）：ANCA是近年研究较多的自身抗体之一，ANCA主要有两个亚型，即抗蛋白酶3（PR3）抗体，称为胞浆型ANCA（C-ANCA）和抗髓过氧化物酶（MPO）抗体，称为核周型ANCA（P-ANCA）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "抗中性粒细胞胞浆抗体"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "ANCA"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "ANCA"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "ANCA"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "抗蛋白酶3（PR3）抗体"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "胞浆型ANCA"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "C-ANCA"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "抗髓过氧化物酶"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 93,
+ "type": "bod",
+ "entity": "MPO"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 106,
+ "type": "bod",
+ "entity": "核周型ANCA"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 113,
+ "type": "bod",
+ "entity": "P-ANCA"
+ }
+ ]
+ },
+ {
+ "text": "ANCA主要出现在以系统性小血管炎为基础病变的AID患者血中，如Wegener肉芽肿、镜下多小动脉炎、系统性血管炎、川崎病、SLE以及过敏性紫癜等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "ANCA"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "系统性小血管炎"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "AID"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "Wegener肉芽肿"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "镜下多小动脉炎"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "系统性血管炎"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "川崎病"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "过敏性紫癜"
+ }
+ ]
+ },
+ {
+ "text": "临床上把ANCA视为小血管炎并肾炎的特殊血清学标志。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "ANCA"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "小血管炎"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "肾炎"
+ }
+ ]
+ },
+ {
+ "text": "（5）抗磷脂抗体（aPL抗体）：aPL抗体是一组非均一性抗体，磷脂是从牛心组织中提取的一种抗原，命名为心磷脂。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "抗磷脂抗体"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "aPL抗体"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "aPL抗体"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "磷脂"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "心磷脂"
+ }
+ ]
+ },
+ {
+ "text": "临床上aPL分为两种，即狼疮凝集物（LAC）和抗心磷脂抗体（aCL）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "aPL"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "狼疮凝集物"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "LAC"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "抗心磷脂抗体"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "aCL"
+ }
+ ]
+ },
+ {
+ "text": "LAC能与凝血酶原复合物中磷脂成分结合而抑制凝血作用，可能与SLE病人出血及凝血机制异常有关，实验发现aCL抗体有laG与IgM两种，IgG型与AID并流产、血栓形成及血小板减少有关；IgM型与AID并溶血性贫血、粒细胞减少、网状青斑及心内膜病变有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "LAC"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "凝血酶原复合物"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "磷脂"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "aCL抗体"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "laG"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "IgM"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "IgG"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "dis",
+ "entity": "AID"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "流产"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "血栓"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "bod",
+ "entity": "血小板"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "IgM"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 99,
+ "type": "dis",
+ "entity": "AID"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 105,
+ "type": "dis",
+ "entity": "溶血性贫血"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "粒细胞减少"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 116,
+ "type": "dis",
+ "entity": "网状青斑"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 122,
+ "type": "dis",
+ "entity": "心内膜病变"
+ }
+ ]
+ },
+ {
+ "text": "（6）抗神经节苷脂抗体（GM抗体）：抗GM抗体针对髓鞘脂类成分，AID中抗GM抗体主要引起神经及精神病变，IgM型抗GM抗体与SLE脑病高度相关。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "抗神经节苷脂抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "GM抗体"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "抗GM抗体"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "髓鞘脂类"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "AID"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "抗GM抗体"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "神经"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "IgM型抗GM抗体"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "SLE脑病"
+ }
+ ]
+ },
+ {
+ "text": "检测抗GM抗体可能有预测SLE神经系统并发症的价值，尤其是脑脊液中抗GM抗体检测。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "抗GM抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "SLE神经系统并发症"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "抗GM抗体检测"
+ }
+ ]
+ },
+ {
+ "text": "6.器官特异性自身抗体同细胞专一成分的自身抗体一样，器官特异性自身抗体主要针对某些器官组织并引起器官特异性AID。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "器官特异性自身抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "器官特异性自身抗体"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "器官组织"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "器官特异性AID"
+ }
+ ]
+ },
+ {
+ "text": "（1）抗脑组织抗体：有41.5%的精神分裂症患者、37%脑血管意外患者血清中可检出抗脑组织抗体，而正常人中该抗体阳性率仅1.4%，先天性脑发育不全者该抗体阳性率为9.1%。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "抗脑组织抗体"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "精神分裂症"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "脑血管"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "抗脑组织抗体"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "先天性脑发育不全"
+ }
+ ]
+ },
+ {
+ "text": "37例癫痫患者中抗脑组织抗体阳性率也皆高于正常对照组，在风湿性疾病脑损害中的诊断价值有待研究。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "癫痫"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "抗脑组织抗体"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "风湿性疾病"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "脑损害"
+ }
+ ]
+ },
+ {
+ "text": "（2）抗心肌M受体抗体：抗心肌抗体的靶抗原十分复杂，可针对肌纤维、肌动蛋白、肌凝蛋白及Z带等抗原成分，因此在心肌梗死、风湿性心肌炎、病毒性心肌炎、心肌病、冠状动脉硬化性心脏病，甚至心脏手术之后，均可检出抗心肌抗体。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "抗心肌M受体抗体"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "抗心肌抗体"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "靶抗原"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肌纤维"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肌动蛋白"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "肌凝蛋白"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "Z带"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "心肌梗死"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "风湿性心肌炎"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "病毒性心肌炎"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 86,
+ "type": "dis",
+ "entity": "冠状动脉硬化性心脏病"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 93,
+ "type": "pro",
+ "entity": "心脏手术"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 105,
+ "type": "bod",
+ "entity": "抗心肌抗体"
+ }
+ ]
+ },
+ {
+ "text": "目前难以确定是组织损伤，自身抗原改变刺激产生自身抗体，还是感染、药物等诱生的自身抗体。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "自身抗体"
+ }
+ ]
+ },
+ {
+ "text": "（3）抗甲状腺球蛋白及抗甲状���微粒体抗体（TGA与TPO）：在桥本甲状腺炎患者血清中高滴度TGA90%～95%，TPO检测也有相应诊断价值。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "抗甲状腺球蛋白"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "抗甲状腺微粒体抗体"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "TGA"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "TPO"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "桥本甲状腺炎"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "ite",
+ "entity": "高滴度TG"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "高滴度TG"
+ }
+ ]
+ },
+ {
+ "text": "（4）类风湿关节炎特异性抗体：多年来在RA患者中（尤其是儿童RA）难以检出特异性抗体，一直是令医师头痛的问题。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "类风湿关节炎特异性抗体"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "RA"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "儿童RA"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "特异性抗体"
+ }
+ ]
+ },
+ {
+ "text": "最近发现一种被称为Sa的抗原物质，其相对分子质量为50000或55000，属于人体组织的正常成分。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "Sa"
+ }
+ ]
+ },
+ {
+ "text": "抗Sa抗体在成人RA中阳性率为31.9%，在SLE为4.3%，干燥综合征为3%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "抗Sa抗体"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "RA"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "SLE"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "干燥综合征"
+ }
+ ]
+ },
+ {
+ "text": "抗Sa抗体对RA诊断特异性为98.6%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "抗Sa抗体"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "RA"
+ }
+ ]
+ },
+ {
+ "text": "研究发现抗Sa抗体与RF、RA3、SSA、SSB、RNP、Sm、Jo-1及Scl-70等多种自身抗体无交叉反应性，遗憾的是Sa抗体对JIA的诊断价值罕见报告。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "抗Sa抗体"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "RF"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "RA3"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "SSA"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "SSB"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "RNP"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "Sm"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "Jo-1"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "Sa抗体"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 68,
+ "type": "dis",
+ "entity": "JIA"
+ }
+ ]
+ },
+ {
+ "text": "抗环瓜氨酸抗体（ACCP）：研究表明，JIA患儿ACCP为阳性率不足2%，远低于成年（63%）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "抗环瓜氨酸抗体"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "ACCP"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "JIA"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "ACCP"
+ }
+ ]
+ },
+ {
+ "text": "因此，ACCP难以作为JIA诊断的筛选手段。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "ACCP"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "JIA"
+ }
+ ]
+ },
+ {
+ "text": "但有报告13%的多关节型和2%的其他类型JIA血清中ACCP抗体为阳性，健康对照仅0.6%阳性，其中RF阳性多关节型JIA患儿中57%ACCP抗体为阳性。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "JIA"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "ACCP抗体"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "RF阳性多关节型JIA"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "ACCP抗体"
+ }
+ ]
+ },
+ {
+ "text": "HLA-DR4阳性多关节型患儿ACCP抗体阳性率高于HLA-DR4阴性的患儿，且与多关节型发病、病程和关节破坏程度有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "HLA-DR4"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "ACCP抗体"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "HLA-DR4"
+ }
+ ]
+ },
+ {
+ "text": "抗核周因子抗体（APF）：NesherG检测64名JIA患儿（28名多关节型，26名少关节型，10名全身型），结果多关节型中APF10名阳性，少关节型中5名阳性，全身型中1名阳性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "抗核周因子抗体"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "APF"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "NesherG检测"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "JIA"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "APF"
+ }
+ ]
+ },
+ {
+ "text": "遗憾的是，以上自身抗体能提示某种器官损害，其特异性及阳性率报告差异极大，以器官疾病命名的自身抗体不一定具有诊断该病的高度特异性，临床医师绝不能僵化地看待自身抗体的报告。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "ite",
+ "entity": "自身抗"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "自身抗"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "提示"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "极大"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "病命名的"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "化地看待"
+ }
+ ]
+ },
+ {
+ "text": "临床检测自身抗体要注意3点：①自身抗体有生理性与病理性之分，生理性自身抗体不但效价低，产生机制也可能不同；②多数自身抗体特异性欠佳，要特别强调临床综合分析；③自身抗体仅用于风湿性疾病诊断，在一些非风湿性疾病中也通过自身抗体检测获取临床信息，如肺癌诊断，淋巴细胞白血病分型等。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "自身抗体"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 81,
+ "type": "ite",
+ "entity": "自身抗"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "自身抗"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 86,
+ "type": "dis",
+ "entity": "体仅用于风"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 98,
+ "type": "dis",
+ "entity": "在一些非风"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 108,
+ "type": "pro",
+ "entity": "中也通过自身"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 118,
+ "type": "dis",
+ "entity": "信息"
+ },
+ {
+ "start_idx": 122,
+ "end_idx": 128,
+ "type": "dis",
+ "entity": "癌诊断，淋巴细"
+ }
+ ]
+ },
+ {
+ "text": "第七章心肌病心肌病（cardiomyopathy）为发生于心肌的疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "cardiomyopathy"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "心肌"
+ }
+ ]
+ },
+ {
+ "text": "该术语最初出现于1957年，当时指一组不能归因于冠状动脉病变的心肌病变。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "冠状动脉"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "心肌"
+ }
+ ]
+ },
+ {
+ "text": "此后，心肌病的定义发生了变化。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "心肌病"
+ }
+ ]
+ },
+ {
+ "text": "目前，心肌病的定义为心肌的结构或功能异常，且无高血压或肺动脉高压、无心脏瓣膜病变、无先天性心脏病而言。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "心脏瓣膜病变"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "心脏病"
+ }
+ ]
+ },
+ {
+ "text": "以解剖与生理改变为依据，可将心肌病分为以下三型：①扩张（充血）型心肌病：此型左心室或双心室扩大，心肌收缩功能不同程度降低充血性心力衰竭的症状与体征。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "扩张（充血）型心肌病"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 59,
+ "type": "sym",
+ "entity": "心肌收缩功能不同程度降低"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 66,
+ "type": "sym",
+ "entity": "充血性心力衰竭"
+ }
+ ]
+ },
+ {
+ "text": "②肥厚性心肌病：先前称之为特发性肥厚性心肌病，以左心室肥厚左心室流出道梗阻舒张功能障碍或心律失常引起猝死。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "肥厚性心肌病"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "左心室肥厚"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "左心室流出道梗阻"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "舒张功能障碍"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "心律"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "心律失常引起猝死"
+ }
+ ]
+ },
+ {
+ "text": "③限制型心肌��（restrictivecardiomyopathy）：心房显著扩大，一般心室大小及收缩功能正常，舒张功能损害，症状由肺及体循环静脉充血引起，也可出现晕厥。",
+ "entities": [
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "体循环"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 83,
+ "type": "sym",
+ "entity": "晕厥"
+ }
+ ]
+ },
+ {
+ "text": "第一节扩张性心肌病【病因】【扩张性心肌病扩张性心肌病（dilatedcardiomyopathy，DCM）在各种类型心肌病中最为常见，在美国及欧洲，其年发病率约为2/10万～8/10万人口，据估计每10万人口中约有36人患有DCM。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "扩张性心肌病"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "dilatedcardiomyopathy"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "DCM"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 114,
+ "type": "dis",
+ "entity": "DCM"
+ }
+ ]
+ },
+ {
+ "text": "此外，20%～30%的DCM患者为家族性的。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "DCM"
+ }
+ ]
+ },
+ {
+ "text": "表9-10扩张性心肌病的病因【病理】扩张性心肌病病变以心肌纤维化为主，心肌肥厚不显著心腔扩大明显二尖瓣环和三尖瓣环增大，乳头肌伸长心腔内附壁血栓心肌节律点及传导系统而引起心律失常。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "扩张性心肌病"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "心肌纤维化"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "心肌肥厚不显著"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "心腔"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "心腔扩大明显"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "二尖瓣环和三尖瓣环增大"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "乳头肌"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "sym",
+ "entity": "乳头肌伸长"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "心腔"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "心腔内附壁血栓"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "心律失常"
+ }
+ ]
+ },
+ {
+ "text": "由于心肌纤维化，心肌收缩功能心力衰竭。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "心肌收缩功能"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "心力衰竭"
+ }
+ ]
+ },
+ {
+ "text": "主要表现为心脏增大心力衰竭，心律失常小动脉栓塞心脏增大气喘、乏力、心悸、咳嗽、胸闷等症状，有的可有偏瘫。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "心脏增大"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "心力衰竭"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "心律"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "心律失常"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "动脉"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "小动脉栓塞"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "心脏增大"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "气喘"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "乏力"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "心悸"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "咳嗽"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "胸闷"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "偏瘫"
+ }
+ ]
+ },
+ {
+ "text": "体格检查可见心尖搏动弥散或抬举心浊音界向左扩大，心率增快可闻及Ⅱ/Ⅵ～Ⅲ/Ⅵ级收缩期杂音（心力衰竭控制后杂音减轻或消失），肝脏增大下肢水肿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "体格检查"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "心尖"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "心尖搏动弥散或抬举"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "心浊音界向左扩大"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "心率"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "心率增快"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "可闻及Ⅱ/Ⅵ～Ⅲ/Ⅵ级收缩期杂音"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "sym",
+ "entity": "肝脏增大"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "下肢"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "sym",
+ "entity": "下肢水肿"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）胸部X线检查心影扩大，由左心室、左心房扩大引起。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "胸部X线检查"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "心影"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "左心房"
+ }
+ ]
+ },
+ {
+ "text": "常存在肺静脉充血，可发展为肺水肿。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肺静脉"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "肺水肿"
+ }
+ ]
+ },
+ {
+ "text": "左肺部分区域可因左心房扩大压迫左支气管而致不张胸腔积液。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "左肺"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "左心房"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "左支气管"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "左肺部分区域可因左心房扩大压迫左支气管而致不张"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "胸腔"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "胸腔积液"
+ }
+ ]
+ },
+ {
+ "text": "（二）心电图及HOLTER大多数患儿心电图上呈窦性心动过速左心室肥大左右心房扩大右心室肥大HOLTER检查可发现心律失常。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "心电图"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "HOLTER"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "心动"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "窦性心动过速"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "左心室肥大"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "心房"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "左右心房扩大"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "右心室肥大"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "HOLTER检查"
+ }
+ ]
+ },
+ {
+ "text": "（三）超声心动图DCM患儿的超声心动图特征包括左心室、左心房扩大，缩短分数及射血分数减低，左心室射血前期与射血期比率增加等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "超声心动图"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "DCM"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "左心房"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "左心室、左心房扩大"
+ }
+ ]
+ },
+ {
+ "text": "（四）心导管检查与活体组织检查由于DCM可由超声心动图检查确定，心导管检查主要用于排除异常的左冠状动脉起源，因这一情况在超声心动图检查时易于漏诊，必要时活体组织检查帮助确定心肌病的病因。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "心导管检查"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "活体组织检查"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "超声心动图检查"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "心导管检查"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "左冠状动脉"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 66,
+ "type": "pro",
+ "entity": "超声心动图检查"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 81,
+ "type": "pro",
+ "entity": "活体组织检查"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "dis",
+ "entity": "心肌病"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】扩张性心肌病的临床特征为心输出量减少、液体潴留及血管收缩活性增加，后者为神经体液因素作用以维持足够的灌注压。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "扩张性心肌病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "心输出量减少"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "液体潴留"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "血管收缩活性增加"
+ }
+ ]
+ },
+ {
+ "text": "增强心肌收缩力的药物1.第一类为拟交感药物包括多巴胺、多巴酚丁胺及肾上腺素。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "多巴胺"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "多巴酚丁胺"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dru",
+ "entity": "肾上腺素"
+ }
+ ]
+ },
+ {
+ "text": "多巴胺小剂量时可改善肾脏功能，剂量加大可增强对心脏的作用，但也可引起外周血管阻力增加，并有可能致心律失常。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "多巴胺"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "ite",
+ "entity": "心律"
+ }
+ ]
+ },
+ {
+ "text": "多巴酚丁胺致心律失常作用较弱，但有报道因可引起肺动脉楔压升高而致肺水肿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "多巴酚丁胺"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "心律"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肺动脉"
+ }
+ ]
+ },
+ {
+ "text": "2.第二类增强心肌收缩力的药物为双吡啶衍生剂包括氨力农及米力农，可通过抑制磷酸二酯酶增加细胞内钙的浓度，有强心及扩张外周血管的作用。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "双吡啶衍生剂"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "氨力农"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "抑制磷酸二酯酶"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "mic",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "血管"
+ }
+ ]
+ },
+ {
+ "text": "其可能的副作用为血小板减少、肝毒性及胃肠道刺激。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "血小板"
+ }
+ ]
+ },
+ {
+ "text": "地高辛为可长期应用的经典心肌收缩力增强药物，但在危重病例，因心肌损害严重及肾功能减退，应减量慎用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "地高辛"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "心肌"
+ }
+ ]
+ },
+ {
+ "text": "3.利尿剂改善液体内环境平衡在扩张性心肌病的治疗中至关重要。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "利尿剂"
+ }
+ ]
+ },
+ {
+ "text": "呋塞米（速尿）为首选的药物，但应注意监测电解质水平，尤其是血钾水平，必要时可适当补充钾盐，也可与螺内酯等类药物合用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "呋塞米"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "速尿"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "ite",
+ "entity": "血钾水平"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "钾盐"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "螺内酯"
+ }
+ ]
+ },
+ {
+ "text": "4.血管扩张剂硝普钠及肼屈嗪可有效扩张外周血管，从而降低后负荷，增加心输出量及减低充盈压。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "血管扩张剂"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "硝普钠"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "肼屈嗪"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "心"
+ }
+ ]
+ },
+ {
+ "text": "ACE抑制剂还有一定的抑制甚至逆转心肌病时的心室重塑作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "ACE抑制剂"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "心室"
+ }
+ ]
+ },
+ {
+ "text": "5.其他治疗扩张性心肌病因心腔扩大血流淤滞，有可能发生血栓形成。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "心肌"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "心腔"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "心腔扩大"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "血流淤滞"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "血栓"
+ }
+ ]
+ },
+ {
+ "text": "药物的选择依心动过速的原因而定。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "心动"
+ }
+ ]
+ },
+ {
+ "text": "6.心脏移植儿童心脏移植近年已增加，且改善了严重心肌病患儿的存活率。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "心脏移植"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "心脏移植"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "心肌病"
+ }
+ ]
+ },
+ {
+ "text": "因此，重症心肌病患儿如积极的内科治疗无效，应考虑心脏移植。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "心肌病"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dep",
+ "entity": "内科"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "心脏移植"
+ }
+ ]
+ },
+ {
+ "text": "二、营养素的主要功能和角色营养素主要功能除了作为能源物质外，其次还作为“建筑”材料，构成和修补机体组织、满足生长发育以及合成机体的免疫物质和激素等。",
+ "entities": [
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "机体组织"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "免疫物质"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "激素"
+ }
+ ]
+ },
+ {
+ "text": "第四节支原体肺炎支原体肺炎（mycoplasmalpneumonia）由肺炎支原体（mycoplasmapneumoniae，MP）引起。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "支原体肺炎"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "支原体肺炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "mycoplasmalpneumonia"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "mic",
+ "entity": "肺炎支原体"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 61,
+ "type": "mic",
+ "entity": "mycoplasmapneumoniae"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "mic",
+ "entity": "MP"
+ }
+ ]
+ },
+ {
+ "text": "北京首都儿科研究所报道，MP肺炎占住院儿童肺炎的19.2%～21.9%。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "MP肺炎"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "北美和欧洲的研究表明，MP占肺炎的15.0%～34.3%，并随年龄增长而增多。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "MP"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "【病因】该病病原体为MP，它是介于细菌和病毒之间的一种微生物，能在细胞外独立生活，具有RNA和DNA。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "MP"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "mic",
+ "entity": "RNA"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "mic",
+ "entity": "DNA"
+ }
+ ]
+ },
+ {
+ "text": "患儿常有发热、畏寒、头痛、咽痛、咳嗽、全身不适、疲乏、食欲缺乏、恶心、呕吐、腹泻等症状，但鼻部卡他症状少见。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "畏寒"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "头痛"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "咽痛"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "咳嗽"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "全身不适"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "疲乏"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "食欲缺乏"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "婴幼儿可表现为憋气，年长儿可感胸闷、胸痛。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "憋气"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "胸闷"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "胸痛"
+ }
+ ]
+ },
+ {
+ "text": "年长患儿肺部常无阳性体征，这是本病的特点之一。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肺部"
+ }
+ ]
+ },
+ {
+ "text": "少数病例呼吸音减弱，有干、湿啰音，这些体征常在X线改变之后出现。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "呼吸音减弱"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "干、湿啰音"
+ }
+ ]
+ },
+ {
+ "text": "此外，可发生肺脓疡、胸膜炎、肺不张、支气管扩张症、弥漫性间质性肺纤维化等。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肺脓疡"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "胸膜炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "肺不张"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "支气管扩张症"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "弥漫性间质性肺纤维化"
+ }
+ ]
+ },
+ {
+ "text": "本病尚可并发神经系统、血液系统、心血管系统、皮肤、肌肉和关节等肺外并发症，如脑膜脑炎、神经根神经炎、心肌炎、心包炎、肾炎、血小板减少、溶血性贫血、噬血细胞综合征及皮疹，尤其是Stevens-Johnson综合征。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "血液系统"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "心血管系统"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "关节"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "脑膜脑炎"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "神经根神经炎"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "心肌炎"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "心包炎"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "肾炎"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "血小板减少"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "溶血性贫血"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "噬血细胞综合征"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 104,
+ "type": "dis",
+ "entity": "Stevens-Johnson综合征"
+ }
+ ]
+ },
+ {
+ "text": "多发生在呼吸道症状出现后10天左右。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "呼吸道"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】X线胸部摄片多表现为单侧病变，大多数侵犯下叶，以右下叶为多，常呈淡薄片状或云雾状浸润，从肺门延伸至肺野，呈支气管肺炎的改变。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "X线胸部摄片"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "支气管肺炎"
+ }
+ ]
+ },
+ {
+ "text": "少数呈均匀的实变阴影，类似大叶性肺炎。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "大叶性肺炎"
+ }
+ ]
+ },
+ {
+ "text": "外周血白细胞计数大多正常，但也有白细胞减少或偏高者。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "外周血白细胞计数"
+ }
+ ]
+ },
+ {
+ "text": "部分患儿血清转氨酶、乳酸脱氢酶、碱性磷酸酶增高。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "血清转氨酶"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "乳酸脱氢酶"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "碱性磷酸酶"
+ }
+ ]
+ },
+ {
+ "text": "血清抗体可通过补体结合试验、间接血球凝集试验、酶联免疫吸附试验、间接免疫荧光试验等方法测定，或通过检测抗原得到早期诊断。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "血清抗体"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "补体结合试验"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "间接血球凝集试验"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 30,
+ "type": "ite",
+ "entity": "酶联免疫吸附试验"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "间接免疫荧光试验"
+ }
+ ]
+ },
+ {
+ "text": "【诊断与鉴别诊断】根据以下临床特征可初步诊断：①多发年龄5～18岁；②咳嗽突出而持久；③肺部体征少而X线改变出现早且严重；④用青霉素无效，红霉素治疗效果好；⑤外周血白细胞计数正常或升高；⑥血清冷凝集阳性。",
+ "entities": [
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "dru",
+ "entity": "红霉素"
+ }
+ ]
+ },
+ {
+ "text": "确诊必须靠呼吸道分泌物中检出MP及特异性抗体IgM检查阳性。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "MP"
+ }
+ ]
+ },
+ {
+ "text": "早期诊断法有ELISA法、单克隆抗体法检测MP抗原，特异IgM及PCR法检测DNA等。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "ELISA法"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "单克隆抗体法检测MP抗原"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "特异IgM及PCR法检测DNA"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】首选大环内酯类抗生素如红霉素，疗程一般较长，不少于2周，停药过早易于复发。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "大环内酯类抗生素"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "红霉素"
+ }
+ ]
+ },
+ {
+ "text": "近年来研究表明新合成的大环内酯类抗生素阿奇霉素、克拉霉素等具有与红霉素同等的抗菌活性，而且耐受性较好。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "阿奇霉素"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "克拉霉素"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "红霉素"
+ }
+ ]
+ },
+ {
+ "text": "近年来有人认为重症MP肺炎的发病可能与人体免疫反应有关，因此，对急性期病情较重者，或肺部病变迁延而出现肺不张、肺间质纤维化，支气管扩张者，或有肺外并发症者，可应用肾上腺皮质激素口服或静脉用药，一般疗程为3～5天。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "重症MP肺炎"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "肺不张"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "肺间质纤维化"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "支气管扩张"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 87,
+ "type": "dru",
+ "entity": "肾上腺皮质激素"
+ }
+ ]
+ },
+ {
+ "text": "参考文献1.秦梅，樊绍曾.亚低温和非氨酯对新生鼠缺氧缺血性脑损伤的保护作用.中华儿科杂志，2001，3（1）：11-112.MhairiGMacDonald，MarthaDMullett，MaryMKSeshia.Neonatology，PathophysiologyandManagementoftheNewborn.6thed.LippincottWilliams＆Wilkins，Phladelphia，20053.BattinMR，DezoeteJA，GunnTR，etal.Neuro-developmentaloutcomeofinfantstreatedwithheadcoolingandmildhypothermiaafterperinatalasphyxia.Pediatrics，2001，107（3）：480-4844.BehrmanRE，KliegmanRM，JensonHB，etal.NelsonTextbookofPediatrics.17thed.SciencePress，Harcourt2.AsiaandSaunders，20045.DaniC，MartelliE，RubaltelliFF.ProphylaxisofgroupBbetahemolyticstreptococcalinfections.ActaBiomedAteneoParmense，2000，71（Suppl1）：541-5416.HansenT.Guidelinesfortreatmentofneonataljaundice，Isthereaplaceforevidence-basedmedicine？",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "缺氧缺血性脑损伤"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "dep",
+ "entity": "儿科"
+ }
+ ]
+ },
+ {
+ "text": "Actapaediatr，2001，90：239-2397.LevitonA，DammanO.Braindamagemarkersinchildren.Neurobiologicalandclinicalaspects.ActaPaediatr，2002，91：9-98.MeeganME，ConroyRM，LengenySO，etal.Effectonneonataltetanusmortalityafteraculturally-basedhealthpromotionprogramme.Lancet，2001，358：640-6419.MoisejrKJ.Non-anti-Dantibodiesinred-cellalloimmunization.EurJObstetGynecolReproBiol，2000，92：75-8110.OhlsRK.Theuseoferythropoietininneonates.ClinPerinatol，2000，27（3）：681-69611.RavelliAM，TobanelliP，VolpiS，etal.Vomitingandgastricmotilityininfantswithcow`smilkallergy.JPediatrGastroenterolNutr，2001，32（1）：59-6412.WarnerL，RochatRW，FichtnerRR，etal.Missedopportunitiesforcongenitalsyphilispreventioninanurbansoutheasternhospital.SexTransmDis，2001，28（2）：92-9213.WhitelawA.Systematicreviewoftherapyafterhypoxic-ischaemicbraininjuryintheperinatalperiod.SeminNeonatol，2000，5（1）：33-4014.EuroNeoStatAnnualReportforVeryLowGestationalAgeInfants2006.TheENSProject.HospitaldeCruces，UnidadNeonatal5-D，PlazadeCrucess/n，48903Barakaldo，Spain.Info.euroneonet@euskalnet.net15.ShenY，YuHM，YuanTM，etal.Erythropoietinattenuateswhitematterdamage，proinflammatorycytokineandchemokineinductionindevelopingratbrainafterintrauterineE．coliinfection.Neuropathology，2009，29（5）：528-52816.VolpeJJ.Braininjuryinprematureinfants：acomplexamalgamofdestructiveanddevelopmentaldisturbances.LancetNeurol，2009，8：110-11017.DengW，PleasureJ，PleasureD，etal.ProgressinPeriventricularLeukomalacia.ArchNeurol，2008，65：1291-129118.俞惠民.围生期宫内感染与新生儿脑白质损伤.实用儿科临床杂志，2005，20（8）：725-72519.StraussmanSharon，Levitsky，LynneL.Neonatalhypoglycemia.CurrentOpinioninEndocrinology，Diabetes＆Obesity，2010，17（1）：20-2020.Committeeonfetusandnewborn，AAP，Committeeonobstetricpractice，ACOG.UseandabuseoftheApgarscore.Pediatrics，1996，98（1）：141-14121.中国新生儿复苏项目专家组.新生儿窒息复苏指南（2007北京修订）.中国儿童保健杂志，2010，18（5）：439-44222.王来栓，倪锦文，周文浩.先天性梅毒的流行病学和诊断治疗现状.ChinJEvidBasedPediatr，2010，5（1）：6423.杜立中，魏克伦，孙眉月.新生儿持续肺动脉高压诊疗常规.中华儿科杂志，2002，40：438-43924.ChambersCD，DiazSH，VanMarterLJ.Selectiveserotonin-reuptakeinhibitorsandriskofpersistentpulmonaryhypertensionoftheneoborn.NEnglJMed，2006，354：579-57925.TiskumaraR，FakhareeSH，LiuCQ，etal.NeonatalinfectionsinAsia.ArchDisChildFetalNeonatalEd，2009，94：144-14426.VergnanoS，SharlandM，KazembeP，etal.Neonatalsepsis：aninternationalperspective.ArchDisChildFetalNeonatalEd，2005，90：220-22027.欧阳颖，梁立阳，苏浩彬，等.新生儿败血症病原学分析.中国新生儿科杂志，2007，22：302",
+ "entities": [
+ {
+ "start_idx": 1472,
+ "end_idx": 1473,
+ "type": "dep",
+ "entity": "儿科"
+ },
+ {
+ "start_idx": 1757,
+ "end_idx": 1761,
+ "type": "dis",
+ "entity": "新生儿窒息"
+ },
+ {
+ "start_idx": 1822,
+ "end_idx": 1823,
+ "type": "dis",
+ "entity": "梅毒"
+ },
+ {
+ "start_idx": 1886,
+ "end_idx": 1895,
+ "type": "dis",
+ "entity": "新生儿持续肺动脉高压"
+ },
+ {
+ "start_idx": 1903,
+ "end_idx": 1904,
+ "type": "dep",
+ "entity": "儿科"
+ }
+ ]
+ },
+ {
+ "text": "第十四章病毒性脑膜炎、脑炎第一节中枢神经系统病毒感染概述中枢神经系统病毒感染的临床表现多种多样，以急性无菌性脑膜炎或脑炎最为常见。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "病毒性脑膜炎"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "脑炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "中枢神经系统病毒感染"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "中枢神经系统病毒感染"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "急性无菌性脑膜炎"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "脑炎"
+ }
+ ]
+ },
+ {
+ "text": "可以引起中枢神经系统感染的病毒多种多样，常见者包括单纯疱疹病毒（herpessimplexvirus，HSV）、肠道病毒以及EB病毒（Epstein-Barrvirus，EBV）等。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "mic",
+ "entity": "疱疹病毒"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 49,
+ "type": "mic",
+ "entity": "herpessimplexvirus"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "mic",
+ "entity": "HSV"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "mic",
+ "entity": "肠道病毒"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 65,
+ "type": "mic",
+ "entity": "EB病毒"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 87,
+ "type": "mic",
+ "entity": "EBV"
+ }
+ ]
+ },
+ {
+ "text": "除少数病毒外，中枢神经系统病毒感染的治疗缺乏特效方法。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ }
+ ]
+ },
+ {
+ "text": "例如虫媒病毒感染好发于相应虫媒生活的地域和季节。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "虫媒病毒感染"
+ }
+ ]
+ },
+ {
+ "text": "多数中枢神经系统病毒感染累及所有年龄人群，无明显的季节或地域差异，例如单纯疱疹病毒性脑炎。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "中枢神经系统病毒感染"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "单纯疱疹病毒性脑炎"
+ }
+ ]
+ },
+ {
+ "text": "我国近年来随着脊髓灰质炎病毒疫苗的强化接种，野病毒株感染者已经消失。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "脊髓灰质炎病毒疫苗"
+ }
+ ]
+ },
+ {
+ "text": "目前疱疹病毒、肠道病毒（除脊髓灰质炎病毒外）和呼吸道病毒（如腺病毒）等几类病毒感染占本病的大多数。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "疱疹病毒"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "肠道病毒"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "mic",
+ "entity": "呼吸道病毒"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "mic",
+ "entity": "腺病毒"
+ }
+ ]
+ },
+ {
+ "text": "【临床分类】根据起病和病程特点，神经系统病毒感染一般可分为四类：急性、亚急性、慢性和胚胎脑病（表16-16）。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "神经系统病毒感染"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "急性"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "亚急性"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "慢性"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "胚胎脑病"
+ }
+ ]
+ },
+ {
+ "text": "首先根据核酸类型，再根据核酸分子量、结构、衣壳的对称型、壳粒数、包膜和病毒形态与大小等进一步分类。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "核酸"
+ }
+ ]
+ },
+ {
+ "text": "比病毒更小的传染因子被称为亚病毒（subvirus），包括类病毒（viroid）、拟病毒（virusoid）和朊病毒。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "亚病毒"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "mic",
+ "entity": "类病毒"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "mic",
+ "entity": "拟病毒"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "mic",
+ "entity": "朊病毒"
+ }
+ ]
+ },
+ {
+ "text": "其中朊病毒是1982年美国学者Prusiner首先报道的一种对核酸酶有抵抗性的感染性蛋白质，被称为朊蛋白（prion），是引起疯牛（羊）病和人类CJD及库鲁（Kuru）病等中枢神经系统慢感染（以前称为慢病毒感染）的致癌因子表16-9神经系统病毒感染的临床类型与疾病*由朊蛋白（prion）感染所致表16-10DNA病毒的分类【常见病毒所致神经系统感染的临床特点】不同病毒所致神经系统感染的临床特点有所差异（表16-16）。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "朊病毒"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "核酸酶"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "朊蛋白"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 91,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 94,
+ "type": "sym",
+ "entity": "中枢神经系统慢感染"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 104,
+ "type": "dis",
+ "entity": "慢病毒感染"
+ },
+ {
+ "start_idx": 140,
+ "end_idx": 151,
+ "type": "dis",
+ "entity": "朊蛋白（prion）感染"
+ },
+ {
+ "start_idx": 160,
+ "end_idx": 164,
+ "type": "mic",
+ "entity": "DNA病毒"
+ },
+ {
+ "start_idx": 175,
+ "end_idx": 180,
+ "type": "dis",
+ "entity": "神经系统感染"
+ },
+ {
+ "start_idx": 193,
+ "end_idx": 198,
+ "type": "dis",
+ "entity": "神经系统感染"
+ }
+ ]
+ },
+ {
+ "text": "表16-11RNA病毒的分类表16-12常见病毒与神经系统疾病+++，关系极密切；++，关系密切；+，有一定关系；？",
+ "entities": [
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "神经系统疾病"
+ }
+ ]
+ },
+ {
+ "text": "五、经导管关闭房间隔缺损及室间隔缺损房间隔缺损与室间缺损是常见的先天性心脏病，通常需要开胸体外转流下进行直视关闭术。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "经导管关闭房间隔缺损"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "室间缺损"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "先天性心脏病"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 56,
+ "type": "pro",
+ "entity": "开胸体外转流下进行直视关闭术"
+ }
+ ]
+ },
+ {
+ "text": "虽然手术死亡率低，但仍有一定的并发症、切口瘢痕形成与术后远期影响等问题。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "切口瘢痕形成"
+ }
+ ]
+ },
+ {
+ "text": "因此，经导管关闭房、室间隔缺损一直为先天性心脏病介入性治疗研究的热点。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "经导管关闭房、室间隔缺损"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "先天性心脏病"
+ }
+ ]
+ },
+ {
+ "text": "另外，随着先天性心脏病手术技术的进展，复杂型心脏病应用生理纠正术，如高危单心室病人作Fontan手术后有较高的并发症及死亡率，术后多死于低心排伴中心静脉压增高。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "先天性心脏病手术"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "复杂型心脏病"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "生理纠正术"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "高危单心室"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 49,
+ "type": "pro",
+ "entity": "Fontan手术"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 78,
+ "type": "dis",
+ "entity": "低心排伴中心静脉压增高"
+ }
+ ]
+ },
+ {
+ "text": "因此，设计开窗的Fontan手术，术时于左右心房之间的房间隔补片上留有直径4～6mm的小窗，术后使留有不同程度的心房水平右向左分流，以维持左心室负荷、心排量及限制中心静脉压增加。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "开窗的Fontan手术"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "左右心房之间的房间隔补片"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "心房"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "心"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "静脉"
+ }
+ ]
+ },
+ {
+ "text": "一旦病人术后循环获得调整，数天或数月后用导管法关闭房间隔交通。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "导管法"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "房间隔"
+ }
+ ]
+ },
+ {
+ "text": "由于这些病人再次开胸手术较困难及危险性较大，而经导管关闭房间隔缺损为最好选择，因此促进了非开胸关闭的装置和技术的研究。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "开胸手术"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "经导管关闭房间隔缺损"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "非开胸关闭"
+ }
+ ]
+ },
+ {
+ "text": "经导管关闭术的指征仍在研究中。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "经导管关闭术"
+ }
+ ]
+ },
+ {
+ "text": "室间隔缺损的堵塞器安置较房间隔缺损困难，并发��亦较多，目前进行的病例还不多，尚缺乏中远期随访。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "equ",
+ "entity": "堵塞器"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "（一）经导管房间隔缺损关闭术1976年，King及Mille首次报道经静脉双伞堵塞装置关闭继发孔型房间隔缺损获得成功，但需7.7mm（23F）递送系统。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "经导管房间隔缺损关闭术"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 53,
+ "type": "pro",
+ "entity": "经静脉双伞堵塞装置关闭继发孔型房间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "随后Rashkind等应用堵塞动脉导管未闭的双伞装置关闭房间隔缺损，先后经单面伞状带钩的堵塞装置，双伞无钩的堵塞器，但仍需3.33mm（10F）递送系统。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "动脉导管未闭"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "equ",
+ "entity": "双伞装置"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 47,
+ "type": "equ",
+ "entity": "单面伞状带钩的堵塞装置"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 56,
+ "type": "equ",
+ "entity": "双伞无钩的堵塞器"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "equ",
+ "entity": "递送系统"
+ }
+ ]
+ },
+ {
+ "text": "以后Lock等改进该装置，成为蚌壳状式闭合器，以适合房间隔缺损的需要，但关闭房间隔缺损的结果仍不尽满意。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "equ",
+ "entity": "蚌壳状式闭合器"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "为此，Sideris等研制成纽扣式双盘堵塞装置，该装置较以上的堵塞器安置方便、安全，而且可使递送系统的直径减至2.67mm（8F），使该技术适合婴儿病人使用，但并发症仍较高，且残余分流率也高。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 22,
+ "type": "equ",
+ "entity": "纽扣式双盘堵塞装置"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "equ",
+ "entity": "堵塞器"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "equ",
+ "entity": "递送系统"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 91,
+ "type": "sym",
+ "entity": "残余分流"
+ }
+ ]
+ },
+ {
+ "text": "1998年Amplatzer双盘自膨性房间隔堵塞装置（AGAmedicalcorporation）面世，由于其具有自膨性、自向心性、完全封堵率高、并发症少、操作方便、递送导管小等优点而迅速风靡全球。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 25,
+ "type": "equ",
+ "entity": "双盘自膨性房间隔堵塞装置"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 47,
+ "type": "equ",
+ "entity": "AGAmedicalcorporation"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 86,
+ "type": "equ",
+ "entity": "导管"
+ }
+ ]
+ },
+ {
+ "text": "作者所在单位的临床应用表明技术成功率达100%，即刻残余分流率＜7%，随访1月分流全部消失，无并发症发生，因而该术值得推广，但其中长期疗效尚需进一步随访研究。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "残余分流"
+ }
+ ]
+ },
+ {
+ "text": "1.适应证及禁忌证（适用于Amplatzer双盘自膨性房间隔缺损堵塞装置）（1）适应证：①继发孔型房间隔缺损；②小儿病例通常直径≤30mm；③右室扩大有右室容量负荷增加的证据；④左向右分流；⑤缺损边缘至冠状窦、房室瓣和右上叶肺静脉的距离≥5mm。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 35,
+ "type": "equ",
+ "entity": "Amplatzer双盘自膨���房间隔缺损堵塞装置"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "继发孔型房间隔缺损"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 74,
+ "type": "dis",
+ "entity": "右室扩大"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "右室"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 121,
+ "type": "sym",
+ "entity": "缺损边缘至冠状窦、房室瓣和右上叶肺静脉的距离≥5mm"
+ }
+ ]
+ },
+ {
+ "text": "（2）禁忌证：①伴有需胸外科手术的先天性心脏畸形；②原发孔型房间隔缺损；③静脉窦型房间隔缺损；④肺静脉异位引流（完全性或部分性）；⑤严重肺动脉高压/双向或右向左分流。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "胸外科手术"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "先天性心脏畸形"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "原发孔型房间隔缺损"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "静脉窦型房间隔缺损"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "肺静脉异位引流"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "严重肺动脉高压"
+ }
+ ]
+ },
+ {
+ "text": "2.方法全麻下经皮股静脉穿刺，各心腔全套血流动力学检查，包括压力及血氧饱和度检测。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "全麻"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "经皮股静脉穿刺"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "心腔"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "压力及血氧饱和度检测"
+ }
+ ]
+ },
+ {
+ "text": "四腔位行右上肺静脉造影以确定房间隔缺损大小，并与食管超声结果相比较。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "四腔位行右上肺静脉造影"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "食管超声"
+ }
+ ]
+ },
+ {
+ "text": "然后用球囊测量导管跨房间隔缺损以稀释造影剂扩张球囊，球囊两侧二凹陷点间的距离为房间隔缺损伸展直径。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "equ",
+ "entity": "球囊"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "导管跨房间隔缺损"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "造影剂"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "equ",
+ "entity": "球囊"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "equ",
+ "entity": "球囊"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "房间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "同时在透视及食管超声下测量。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "透视"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "食管超声"
+ }
+ ]
+ },
+ {
+ "text": "再以同样量造影剂在体外扩张球囊，用测量板测量轻度变形时的球囊直径。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "造影剂"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "equ",
+ "entity": "球囊"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "equ",
+ "entity": "测量板"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "equ",
+ "entity": "球囊"
+ }
+ ]
+ },
+ {
+ "text": "选择腰部直径等于或大于房间隔缺损伸展直径1～2mm的Amplatzer房间隔缺损封堵器。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "房间隔缺损"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 42,
+ "type": "equ",
+ "entity": "Amplatzer房间隔缺损封堵器"
+ }
+ ]
+ },
+ {
+ "text": "装置经股静脉途径在长引导鞘内推送，在透视及食管超声监视下先在左心房内释放左侧盘，回撤系统，使腰部卡于房间隔缺损，然后释放右盘。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "股静脉"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "equ",
+ "entity": "长引导鞘"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "透视"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "食管超声"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "左心房"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "equ",
+ "entity": "左侧盘"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "equ",
+ "entity": "系统"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "腰部"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "房间隔缺损"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "equ",
+ "entity": "右盘"
+ }
+ ]
+ },
+ {
+ "text": "3.疗效评价由于该法设计合理，操作较稳定安全，根据大系列报道该堵塞装置技术成功率高达97%，一年完全堵塞率达94.9%，但远期随访，包括血流动力学、心功能等其结果尚待进一步评价。",
+ "entities": [
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "equ",
+ "entity": "堵塞装置"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 72,
+ "type": "ite",
+ "entity": "血流动力学"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "ite",
+ "entity": "心功能"
+ }
+ ]
+ },
+ {
+ "text": "4.并发症由于Amplatzer堵塞器操作方便、安全、成功率高，因此该法并发症较少。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 18,
+ "type": "equ",
+ "entity": "Amplatzer堵塞器"
+ }
+ ]
+ },
+ {
+ "text": "除术时有一过性心律失常外，偶有堵塞器脱落、心包填塞、二尖瓣关闭不全、局部血管并发症等。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "过性心律失常"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "堵塞器脱落"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "心包填塞"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "二尖瓣关闭不全"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "局部血管并发症"
+ }
+ ]
+ },
+ {
+ "text": "5.随访术前3天及术后3～6个月内口服阿司匹林3～5mg/（kg•d）预防血小板在堵塞器上过度凝聚。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "阿司匹林"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "血小板"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "equ",
+ "entity": "堵塞器"
+ }
+ ]
+ },
+ {
+ "text": "术前后常规抗生素静脉点滴以预防感染。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "静脉点滴"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "感染"
+ }
+ ]
+ },
+ {
+ "text": "术后1月、3月、6月、1年门诊随访。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dep",
+ "entity": "门诊"
+ }
+ ]
+ },
+ {
+ "text": "随访内容包括超声心动图、胸片、心电图及血常规等，以确定是否有残余分流、装置异位及溶血等并发症。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "超声心动图"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "胸片"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "心电图"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "血常规"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "残余分流"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "装置异位"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "（二）经导管室间隔缺损关闭术自1988年Lock等首先报道应用双伞堵塞装置经导管关闭室间隔缺损以来，目前已有多种室间隔缺损封堵装置问世，包括蚌壳状封堵装置、Rashkind动脉导管未闭封堵装置、纽扣式补片装置以及近期推出的Amplatzer室间隔缺损封堵装置等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "经导管室间隔缺损关闭术"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "equ",
+ "entity": "双伞堵塞装置"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "经导管关闭室间隔缺损"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 64,
+ "type": "equ",
+ "entity": "室间隔缺损封堵装置"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 76,
+ "type": "equ",
+ "entity": "蚌壳状封堵装置"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 95,
+ "type": "equ",
+ "entity": "Rashkind动脉导管未闭封堵装置"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 103,
+ "type": "equ",
+ "entity": "纽扣式补片装置"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 128,
+ "type": "equ",
+ "entity": "Amplatzer室间隔缺损封堵装置"
+ }
+ ]
+ },
+ {
+ "text": "由于经导管堵塞技术的复杂性、效果不确切及经验有限，目前尚不能确定哪一种装置更优越，或是否经导管室间隔缺损关闭术优于外科手术。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "经导管堵塞技术"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 54,
+ "type": "pro",
+ "entity": "经导管室间隔缺损关闭术"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "dep",
+ "entity": "外科"
+ }
+ ]
+ },
+ {
+ "text": "目前可经导管关闭的室间隔缺损的类型主要为肌部室间隔缺损及部分膜部室间隔缺损。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "经导管关闭"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "肌部室间隔缺损"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "部分膜部室间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "第四节军团菌感染1976年美国费城暴发军团菌肺炎，军团菌肺炎是一种以肺部感染为主、伴全身多系统损害的急性传染病，可引起任何年龄的感染。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "军团菌感染"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "肺部感染"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "全身多系统损害"
+ }
+ ]
+ },
+ {
+ "text": "在儿童的肺部感染性疾病中也很重要。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "儿童的肺部感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "【病原与流行病学】军团菌是一种机会致病菌，有42个种，64个血清型，其中至少19个种与人类疾病有关。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "军团菌"
+ }
+ ]
+ },
+ {
+ "text": "与人类关系最为密切的为嗜肺军团菌种（Legionellapneumophile，Lp），已发现15个血清型（L1～L15）。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "嗜肺军团菌"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 38,
+ "type": "mic",
+ "entity": "Legionellapneumophile"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "mic",
+ "entity": "Lp"
+ }
+ ]
+ },
+ {
+ "text": "军团菌为需氧革兰染色阴性杆菌，是一种人类单核细胞和巨噬细胞的兼性细胞内寄生菌，培养和分离困难。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "军团菌"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 13,
+ "type": "mic",
+ "entity": "需氧革兰染色阴性杆菌"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "单核细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ }
+ ]
+ },
+ {
+ "text": "流行病学调查发现军团菌暴发与冷却塔、热水系统、温泉浴等水装置或花盆肥料有关。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "军团菌"
+ }
+ ]
+ },
+ {
+ "text": "儿童感染军团菌的危险因素有慢性疾患及应用免疫抑制剂。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "mic",
+ "entity": "军团菌"
+ }
+ ]
+ },
+ {
+ "text": "新生儿军团菌病的高危因素有早产、先天性心脏病、支气管发育不良和接受激素治疗。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "新生儿军团菌病"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "早产"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "先天性心脏病"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "支气管"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "支气管发育不良"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "激素治疗"
+ }
+ ]
+ },
+ {
+ "text": "小儿军团菌肺炎病情相对较重。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "小儿军团菌肺炎"
+ }
+ ]
+ },
+ {
+ "text": "污染有军团菌的直径小于5μm的小颗粒气溶胶可直接穿入支气管和肺部造成感染。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "军团菌"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "支气管"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肺部"
+ }
+ ]
+ },
+ {
+ "text": "军团菌产生的有害物质可造成组织损伤：外膜蛋白MIP可促进吞噬细胞对细菌的摄入并破坏细胞的杀菌功能；Lp的外毒素有消化卵黄囊和灭活抗糜蛋白酶的作用；脂多糖Lps作为内毒素有利于细菌黏附宿主细胞，保护细菌免受细胞内酶的破坏，促进单核/吞噬细胞对细菌的摄入，阻止吞噬体与溶酶体的融合；磷酸酶和蛋白酶影响吞噬细胞的杀菌功能。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "军团菌"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "组织损伤"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "吞噬细胞"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 54,
+ "type": "mic",
+ "entity": "Lp的外毒素"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "宿主细胞"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 118,
+ "type": "bod",
+ "entity": "单核/吞噬细胞"
+ }
+ ]
+ },
+ {
+ "text": "【病理改变】肺炎急性期为多灶性纤维素性化脓性炎症，分两型：Ⅰ型为急性纤维素性化脓性肺炎95%，以大量纤维素渗出，中性粒细胞崩解，细胞碎片及巨噬细胞为主；��型为急性弥漫性肺泡损伤。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "多灶性纤维素性化脓性炎症"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "急性纤维素性化脓性肺炎"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "大量纤维素渗出"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "中性粒细胞"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "中性粒细胞崩解"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "急性弥漫性肺泡损伤"
+ }
+ ]
+ },
+ {
+ "text": "病变中可见肺泡上皮增生、脱屑及透明膜形成，严重者可致蜂窝肺。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肺泡上皮"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "肺泡上皮增生、脱屑"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "透明膜形成"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "蜂窝肺"
+ }
+ ]
+ },
+ {
+ "text": "急性后期为机化性肺炎。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "机化性肺炎"
+ }
+ ]
+ },
+ {
+ "text": "胸膜病变为浆液性、浆液纤维素性胸膜炎或化脓性胸膜炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "胸膜"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "胸膜病变"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "浆液性、浆液纤维素性胸膜炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "化脓性胸膜炎"
+ }
+ ]
+ },
+ {
+ "text": "开始有短暂不适，急起高热，体温最高可达40℃以上，伴寒战，干咳，全身肌肉酸痛明显，恶心、腹痛、腹泻等胃肠道症状显著。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "不适"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "急起高热"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "体温最高可达40℃以上"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "寒战"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "干咳"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "肌肉酸痛"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "胃肠道症状"
+ }
+ ]
+ },
+ {
+ "text": "军团菌肺炎临床表现复杂，病情程度差异悬殊，轻者无明显临床症状，重者可引起以肺部感染为主的多器官损害，如ARDS、急性肾衰竭、休克和弥漫性血管内凝血。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "肺部感染"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "多器官损害"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "ARDS"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "急性肾衰竭"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 72,
+ "type": "sym",
+ "entity": "弥漫性血管内凝血"
+ }
+ ]
+ },
+ {
+ "text": "常有以下较为特殊的临床表现：①与高热不相称的相对缓脉；②剧烈胸痛，在成人易误诊为肺栓塞；③胃肠道症状显著，为水样便，呈无菌性腹泻；④电解质紊乱，可合并低钠血症、低钾血症，此项表现有助于诊断和鉴别诊断；⑤多汗症状突出。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "缓脉"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "剧烈胸痛"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "肺栓塞"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "胃肠道症状"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "水样便"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "无菌性腹泻"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 70,
+ "type": "sym",
+ "entity": "电解质紊乱"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 78,
+ "type": "dis",
+ "entity": "低钠血症"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dis",
+ "entity": "低钾血症"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 102,
+ "type": "sym",
+ "entity": "多汗"
+ }
+ ]
+ },
+ {
+ "text": "【影像学检查】X线的表现呈多样性、缺乏特异性，可见斑片影、纱网影、边缘清楚的小结节影、条索影、弥漫肺浸润影等，胸腔积液相对多见。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "X线"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "斑片影"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "纱网影"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "边缘清楚的小结节影"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "条索影"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "弥漫肺浸润影"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "胸腔"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "胸腔积液"
+ }
+ ]
+ },
+ {
+ "text": "肺CT可发现早期病灶。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "pro",
+ "entity": "肺CT"
+ }
+ ]
+ },
+ {
+ "text": "吸收较慢，有人认为军团菌肺炎的吸收是最慢的。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】根据国内1992年制定的军团菌肺炎诊断标准：①临床表现如发热、寒战、咳嗽、胸痛等呼吸道感染症状；②X线胸片具有炎性阴影；③呼吸道分泌物、痰、血或胸水在活性炭母浸液琼脂培养基BCYE或其他特殊培养基上培养有军团菌生长；④呼吸道分泌物直接荧光法DFA检查阳性；⑤血间接荧光法IFA检查前后2次抗体滴度呈4倍或以上增高，达1∶128或以上；血试管凝集实验TAT检查前后2次抗体滴度呈4倍或以上增高，达1∶160或以上；血微量凝集实验MAA检查前后2次抗体滴度呈4倍或以上增高，达1∶64或以上。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "寒战"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "咳嗽"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "胸痛"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "呼吸道感染症状"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "pro",
+ "entity": "X线胸片"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "炎性阴影"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "呼吸道分泌物"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "痰"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "胸水"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 89,
+ "type": "equ",
+ "entity": "活性炭母浸液琼脂培养基"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 108,
+ "type": "mic",
+ "entity": "军团菌"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 118,
+ "type": "bod",
+ "entity": "呼吸道分泌物"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 128,
+ "type": "pro",
+ "entity": "荧光法DFA检查"
+ },
+ {
+ "start_idx": 133,
+ "end_idx": 143,
+ "type": "pro",
+ "entity": "血间接荧光法IFA检查"
+ },
+ {
+ "start_idx": 171,
+ "end_idx": 182,
+ "type": "pro",
+ "entity": "血试管凝集实验TAT检查"
+ },
+ {
+ "start_idx": 210,
+ "end_idx": 219,
+ "type": "pro",
+ "entity": "血微量凝集实验MAA"
+ }
+ ]
+ },
+ {
+ "text": "凡具有以上①、②项，同时具有③、④、⑤项中任何一项者，即可诊断为军团菌肺炎。",
+ "entities": [
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ }
+ ]
+ },
+ {
+ "text": "对于IFA或TAT效价有一次增高，IFA=1∶256或TAT=1∶320，同时有临床及X线胸片炎症表现的病例可考虑为可疑军团菌肺炎。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "IFA"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "TAT"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "IFA"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "ite",
+ "entity": "TAT"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "X线胸片"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "炎症"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "军团菌肺炎"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】（1）抗菌治疗。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "抗菌治疗"
+ }
+ ]
+ },
+ {
+ "text": "首选红霉素，30～50mg/（kg•d），14～21天，静脉滴注或口服分4次，疗程3周；或阿奇霉素10mg/（kg•d），3～5天，或联用利福平。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "红霉素"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "静脉滴注"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "dru",
+ "entity": "阿奇霉素"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "dru",
+ "entity": "利福平"
+ }
+ ]
+ },
+ {
+ "text": "危重病例必要时可考虑选用喹诺酮类抗生素。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "喹诺酮类抗生素"
+ }
+ ]
+ },
+ {
+ "text": "（2）对症治疗与支持治疗。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "支持治疗"
+ }
+ ]
+ },
+ {
+ "text": "重症军团菌病往往出现进行性呼吸困难致呼吸衰竭、肾衰竭、感染性休克、DIC和脑病。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "重症军团菌病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "进行性呼吸困难"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "肾衰竭"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "感染性休克"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "DIC"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "脑病"
+ }
+ ]
+ },
+ {
+ "text": "这些病往往是军团菌病死亡的重要原因，应积极防治。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "军团菌病"
+ }
+ ]
+ },
+ {
+ "text": "第四节气道反应性气道高反应性（BHR）是指气道对外界特异性或非特异性刺激过于强烈的反应，是儿童支气管哮喘的主要病理生理特征。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "气道反应性"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "气道高反应性"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "BHR"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "支气管哮喘"
+ }
+ ]
+ },
+ {
+ "text": "气道反应性测定对儿童不典型哮喘、咳嗽变异型哮喘的诊断，以及支气管哮喘患儿用药治疗期间的疗效判断和何时停药显得格外重要。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "气道反应性"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "不典型哮喘"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "咳嗽变异型哮喘"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "支气管哮喘"
+ }
+ ]
+ },
+ {
+ "text": "一、支气管激发试验分为直接激发试验和间接激发试验，前者主要选用外源性非选择性直接激发剂，如组胺、乙酰甲胆碱。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "支气管激发试验"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "直接激发试验"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "间接激发试验"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 42,
+ "type": "dru",
+ "entity": "外源性非选择性直接激发剂"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "dru",
+ "entity": "组胺"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "dru",
+ "entity": "乙酰甲胆碱"
+ }
+ ]
+ },
+ {
+ "text": "间接激发试验主要通过刺激支气管内炎性细胞使其释放多种能间接引起支气管狭窄的介质，作用于支气管平滑肌上特异性受体而引起气道收缩。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "间接激发试验"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "支气管内炎性细胞"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "支气管"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "支气管平滑肌"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "气道"
+ }
+ ]
+ },
+ {
+ "text": "目前间接激发试验不论在成人还是儿童应用都很少，尤其是儿童尚没有规范的量化标准。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "间接激发试验"
+ }
+ ]
+ },
+ {
+ "text": "而且特异性抗原刺激危险性较大，可诱发严重的哮喘。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "哮喘"
+ }
+ ]
+ },
+ {
+ "text": "目前大多数支气管激发试验选用前者。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "支气管激发试验"
+ }
+ ]
+ },
+ {
+ "text": "直接支气管激发试验检测方法目前主要有两种：1.用常规通气方法以吸药前的FEV1做对照，间歇吸入不同浓度（或相同浓度）的乙酰甲胆碱或组胺，每吸入1次，检测当时的FEV1。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "直接支气管激发试验"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 49,
+ "type": "ite",
+ "entity": "FEV1"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 74,
+ "type": "dru",
+ "entity": "乙酰甲胆碱"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "dru",
+ "entity": "组胺"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 104,
+ "type": "ite",
+ "entity": "FEV1"
+ }
+ ]
+ },
+ {
+ "text": "一般以FEV1较对照值下降20%的最低累积剂量（PD20-FEV1）或最低累积浓度（PC20-FEV1）为试验的反应阈值，当FEV1下降大于20%对照值或基础值时为激发试验阳性。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "FEV1"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 109,
+ "type": "ite",
+ "entity": "FEV1"
+ }
+ ]
+ },
+ {
+ "text": "2.连续呼吸的Astograph法原理是应用强迫振荡技术进行检测，在连续吸入不同浓度的乙酰甲胆碱时，不断监测呼吸阻力。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "强迫振荡技术"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "乙酰甲胆碱"
+ }
+ ]
+ },
+ {
+ "text": "整个雾化系统包括12个雾化罐，第1罐为生理盐水，第12罐为支气管扩张剂，第2～11罐为浓度依次递增（49～25000μg/mL）的乙酰甲胆碱。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "equ",
+ "entity": "雾化罐"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "生理盐水"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "支气管扩张剂"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 69,
+ "type": "dru",
+ "entity": "乙酰甲胆碱"
+ }
+ ]
+ },
+ {
+ "text": "以吸入生理盐水时的阻力为基础阻力，当呼吸阻力增加到基础阻力的2倍时，改为吸入支气管扩张剂。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "生理盐水"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "支气管扩张剂"
+ }
+ ]
+ },
+ {
+ "text": "最后按照所测出的气道反应阈值得出诊断结果。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "气道"
+ }
+ ]
+ },
+ {
+ "text": "3.注意事项（1）检查前须停药：β受体兴奋剂（沙丁胺醇等）应停用12小时以上，缓释型停用24小时以上；甲基黄嘌呤类（茶碱）普通型停用12小时以上，缓释型停用24小时以上，抗胆碱能类药（异丙溴托胺等）停用12小时以上；抗组织胺类药停用48小时以上；糖皮质激素停用12小时以上，另外避免吸烟、咖啡、可乐饮料等6小时以上；（2）检测前常规肺功能：FEV1＞预计值70%以上。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "β受体兴奋剂"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "沙丁胺醇"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "甲基黄嘌呤类"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "茶碱"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 90,
+ "type": "dru",
+ "entity": "抗胆碱能类药"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 96,
+ "type": "dru",
+ "entity": "异丙溴托胺"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 113,
+ "type": "dru",
+ "entity": "抗组织胺类药"
+ },
+ {
+ "start_idx": 123,
+ "end_idx": 127,
+ "type": "dru",
+ "entity": "糖皮质激素"
+ },
+ {
+ "start_idx": 164,
+ "end_idx": 168,
+ "type": "ite",
+ "entity": "常规肺功能"
+ },
+ {
+ "start_idx": 170,
+ "end_idx": 184,
+ "type": "ite",
+ "entity": "FEV1"
+ }
+ ]
+ },
+ {
+ "text": "（3）检测时监测：激发试验可能会诱发喘息，在检测过程中须加强肺部听诊，准备好支气管舒张剂和抢救设备。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "激发试验"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "喘息"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "pro",
+ "entity": "肺部听诊"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "支气管舒张剂"
+ }
+ ]
+ },
+ {
+ "text": "在检测结束时须给予支气管舒张剂吸入，待患儿常规肺功能恢复FEV1＞预计值70%以上，方可以回家。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "支气管舒张剂"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "常规肺功能"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 42,
+ "type": "ite",
+ "entity": "FEV1"
+ }
+ ]
+ },
+ {
+ "text": "第三节右室双出口右室双出口（doubleoutletsofrightventricle）是指当两根大血管完全或接近完全起自右心室，占出生婴儿的0.032‰。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "doubleoutletsofrightventricle"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "大血管"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "右心室"
+ }
+ ]
+ },
+ {
+ "text": "因此，右室双出口可与双心室、单心室或任何大血管相互关系及任何房室连接类型同时存在。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "双心室"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "单心室"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "大血管"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "房室"
+ }
+ ]
+ },
+ {
+ "text": "【病理解剖】右室双出口不是一种单一的先天性心脏畸形，该术语仅仅用于描述各种心脏畸形时大血管的位置。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "先天性心脏畸形"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "心脏畸形"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "血管"
+ }
+ ]
+ },
+ {
+ "text": "尽管这种心室大血管连接可合并任何类型的心脏节段连接类型，但绝大多数为心房正位，房室连接一致。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "心房"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "房室"
+ }
+ ]
+ },
+ {
+ "text": "大血管相互关系常见的类型有：①主、肺动脉瓣相对关系正常，主动脉瓣位于肺动脉的右后方，此型最多见；②大动脉总干相互平行，主动脉瓣位于右侧，即所谓“Taussing-Bing畸形”；③大动脉总干相互平行，主动脉瓣位于左侧，此型最少见。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "大血管"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "主、肺动脉瓣相对关系正常"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "主动脉瓣位于肺动脉的右后方"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "大动脉总干"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "主动脉瓣"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 86,
+ "type": "dis",
+ "entity": "Taussing-Bing畸形"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "大动脉总干"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "bod",
+ "entity": "主动脉瓣"
+ }
+ ]
+ },
+ {
+ "text": "也有两根大血管有螺旋交叉而主动脉位于肺动脉的左后方者。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "两根大血管有螺旋交叉而主动脉位于肺动脉的左后方"
+ }
+ ]
+ },
+ {
+ "text": "但近30%的右室双出口主动脉瓣位于右侧且与肺动脉瓣在同一水平，近54%的右室双出口主动脉瓣位于肺动脉瓣的右前方。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "主动脉瓣"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "主动脉瓣"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ }
+ ]
+ },
+ {
+ "text": "右室双出口最常见且被广泛接受的分型方法是依据室间隔缺损的位置分为四种类型，即：①伴有主动脉下室间隔缺损的右室双出口；②伴有肺动脉下室间隔缺损的右室双出口；③伴有双动脉下室间隔缺损的右室双出口；④伴有远离大动脉室间隔缺损的右室双出口。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "双动脉"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 88,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 94,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 103,
+ "type": "bod",
+ "entity": "大动脉"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 108,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 114,
+ "type": "dis",
+ "entity": "右室双出口"
+ }
+ ]
+ },
+ {
+ "text": "在临床上的分类为：①伴主动脉下室间隔缺损，主动脉瓣位于肺动脉右侧及右室流出道狭窄（法四型右室双出口）；②伴肺动脉下室间隔缺损，主动脉瓣位于肺动脉右侧；③伴主动脉下室间隔缺损，主动脉瓣位于肺动脉右侧，不伴有右心室流出道狭窄的右室双出口较常见。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "主动脉瓣"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "法四型右室双出口"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 95,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 104,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 107,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 115,
+ "type": "dis",
+ "entity": "右室双出口"
+ }
+ ]
+ },
+ {
+ "text": "从病理解剖学上，无论室间隔缺损为何种类型，室间隔缺损的位置几乎是固定的，即位于隔束的两个分叉之间，而室间隔缺损位置的变化取决于大血管本身的排列、相互关系和流出道室间隔的大小。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "室间隔"
+ }
+ ]
+ },
+ {
+ "text": "据此，在右室双出口的心脏，肌部室间隔仅有流入道及小梁部。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肌部"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "室间隔"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "流入道"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "小梁部"
+ }
+ ]
+ },
+ {
+ "text": "当两根大血管均发自右心室，流出道室间隔（圆锥隔或漏斗部）完全是右心室内的结构。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "室间隔"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "右心室"
+ }
+ ]
+ },
+ {
+ "text": "仅有的例外是当室间隔缺损是肌部流入道或心尖小梁部，或膜周流入道向后主要向流入道延伸，即形成远离大动脉型的室间隔缺损。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肌部流入道"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "心尖小梁部"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "膜周流入道"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "流入道"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "大动脉"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "漏斗部的形态也有许多类型，大动脉瓣近端与室间隔缺损顶部的形态取决于心室漏斗部褶。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "大动脉瓣"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "心室"
+ }
+ ]
+ },
+ {
+ "text": "当两根大血管的空间关系基本正常的情况下，两根大血管短轴连线与室间隔是平行的；此时的流出道相对与室间隔是向右成角且流出道室隔几乎都是与隔束的前臂融合，此时，位于隔束的两臂之间的室间隔缺损位于主动脉下。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "室间隔"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "室间隔"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "前臂"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "臂"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 91,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "主动脉"
+ }
+ ]
+ },
+ {
+ "text": "在极少见的情况下，流出道室间隔明显发育不良甚至缺如时，位于隔束两臂间的室间隔缺损即为双动脉下。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "室间隔"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "发育不良"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "双动脉下"
+ }
+ ]
+ },
+ {
+ "text": "因此，在两根大血管的相互关系基本正常的情况下，室间隔缺损绝大多数是主动脉下，有时是双动脉下，较少见的有远离大动脉型。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "双动脉"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "大动脉"
+ }
+ ]
+ },
+ {
+ "text": "至今尚未见到大动脉位置关系正常而室间隔缺损为肺动脉下的类型。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "大动脉"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺动脉"
+ }
+ ]
+ },
+ {
+ "text": "当两根大血管基本平行且主动脉位于右侧时（Taussing-Bing畸形），两根大血管短轴连线与三尖瓣与动脉瓣间的心室漏斗部褶平行，仅有左位的肺动脉靠近室间隔缺损。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "Taussing-Bing畸形"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "三尖"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "动脉"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "因此，发育良好的流出道间隔与心室漏斗部褶融合形成了肺动脉下室间隔缺损，在很少情况下，流出道室间隔明显发育不良甚至缺如时，室间隔缺损即为双动脉下。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "肺动脉下室间隔缺损"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "双动脉"
+ }
+ ]
+ },
+ {
+ "text": "在双动脉下室间隔缺损时，有可能两根大血管都有骑跨，Brandt等称之为“双心室双出口”伴左位主动脉，流出道室隔亦可与隔束的前支融合，因此可以有室间隔缺损与右后位的肺动脉相通。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "双动脉下室间隔缺损"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "双心室双出口"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "流出道室隔"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "隔束"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "肺动脉"
+ }
+ ]
+ },
+ {
+ "text": "室间隔缺损的底部边界通常由隔束的两个支组成；左右边界可以是流出道间隔、心室游离壁或心室漏斗部褶，主要取决于室间隔缺损本身为主动脉下、肺动脉下或双动脉下。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "隔束"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "心室游离壁"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "心室漏斗部褶"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "主动脉下"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "肺动脉下"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "双动脉下"
+ }
+ ]
+ },
+ {
+ "text": "同时心室漏斗部褶本身亦可影响右室双出口的类型。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "漏斗部褶"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "右室双出口"
+ }
+ ]
+ },
+ {
+ "text": "当该心室漏斗部褶与隔束的后支融合时，室间隔缺损即有了后下边缘，此时对外科医生非常重要，因为该肌束内有传导束并起保护作用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "漏斗部褶"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "隔束"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "dep",
+ "entity": "外科"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "肌束"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "传导束"
+ }
+ ]
+ },
+ {
+ "text": "相反，当后支未向心室-漏斗部褶延伸时，形成二、三尖瓣纤维连接，此时的室间隔缺损为膜周型，传导束通常多在缺损的后下边缘走行。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "传导束"
+ }
+ ]
+ },
+ {
+ "text": "但有一点可以用于区分，即是否在大动脉与房室瓣间有漏斗部肌性分隔。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "大动脉"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "房室"
+ }
+ ]
+ },
+ {
+ "text": "同样，当右室双出口伴有肺动脉瓣下室间隔缺损造成左心室血流直接进入肺动脉时，无论从血流动力学或解剖上均与完全性大血管转位相似，鉴别点是二尖瓣肺动脉瓣的纤维连接，如果存在纤维连接即为完全性大血管转位。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "二尖瓣"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "血管"
+ }
+ ]
+ },
+ {
+ "text": "同时，右室双出口合并心脾综合征并不少见，无脾综合征（双右心房结构）绝大多数合并有完全性肺静脉异位引流，多脾综合征（双左心房结构）常合并有体静脉的回流异常、特别是下腔静脉的奇静脉延续和共同房室瓣。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "右室双出口合并心脾综合征"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "无脾综合征"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "肺静脉异位"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "多脾综合征"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "体静脉"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dis",
+ "entity": "下腔静脉"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "奇静脉"
+ }
+ ]
+ },
+ {
+ "text": "而且还要注意窦房结异位。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "窦房结异位"
+ }
+ ]
+ },
+ {
+ "text": "【病理生理】室间隔缺损与大血管的相对关系、有无合并流出道狭窄及体肺循环的相对阻力决定了患儿的血流动力学状态。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "体肺循环"
+ }
+ ]
+ },
+ {
+ "text": "其血流动力学可类似于室间隔缺损、右心室型单心室、法洛四联症或完全性大血管转位。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "血流"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "右心室型单心室"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "法洛四联症"
+ }
+ ]
+ },
+ {
+ "text": "可有青紫、充血性心力衰竭或两者同时存在。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "青紫、充血性心力衰竭"
+ }
+ ]
+ },
+ {
+ "text": "几乎所有的患儿均有不同程度的低氧血症。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "低氧血症"
+ }
+ ]
+ },
+ {
+ "text": "（一）室间隔缺损位置与氧饱和度关系：所有伴有肺动脉下室间隔缺损的患儿，无论伴或不伴有肺动脉狭窄或肺血管阻塞性疾病，肺循环氧饱和度均高于体循环氧饱和度。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "氧饱和度"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "肺血管阻塞性疾病"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 63,
+ "type": "ite",
+ "entity": "肺循环氧饱和度"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 73,
+ "type": "ite",
+ "entity": "体循环氧饱和度"
+ }
+ ]
+ },
+ {
+ "text": "伴主动脉下室间隔缺损时，约60%的患儿体循环氧饱和度高于肺循环，伴或不伴有肺动脉狭窄或肺血管阻塞性疾病并不一定影响其氧饱和度变化。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "体循环氧饱和度"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺循环"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "肺血管阻塞性疾病"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "氧饱和度"
+ }
+ ]
+ },
+ {
+ "text": "伴双动脉下室间隔缺损时，肺循环氧饱和度多高于体循环氧��和度。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "双动脉"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "肺循环氧饱和度"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "ite",
+ "entity": "体循环氧饱和度"
+ }
+ ]
+ },
+ {
+ "text": "而伴远离大动脉的室间隔缺损时，体、肺循环氧饱和度差异较大。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "大动脉"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "体、肺循环氧饱和度"
+ }
+ ]
+ },
+ {
+ "text": "（二）心室、动脉压力由于主动脉发自右心室，右心室压力接近体循环。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "心室"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "动脉"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "体循环"
+ }
+ ]
+ },
+ {
+ "text": "当存在肺动脉瓣上或瓣下狭窄时，肺动脉压力将明显降低。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肺动脉瓣上或瓣下狭窄"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肺动脉"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】患儿可有青紫、充血性心力衰竭的症状，亦可毫无症状。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "青紫、充血性心力衰竭"
+ }
+ ]
+ },
+ {
+ "text": "其他类型的右室双出口体肺循环平衡良好，往往在新生儿期后才逐渐出现青紫或缺氧发作。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "体肺循环"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "缺氧"
+ }
+ ]
+ },
+ {
+ "text": "伴肺动脉下室间隔缺损的右室双出口常表现为安静时轻度青紫，哭吵后青紫加剧。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "青紫"
+ }
+ ]
+ },
+ {
+ "text": "右室双出口无特异性的体征。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "右室双出口"
+ }
+ ]
+ },
+ {
+ "text": "（一）主动脉下室间隔缺损伴肺动脉狭窄临床表现与法洛四联症相似。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "主动脉下室间隔缺损"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "法洛四联症"
+ }
+ ]
+ },
+ {
+ "text": "第一心音正常，第二心音单一，有时在心尖区可及第三心音。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "第��心音正常"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "第二心音单一"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "有时在心尖区可及第三心音"
+ }
+ ]
+ },
+ {
+ "text": "（二）肺动脉下室间隔缺损伴或不伴有肺动脉狭窄临床表现与完全性大血管转位伴室间隔缺损相似。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肺动脉下室间隔缺损"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "大血管转位"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "伴室间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "通常在婴儿期即表现为青紫和充血性心力衰竭。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "充血性心力衰竭"
+ }
+ ]
+ },
+ {
+ "text": "如伴有肺动脉狭窄时，青紫出现时间更早但常无心力衰竭表现。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "心力衰竭"
+ }
+ ]
+ },
+ {
+ "text": "肺血流量增加者可在心尖部闻及滚动样舒张期杂音。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "肺血流量增加者可在心尖部闻及滚动样舒张期杂音"
+ }
+ ]
+ },
+ {
+ "text": "（三）主动脉下室间隔缺损不伴肺动脉狭窄临床表现与大型室间隔缺损伴肺动脉高压类似。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "主动脉下室间隔缺损"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "肺动脉高压"
+ }
+ ]
+ },
+ {
+ "text": "通常青紫轻微但气急和充血性心力衰竭表现明显，有反复的上呼吸道感染。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "气急"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "充血性心力衰竭"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "上呼吸道感染"
+ }
+ ]
+ },
+ {
+ "text": "（四）主动脉下室间隔缺损伴肺血管阻塞性疾病如上组类型伴有器质性肺高压时，此时肺动脉血流减少，心功能衰竭及反复呼吸道感染少见。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "主动脉下室间隔缺损"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "肺血管阻塞性疾病"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "器质性肺高压"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "心功能衰竭"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "反复呼吸道感染"
+ }
+ ]
+ },
+ {
+ "text": "可出现青紫和杵状指（趾）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "青紫"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "杵状指（趾）"
+ }
+ ]
+ },
+ {
+ "text": "体格检查常无杂音闻及，第二心音响亮而单一，同时可及肺动脉反流所致的舒张期杂音。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "体格检查常无杂音闻及"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "第二心音响亮而单一"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "舒张期杂音"
+ }
+ ]
+ },
+ {
+ "text": "【辅助检查】（一）心电图常表现为窦性心律、电轴右偏及不同程度的右心室肥大，右胸前导联QRS波常表现为qR型。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "心电图"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "窦性心律"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "电轴右偏及不同程度的右心室肥大"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "右胸前导联QRS波常表现为qR型"
+ }
+ ]
+ },
+ {
+ "text": "左心室常不扩大，如果有明显的左心室大则提示有可能合并限制性的室间隔缺损。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "左心室常不扩大"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "（二）胸部X线无特征性的改变，心脏大小及肺血多少取决于当时的血流动力学状态，可为小心脏，肺血减少，也可表现为大心脏，肺血明显增多。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "胸部X线"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "肺血"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "小心脏"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "肺血减少"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "肺血明显增多"
+ }
+ ]
+ },
+ {
+ "text": "（三）超声心动图剑突下扫查对诊断右室双出口非常有用（图9-9），诊断标准为两根大血管全部或大部分发自右心室，双圆锥常见但并不是诊断的必须条件。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "超声心动图"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "剑突"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "右心室"
+ }
+ ]
+ },
+ {
+ "text": "胸骨旁长轴及短轴可检测大血管的相互关系及动脉下圆锥。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "胸骨旁长轴及短轴"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "动脉"
+ }
+ ]
+ },
+ {
+ "text": "由于右心室双出口的解剖类型变化较多且伴发畸形多样，必须进行全面的循序分段诊断。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "右心室双出口"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "畸形"
+ }
+ ]
+ },
+ {
+ "text": "（四）心导管造影在心外手术以前，通常需要通过心导管及造影证实超声心动图诊断并获得详细的血流动力学信息。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "心导管造影"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "心外手术"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "equ",
+ "entity": "心导管"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "造影"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "超声心动图"
+ }
+ ]
+ },
+ {
+ "text": "其血流动力学表现可类似于大分流量的左向右分流、右心室型单心室、法洛四联症、完全性大血管转位及肺动脉狭窄。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "右心室型单心室"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "法洛四联症"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "完全性大血管转位"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ }
+ ]
+ },
+ {
+ "text": "超声心动图所获得的信息可用于选择合适的透照位置以明确大血管的起源及室间隔缺损的位置。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "超声心动图"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ }
+ ]
+ },
+ {
+ "text": "由于大动脉多为侧侧关系且半月瓣在同一水平，采用双向DSA行前后位及侧位投照较为理想（图9-9）。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "大动脉"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "半月瓣"
+ }
+ ]
+ },
+ {
+ "text": "图9-30右室双出口经剑突下超声心动图主动脉、肺动脉分别位于右、左侧，半月瓣位于同一水平，均发自右心室，可见双圆锥，右心室肥厚明显图9-31右室双出口右心室造影主肺动脉均发自右心室，主动脉瓣位于肺动脉瓣的右前方且与肺动脉瓣在同一水平（A.右心室前后位造影；B.右心室侧位造影）【治疗】在治疗以前必须考虑以下几点：双心室修补是否可能？",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "超声心动图"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "半月瓣"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "双圆锥"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 64,
+ "type": "sym",
+ "entity": "右心室肥厚明显"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 74,
+ "type": "dis",
+ "entity": "右室双出口"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 79,
+ "type": "pro",
+ "entity": "右心室造影"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "主肺动脉"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "主动脉瓣"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 100,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 110,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ },
+ {
+ "start_idx": 119,
+ "end_idx": 126,
+ "type": "pro",
+ "entity": "右心室前后位造影"
+ },
+ {
+ "start_idx": 130,
+ "end_idx": 136,
+ "type": "pro",
+ "entity": "右心室侧位造影"
+ },
+ {
+ "start_idx": 156,
+ "end_idx": 160,
+ "type": "pro",
+ "entity": "双心室修补"
+ }
+ ]
+ },
+ {
+ "text": "心室发育是否正常？",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "心室"
+ }
+ ]
+ },
+ {
+ "text": "是否仅可进行Fantan一类的手术��",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "Fantan"
+ }
+ ]
+ },
+ {
+ "text": "如果有可能进行双心室修补，是否存在肺动脉狭窄？",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "双心室修补"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ }
+ ]
+ },
+ {
+ "text": "是否需要人工带瓣管道？",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "人工带瓣管道"
+ }
+ ]
+ },
+ {
+ "text": "在小婴儿，由于生长发育较快，一般须避免使用人工带瓣管道。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "人工带瓣管道"
+ }
+ ]
+ },
+ {
+ "text": "手术而不采用以后必须更换的人工带瓣管道。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "人工带瓣管道"
+ }
+ ]
+ },
+ {
+ "text": "在室间隔缺损关闭后，是否有可能进行循环的转换手术，如有可能，是否可进行大动脉转换术（如冠状动脉是否适合做大动脉转换术）？",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "大动脉转换术"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "冠状动脉"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 57,
+ "type": "pro",
+ "entity": "大动脉转换术"
+ }
+ ]
+ },
+ {
+ "text": "有时关闭室间隔缺损可使患儿得到生存，而有时关闭室间隔缺损并解除肺动脉狭窄可得到良好的效果。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "室间隔缺"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "肺动脉狭窄"
+ }
+ ]
+ },
+ {
+ "text": "一般主张在2岁以后才作根治术，手术的目的是：①建立左心室与主动脉间的通道：用Dacron补片在室间隔缺损与主动脉瓣下流出道间建立人工隧道，注意避免此连接的梗阻，有时需扩大室间隔缺损；②建立右心室与肺动脉间的通路：可通过右心室流出道扩大补片、肺动脉瓣切开或在右心室与肺动脉间用人工带瓣管道连接；③修复伴发畸形。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "根治术"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "左心室"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 45,
+ "type": "equ",
+ "entity": "Dacron补片"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "主动脉瓣下"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "pro",
+ "entity": "人工隧道"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 89,
+ "type": "dis",
+ "entity": "室间隔缺损"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 98,
+ "end_idx": 100,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 111,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 114,
+ "type": "bod",
+ "entity": "流出道"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 118,
+ "type": "equ",
+ "entity": "补片"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 123,
+ "type": "bod",
+ "entity": "肺动脉瓣"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 130,
+ "type": "bod",
+ "entity": "右心室"
+ },
+ {
+ "start_idx": 132,
+ "end_idx": 134,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 137,
+ "end_idx": 142,
+ "type": "pro",
+ "entity": "人工带瓣管道"
+ },
+ {
+ "start_idx": 151,
+ "end_idx": 152,
+ "type": "dis",
+ "entity": "畸形"
+ }
+ ]
+ },
+ {
+ "text": "最近报道，右心室双出口在新生儿期行根治术的死亡率可低至4%～8%。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "右心室双出口"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "根治术"
+ }
+ ]
+ },
+ {
+ "text": "四、新生儿常用基本通气模式（一）持续气道正压持续气道正压（continuouspositiveairwaypressure，CPAP）也称自主呼吸（spontaneousbreathing，Spont），是指有自主呼吸的婴儿在整个呼吸周期中（吸气和呼气）接受呼吸机供给的高于大气压的气体压力，其作用为吸气时气体易于进入肺内，减少呼吸功；呼气时可防止病变肺泡萎陷，增加FRC，改善肺泡通气、血流比，从而升高PaO2。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "持续气道正压"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "持续气道正压"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 60,
+ "type": "pro",
+ "entity": "continuouspositiveairwaypressure"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "CPAP"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "pro",
+ "entity": "自主呼吸"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 93,
+ "type": "pro",
+ "entity": "spontaneousbreathing"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 99,
+ "type": "pro",
+ "entity": "Spont"
+ },
+ {
+ "start_idx": 129,
+ "end_idx": 131,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 159,
+ "end_idx": 159,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 176,
+ "end_idx": 177,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 183,
+ "end_idx": 185,
+ "type": "ite",
+ "entity": "FRC"
+ },
+ {
+ "start_idx": 189,
+ "end_idx": 190,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "主要用于低氧血症、轻型RDS和频发的呼吸暂停。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "轻型RDS"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "呼吸暂停"
+ }
+ ]
+ },
+ {
+ "text": "多主张应用鼻塞CPAP，但因易吞入空气导致腹胀，使用时应放置胃管以排气；经气管插管作CPAP，可增加气道阻力和呼吸功，只是在应用或撤离呼吸机前的短时间内应用。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "鼻塞CPAP"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "equ",
+ "entity": "胃管"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "气管插管"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "CPAP"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "压力一般为3～8cmH2O，压力＞8cmH2O（尤其当肺顺应性改善时）可影响静脉回流及降低心排血量，还会造成潮气量减低和PaCO2升高。",
+ "entities": [
+ {
+ "start_idx": 49,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "心"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 78,
+ "type": "ite",
+ "entity": "潮气量"
+ }
+ ]
+ },
+ {
+ "text": "CPAP不宜使用纯氧作气源。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "CPAP"
+ }
+ ]
+ },
+ {
+ "text": "（二）间歇指令通气间歇指令通气（intermittentmandatoryventilation，IMV）也称为间歇正压通气（intermittentpositivepressureventilation，IPPV）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "间歇指令通气"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "间歇指令通气"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "intermittentmandatoryventilation"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "pro",
+ "entity": "IMV"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 61,
+ "type": "pro",
+ "entity": "间歇正压通气"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 101,
+ "type": "pro",
+ "entity": "intermittentpositivepressureventilation"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 106,
+ "type": "pro",
+ "entity": "IPPV"
+ }
+ ]
+ },
+ {
+ "text": "IMV是指呼吸机以预设的频率、压力和吸、呼气时间对患儿施以正压通气，患儿如有自主呼吸，则按自己的频率和形式进行呼吸，其总的通气量=患儿自主呼吸的通气量+呼吸机正压通气量；患儿接受正压通气的频率=呼吸机的预设频率。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "pro",
+ "entity": "IMV"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "正压通气"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 78,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 92,
+ "type": "pro",
+ "entity": "正压通气"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 99,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "当应用较高频率IMV时，呼吸机可提供完全的通气支持。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "IMV"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "因此，当患儿无自主呼吸时，可应用较高频率的IMV；随着自主呼吸的出现和增强，应相应减低IMV的频率，撤机前则可使IMV的频率降到5～10次/分，减少呼吸机的正压通气，以增强患儿自主呼吸的能力，达到依靠自主呼吸能保证气体交换的目的。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "IMV"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "IMV"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "pro",
+ "entity": "IMV"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "pro",
+ "entity": "正压通气"
+ }
+ ]
+ },
+ {
+ "text": "此方式由于呼吸机送气经常与患儿的呼气相冲突即人机不同步，故可导致小气道损伤、慢性肺疾病、脑室内出血和脑室周围白质软化等的发生。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "小气道损伤"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "慢性肺疾病"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "脑室内出血"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "脑室周围白质软化"
+ }
+ ]
+ },
+ {
+ "text": "（三）同步间歇指令通气同步间歇指令通气（synchronizedintermittentmandatoryventilation，SIMV）是指呼吸机通过识别患儿吸气初期气道压力或气体流速或腹部阻抗的变化，触发呼吸机以预设的频率进行机械通气，即与患儿吸气同步；当患儿呼吸暂停或无自主呼吸时，呼吸机则以设定的频率控制通气。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "同步间歇指令通气"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "同步间歇指令通气"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 63,
+ "type": "pro",
+ "entity": "synchronizedintermittentmandatoryventilation"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "pro",
+ "entity": "SIMV"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 86,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 107,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 119,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 145,
+ "end_idx": 147,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "患儿的吸气只有在呼吸机按预设频率送气前的较短时间内才能触发呼吸机的机械通气，因此，患儿接受正压通气的频率=呼吸机的预设频率。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "正压通气"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "SIMV从根本上解决了人机不同步现象，从而避免了IMV的副作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "SIMV"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "IMV"
+ }
+ ]
+ },
+ {
+ "text": "（四）助-控制通气助-控制通气（assist/controlventilation，A/C）也称为同步间歇正压通气（synchronizedintermittentpositivepressureventilation，SIPPV）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "助-控制通气"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "助-控制通气"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "assist/controlventilation"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "A/C"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 56,
+ "type": "pro",
+ "entity": "同步间歇正压通气"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 108,
+ "type": "pro",
+ "entity": "synchronizedintermittentpositivepressureventilation"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 114,
+ "type": "pro",
+ "entity": "SIPPV"
+ }
+ ]
+ },
+ {
+ "text": "所谓辅助通气是指患儿的自主吸气触发机械通气，机械通气的频率是由自主呼吸的频率所决定；所谓控制通气是指呼吸机按预设的频率进行机械通气。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "辅助通气"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "控制通气"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "A/C是将辅助通气与控制通气相结合的通气模式，当自主呼吸较强时，依靠自主吸气触发机械通气，提供与自主呼吸频率相同并且同步的机械通气；当呼吸微弱或无自主呼吸时，呼吸机则按预设的通气频率进行机械通气，以保证患儿需要的通气量。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "pro",
+ "entity": "A/C"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "辅助通气"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "控制通气"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 81,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 96,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "因此，应用A/C模式时，患儿接受机械通气的频率≥预设的频率。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "A/C"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "当患儿自主呼吸较强和较快时，由于患儿接受机械通气的频率大于预设频率，可产生过度通气，故应及时调低压力或降低触发敏感度（增大其负值），一般触发敏感度设置既要避免过度敏感，导致过多触发，也要避免触发敏感度过低，造成费力触发。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "此外，有关压力支持通气（pressuresupportventilation，PSV）、容量控制通气（volume-controlventilation，VCV）、压力调节容量控制通气（pressureregulatedvolume-controlventilation，PRVC）、适应性支持通气（adaptivesupportventilation，ASV）、压力释放通气（pressurereleaseventilation，FRV）、双相气道正压通气（biphasicpositiveairwaypressure，BI-PAP）、指令分钟通气（mandatoryminuteventilation，MMV）、容量支持通气（vo1umesupportventilation，VSV）及成比率通气（proportionalassistedventilation，PAV）等通气模式，在新生儿不常用或不宜使用，故在此不一一赘述。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "压力支持通气"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "pressuresupportventilation"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "PSV"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 49,
+ "type": "pro",
+ "entity": "容量控制通气"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 75,
+ "type": "pro",
+ "entity": "volume-controlventilation"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "pro",
+ "entity": "VCV"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 91,
+ "type": "pro",
+ "entity": "压力调节容量控制通气"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 134,
+ "type": "pro",
+ "entity": "pressureregulatedvolume-controlventilation"
+ },
+ {
+ "start_idx": 136,
+ "end_idx": 139,
+ "type": "pro",
+ "entity": "PRVC"
+ },
+ {
+ "start_idx": 142,
+ "end_idx": 148,
+ "type": "pro",
+ "entity": "适应性支持通气"
+ },
+ {
+ "start_idx": 150,
+ "end_idx": 175,
+ "type": "pro",
+ "entity": "adaptivesupportventilation"
+ },
+ {
+ "start_idx": 177,
+ "end_idx": 179,
+ "type": "pro",
+ "entity": "ASV"
+ },
+ {
+ "start_idx": 182,
+ "end_idx": 187,
+ "type": "pro",
+ "entity": "压力释放通气"
+ },
+ {
+ "start_idx": 189,
+ "end_idx": 214,
+ "type": "pro",
+ "entity": "pressurereleaseventilation"
+ },
+ {
+ "start_idx": 216,
+ "end_idx": 218,
+ "type": "pro",
+ "entity": "FRV"
+ },
+ {
+ "start_idx": 221,
+ "end_idx": 228,
+ "type": "pro",
+ "entity": "双相气道正压通气"
+ },
+ {
+ "start_idx": 230,
+ "end_idx": 259,
+ "type": "pro",
+ "entity": "biphasicpositiveairwaypressure"
+ },
+ {
+ "start_idx": 261,
+ "end_idx": 266,
+ "type": "pro",
+ "entity": "BI-PAP"
+ },
+ {
+ "start_idx": 269,
+ "end_idx": 274,
+ "type": "pro",
+ "entity": "指令分钟通气"
+ },
+ {
+ "start_idx": 276,
+ "end_idx": 301,
+ "type": "pro",
+ "entity": "mandatoryminuteventilation"
+ },
+ {
+ "start_idx": 303,
+ "end_idx": 305,
+ "type": "pro",
+ "entity": "MMV"
+ },
+ {
+ "start_idx": 308,
+ "end_idx": 313,
+ "type": "pro",
+ "entity": "容量支持通气"
+ },
+ {
+ "start_idx": 315,
+ "end_idx": 338,
+ "type": "pro",
+ "entity": "vo1umesupportventilation"
+ },
+ {
+ "start_idx": 340,
+ "end_idx": 342,
+ "type": "pro",
+ "entity": "VSV"
+ },
+ {
+ "start_idx": 345,
+ "end_idx": 349,
+ "type": "pro",
+ "entity": "成比率通气"
+ },
+ {
+ "start_idx": 351,
+ "end_idx": 381,
+ "type": "pro",
+ "entity": "proportionalassistedventilation"
+ },
+ {
+ "start_idx": 383,
+ "end_idx": 385,
+ "type": "pro",
+ "entity": "PAV"
+ }
+ ]
+ },
+ {
+ "text": "第九章结核病第一节概况结核病（tuberculosis）是由结核杆菌感染引起的慢性感染性疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "tuberculosis"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "mic",
+ "entity": "结核杆菌"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "慢性感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "全身各个器官都可累及，以肺结核病为最常见。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "器官"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "肺结核病"
+ }
+ ]
+ },
+ {
+ "text": "目前在全球范围内，由于耐药结核菌株的出现与扩展，结核病与艾滋病的双重感染，许多国家结核病控制规划不完善，使得全球结核病疫情明显上升并呈持续上升的趋势。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "结核菌"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "艾滋病"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "在全球所有感染性疾病中，结核病已成为成年人的首要死因。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "感染性疾病"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "世界卫生组织于1993年4月向全世界宣布：全球处于结核病紧急状态。",
+ "entities": [
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "同样，我国结核病流行形势也十分严峻。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "30年来由于推广了卡介苗接种及应用抗结核治疗，结核病流行情况大为好转，但由于人口众多，结核病仍为我国常见病。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "卡介苗"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "接种"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "抗结核治疗"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "一、病原结核病的病原为结核杆菌，包括结核分枝杆菌、牛型分枝杆菌和非洲分枝杆菌，属放线菌目、分枝杆菌科。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "结核杆菌"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "结核分枝杆菌"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "mic",
+ "entity": "牛型分枝杆菌"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 37,
+ "type": "mic",
+ "entity": "非洲分枝杆菌"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "mic",
+ "entity": "放线菌"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "mic",
+ "entity": "分枝杆菌"
+ }
+ ]
+ },
+ {
+ "text": "结核杆菌为无芽胞、不运动、多形性，长2～4μm，稍弯曲的革兰弱阳性杆菌。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "结核杆菌"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "革兰弱阳性杆菌"
+ }
+ ]
+ },
+ {
+ "text": "所有分枝杆菌均具有抗酸特性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "分枝杆菌"
+ }
+ ]
+ },
+ {
+ "text": "除了上述引起结核病的分枝杆菌，其他分枝杆菌则称为非结核分枝杆菌。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "结核病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "mic",
+ "entity": "分枝杆菌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "分枝杆菌"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "mic",
+ "entity": "非结核分枝杆菌"
+ }
+ ]
+ },
+ {
+ "text": "这些分枝杆菌在健康人或免疫缺陷的患者，可以引起局限性病变，如局部的淋巴结炎。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "分枝杆菌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "免疫缺陷"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "局限性病变"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "淋巴结炎"
+ }
+ ]
+ },
+ {
+ "text": "第十章小儿血尿的鉴别诊断血尿（hematuria）是儿科泌尿系统疾病最常见的症状，可分为肉眼及镜下血尿。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "小儿血尿的鉴别诊断"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "hematuria"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "dep",
+ "entity": "儿科"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "泌尿系统"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "肉眼及镜下血尿"
+ }
+ ]
+ },
+ {
+ "text": "首先要鉴别是真性血尿还是假性血尿，假性血尿（falsehematuria）常可见于：①非泌尿道出血：阴道出血混入，尤其青春期女孩应排除月经污染。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "真性血尿"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "假性血尿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "假性血尿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "falsehematuria"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "泌尿道"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "非泌尿道出血"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "阴道"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "阴道出血"
+ }
+ ]
+ },
+ {
+ "text": "②红色尿：机体某些代谢产物如卟啉尿可使尿呈红色，酚红、刚果红、氨基比林及柔红霉素等也可使尿呈红色；新生儿期由于尿中排出较多尿酸盐也可使尿布红��；红色尿还见于血红蛋白尿及肌红蛋白尿；某些食物、蔬菜中的色素也使尿呈红色。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "红色尿"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "卟啉尿"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "氨基比林"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dru",
+ "entity": "柔红霉素"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "尿呈红色"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "尿酸盐"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "尿中排出较多尿酸盐"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "红色尿"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "血红蛋白尿"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "肌红蛋白尿"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 106,
+ "type": "sym",
+ "entity": "尿呈红色"
+ }
+ ]
+ },
+ {
+ "text": "鉴别点在于尿镜检时无红细胞。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "尿镜检"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "无红细胞"
+ }
+ ]
+ },
+ {
+ "text": "血尿的检查方法及标准为：取10ml清洁新鲜中段尿（以晨尿为好），以1500转/min离心5分钟，取沉渣镜检，正常人红细胞仅为0～2个/高倍视野（HPF），当红细胞＞3个/HPF则考虑有病理意义。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 87,
+ "type": "sym",
+ "entity": "红细胞＞3个/HPF"
+ }
+ ]
+ },
+ {
+ "text": "出血量超过1ml/L尿液，则可见肉眼血尿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "出血量超过1ml/L尿液"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ }
+ ]
+ },
+ {
+ "text": "大量出血呈烟灰水样，酸性尿时色较暗红，肉眼血尿放置久也呈暗红色。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "大量出血呈烟灰水样"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "酸性尿时色较暗红"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ }
+ ]
+ },
+ {
+ "text": "病毒感染及剧烈运动后偶有一过性血尿，排除方法为3次以上尿镜检。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "病毒感染"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "一过性血尿"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "3次以上尿镜检"
+ }
+ ]
+ },
+ {
+ "text": "【病因】血尿病因复杂，泌尿系统各部位的炎症、畸形、结石、外伤及肿瘤等均可引起血尿，还可见于全身血液系统疾病时因凝血机制障碍而致血尿。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "泌尿系统各部位的炎症、畸形、结石、外伤"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "肿瘤"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "全身血液系统疾病"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "凝血机制障碍"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "sym",
+ "entity": "血尿"
+ }
+ ]
+ },
+ {
+ "text": "但最多见的是肾小球性血尿。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "肾小球性血尿"
+ }
+ ]
+ },
+ {
+ "text": "（一）肾小球性血尿指血尿部位来源于肾小球。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "肾小球性血尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肾小球"
+ }
+ ]
+ },
+ {
+ "text": "1.原发性肾小球疾病如急性、慢性肾小球肾炎，肾病综合征（肾病），急进性肾炎，IgA肾病，遗传性肾炎等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "原发性肾小球疾病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "急性、慢性肾小球肾炎"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "肾病综合征"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "肾病"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "急进性肾炎"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "遗传性肾炎"
+ }
+ ]
+ },
+ {
+ "text": "2.继发性肾小球疾病如系统性红斑狼疮肾炎（LN），紫癜肾炎，乙型肝炎相关性肾炎，溶血尿毒综合征（HUS），肺出血肾炎综合征等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "继发性肾小球疾病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "系统性红斑狼疮肾炎"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "LN"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "紫癜肾炎"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "乙型肝炎相关性肾炎"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "溶血尿毒综合征"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "HUS"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "肺出血肾炎综合征"
+ }
+ ]
+ },
+ {
+ "text": "（二）非肾小球性血尿血尿来源于肾小球以下泌尿系统，肾盏、肾盂、输尿管、膀胱或尿道。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "非肾小球性血尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "泌尿系统"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肾盏"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肾盂"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "输尿管"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "尿道"
+ }
+ ]
+ },
+ {
+ "text": "1.泌尿道急性及慢性感染。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "泌尿道急性及慢性感染"
+ }
+ ]
+ },
+ {
+ "text": "2.肾盂、膀胱及输尿管结石。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肾盂、膀胱及输尿管结石"
+ }
+ ]
+ },
+ {
+ "text": "3.特发性高钙尿症。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "特发性高钙尿症"
+ }
+ ]
+ },
+ {
+ "text": "4.左肾静脉压迫综合征（leftrenalveinentrapmentsyndrome，或称胡桃夹现象nutcrackerphenomenon）。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "左肾静脉压迫综合征"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "leftrenalveinentrapmentsyndrome"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "胡桃夹现象"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 70,
+ "type": "sym",
+ "entity": "nutcrackerphenomenon"
+ }
+ ]
+ },
+ {
+ "text": "6.肿瘤、外伤及异物。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "肿瘤"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "外伤"
+ }
+ ]
+ },
+ {
+ "text": "7.药物所致肾及膀胱损伤如环磷酰胺、磺胺类、氨基糖苷类抗生素如庆大霉素等。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肾及膀胱损伤"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "环磷酰胺"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "磺胺类"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "氨基糖苷类抗生素"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "庆大霉素"
+ }
+ ]
+ },
+ {
+ "text": "8.结核、原虫及螺旋体等感染。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "结核、原虫及螺旋体等感染"
+ }
+ ]
+ },
+ {
+ "text": "9.全身疾病引起的出血，如血小板减少性紫癜、新生儿自然出血症及血友病等。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "血小板减少性紫癜"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "新生儿自然出血症"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "血友病"
+ }
+ ]
+ },
+ {
+ "text": "【诊断与鉴别诊断】病史及体检1.血尿有关病史既往有无肉眼血尿发作史和常规尿检查史；家族中有无肾脏病史及尿毒症者、有无耳聋患者；发病有无前驱感染及诱因；有无发热、皮疹、关节肿痛，便血或咯血史；抗生素、磺胺类药物及环磷酰胺等药物应用史。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "肉眼血尿"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "常规尿检查"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "肾脏病"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "尿毒症"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "耳聋"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 70,
+ "type": "sym",
+ "entity": "前驱感染"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "关节"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 86,
+ "type": "sym",
+ "entity": "关节肿痛"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 89,
+ "type": "sym",
+ "entity": "便血"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 92,
+ "type": "sym",
+ "entity": "咯血"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 97,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 103,
+ "type": "dru",
+ "entity": "磺胺类药物"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 108,
+ "type": "dru",
+ "entity": "环磷酰胺"
+ }
+ ]
+ },
+ {
+ "text": "引起血尿的原因按年龄来分：①新生儿期：可见于新生儿出血、严重缺氧、窒息、肾静脉血栓及急性肾乳头坏死等；②婴幼儿期最常见泌尿系感染及先天性尿路畸形，其次为肾胚胎瘤、肾母细胞瘤、HUS及重症遗传性肾炎，部分良性家族性血尿也在3岁前起病；③儿童期最常见为急性肾炎综合征及各类原发及继发性肾小球肾炎，其次为泌尿系感染、家族性良性血尿、遗传性进行性肾炎、高钙尿症及左肾静脉扩张等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "新生儿出血"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "严重缺氧"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "肾静脉"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "肾静脉血栓"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "急性肾乳头坏死"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "泌尿系"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "泌尿系感染"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "先天性尿路畸形"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "肾胚胎瘤"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "肾母细胞瘤"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 89,
+ "type": "dis",
+ "entity": "HUS"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 97,
+ "type": "dis",
+ "entity": "重症遗传性肾炎"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 107,
+ "type": "sym",
+ "entity": "良性家族性血尿"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 130,
+ "type": "dis",
+ "entity": "急性肾炎综合征"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 144,
+ "type": "dis",
+ "entity": "原发及继发性肾小球肾炎"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 153,
+ "type": "dis",
+ "entity": "泌尿系感染"
+ },
+ {
+ "start_idx": 155,
+ "end_idx": 161,
+ "type": "sym",
+ "entity": "家族性良性血尿"
+ },
+ {
+ "start_idx": 163,
+ "end_idx": 170,
+ "type": "dis",
+ "entity": "遗传性进行性肾炎"
+ },
+ {
+ "start_idx": 172,
+ "end_idx": 175,
+ "type": "dis",
+ "entity": "高钙尿症"
+ },
+ {
+ "start_idx": 177,
+ "end_idx": 182,
+ "type": "dis",
+ "entity": "左肾静脉扩张"
+ }
+ ]
+ },
+ {
+ "text": "2.体格检查对血尿的初诊患儿要做全面的体格检查，包括生长发育状况，有无水肿、高血压及贫血貌；皮肤有无出血点、瘀斑及皮疹；腹部有无包块，肾区有无叩击痛；有无耳聋，特别是神经性耳聋，眼疾等；并检查外生殖器，特别是男孩有无包茎及包皮粘连。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "体格检查"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "体格检查"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "贫血貌"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "出血点"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "瘀斑"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "肾区"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "叩击痛"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "dis",
+ "entity": "耳聋"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "神经性耳聋"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "dis",
+ "entity": "眼疾"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 99,
+ "type": "bod",
+ "entity": "外生殖器"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 109,
+ "type": "sym",
+ "entity": "包茎"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 114,
+ "type": "sym",
+ "entity": "包皮粘连"
+ }
+ ]
+ },
+ {
+ "text": "3.结合病史、临床表现及体格检查综合分析（1）血尿和感染有关：急性肾炎综合征常有较明显的前驱感染病史；病毒感染如腮腺炎或EB病毒感染可出现一过性血尿；细菌性心内膜炎可伴肾梗死出现血尿；流行性出血热有出血、发热和肾衰竭；HUS常有肠道感染史；肾结核不仅有血尿，更多伴脓尿；最常见的泌尿系感染可由细菌、病毒及衣原体等引起，表现血尿伴尿路刺激症状，但小婴儿可仅表现为发热、拒食、哭闹及体重不增等。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "体格检查"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "急性肾炎综合征"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "前驱感染"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "病毒感染"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "腮腺炎"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "EB病毒感染"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "一过性血尿"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 81,
+ "type": "dis",
+ "entity": "细菌性心内膜炎"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "dis",
+ "entity": "肾梗死"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 97,
+ "type": "dis",
+ "entity": "流行性出血热"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 100,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 103,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 107,
+ "type": "dis",
+ "entity": "肾衰竭"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "HUS"
+ },
+ {
+ "start_idx": 114,
+ "end_idx": 117,
+ "type": "dis",
+ "entity": "肠道感染"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 122,
+ "type": "dis",
+ "entity": "肾结核"
+ },
+ {
+ "start_idx": 126,
+ "end_idx": 127,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 132,
+ "end_idx": 133,
+ "type": "sym",
+ "entity": "脓尿"
+ },
+ {
+ "start_idx": 139,
+ "end_idx": 143,
+ "type": "dis",
+ "entity": "泌尿系感染"
+ },
+ {
+ "start_idx": 146,
+ "end_idx": 147,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 150,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 152,
+ "end_idx": 154,
+ "type": "mic",
+ "entity": "衣原体"
+ },
+ {
+ "start_idx": 161,
+ "end_idx": 162,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 164,
+ "end_idx": 165,
+ "type": "bod",
+ "entity": "尿路"
+ },
+ {
+ "start_idx": 164,
+ "end_idx": 169,
+ "type": "sym",
+ "entity": "尿路刺激症状"
+ },
+ {
+ "start_idx": 180,
+ "end_idx": 181,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 183,
+ "end_idx": 184,
+ "type": "sym",
+ "entity": "拒食"
+ },
+ {
+ "start_idx": 186,
+ "end_idx": 187,
+ "type": "sym",
+ "entity": "哭闹"
+ },
+ {
+ "start_idx": 189,
+ "end_idx": 192,
+ "type": "sym",
+ "entity": "体重不增"
+ }
+ ]
+ },
+ {
+ "text": "（2）血尿伴蛋白尿、水肿和高血压：最常见为急性肾炎综合征，当血清补体C3下降且在8周内恢复正常，并有血清抗“O”升高，则可确诊为急性链球菌感染后肾小球肾炎；当血尿伴有进行性少尿及肾功能急骤恶化者考虑急进性肾炎可能性大；儿童期发作性肉眼血尿且和上呼吸道关系密切，则应考虑IgA肾病；持续低补体伴血尿及中度以上蛋白尿多见于膜增殖性肾炎；生长发育障碍、中度以上贫血、持续高血压及肾功能不全首先想到慢性肾炎；血尿伴大量蛋白尿则为肾炎性肾病，病理可见多种形态改变，特别应注意微小病变也有13%可出现镜下血尿。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "急性肾炎综合征"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "血清补体C3"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "血清补体C3下降"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "血清抗“O”升高"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "急性链球菌感染"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "肾小球肾炎"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 87,
+ "type": "sym",
+ "entity": "进行性少尿"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 91,
+ "type": "ite",
+ "entity": "肾功能"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 95,
+ "type": "sym",
+ "entity": "肾功能急骤恶化"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 103,
+ "type": "dis",
+ "entity": "急进性肾炎"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 118,
+ "type": "sym",
+ "entity": "儿童期发作性肉眼血尿"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 124,
+ "type": "bod",
+ "entity": "上呼吸道"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 138,
+ "type": "dis",
+ "entity": "IgA肾病"
+ },
+ {
+ "start_idx": 140,
+ "end_idx": 144,
+ "type": "sym",
+ "entity": "持续低补体"
+ },
+ {
+ "start_idx": 146,
+ "end_idx": 147,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 155,
+ "type": "sym",
+ "entity": "中度以上蛋白尿"
+ },
+ {
+ "start_idx": 159,
+ "end_idx": 164,
+ "type": "sym",
+ "entity": "膜增殖性肾炎"
+ },
+ {
+ "start_idx": 166,
+ "end_idx": 171,
+ "type": "sym",
+ "entity": "生长发育障碍"
+ },
+ {
+ "start_idx": 173,
+ "end_idx": 178,
+ "type": "sym",
+ "entity": "中度以上贫血"
+ },
+ {
+ "start_idx": 180,
+ "end_idx": 184,
+ "type": "sym",
+ "entity": "持续高血压"
+ },
+ {
+ "start_idx": 186,
+ "end_idx": 190,
+ "type": "sym",
+ "entity": "肾功能不全"
+ },
+ {
+ "start_idx": 195,
+ "end_idx": 198,
+ "type": "dis",
+ "entity": "慢性肾炎"
+ },
+ {
+ "start_idx": 200,
+ "end_idx": 201,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 203,
+ "end_idx": 207,
+ "type": "sym",
+ "entity": "大量蛋白尿"
+ },
+ {
+ "start_idx": 210,
+ "end_idx": 214,
+ "type": "dis",
+ "entity": "肾炎性肾病"
+ },
+ {
+ "start_idx": 244,
+ "end_idx": 247,
+ "type": "sym",
+ "entity": "镜下血尿"
+ }
+ ]
+ },
+ {
+ "text": "（3）系统性疾病及遗传性疾病的肾损害：典型的紫癜肾炎及LN不难诊断，但应注意不典型病例及急、重型病例。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "系统性疾病"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "遗传性疾病"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "肾损害"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "紫癜肾炎"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "LN"
+ }
+ ]
+ },
+ {
+ "text": "我科有持续三年血尿伴轻～中度蛋白尿，反复查抗核抗体阴性，最终靠肾活体组织检查为典型免疫荧光表现，始确诊为LN的病例，更有学龄前4～5岁儿童以全身皮疹、贫血及镜下血尿起病的LN者；血尿伴不明原因的发热、消瘦、贫血及咯血史应疑为肺出血肾炎综合征；发热伴面、颈及上胸部潮红，热退后出现低血压、休克、少尿，继而出现血尿应考虑流行性出血热；HUS除血尿及少尿外还有皮肤黏膜出血及黄疸；家族性良性血尿常有明确家族史，当同时伴耳聋、眼疾及肾功能进行性恶化者，尤其是男孩，最多见为Alport综合征。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "轻～中度蛋白尿"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "抗核抗体"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "抗核抗体阴性"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "典型免疫荧光表现"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "LN"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "全身皮疹"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 76,
+ "type": "sym",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "镜下血尿"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 86,
+ "type": "dis",
+ "entity": "LN"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 98,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 101,
+ "type": "sym",
+ "entity": "消瘦"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 104,
+ "type": "sym",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 108,
+ "type": "sym",
+ "entity": "咯血史"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 119,
+ "type": "dis",
+ "entity": "肺出血肾炎综合征"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 122,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 130,
+ "type": "bod",
+ "entity": "面、颈及上胸部"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 132,
+ "type": "sym",
+ "entity": "面、颈及上胸部潮红"
+ },
+ {
+ "start_idx": 139,
+ "end_idx": 141,
+ "type": "sym",
+ "entity": "低血压"
+ },
+ {
+ "start_idx": 143,
+ "end_idx": 144,
+ "type": "sym",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 146,
+ "end_idx": 147,
+ "type": "sym",
+ "entity": "少尿"
+ },
+ {
+ "start_idx": 153,
+ "end_idx": 154,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 158,
+ "end_idx": 163,
+ "type": "sym",
+ "entity": "流行性出血热"
+ },
+ {
+ "start_idx": 165,
+ "end_idx": 167,
+ "type": "sym",
+ "entity": "HUS"
+ },
+ {
+ "start_idx": 169,
+ "end_idx": 170,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 172,
+ "end_idx": 173,
+ "type": "sym",
+ "entity": "少尿"
+ },
+ {
+ "start_idx": 177,
+ "end_idx": 180,
+ "type": "bod",
+ "entity": "皮肤黏膜"
+ },
+ {
+ "start_idx": 177,
+ "end_idx": 182,
+ "type": "sym",
+ "entity": "皮肤黏膜出血"
+ },
+ {
+ "start_idx": 184,
+ "end_idx": 185,
+ "type": "dis",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 187,
+ "end_idx": 193,
+ "type": "sym",
+ "entity": "家族性良性血尿"
+ },
+ {
+ "start_idx": 206,
+ "end_idx": 207,
+ "type": "dis",
+ "entity": "耳聋"
+ },
+ {
+ "start_idx": 209,
+ "end_idx": 210,
+ "type": "dis",
+ "entity": "眼疾"
+ },
+ {
+ "start_idx": 212,
+ "end_idx": 219,
+ "type": "dis",
+ "entity": "肾功能进行性恶化"
+ },
+ {
+ "start_idx": 232,
+ "end_idx": 240,
+ "type": "dis",
+ "entity": "Alport综合征"
+ }
+ ]
+ },
+ {
+ "text": "4.特殊类型血尿包括特发性高钙尿及胡桃夹现象。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "特发性高钙尿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "胡桃夹现象"
+ }
+ ]
+ },
+ {
+ "text": "后者需通过尿红细胞形态、尿Ca/Cr比值、24小时尿钙定量及腹部B超鉴别。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "尿红细胞形态"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "尿Ca/Cr比值"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 28,
+ "type": "ite",
+ "entity": "24小时尿钙定量"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "ite",
+ "entity": "腹部B超"
+ }
+ ]
+ },
+ {
+ "text": "5.肉眼观察带有血凝块多来自下泌尿道，血块或混合黏膜样物质多来自膀胱，滴血多来自尿道。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "下泌尿道"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "带有血凝块多来自下泌尿道"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "膀胱"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "血块或混合黏膜样物质多来自膀胱"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "滴血多来自尿道"
+ }
+ ]
+ },
+ {
+ "text": "尿三杯试验：用三只白色透明容器收集患儿排尿过程中的初、中、终段的尿液（初及中段尿液不得少于20ml）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "尿三杯试验"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "尿液"
+ }
+ ]
+ },
+ {
+ "text": "仅有初段血尿表示病变在尿道；终末滴血示病变在膀胱颈部和三角区、后尿道及前列腺等处；全程血尿则提示肾、输尿管或膀胱。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "尿道"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "病变在尿道"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "终末滴血"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "膀胱颈部和三角区"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "后尿道"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "前列腺"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "病变在膀胱颈部和三角区、后尿道及前列腺"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "输尿管"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "膀胱"
+ }
+ ]
+ },
+ {
+ "text": "6.肾小球性血尿特点肾小球性血尿为全程血尿，无血凝块；可有肾区钝痛；常合并蛋白尿及管型，特别是有红细胞管型更说明血尿来自肾实质；尿沉渣红细胞形态及容积分布曲线检查符合肾小球血尿。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "肾小球性血尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "肾小球性血尿"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "无血凝块"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肾区"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "肾区钝痛"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "合并蛋白尿及管型"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "红细胞管型"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "血尿来自肾实质"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 80,
+ "type": "pro",
+ "entity": "尿沉渣红细胞形态及容积分布曲线检查"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 87,
+ "type": "sym",
+ "entity": "肾小球血尿"
+ }
+ ]
+ },
+ {
+ "text": "【有关实验室检查】（一）尿常规检查常用多联试纸法，可作为过筛及普查，敏感性为90%，但假阳性较高，需进一步做尿沉渣镜检以明确，当离心尿红细胞＞3个/HPF且三次以上则有病理意义；血尿如伴蛋白尿及红细胞管型则多为肾小球病变。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "尿常规检查"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "多联试纸法"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 58,
+ "type": "pro",
+ "entity": "尿沉渣镜检"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "离心尿红细胞"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 76,
+ "type": "sym",
+ "entity": "离心尿红细胞＞3个/HPF"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 95,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 101,
+ "type": "sym",
+ "entity": "红细胞管型"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 107,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 109,
+ "type": "sym",
+ "entity": "肾小球病变"
+ }
+ ]
+ },
+ {
+ "text": "（二）尿红细胞形态近年来采用相差显微镜及扫描电镜观察尿红细胞形态变化，肾实质病变时红细胞通过基底膜受挤压，并受肾小管渗透压作用而变形，故认为当尿中红细胞形态以变形红细胞为主时属肾小球性血尿，其变形程度和肾病变严重性相一致。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "尿红细胞形态"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "equ",
+ "entity": "显微镜"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "equ",
+ "entity": "扫描电镜"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "ite",
+ "entity": "尿红细胞形态"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "肾实质病变"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "基底膜"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "红细胞通过基底膜受挤压"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 77,
+ "type": "ite",
+ "entity": "红细胞形态"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "变形红细胞"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 85,
+ "type": "sym",
+ "entity": "尿中红细胞形态以变形红细胞为主"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "肾小球性血尿"
+ }
+ ]
+ },
+ {
+ "text": "而红细胞形态基本正常、均一则为非肾小球性血尿，多由尿路血管破裂出血而造成。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "非肾小球性血尿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "尿路血管"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "尿路血管破裂出血"
+ }
+ ]
+ },
+ {
+ "text": "当红细胞形态严重变形呈芽胞、环状及穿孔等改变，称为严重变形红细胞，当其数目＞30%以上考虑为肾性血尿，如以均一型红细胞为主，或变形红细胞数目＜10%应考虑为非肾性血尿。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "红细胞形态"
+ },
+ {
+ "start_idx": 1,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "红细胞形态严重变形呈芽胞、环状及穿孔等改变"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "严重变形红细胞"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "肾性血尿"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 58,
+ "type": "ite",
+ "entity": "均一型红细胞"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "以均一型红细胞为主"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 67,
+ "type": "ite",
+ "entity": "变形红细胞"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "变形红细胞数目＜10%"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "非肾性血尿"
+ }
+ ]
+ },
+ {
+ "text": "临床诊断符合率各家报告均在95%左右，但需注意尿中红细胞＜8000个/ml及低比重时不可靠。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "尿中红细胞＜8000个/ml"
+ }
+ ]
+ },
+ {
+ "text": "血细胞自动分析仪测定尿红细胞形态容积分布曲线，对判断血尿来源有一定意义，当尿红细胞平均容积（MCV）＜72fl，且呈小细胞分布，则说明为肾小球血尿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "equ",
+ "entity": "血细胞自动分析仪"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "尿红细胞形态"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "尿红细胞形态容积分布曲线"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "尿红细胞"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "尿红细胞平均容积（MCV）＜72fl"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "小细胞"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "小细胞分布"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 72,
+ "type": "sym",
+ "entity": "肾小球血尿"
+ }
+ ]
+ },
+ {
+ "text": "本法不受、尿比重、pH及主观影响，有一定临床应用价值。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "尿比重"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "pH"
+ }
+ ]
+ },
+ {
+ "text": "（三）血常规及相应的血液系统检查如贫血程度、生血状况（网织红细胞计数、血小板计数、出凝血时间、凝血酶原时间、纤维蛋白原水平及血浆抗凝血酶-Ⅲ（AT-Ⅲ）等对于以血尿表现的各类原发及继发性肾炎、肾衰竭、合并血栓，或全身血液疾病所致血尿的诊断及鉴别诊断有意义。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "血常规"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "血液系统检查"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "贫血程度"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "生血状况"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 33,
+ "type": "ite",
+ "entity": "网织红细胞计数"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "血小板计数"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "出凝血时间"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 52,
+ "type": "ite",
+ "entity": "凝血酶原时间"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 60,
+ "type": "ite",
+ "entity": "纤维蛋白原水平"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "血浆抗凝血酶-Ⅲ"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 74,
+ "type": "ite",
+ "entity": "AT-Ⅲ"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 94,
+ "type": "dis",
+ "entity": "继发性肾炎"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 98,
+ "type": "dis",
+ "entity": "肾衰竭"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "dis",
+ "entity": "合并血栓"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "全身血液疾病"
+ },
+ {
+ "start_idx": 114,
+ "end_idx": 115,
+ "type": "sym",
+ "entity": "血尿"
+ }
+ ]
+ },
+ {
+ "text": "（四）其他肾性血尿相关化验血尿伴蛋白尿要进一步测定24小时尿蛋白定量，当尿蛋白＞1g/24h多明确有肾实质病变；ASO、血补体C3及乙型肝炎相关抗原测定可鉴别肾炎性质；BUN、Cr及Ccr等指标可判断肾功能受损。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "肾性血尿相关化验"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "血尿伴蛋白尿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "ite",
+ "entity": "24小时尿蛋白定量"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "ite",
+ "entity": "尿蛋白"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "尿蛋白＞1g/24h"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "肾实质病变"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "ite",
+ "entity": "ASO"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "ite",
+ "entity": "血补体C3"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 73,
+ "type": "ite",
+ "entity": "乙型肝炎相关抗原"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "肾炎"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 89,
+ "type": "ite",
+ "entity": "Cr"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 93,
+ "type": "ite",
+ "entity": "Ccr"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "dis",
+ "entity": "肾功能受"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "pro",
+ "entity": "肾功能受"
+ }
+ ]
+ },
+ {
+ "text": "（五）尿钙测定当随意尿Ca/Cr＞0.21时，则进一步测定24小时尿钙定量，当尿Ca＞4mg/（kg•d）则应疑为高钙尿症，应查2～3次才能确定。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "尿钙"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "尿Ca/Cr"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "随意尿Ca/Cr＞0.21时"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "24小时尿钙定量"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "ite",
+ "entity": "尿Ca"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "尿Ca＞4mg/（kg•d）"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "高钙尿症"
+ }
+ ]
+ },
+ {
+ "text": "（六）尿细菌检查尿沉渣涂片找细菌、尿细菌计数及尿培养以确定泌尿系感染引起血尿的病因，反复发作者要除外伴有膀胱输尿管反流。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "尿细菌检查"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "equ",
+ "entity": "尿沉渣涂片"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "尿细菌计数"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "尿培养"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "泌尿系"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "泌尿系感染"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "膀胱输尿管"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "膀胱输尿管反流"
+ }
+ ]
+ },
+ {
+ "text": "（七）特殊检查疑为结石引起做腹部平片；B型超声可观察肾脏大小、结构、肾静脉扩张、结石、畸形及肿物，对血尿诊断及鉴别诊断极为重要；静脉肾盂造影及膀胱逆行造影根据需要选用；数字减影血管造影可明确有无动静脉瘘、血管病变及血栓等；肾CT检查可除外占位性病变，但小儿应用较少。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "结石"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "腹部平片"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "B型超声"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肾静脉"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "肾静脉扩张"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "结石"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "畸形"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 69,
+ "type": "pro",
+ "entity": "静脉肾盂造影"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 76,
+ "type": "pro",
+ "entity": "膀胱逆行造影"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 91,
+ "type": "pro",
+ "entity": "数字减影血管造影"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 100,
+ "type": "dis",
+ "entity": "动静脉瘘"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 105,
+ "type": "dis",
+ "entity": "血管病变"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 108,
+ "type": "dis",
+ "entity": "血栓"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 115,
+ "type": "ite",
+ "entity": "肾CT检查"
+ }
+ ]
+ },
+ {
+ "text": "（八）肾活体组织检查可明确肾小球血尿的病因，对指导治疗及判断预后有一定帮助，以下指征可考虑做肾活体组织检查：①血尿伴尿蛋白定量＞1～2g/24h，或伴高血压及氮质血症者；②伴持续补体C3下降者；③有肾炎家族史者；凡尿中的红细胞数量超过正常而无明确的临床症状、实验室改变及肾功能异常者，称为单纯性血尿，如持续半年以上，也应考虑肾活体组织检查。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "肾小球血尿"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 62,
+ "type": "ite",
+ "entity": "血尿伴尿蛋白定量"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "血尿伴尿蛋白定量＞1～2g/24h"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "氮质血症"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 92,
+ "type": "bod",
+ "entity": "补体C3"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 94,
+ "type": "sym",
+ "entity": "持续补体C3下降"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 100,
+ "type": "dis",
+ "entity": "肾炎"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 114,
+ "type": "ite",
+ "entity": "红细胞数量"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 139,
+ "type": "sym",
+ "entity": "尿中的红细胞数量超过正常而无明确的临床症状、实验室改变及肾功能异常"
+ },
+ {
+ "start_idx": 144,
+ "end_idx": 148,
+ "type": "sym",
+ "entity": "单纯性血尿"
+ },
+ {
+ "start_idx": 162,
+ "end_idx": 168,
+ "type": "pro",
+ "entity": "肾活体组织检查"
+ }
+ ]
+ },
+ {
+ "text": "【治疗和预后】血尿较重时适当注意休息，根据不同病因予以相应治疗。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "血尿"
+ }
+ ]
+ },
+ {
+ "text": "血尿是一个多病因的复杂问题，诊断不明确者应长期随访，特别是血尿伴蛋白尿者。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "血尿伴蛋白尿"
+ }
+ ]
+ },
+ {
+ "text": "二、诊断和鉴别诊断（一）临床诊断根据以上呼吸系统表现，加上神经系统、心血管、内脏功能变化的表现，结合血气分析分析，可以初步做出呼吸衰竭的临床诊断。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "呼吸系统"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "心血管"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "内脏"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "pro",
+ "entity": "血气分析"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "（二）血气分析诊���一般认为在海平面大气压水平，吸入空气时，PaCO2＞8kPa，PaO2＜6.67kPa，提示呼吸衰竭。",
+ "entities": [
+ {
+ "start_idx": 77,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "对于小儿急性和慢性呼吸衰竭的血气检查主要有以下特点。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "急性和慢性呼吸衰竭"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "血气检查"
+ }
+ ]
+ },
+ {
+ "text": "1.呼吸性酸中毒动脉血pH＜7.35，PaCO2＞7kPa，PaO2＞8kPa，BE＞-5mmol/L，＞20mmol/L。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "呼吸性酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "多见于急性梗阻性通气障碍、通气-灌流失调。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "急性梗阻性通气障碍"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "通气-灌流失调"
+ }
+ ]
+ },
+ {
+ "text": "2.混合性酸中毒动脉血pH<7.25，PaCO2＞7kPa，PaO2＜8kPa，BE＜-5mmol/L，＜20mmol/L。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "混合性酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "多见于持续低氧血症伴通气、换气障碍，严重通气-灌流失调。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "通气、换气障碍"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "严重通气-灌流失调"
+ }
+ ]
+ },
+ {
+ "text": "3.呼吸性碱中毒动脉血pH＞7.45，PaCO2＜4kPa，PaO2＞8kPa，BE＞5mmol/L，＜20mmol/L。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "呼吸性碱中毒"
+ }
+ ]
+ },
+ {
+ "text": "多见于机械通气过度时。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "机械通气过度"
+ }
+ ]
+ },
+ {
+ "text": "4.代谢性酸中毒合并呼吸性碱中毒表现为动脉血pH＜7.45，PaCO2＜4kPa，PaO2＞8kPa，BE＜-5mmol/L，＜20mmol/L。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "代谢性酸中毒"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "呼吸性碱中毒"
+ }
+ ]
+ },
+ {
+ "text": "可见于呼吸衰竭应用利尿剂后，以及机械通气纠正呼吸性酸中毒后。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "利尿剂"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "呼吸性酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "5.代谢性碱中毒合并呼吸性酸中毒发生代谢性碱中毒的原因与长时间应用碱液、呋塞米、甘露醇、肾上腺皮质激素等药物，吐泻引起的低钾，机械通气掌握不当，以及肾脏调节慢等有关。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "代谢性碱中毒"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "呼吸性酸中毒"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "代谢性碱中毒"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "碱液"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "呋塞米"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dru",
+ "entity": "甘露醇"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "肾上腺皮质激素"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "吐泻"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "低钾"
+ }
+ ]
+ },
+ {
+ "text": "6.氧合指数（oxygenationindex，OI）结合血气参数和机械通气参数可以判断呼吸衰竭的危重程度，可以采用OI［OI=FiO2×MAP×100/PaO2，MAP为平均气道压（cmH2O），可以从呼吸机直接读取，PaO2单位mmHg］。",
+ "entities": [
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 135,
+ "end_idx": 137,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "OI＜5，正常或轻度呼吸功能不全；OI=5～10，呼吸功能不全和呼吸衰竭，如果气体交换有明显障碍，需要机械通气；OI=10～20，中-重度呼吸衰竭，依赖机械通气；OI=20～30，严重呼吸衰竭，可能伴有肺内静-动脉分流，有应用气道滴入肺表面活性物质治疗指征。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "轻度呼吸功能不全"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "呼吸功能不全和呼吸衰竭"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "气体交换有明显障碍"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "中-重度呼吸衰竭"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 95,
+ "type": "dis",
+ "entity": "严重呼吸衰竭"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 101,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 114,
+ "type": "bod",
+ "entity": "气道"
+ }
+ ]
+ },
+ {
+ "text": "OI=30～40，严重呼吸衰竭伴有肺动脉高压和肺外右向左分流，有吸入一氧化氮，体外膜肺等特殊呼吸治疗、生命支持治疗指征。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "吸入一氧化氮"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "体外膜肺"
+ }
+ ]
+ },
+ {
+ "text": "（三）鉴别诊断1.呼吸功能不全单纯使用血气值作为呼吸衰竭的诊断依据并不十分准确。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "呼吸功能不全"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "比如在吸入30%～40%氧后30～60分钟，患儿PaO2＞8kPa，有可能为呼吸功能不全。",
+ "entities": [
+ {
+ "start_idx": 49,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "呼吸功能不全"
+ }
+ ]
+ },
+ {
+ "text": "因此，在对呼吸困难症状出现时，采用持续非介入性正压通气、或气道插管机械通气和气道清洗使黏稠分泌物导致的气道阻塞复通后，呼吸困难症状迅速缓解。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "呼吸困难症状"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "持续非介入性正压通气"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "气道插管机械通气"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "气道清洗"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "气道阻塞"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "呼吸困难"
+ }
+ ]
+ },
+ {
+ "text": "因此，需要与单纯性原发于肺部或肺外疾病演变发展的严重呼吸困难加以区别。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肺"
+ }
+ ]
+ },
+ {
+ "text": "2.急性呼吸窘迫综合征（ARDS）ARDS是与肺部和其他脏器感染等有关的急性肺部炎症损伤导致的临床综合征，因肺泡-毛细血管通透性增加而有严重肺水肿。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "急性呼吸窘迫综合征（ARDS）"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "ARDS"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "急性肺部炎症"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 72,
+ "type": "sym",
+ "entity": "肺水肿"
+ }
+ ]
+ },
+ {
+ "text": "小儿ARDS多为急性起病，主要表现为呼吸窘迫症状，放射学检查为双侧肺弥漫性炎症和渗出改变，血气分析提示严重低氧血症，PaO2/FiO2＜27kPa（200mmHg）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "小儿ARDS"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "呼吸窘迫症状"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "放射学检查"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "双侧肺弥漫性炎症"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "血气分析"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "严重低氧血症"
+ }
+ ]
+ },
+ {
+ "text": "可以合并严重肺内分流和肺动脉高压，应用常规机械通气往往效果差。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "随着急救技术的提高和肺保护性策略的应用，临床预后已有明显改善。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "急救技术"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "肺保护性策略"
+ }
+ ]
+ },
+ {
+ "text": "3.感染性休克和全身性炎症反应综合征小儿感染性休克时可因心肌麻痹、肺血管痉挛、全身炎症反应时毒素刺激等，导致肺部严重损伤和呼吸功能障碍。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "感染性休克"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "全身性炎症反应综合征"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "感染性休克"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "心肌麻痹"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "肺血管痉挛"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "全身炎症"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "肺部严重损伤"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "呼吸功能障碍"
+ }
+ ]
+ },
+ {
+ "text": "此时应及时处理原发病因，采取抗感染和抗休克措施，解除导致呼吸功能障碍的主要原因。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "抗感染"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "抗休克措施"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "呼吸功能障碍"
+ }
+ ]
+ },
+ {
+ "text": "第八节肺的神经内分泌调节功能（一）呼吸道上皮细胞中的神经内分泌细胞分泌5-羟色胺，具有收缩血管、刺激肺呼吸作用在肺血管内皮被单胺氧化酶降解而灭活。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "呼吸道上皮细胞"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "神经内分泌细胞"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "5-羟色胺"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "单胺氧化酶"
+ }
+ ]
+ },
+ {
+ "text": "血液中的去甲肾上腺素也在肺血管内皮中被单胺氧化酶和儿茶酚胺甲基转化酶降解。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "去甲肾上腺素"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "单胺氧化酶"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "儿茶酚胺甲基转化酶"
+ }
+ ]
+ },
+ {
+ "text": "循环中95%血管紧张素Ⅰ（AT-Ⅰ）在肺内皮细胞的血管紧张素转化酶作用下，由10肽变为8肽的AT-Ⅱ和7肽的AT-Ⅲ，活性分别提高50倍或25～30倍。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "血管紧张素Ⅰ"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "AT-Ⅰ"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肺内皮细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "血管紧张素转化酶"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "AT-Ⅱ"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "AT-Ⅲ"
+ }
+ ]
+ },
+ {
+ "text": "肺内产生的或循环中的前列腺素如PGE、PGF也在肺血管内皮降解和灭活，但PGI2则不被灭活。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "前列腺素"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "PGE"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "PGF"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "PGI2"
+ }
+ ]
+ },
+ {
+ "text": "（二）肥大细胞和IgE肥大细胞多分布在小支气管和细支气管黏膜浅层，其细胞质含有异染颗粒。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肥大细胞"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "IgE"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肥大细胞"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "小支气管"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "细支气管黏膜"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "细胞质"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "异染颗粒"
+ }
+ ]
+ },
+ {
+ "text": "肥大细胞膜表面有大量IgE的Fc段受体。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "肥大细胞膜"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "IgE的Fc段受体"
+ }
+ ]
+ },
+ {
+ "text": "当IgE与受体结合后，肥大细胞即致敏，在同种小剂量抗原与细胞膜表面结合的IgE再次结合时，诱发经钙离子介导的细胞脱颗粒作用。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "IgE"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肥大细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "mic",
+ "entity": "抗原"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "细胞膜"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "IgE"
+ }
+ ]
+ },
+ {
+ "text": "（三）肺巨噬细胞巨噬细胞在肺组织内分布不同，肺泡内者称为肺泡巨噬细胞，直径20～40μm，具有活跃的吞噬功能，可以清除细菌、病毒、吸入物颗粒、衰老坏死的细胞，抗肿瘤，调节肺表面活性物质磷脂代谢。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肺巨噬细胞"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肺组织"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "肺泡巨噬细胞"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 91,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "巨噬细胞-粒细胞集落刺激因子调节巨噬细胞功能。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ }
+ ]
+ },
+ {
+ "text": "先天性巨噬细胞-粒细胞集落刺激因子缺陷，可以使肺泡巨噬细胞无功能，导致肺泡磷脂代谢异常，可能为肺泡蛋白沉积症的发生原因。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肺泡巨噬细胞"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "肺泡蛋白沉积症"
+ }
+ ]
+ },
+ {
+ "text": "第五节新生儿呼吸窘迫综合征新生儿呼吸窘迫综合征（respiratorydistresssyndrome，RDS），也称为肺透明膜病（hyalinemembranedisease，HMD）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "新生儿呼吸窘迫综合征"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "新生儿呼吸窘迫综合征"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "肺透明膜病"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 91,
+ "type": "dis",
+ "entity": "HMD"
+ }
+ ]
+ },
+ {
+ "text": "其基本特点为肺发育不成熟、肺表面活性物质缺乏而导致的肺泡不张、肺液转运障碍、肺毛细血管-肺泡间高通透性渗出性病变。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "肺泡不张"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "肺液转运障碍"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肺毛细血管-肺泡"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "肺毛细血管-肺泡间高通透性渗出性病变"
+ }
+ ]
+ },
+ {
+ "text": "以机械通气和肺表面活性物质替代疗法治疗为主的呼吸治疗和危重监护技术，已经能够使90%以上的RDS患儿存活。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "肺表面活性物质替代疗法"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "呼吸治疗"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "危重监护技术"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "【临床流行病学】RDS主要发生在早产儿，其发生率和严重程度与胎龄及出生体重呈反比。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "2006年，EuroNeoStat的数据显示RDS发病率在胎龄23～25周早产儿为91%，26～27周88%，28～29周74%，30～31周52%。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "RDS发病率占所有新生儿的1%，尤其多见于胎龄32周以下的早产儿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "美国资料显示，在胎龄29周内出生的早产儿中RDS的发病率可以高达60%，但在胎龄40周时基本不发生。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "发生RDS的高危因素包括男性、双胎，前一胎有RDS病史、母亲患糖尿病、剖宫产且无产程发动等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "糖尿病"
+ }
+ ]
+ },
+ {
+ "text": "低龄怀孕、孕期吸烟、吸毒、药物、妊娠高血压等也与RDS发生相关。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "羊膜早破（分娩前24～48小时）则会降低RDS发生的危险性，可能为胎儿处于应激下，肾上腺激素分泌，促进了肺成熟；但一般认为胎儿宫内窘迫与RDS的发生没有直接关系，但会影响到早产儿生后早期的呼吸适应，如呼吸费力和肺液清除延缓等，其发生可以达50%。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肾上腺激素"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "sym",
+ "entity": "呼吸费力"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 110,
+ "type": "sym",
+ "entity": "肺液清除延缓"
+ }
+ ]
+ },
+ {
+ "text": "肺表面活性物质可以降低RDS病死率。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "Curosurf（固尔苏）临床研究中对照组病死率为50%，治疗组为30%，使RDS净存活率提高20%。",
+ "entities": [
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "20世纪90年代初的临床研究表明，肺表面活性物质治疗使RDS的生存率提高到75%，在多剂量治疗时可以提高到80%～90%。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "美国在20世纪80年代末开始常规应用肺表面活性物质治疗RDS，在1989—1990年间1岁以下婴儿病死率由8.5%下降为6.3%，主要为RDS死亡率的下降。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "【病因及发病机制】1.因肺发育不成熟，过低的表面活性物质使肺泡气液界面表面张力升高，肺泡萎陷，使功能余气量下降，肺顺应性曲线下移，顺应性下降，无效腔通气，呼吸做功显著增加，能量耗竭，导致全身脏器功能衰竭。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "表面活性物质"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 100,
+ "type": "sym",
+ "entity": "全身脏器功能衰竭"
+ }
+ ]
+ },
+ {
+ "text": "2.不成熟肺的肺泡数量和通气面积太少，肺泡间隔宽，气体弥散和交换严重不足。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "3.呼气末肺泡萎陷，通气困难，出现低氧血症，使肺泡上皮细胞合成表面活性物质能力下降。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肺泡上皮细胞"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "4.持续低氧导致肺血管痉挛，出现肺动脉高压，肺血流减少，肺外右向左分流，肺内动静脉分流，使通气-灌流比例失调，影响气血交换。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "持续低氧"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肺血管痉挛"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肺内动静脉"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "肺血流减少，肺外右向左分流，肺内动静脉分流"
+ }
+ ]
+ },
+ {
+ "text": "5.持续低氧和酸中毒可以造成心肌损害，心输出量下降，全身性低血压、低灌流，最后出现以呼吸衰竭为主的多脏器衰竭。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "持续低氧"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "心肌损害"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "心输出量下降"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "ite",
+ "entity": "低血压"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "全身性低血压"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "低灌流"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "以呼吸���竭为主的多脏器衰竭"
+ }
+ ]
+ },
+ {
+ "text": "【病理组织学】大体解剖时，肺多为实变，外观显暗红色，水中下沉。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺"
+ }
+ ]
+ },
+ {
+ "text": "机械通气后的肺泡可以局部扩张，未经机械通气的RDS患儿肺主要表现为不张、充血和水肿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "肺主要表现为不张、充血和水肿"
+ }
+ ]
+ },
+ {
+ "text": "显微镜下肺泡萎陷，上皮细胞多立方状、少扁平状，肺泡间隔宽、充气少，细小支气管、肺泡导管和肺泡扩张，上皮细胞脱落坏死，有呈嗜伊红色膜内衬，为透明膜形成。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "equ",
+ "entity": "显微镜"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 66,
+ "type": "sym",
+ "entity": "呈嗜伊红色膜内衬"
+ }
+ ]
+ },
+ {
+ "text": "已经通过气的肺则主要为小气道损伤，为肺泡不张的继发性改变。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "小气道损伤"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "肺微血管和毛细血管中可以有血栓形成、出血。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肺微血管"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "毛细血管"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "血栓形成、出血"
+ }
+ ]
+ },
+ {
+ "text": "【病理生理】由于肺表面活性物质的分泌合成作用下降，肺表面活性物质再循环途径的阻断，或者因肺泡腔内液体过多（转运障碍、高渗出），均可以使肺表面活性物质不足。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "病理性渗出液含大量血浆蛋白，在肺泡腔内干扰和抑制肺表面活性物质功能。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "血浆蛋白"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "出生时吸入、肺炎、肺发育不良、肺出血以及窒息缺氧性损害等出生早期病况均可与上述病理生理相关。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "肺发育不良"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "肺出血"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "窒息缺氧性损害"
+ }
+ ]
+ },
+ {
+ "text": "早产儿肺内肺表面活性物质的磷脂总量只有足月儿的10%～30%或更低，且缺乏SP-A、B、C等主要肺表面活性物质蛋白，因而在数量和质量上均劣于足月儿，是发生RDS的主要原因。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "肺表面活性物质蛋白"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "应用外源性肺表面活性物质制剂可以迅速提高肺内的肺表面活性物质含量。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "外源性肺表面活性物质制剂"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "将肺表面活性物质经气道滴入RDS患儿肺内后，肺表面活性物质磷脂会立即被肺泡上皮细胞摄取，并逐渐强化内源性肺表面活性物质的功能活性，特别是促使SP-A、B、C的合成分泌。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肺内"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺表面活性物质磷脂"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肺泡上皮细胞"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】RDS主要发生在早产儿，尤其在胎龄小于32周、出生体重低于2000g的早产儿。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "可以是刚一出生即出现症状或出生后6小时内发病，表现为呼吸困难症状，如呼吸频率加快（＞60次/分）或呼吸浅弱，鼻翼扇动，呼气呻吟，锁骨上、肋间和胸骨下吸气性凹陷（“三凹征”），青紫。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "呼吸困难"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "呼吸频率加快"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "呼吸浅弱"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "鼻翼"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "鼻翼扇动"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "呼气呻吟"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 85,
+ "type": "sym",
+ "entity": "锁骨上、肋间和胸骨下吸气性凹陷（“三凹征”）"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "青紫"
+ }
+ ]
+ },
+ {
+ "text": "这类症状呈进行性加重，并可发生呼吸暂停。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "呼吸暂停"
+ }
+ ]
+ },
+ {
+ "text": "典型的X线胸片显示RDS早期的肺部网状细颗粒影和后期的毛玻璃状（“白肺”）征象以及相对增强的支气管充气征，伴早产儿胸廓和肺容积偏小特征。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "X线胸片"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "肺部"
+ }
+ ]
+ },
+ {
+ "text": "血气分析显示酸中毒、低氧血症和高碳酸血症。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "血气分析"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "高碳酸血症"
+ }
+ ]
+ },
+ {
+ "text": "如果持续低氧血症和酸中毒不能纠正，患儿可以并发肺动脉高压、呼吸与心力衰竭，可在48～72小时内死亡。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "呼吸与心力衰竭"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "死亡"
+ }
+ ]
+ },
+ {
+ "text": "经辅助或强制通气的患儿在3～5天后，随内源性肺表面活性物质增多，症状会好转，表现为自限性恢复的特点。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "内源性肺表面活性"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）卵磷脂/鞘磷脂比（L/S）羊水中L/S比值＜1，胎儿发生RDS危险性可达100%；L/S＞2，发生RDS的危险性＜1%。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "L/S"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "同一胎龄小儿的L/S可以变化很大，因此单纯用L/S不能判断是否发生RDS，但可以作为预防的指征。",
+ "entities": [
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "羊水中磷脂酰甘油（PG）和SP-A也可以作为判断肺成熟的辅助指标，两者在接近出生前偏低，提示肺不成熟。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "肺"
+ }
+ ]
+ },
+ {
+ "text": "在肺不成熟的胎儿，如果L/S、PG、SP-A均很低，发生RDS的危险性非常高。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "测定气道吸出液或出生后早期胃液的以上指标，也可以辅助判断RDS治疗效果及转归。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "胃液"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "也有研究应用显微镜微泡计数法，检测气道清洗液或胃液中微小气泡与大气泡比例，间接判断内源性肺表面活性物质含量与活性，可有助于床旁快速判断RDS疾病程度和治疗效果。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "equ",
+ "entity": "显微镜"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "胃液"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "内源性肺表面活性物质"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "（二）血气分析为最主要实验室检查。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "血气分析"
+ }
+ ]
+ },
+ {
+ "text": "患儿呼吸治疗时必须测定动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）和pH。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "动脉血氧分压"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 35,
+ "type": "ite",
+ "entity": "二氧化碳分压"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "pH"
+ }
+ ]
+ },
+ {
+ "text": "发病早期，PaO2＜6.5kPa（50mmHg），PaCO2＞8kPa（60mmHg），pH＜7.20，BE＜-5.0mmol/L，应考虑低氧血症、高碳酸血症、代谢性酸中毒，经吸氧或辅助通气治疗无改善，可转为气道插管和呼吸机治疗，避免发生严重呼吸衰竭。",
+ "entities": [
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "ite",
+ "entity": "pH"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 84,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 90,
+ "type": "dis",
+ "entity": "高碳酸血症"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 97,
+ "type": "dis",
+ "entity": "代谢性酸中毒"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 101,
+ "type": "pro",
+ "entity": "吸氧"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 108,
+ "type": "pro",
+ "entity": "辅助通气治疗"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 119,
+ "type": "pro",
+ "entity": "气道插管"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 125,
+ "type": "pro",
+ "entity": "呼吸机治疗"
+ },
+ {
+ "start_idx": 131,
+ "end_idx": 136,
+ "type": "sym",
+ "entity": "严重呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "一般在开始机械通气后1～3小时以及随后2～3天的每12～24小时，需要检查动脉血气值，以判断病情转归和调节呼吸机参数，以保持合适的通气量和氧供。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "动脉血气"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "【诊断与鉴别诊断】根据上述临床表现及胸部X线的表现，诊断不难。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "胸部X线"
+ }
+ ]
+ },
+ {
+ "text": "需要鉴别诊断的疾病有：（一）新生儿湿肺又称暂时性呼吸困难或肺液转运障碍。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "新生儿湿肺"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "暂时性呼吸困难"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "肺液转运障碍"
+ }
+ ]
+ },
+ {
+ "text": "X线胸片特征为肺门纹理增强，肺泡、叶间、间质积液，肺血管充血，肺气肿等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "X线胸片"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肺门"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "叶间"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "间质"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "间质积液"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "肺血管充血"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "肺气肿"
+ }
+ ]
+ },
+ {
+ "text": "如果经吸氧临床症状没有改善或吸氧加重时，宜采用持续气道正压通气（CPAP）或气道插管机械通气治疗，一般24～72小时X线检查见肺液快速吸收和呼吸急促症状的缓解。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "吸氧"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "吸氧"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "正压通气"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "CPAP"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "气道插管机械通气治疗"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "pro",
+ "entity": "X线检查"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 68,
+ "type": "sym",
+ "entity": "肺液快速吸收"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 78,
+ "type": "sym",
+ "entity": "呼吸急促症状的缓解"
+ }
+ ]
+ },
+ {
+ "text": "（二）B族溶血性链球菌（GBS）肺炎可见于早产、近足月和足月新生儿，母亲妊娠后期有感染及羊膜早破史，临床发病特点同早产儿RDS，可以有细菌培养阳性。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "B族溶血性链球菌（GBS）肺炎"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "羊膜早破"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "胸部X线检查表现为肺叶或节段炎症特征及肺泡萎陷征，临床有感染征象，病程1～2周。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "胸部X线检查"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肺叶"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "肺叶或节段炎症"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "肺泡萎陷征"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "感染"
+ }
+ ]
+ },
+ {
+ "text": "治疗以出生后最初3天采用联合广谱抗生素，如氨苄西林加庆大霉素，随后应用7～10天氨苄西林或青霉素，剂量要參考最小抑菌浓度，避免因剂量偏低导致失去作用。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "联合广谱抗生素"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "氨苄西林"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "庆大霉素"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "氨苄西林"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "（三）遗传性SP-B缺乏症又称为“先天性肺表面活性物质蛋白缺乏症”，于1993年在美国发现，目前全世界有100多例经分子生物学技术诊断明确的患儿。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "遗传性SP-B缺乏症"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "先天性肺表面活性物质蛋白缺乏症"
+ }
+ ]
+ },
+ {
+ "text": "发病原因为调控SP-B合成的DNA序列碱基突变。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "SP-B"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "DNA"
+ }
+ ]
+ },
+ {
+ "text": "临床上表现为足月出生的小儿出现进行性呼吸困难，经任何治疗干预无效。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "进行性呼吸困难"
+ }
+ ]
+ },
+ {
+ "text": "肺病理表现类似早产儿RDS，肺活检发现SP-B蛋白和SP-BmRNA缺乏，并可以伴前SP-C合成与表达的异常，其肺组织病理类似肺泡蛋白沉积症。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "早产儿RDS"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "肺活检"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "SP-B蛋白"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "SP-BmRNA"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "肺组织"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "肺泡蛋白沉积症"
+ }
+ ]
+ },
+ {
+ "text": "外源性肺表面活性物质治疗仅能暂时缓解症状，患儿多依赖肺移植，否则多在1岁内死亡。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "外源性肺表面活性物质"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "肺移植"
+ }
+ ]
+ },
+ {
+ "text": "【预防】预防RDS的主要手段包括预期产程并及时做好接生和早产儿复苏急救准备，还可以通过产前评估、产前母体糖皮质激素以及出生后肺表面活性物质的预防性给药，达到预防RDS发生的目的。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "糖皮质激素"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "肺表面活性物质在妊娠22～24周胎儿肺中出现，25周左右已可在羊水中检测出，在32～35周大量合成。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "羊水"
+ }
+ ]
+ },
+ {
+ "text": "肺表面活性物质在足月出生的新生儿肺内非常丰富，且具有很高的表面活性，但在32周以下出生的早产儿，特别是28周以下出生、体重低于1000g的超低出生体重儿，60%～80%可以发生呼吸窘迫。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肺内"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 91,
+ "type": "sym",
+ "entity": "呼吸窘迫"
+ }
+ ]
+ },
+ {
+ "text": "产前给予糖皮质激素治疗，一般产前使用激素的最佳时间为分娩前24小时～7天，给予地塞米松每次6mg，2～4次，每次间隔12～24小时；或倍他米松，每次12mg，每天1次，共2次，可以显著降低24～34周早产新生儿RDS发生率和新生儿死亡接近50%，并可以减少新生儿脑室内出血。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "糖皮质激素治疗"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "dru",
+ "entity": "地塞米松"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 107,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 131,
+ "end_idx": 133,
+ "type": "bod",
+ "entity": "脑室内"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 135,
+ "type": "sym",
+ "entity": "新生儿脑室内出血"
+ }
+ ]
+ },
+ {
+ "text": "对于早产儿出生后立即预防性气道内给予肺表面活性物质可以减少RDS发生。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "��治疗】（一）辅助呼吸治疗1.氧疗可以部分改善低氧血症，其作用原理为提高局部通气-灌流差的肺泡内氧分压，使局部痉挛血管舒张，减少右向左分流，提高动脉氧饱和度。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "辅助呼吸治疗"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "氧疗"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "ite",
+ "entity": "氧分压"
+ }
+ ]
+ },
+ {
+ "text": "持续高氧（FiO2＞0.5）24小时以上可以导致肺水肿和炎症，严重者出现支气管发育不良（BPD）和眼球后视神经血管损害。",
+ "entities": [
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "肺水肿"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "支气管发育不良"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "BPD"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "眼球后视神经血管损害"
+ }
+ ]
+ },
+ {
+ "text": "2.经鼻持续气道正压通气（CPAP）简易水封瓶CPAP装置，或带有湿化器的专用CPAP装置产品，比较简单，使用方便，但存在氧浓度无法控制和调节、压力不稳定、易诱发气胸等并发症的缺点。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "经鼻持续气道正压通气"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "equ",
+ "entity": "CPAP装置"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "equ",
+ "entity": "湿化器"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 44,
+ "type": "equ",
+ "entity": "CPAP装置"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "气胸"
+ }
+ ]
+ },
+ {
+ "text": "CPAP装置供氧浓度连续可调（21%～100%），气流流量可变（0～12L/min），并具有供气压力上限报警和安全卸压（11cmH2O）阀门装置，在治疗中可以保持供气压力稳定，显著提高使用的安全性和有效性，减少气胸等并发症，尤其适用于<1500g体重的早产儿和极低出生体重儿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "equ",
+ "entity": "CPAP装置"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 112,
+ "type": "dis",
+ "entity": "气胸"
+ }
+ ]
+ },
+ {
+ "text": "经1～3天治疗后，如果PEEP可以下调至0～1cmH2O以下，供氧浓度在25%以下，仍可维持SpO2达到88%～93%，可以转为短时间头罩吸氧至停止呼吸治疗。",
+ "entities": [
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "pro",
+ "entity": "头罩吸氧"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 89,
+ "type": "pro",
+ "entity": "呼吸治疗"
+ }
+ ]
+ },
+ {
+ "text": "3.气道插管和呼吸机治疗应用指征一般考虑经头罩或CPAP治疗6～12小时以上病情无改善，且继续加重，可以考虑气道插管和机械通气。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "气道插管"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "呼吸机治疗"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "equ",
+ "entity": "头罩"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "CPAP治疗"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "pro",
+ "entity": "气道插管"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "临床采用机械通气的一般原则为：FiO2＞0.5，呼吸机参数设定为吸气时间（Ti）最初在0.3～0.4秒，呼气末正压（PEEP）在3～6cmH2O，通气频率（f）为50～60次/分，气道峰压（PIP）在20～30cmH2O，以可见胸廓运动为适宜，潮气量（VT）通气6～8ml/kg体重，达到PaO2在50～70mmHg，PaCO2在45～55mmHg。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "如果出现呼吸对抗，可以考虑采用镇静剂和肌肉松弛剂，或调节同步触发通气。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "镇静剂"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "肌肉松弛剂"
+ }
+ ]
+ },
+ {
+ "text": "严重呼吸衰竭时伴有肺动脉高压者，可以吸入一氧化氮（NO），高频振荡通气（HFOV）也可以治疗早产儿RDS，在缺乏肺表面活性物质制剂或常频机械通气效果不良时选用HFOV，可能迅速改善通气障碍，缩短呼吸机治疗时间，并降低CLD发生危险性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "一氧化氮"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "NO"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "高频振荡通气"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "HFOV"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "早产儿RDS"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 64,
+ "type": "dru",
+ "entity": "肺表面活性物质制剂"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 71,
+ "type": "pro",
+ "entity": "常频机械通气"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "pro",
+ "entity": "HFOV"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 99,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "参数调节原则上以动脉PaCO2不出现急剧变化为适宜，避免导致脑血流迅速下降，诱发继发性缺血缺氧性脑损伤。",
+ "entities": [
+ {
+ "start_idx": 51,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "继发性缺血缺氧性脑损伤"
+ }
+ ]
+ },
+ {
+ "text": "（二）液体治疗由于RDS早期有肺液转运障碍和肺血管高通透性水肿，出生后最初3天进液量可以控制在50～70ml/（kg•d），然后逐渐提高到80～100ml/（kg•d）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "液体治疗"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "肺液"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "肺液转运障碍"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺血管"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "肺血管高通透性水肿"
+ }
+ ]
+ },
+ {
+ "text": "密切监测血电解质，酌情给予钠盐，避免因皮肤薄、非显性失水等原因导致高钠血症和脑损害。",
+ "entities": [
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "高钠血症"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "脑损害"
+ }
+ ]
+ },
+ {
+ "text": "在用补液治疗高钠血症时，可能会导致高血糖，可以视情况经胃管输入液体。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "补液"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "高钠血症"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "血糖"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "高血糖"
+ }
+ ]
+ },
+ {
+ "text": "补充胶体液亦应谨慎，因由于高血管通透性会使输入蛋白沉着于肺间质，使间质胶体渗透压增加，加重间质肺液滞留。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺间质"
+ }
+ ]
+ },
+ {
+ "text": "碳酸氢钠液可以稀释后缓慢静脉推注，不主张持续滴注。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "碳酸氢钠液"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "静脉推注"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "持续滴注"
+ }
+ ]
+ },
+ {
+ "text": "RDS患儿会因低氧血症使细胞钠-钾ATP酶功能低下和肾功能不全，出现高钾血症，因此出生早期不必补钾。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "高钾血症"
+ }
+ ]
+ },
+ {
+ "text": "出生后会出现短时间甲状旁腺功能低下，可以适当补充钙剂。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "钙剂"
+ }
+ ]
+ },
+ {
+ "text": "（三）血压维持早产儿外周血压低于30mmHg时，脑血流低灌注可以导致脑损伤。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "血压维持"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "脑损伤"
+ }
+ ]
+ },
+ {
+ "text": "低血压可能与血容量过低有关。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "低血压"
+ }
+ ]
+ },
+ {
+ "text": "可以按10～20ml/kg输入血浆等液体以提高血压，同时给予多巴胺和多巴酚丁胺5～15μg/（kg•min）。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "多巴胺"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "多巴酚丁胺"
+ }
+ ]
+ },
+ {
+ "text": "纠正低血压要避免剧烈血压波动，否则会诱发脑出血。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "低血压"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "脑出血"
+ }
+ ]
+ },
+ {
+ "text": "在有肺动脉高压时，目前不主张用全身性扩张血管药物，因可造成全身血管舒张导致低血压。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "肺动脉"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "全身血管舒张导致低血压"
+ }
+ ]
+ },
+ {
+ "text": "可以考虑应用关闭动脉导管药物和吸入NO等治疗方式。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "关闭动脉导管药物"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "吸入NO"
+ }
+ ]
+ },
+ {
+ "text": "（四）护理对极低体重新生儿RDS，可通过伺服控制方式，调节环境温度在36.5～37℃，控制肛温在37℃。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "护理"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "新生儿RDS"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "ite",
+ "entity": "肛温"
+ }
+ ]
+ },
+ {
+ "text": "不主张反复气道吸引、改变体位等护理，以减少因过多刺激带来脑血流剧烈波动导致颅内出血。",
+ "entities": [
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "颅内出血"
+ }
+ ]
+ },
+ {
+ "text": "动脉留置导管主要在发病早期稳定后应该及时拔掉，避免医源性损害。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "equ",
+ "entity": "动脉留置导管"
+ }
+ ]
+ },
+ {
+ "text": "俯卧位可以应用于机械通气时，可以促进背部肺泡扩张，改善局部肺泡的通气灌流失调。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "（五）营养在RDS急性期不给予脂肪乳剂，因脂肪乳剂会对于低氧性肺血流下降产生不利影响。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "营养"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "脂肪乳剂"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "脂肪乳剂"
+ }
+ ]
+ },
+ {
+ "text": "对于贫血者，可以输血和补充红细胞成分等，保持红细胞压积在40%～50%。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "输血"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "补充红细胞成分"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "（六）抗生素应用如果考虑为GBS感染，在做血培养后应用氨苄西林和庆大霉素预防性治疗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "GBS感染"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "氨苄西林"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "庆大霉素"
+ }
+ ]
+ },
+ {
+ "text": "如果血培养阴性，外周白细胞计数为正常范围，可以停用抗生素。",
+ "entities": [
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "一般应用抗生素为1周。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "如果母亲在分娩前已经应用过抗生素，对血培养阴性者必须根据临床状况处理。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "对于呼吸机治疗过程中出现气道清洗液培养细菌阳性，可以根据是否为致病菌和药敏试验结果来决定抗生素是否应用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "equ",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "（七）肺表面活性物质治疗20世纪80～90年代，国际儿科新生儿医学最突出成果是应用外源性肺表面活性物质（pulmonarysurfactant）对RDS的研究在临床预防和治疗的成功。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "肺表面活性物质治疗"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "dep",
+ "entity": "儿科"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "外源性肺表面活性物质"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "1959年，美国MaryEllenAvery医师首次提出HMD的病因是肺表面活性物质缺乏。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "HMD"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "1980年，日本藤原泽郎（TetsuroFujiwara）医师首次报道了应用牛肺表面活性物质制剂治疗10例HMD成功。",
+ "entities": [
+ {
+ "start_idx": 38,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "牛肺表面活性物质制剂"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "HMD"
+ }
+ ]
+ },
+ {
+ "text": "1990年以来，发达国家和地区已普遍应用肺表面活性物质预防和治疗RDS。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "1.肺表面活性物质制剂目前国外常规应用的肺表面活性物质制剂为牛和猪肺提取物，富含磷脂和一定量的SP-B和C，不含SP-A，其中以Survanta（牛肺，美国）、Infasurf（小牛肺、美国）、Curosurf（猪肺，意大利）为代表。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "肺表面活性物质制剂"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "肺表面活性物质制剂"
+ }
+ ]
+ },
+ {
+ "text": "肺表面活性物质制剂应用指征仅限于新生儿RDS，但也有应用于新生儿和婴幼儿肺部炎症、吸入性损伤等的报道，有一定疗效。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "肺表面活性物质制剂"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "新生儿RDS"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "吸入性损伤"
+ }
+ ]
+ },
+ {
+ "text": "外源性肺表面活性物质的代谢主要为肺泡Ⅱ型上皮细胞的摄取和再利用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "外源性肺表面活性物质"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肺泡Ⅱ型上皮细胞"
+ }
+ ]
+ },
+ {
+ "text": "动物研究显示治疗剂量的肺表面活性物质磷脂的生物半衰期为30～40小时，肺内清除速率为每小时2%～4%。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肺表面活性物质磷脂"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肺内"
+ }
+ ]
+ },
+ {
+ "text": "应用稳定同位素的人体研究发现，新生儿肺通过摄取原料合成肺表面活性物质磷脂（磷脂酰胆碱）的速率为每天肺内总量的2%～4%，或4.2mg/（kg•d），但半衰期长达5～6天。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肺表面活性物质磷脂"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "磷脂酰胆碱"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "肺"
+ }
+ ]
+ },
+ {
+ "text": "2.肺表面活性物质预防性治疗RDS的指征出生体重1000克以下常规应用，一般在出生后15～30分钟气道插管后滴入100mg/kg，以防止RDS的发生。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "气道插管"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "临床试验的的结论表明对于部分婴儿是有利的，但从经济上看，可能对相当一部分原本不发生RDS的婴儿做了不必要的治疗，因而不主张广泛使用，而局限于对小胎龄极低出生体重儿和珍贵儿有选择地使用。",
+ "entities": [
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "对于胎龄在30～35周、中度呼吸困难的RDS患儿，即使单纯呼吸机治疗，也可以在3～4天后恢复，而不需要依赖外源性表面活性物质治疗。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "中度呼吸困难"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 61,
+ "type": "dru",
+ "entity": "外源性表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "3.表面活性物质救治性（rescue）治疗RDS的指征对于已经出现RDS临床征象的早产儿，可以在机械通气下气道滴入100～200mg/kg，并调节呼吸机参数，保持合适的通气压力，避免出现气漏等并发症。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "表面活性物质"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 75,
+ "type": "equ",
+ "entity": "呼吸机"
+ }
+ ]
+ },
+ {
+ "text": "肺表面活性物质治疗的疗效首先为用药后短时期内氧合状况的改善。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "肺表面活性物质治疗"
+ }
+ ]
+ },
+ {
+ "text": "可以表现为血氧分压的迅速提高，一般给药后几分钟到1～2小时内可以使动脉氧分压提高50%以上，吸入氧浓度下调10%～20%以上。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "血氧分压"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "ite",
+ "entity": "氧分压"
+ }
+ ]
+ },
+ {
+ "text": "相应的可以将机械通气的吸气峰压减少3～4cmH2O。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "疗效不佳的原因，除了表面活性物质制剂本身外，主要与RDS肺内有肺表面活性物质耗竭，缺氧对肺泡组织细胞合成肺表面活性物质的抑制，肺泡毛细血管高通透性致大量血浆蛋白渗出，抑制内源性肺表面活性物质活性有关。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "表面活性物质制剂"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "缺氧"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "肺泡组织细胞"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "肺泡毛细血管"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 94,
+ "type": "bod",
+ "entity": "内源性肺表面活性物质"
+ }
+ ]
+ },
+ {
+ "text": "（一）支气管肺发育不良（bronchopulmonarydysplasia，BPD）为继发性慢性肺部病变，早产儿特别是经较长时间氧疗和机械通气可诱发，表现为生后2～3周对机械通气和吸入氧的依赖，严重病例肺部有放射学上纤维化的表现。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "支气管肺发育不良"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "BPD"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "继发性慢性肺部病变"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "氧疗"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 70,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 88,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 102,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 110,
+ "type": "sym",
+ "entity": "肺部有放射学上纤维化"
+ }
+ ]
+ },
+ {
+ "text": "呋塞米，静脉1mg/kg，一天2次，口服2mg/（kg•d）；氢氯噻嗪，2mg/kg，一天2次，与氯化钾同时服用；氨茶碱剂量控制以血浓度保持为12～15mg/L为安全有效。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "呋塞米"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "氢氯噻嗪"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "dru",
+ "entity": "氯化钾"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "氨茶碱"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "ite",
+ "entity": "血浓度"
+ }
+ ]
+ },
+ {
+ "text": "地塞米松治疗在出生后第4周开始，0.25mg/kg，一天2次，每1～2天剂量减半至0.01～0.02mg/kg，一天2次，总疗程在5～7天，以尽量减少皮质激素的不良反应，如高血糖、消化道出血、肾上腺皮质功能抑制、败血症、生长迟缓等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "地塞米松"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 78,
+ "type": "dru",
+ "entity": "皮质激素"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "高血糖"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 92,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 94,
+ "type": "sym",
+ "entity": "消化道出血"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 100,
+ "type": "bod",
+ "entity": "肾上腺皮质"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 104,
+ "type": "sym",
+ "entity": "肾上腺皮质功能抑制"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 108,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 113,
+ "type": "sym",
+ "entity": "生长迟缓"
+ }
+ ]
+ },
+ {
+ "text": "如果皮质激素治疗7天无效，应放弃该疗法。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "皮质激素"
+ }
+ ]
+ },
+ {
+ "text": "治疗效果以小儿依赖呼吸机和高氧治疗的状况缓解、体重增加、没有感染等并发症来判断。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "高氧治疗"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "高氧治疗的状况缓解"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "体重增加"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "没有感染"
+ }
+ ]
+ },
+ {
+ "text": "（二）气胸及纵隔气漏气胸和气漏（纵隔气肿、间质气肿）是RDS的主要并发症，一般需要行胸腔插管闭式引流。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "纵隔气漏"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "气漏"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "纵隔气肿"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "间质气肿"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 49,
+ "type": "pro",
+ "entity": "胸腔插管闭式引流"
+ }
+ ]
+ },
+ {
+ "text": "主要预防手段为柔和的复苏手法和小潮气量机械通气，或采用新型CPAP装置，可以通过稳定通气压力降低其发生率。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "小潮气量机械通气"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 34,
+ "type": "equ",
+ "entity": "新型CPAP装置"
+ }
+ ]
+ },
+ {
+ "text": "目前，经肺表面活性物质治疗后的发生率可以减到10%以下。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "肺表面活性物质治疗"
+ }
+ ]
+ },
+ {
+ "text": "（三）肺出血肺出血为严重临床并发症，一般止血药物往往难以奏效。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "肺出血"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肺出血"
+ }
+ ]
+ },
+ {
+ "text": "约有2%～7%的经肺表面活性物质治疗的新生儿可以并发肺出血。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "肺表面活性物质治疗"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "肺出血"
+ }
+ ]
+ },
+ {
+ "text": "有报道应用肺表面活性物质制剂治疗肺出血有效，但对于早产极低出生体重儿预后差。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "肺表面活性物质制剂"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "肺出血"
+ }
+ ]
+ },
+ {
+ "text": "（四）持续动脉导管开放持续动脉导管开放（PDA）多见于经肺表面活性物质治疗后的RDS患儿。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "持续动脉导管开放"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "持续动脉导管开放"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "PDA"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "肺表面活性物质治疗"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "为使关闭动脉导管，可以在出生后第3天起，静脉给予吲哚美辛（indomethacin）或布洛芬（ibuprofen）治疗。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "equ",
+ "entity": "动脉导管"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "吲哚美辛"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "dru",
+ "entity": "布洛芬"
+ }
+ ]
+ },
+ {
+ "text": "如果无效，可以手术结扎使之关闭。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "手术结扎"
+ }
+ ]
+ },
+ {
+ "text": "【足月儿RDS】（一）足月儿原发性RDS一般见于窒息后有肺水肿的足月儿。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "足月儿原发性RDS"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "肺水肿"
+ }
+ ]
+ },
+ {
+ "text": "大部分没有胎粪污染羊水，而无早产儿发生RDS的情况，但可以有产前和产时窒息史，使肺泡上皮细胞的肺液清除功能下降。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肺泡上皮细胞"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "肺液"
+ }
+ ]
+ },
+ {
+ "text": "同时，可以有胸片肺野渗出似炎症、心影大、二尖瓣和三尖瓣关闭不全、低血压、肝脏增大、少尿等症状。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "二尖瓣"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "三尖瓣"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "胸片肺野渗出似炎症、心影大、二尖瓣和三尖瓣关闭不全、低血压、肝脏增大、少尿"
+ }
+ ]
+ },
+ {
+ "text": "彩超检查可以发现心脏收缩力和心输出量下降等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "彩超检查"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "心脏"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "心脏收缩力和心输出量下降"
+ }
+ ]
+ },
+ {
+ "text": "但一般在机械通气和纠正低氧、酸中毒后，会在24小时恢复。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "低氧"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "（二）足月儿获得性RDS随着年龄的增加，发生RDS的比例逐渐降低，但是由于非医学适应证剖宫产比例的增高，即使达37周，发生RDS的比例仍可达4%左右。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "足月儿获得性RDS"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "RDS"
+ }
+ ]
+ },
+ {
+ "text": "此类患儿与早产儿RDS在临床症状和放射学检查上相似，而不同于窒息后肺水肿，其没有窒息史及心功能低下。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "早产儿RDS"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "放射学检查"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "肺水肿"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "窒息"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "心功能低下"
+ }
+ ]
+ },
+ {
+ "text": "可能为表面活性物质相对缺乏，可以考虑用外源性表面活性物质治疗，如果效果不好，则可以用高频震荡通气（HFOV）等治疗手段。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "表面活性物质"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "外源性表面活性物质治疗"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "高频震荡通气"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "HFOV"
+ }
+ ]
+ },
+ {
+ "text": "（三）先天性肺泡蛋白沉积症和表面活性物质蛋白B缺乏发病原因为调控SP-B合成的DNA序列碱基突变。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "先天性肺泡蛋白沉积症"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "表面活性物质蛋白B缺乏"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "SP-B"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "DNA"
+ }
+ ]
+ },
+ {
+ "text": "临床上表现为足月出生小儿进行性呼吸困难，经任何治疗干预无效。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "小儿进行性呼吸困难"
+ }
+ ]
+ },
+ {
+ "text": "肺病理表现类似早产儿RDS，肺活检发现SP-B蛋白和SP-BmRNA缺乏，而前SP-C（proSPC）基因表达提高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "早产儿RDS"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "肺活检"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "SP-B蛋白"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "SP-BmRNA"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "SP-B蛋白和SP-BmRNA缺乏"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "前SP-C"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "proSPC"
+ }
+ ]
+ },
+ {
+ "text": "肺组织病理类似肺泡蛋白沉积症。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "肺组织"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "肺泡蛋白沉积症"
+ }
+ ]
+ },
+ {
+ "text": "外源性肺表面活性物质治疗仅能暂时缓解症状，不能治愈，患儿多在1岁内死亡，或者依赖肺移植。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "外源性肺表面活性物质治疗"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "肺移植"
+ }
+ ]
+ },
+ {
+ "text": "六、对重复肾活检的认识重复肾活检的目的在于了解疾病的演变过程，观察药物治疗效果及判断预后，在临床及科研工作中有重要的价值。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "重复肾活检"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "重复肾活检"
+ }
+ ]
+ },
+ {
+ "text": "除一些列为临床观察及科研的病例行重复肾活检外，无论哪种类型的肾脏疾病，只要治疗效果不佳，经过一定时期的随访，病理类型有可能发生变化者，均为重复肾活检的对象。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "重复肾活检"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "肾脏疾病"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 73,
+ "type": "pro",
+ "entity": "重复肾活检"
+ }
+ ]
+ },
+ {
+ "text": "当然患者的临床及其他实验室检查条件必须符合一般肾活检的指征。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "实验室检查"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "肾活检"
+ }
+ ]
+ },
+ {
+ "text": "临床工作中，较常进行重复肾活检的疾病包括下述三种：①各种原发及继发性肾小球疾病，如新月体性肾炎、抗GBM肾炎、狼疮性肾炎、紫癜性肾炎和坏死性血管炎肾损害等；②经正规治疗临床症状不缓解，血尿、蛋白尿持续者，如以蛋白尿为主的局灶节段性肾小球肾炎、膜性肾病、系膜病变及以血尿为主的IgA肾炎等；③临床过程发生突然变化如肾移植后排斥等。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "重复肾活检"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "原发及继发性肾小球疾病"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "新月体性肾炎"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "抗GBM肾炎"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "狼疮性肾炎"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "紫癜性肾炎"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "坏死性血管炎肾损害"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 97,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 106,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 119,
+ "type": "dis",
+ "entity": "局灶节段性肾小球肾炎"
+ },
+ {
+ "start_idx": 121,
+ "end_idx": 124,
+ "type": "dis",
+ "entity": "膜性肾病"
+ },
+ {
+ "start_idx": 126,
+ "end_idx": 129,
+ "type": "dis",
+ "entity": "系膜病变"
+ },
+ {
+ "start_idx": 132,
+ "end_idx": 133,
+ "type": "sym",
+ "entity": "血尿"
+ },
+ {
+ "start_idx": 137,
+ "end_idx": 141,
+ "type": "dis",
+ "entity": "IgA肾炎"
+ },
+ {
+ "start_idx": 156,
+ "end_idx": 158,
+ "type": "pro",
+ "entity": "肾移植"
+ }
+ ]
+ },
+ {
+ "text": "二、新生儿后期贫血新生儿后期贫血主要是指出生1周以后发生的贫血，一般多为慢性贫血，主要有以下几种类型：（一）新生儿生理性贫血新生儿生理性贫血是指足月儿生后6～12周时血红蛋白下降至95～110g/L，主要原因有：在宫内，胎儿血氧饱和度约50%，相对缺氧状态使促红细胞生成素含量较高，红细胞较多，出生后血氧饱和度显著增高，促红细胞生成素分泌明显减少，红细胞产生减少。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "新生儿生理性贫血"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "新生儿生理性贫血"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 86,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 116,
+ "type": "ite",
+ "entity": "血氧饱和度"
+ },
+ {
+ "start_idx": 129,
+ "end_idx": 135,
+ "type": "bod",
+ "entity": "促红细胞生成素"
+ },
+ {
+ "start_idx": 141,
+ "end_idx": 143,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 150,
+ "end_idx": 154,
+ "type": "ite",
+ "entity": "血氧饱和度"
+ },
+ {
+ "start_idx": 160,
+ "end_idx": 166,
+ "type": "bod",
+ "entity": "促红细胞生成素"
+ },
+ {
+ "start_idx": 174,
+ "end_idx": 176,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "新生儿红细胞寿命较短。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "（二）早产儿贫血早产儿贫血是早产儿（尤其是极低出生体重儿）的常见现象，严重者影响早产儿的生长发育，因此早产儿贫血并非生理性。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "早产儿贫血"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "早产儿贫血"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "早产儿贫血"
+ }
+ ]
+ },
+ {
+ "text": "早产儿贫血的主要临床表现为苍白、气急、心率增快、烦躁不安或淡漠、食欲下降、喂养困难、体重不增。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "苍白"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "气急"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "心率增快"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "烦躁不安"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "淡漠"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "食欲下降"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "喂养困难"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "体重不增"
+ }
+ ]
+ },
+ {
+ "text": "胎龄越小，出生体重越低，贫血出现越早，程度越严重，持续时间越长。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "胎龄越小"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "出生体重越低"
+ }
+ ]
+ },
+ {
+ "text": "（三）新生儿晚期贫血晚期贫血是指部分Rh血型不合溶血病患儿在生后2～6周发生明显贫血。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "新生儿晚期贫血"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "晚期贫血"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "Rh血型不合溶血病"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "贫血"
+ }
+ ]
+ },
+ {
+ "text": "这是由于部分Rh血型不合溶血病患儿早期症状不严重，不需换血治疗，但Rh血型抗体却在体内持续存在较长时间（超过1～2个月），继续溶血而导致晚期贫血。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "部分Rh血型不合溶血病"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "换血治疗"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "Rh血型抗体"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "溶血"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "晚期贫血"
+ }
+ ]
+ },
+ {
+ "text": "第五节微生物学检查呼吸道感染的病原学诊断极为重要，在指导抗生素的合理应用和疾病的预防中起关键作用。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "微生物学检查"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "具体方法因病原菌而异。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "病原菌"
+ }
+ ]
+ },
+ {
+ "text": "一、细菌学检查对上呼吸道标本培养结果的解释要特别小心，因为上呼吸道正常情况下就存在许多微生物，包括小儿肺炎常见的病原菌，如肺炎链球菌、流感嗜血杆菌等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "细菌学检查"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "上呼吸道"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "标本培养"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "上呼吸道"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "小儿肺炎"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "mic",
+ "entity": "病原菌"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "mic",
+ "entity": "肺炎链球菌"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 72,
+ "type": "mic",
+ "entity": "流感嗜血杆菌"
+ }
+ ]
+ },
+ {
+ "text": "因而从呼吸道分泌物中分离出细菌并不代表它们在呼吸道感染中的致病作用。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "呼吸道分泌物"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ }
+ ]
+ },
+ {
+ "text": "咽拭子细菌培养主要应用于链球菌咽炎的诊断。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "咽拭子细菌培养"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "链球菌咽炎"
+ }
+ ]
+ },
+ {
+ "text": "要压下舌根以免被口腔菌污染。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "舌根"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "口腔菌"
+ }
+ ]
+ },
+ {
+ "text": "正常情况下喉、气管以下均为无菌区，这些部位采集的标本均可送细菌室分析，一旦培养阳性，理论上均有诊断意义。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "喉"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "气管"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dep",
+ "entity": "细菌室"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "阳性"
+ }
+ ]
+ },
+ {
+ "text": "但在实际操作过程中，无一例外地受到口腔、鼻咽部细菌的污染，有时送检的可能不是痰液，而是唾液。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "口腔"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "鼻咽部"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "痰液"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "唾液"
+ }
+ ]
+ },
+ {
+ "text": "在细菌室，送检标本最多的是痰，而痰中培养出的细菌种类和数量与通过肺穿刺所得的结果一致性很差。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "dep",
+ "entity": "细菌室"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "痰"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "痰"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "肺穿刺"
+ }
+ ]
+ },
+ {
+ "text": "因而必须用直接Gram染色镜检筛选痰标本，以确定痰标本的质量。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "Gram染色镜检"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "痰"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "痰"
+ }
+ ]
+ },
+ {
+ "text": "在低倍镜下（100倍）检查每个视野的鳞状上皮细胞如超过10个（也有人认为超过25个），即可判定为不合格痰标本。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "equ",
+ "entity": "低倍镜"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "equ",
+ "entity": "鳞状上皮细胞"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "痰"
+ }
+ ]
+ },
+ {
+ "text": "除一般培养外，可根据病例情况进行特殊培养，如结核菌培养、厌氧菌培养。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "mic",
+ "entity": "结核菌"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "mic",
+ "entity": "厌氧菌"
+ }
+ ]
+ },
+ {
+ "text": "痰定量培养可提供较为正确的病原学诊断，一般认为当细菌数超过105CFU/ml时有诊断意义。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "痰定量培养"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "为减少标本受污染的机会，可通过纤维支气管镜下保护性毛刷或特殊的气囊导管进行支气管肺泡灌洗取得标本进行培养，亦可通过肺穿刺吸引获取标本。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "equ",
+ "entity": "纤维支气管镜"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "equ",
+ "entity": "保护性毛刷"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "equ",
+ "entity": "气囊导管"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 43,
+ "type": "pro",
+ "entity": "支气管肺泡灌洗"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "pro",
+ "entity": "肺穿刺"
+ }
+ ]
+ },
+ {
+ "text": "胸水、血培养阳性可作为细菌性肺炎的重要诊断依据，但其阳性率不高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "胸水、血培养阳性"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "细菌性肺炎"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "阳性"
+ }
+ ]
+ },
+ {
+ "text": "此外亦可通过乳胶凝集试验、对流免疫电泳等血清学方法测定血液或尿液中的细菌抗原进行诊断。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "乳胶凝集试验"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "对流免疫电泳"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "血清学方法"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "尿液"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "mic",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "活泼好动，活动范围增大，大脑思维能力明显增强，智力发育迅速，是学习知识和培养生活自理能力的良好阶段。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "大脑"
+ }
+ ]
+ },
+ {
+ "text": "此期的儿童易缺乏的营养素为钙、铁、锌、维生素A和维生素B2等，而且正值乳牙更换期，充足供给钙质可保证恒牙的正常生长。",
+ "entities": [
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "乳牙"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "恒牙"
+ }
+ ]
+ },
+ {
+ "text": "五、肾活检绝对及相对禁忌证（一）绝对禁忌证指临床上有明显出血倾向的患者，孤立肾或对侧肾脏已切除者、多囊肾或肾脏囊性病变、肾脏肿瘤以及动脉瘤也都不宜行肾活检。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "肾活检"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "出血倾向"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "孤立肾"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "多囊肾"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "肾脏囊性病变"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "肾脏肿瘤"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 68,
+ "type": "dis",
+ "entity": "动脉瘤"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "pro",
+ "entity": "肾活检"
+ }
+ ]
+ },
+ {
+ "text": "（二）相对或暂时禁忌证1.终末期肾脏疾病慢性肾衰竭时作肾活检危险性大，易出现并发症，由于肾脏萎缩常使穿刺成功率降低，即使取得足够的肾组织，但由于病变严重，正常结构消失，已被纤维化的组织所替代，因而难以确定原发病，因此过去此类疾病不列为肾活检的指征。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "慢性肾衰竭"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "肾活检"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "pro",
+ "entity": "穿刺"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "肾组织"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 119,
+ "type": "pro",
+ "entity": "肾活检"
+ }
+ ]
+ },
+ {
+ "text": "近年来，由于对慢性肾衰竭患者治疗的进展、透析疗法的普及以及穿刺的安全性也有所提高，因此，我们主张对肾脏大小尚在正常范围内的肾衰竭患者应争取作肾活检，以确定是否存在活动性、可逆性病变。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "慢性肾衰竭"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "透析疗法"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "穿刺"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "肾衰竭"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 72,
+ "type": "pro",
+ "entity": "肾活检"
+ }
+ ]
+ },
+ {
+ "text": "对于萎缩肾，目前仍认为是穿刺的禁忌证。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "萎缩肾"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "穿刺"
+ }
+ ]
+ },
+ {
+ "text": "2.对侧肾功能不良为防止穿刺发生并发症，应避免行健侧。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "对侧肾功能不良"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "穿刺"
+ }
+ ]
+ },
+ {
+ "text": "3.肾脏感染性病变如肾结核、脓肿和活动性肾盂肾炎，穿刺易致感染扩散，因此不做肾穿刺。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肾脏感染性病变"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肾结核"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "脓肿"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "活动性肾盂肾炎"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "穿刺"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "易致"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "肾穿刺"
+ }
+ ]
+ },
+ {
+ "text": "4.难以控制的高血压穿刺后出血机会明显增多。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "穿刺"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "出血"
+ }
+ ]
+ },
+ {
+ "text": "5.肾活检的相对禁忌证还包括严重贫血、血容量不足、心功能不全以及肾钙化等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "肾活检"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "血容量不足"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "心功能不全"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "肾钙化"
+ }
+ ]
+ },
+ {
+ "text": "九、水痘肺炎水痘肺炎（varicellapneumonia）由水痘-带状疱疹病毒引起，为全身性疾病，可发生支气管炎和间质性肺炎。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "水痘肺炎"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "水痘肺炎"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "varicellapneumonia"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "水痘-带状疱疹病毒"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "支气管炎"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "间质性肺炎"
+ }
+ ]
+ },
+ {
+ "text": "年龄越小越易发生肺炎。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "多在水痘发生1周内，表现咳嗽，肺部有湿性啰音，X线检查呈现双肺野结节性浸润阴影。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "水痘"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "咳嗽"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "湿性啰音"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "X线检查"
+ }
+ ]
+ },
+ {
+ "text": "水痘患儿如出现呼吸道症状和体征，应考虑本病。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "水痘"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "呼吸道"
+ }
+ ]
+ },
+ {
+ "text": "部分年幼婴儿，水痘肺炎可出现在皮疹之前，极易误诊和漏诊。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "水痘肺炎"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "皮疹"
+ }
+ ]
+ },
+ {
+ "text": "因而有明确水痘接触史者，如发生肺炎，亦应考虑本病，并予以隔离。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "水痘"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "二、供肾的选择儿童肾移植具有更广泛的供肾来源，成人供肾移植给10岁以上的儿童，技术操作与成人肾移植无差别；成人肾移植给婴幼儿需克服手术操作中的一些困难；体重7～8kg以下的婴幼儿宜使用儿童供肾；取自5岁以下小儿的尸体肾移植给年龄较大的儿童可获满意的肾功能。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 95,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 108,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 124,
+ "type": "bod",
+ "entity": "肾"
+ }
+ ]
+ },
+ {
+ "text": "儿童肾移植更容易从亲属中获取活体肾移植，无论在组织相容性还是缩短缺血时间上都更具优越性，从而降低排斥反应的发生率。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "肾移植"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "血"
+ }
+ ]
+ },
+ {
+ "text": "另有成功病例报道将新生儿尸体双肾连同主动脉、腔静脉一并切下并移植给先天性马蹄肾肾衰竭的患儿。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "主动脉"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "腔静脉"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "先天性马蹄肾肾衰竭"
+ }
+ ]
+ },
+ {
+ "text": "三、葡萄糖-6-磷酸脱氢酶缺陷症红细胞葡萄糖-6-磷酸脱氢酶（glucose-6-phosphatedehydrogenase，G-6-PD）缺陷症是一种常见伴性不完全显性遗传性红细胞膜酶缺陷病，此类缺陷遍布全世界，据统计约有2亿多人具有此类缺陷。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "葡萄糖-6-磷酸脱氢酶缺陷症"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 96,
+ "type": "dis",
+ "entity": "红细胞膜酶缺陷病"
+ }
+ ]
+ },
+ {
+ "text": "编码该酶蛋白的基因位于X染色体长臂2区8带（Xq28）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "酶蛋白"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "X染色体"
+ }
+ ]
+ },
+ {
+ "text": "目前已证实至少有90种G-6-PD突变基因存在，大多为编码区内单个或多个碱基置换的突变，少数为缺失型。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "G-6-PD突变基因"
+ }
+ ]
+ },
+ {
+ "text": "出现慢性非球形红细胞溶血性贫血（CNSHA）者的基因突变发生于G-6-PD基因羧基末端第1089～1361核苷酸序列中，突变发生于氨基末端者病情较轻。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "慢性非球形红细胞溶血性贫血"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "CNSHA"
+ }
+ ]
+ },
+ {
+ "text": "我国已发现12种G-6-PD突变基因，均为点突变。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "G-6-PD突变基因"
+ }
+ ]
+ },
+ {
+ "text": "多种G-6-PD突变基因所表达的产物为各种变异酶，它们的活性大多降低或稳定性降低。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "G-6-PD突变基因"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "变异酶"
+ }
+ ]
+ },
+ {
+ "text": "到目前为止，已发现400多种G-6-PD变异酶，其中可引起各种溶血症者有100种以上。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "G-6-PD变异酶"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "溶血症"
+ }
+ ]
+ },
+ {
+ "text": "根据酶的活性和是否出现临床表现，可将它们分为五大类：①严重酶缺陷伴CNSHA；②酶活性严重缺乏，活性＜10%；③酶活性轻～中度缺陷，活性为10%～60%；④酶活性轻度降低或正常，活性为60%～100%；⑤酶活性增加，高于正常的4～5倍。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "严重酶缺陷伴CNSHA"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 78,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 102,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "其中②③类多数表现为新生儿高胆红素血症及急性溶血性贫血，少数伴有CNSHA。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "新生儿高胆红素血症"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "急性溶血性贫血"
+ }
+ ]
+ },
+ {
+ "text": "根据发病种族的不同，将G-6-PD分为G-6-PDA和G-6-PDB两种变异型。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "G-6-PD"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "G-6-PDA"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "G-6-PDB"
+ }
+ ]
+ },
+ {
+ "text": "在我国广东，还发现另一种变异型，称为G-6-PDCanton（广东型），区域发病率可高达5%。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "G-6-PDCanton"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制】G-6-PD在磷酸戊糖旁路中是6-磷酸葡萄糖（G-6-P）转变为6-磷酸葡萄糖酸（G-6-PG）反应中必需的酶。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "G-6-PD"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "磷酸戊糖旁路"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "6-磷酸葡萄糖"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "G-6-P"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "6-磷酸葡萄糖酸"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "G-6-PG"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "G-6-PD缺乏时，使还原型三磷酸吡啶核苷（NADPH）减少，不能维持生理浓度的还原型谷胱甘肽（GSH），从而使红细胞膜蛋白和酶蛋白中的巯基遭受氧化，改变了红细胞膜的完整性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "G-6-PD"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "还原型三磷酸吡啶核苷"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "NADPH"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "还原型谷胱甘肽"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "GSH"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "红细胞膜蛋白"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "酶蛋白"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "红细胞膜"
+ }
+ ]
+ },
+ {
+ "text": "此外，NADPH减少时，使高铁血红蛋白（MHb）不能转变为氧合血红蛋白，MHb增加致红细胞内不可溶性变性珠蛋白小体（Heinz小体）形成明显增加，红细胞膜变硬，通过脾脏时Heinz小体被巨噬细胞摘出，随之丢失部分的红细胞膜，致表面积减少，可塑性降低，而易破裂溶血。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "NADPH"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "高铁血红蛋白"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "MHb"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "氧合血红蛋白"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "MHb"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "不可溶性变性珠蛋白小体"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "Heinz小体"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "红细胞膜"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "脾脏"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 91,
+ "type": "bod",
+ "entity": "Heinz小体"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 110,
+ "type": "bod",
+ "entity": "红细胞膜"
+ },
+ {
+ "start_idx": 129,
+ "end_idx": 130,
+ "type": "sym",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】本病一般可分为四种类型：（一）新生儿高胆红素血症新生儿红细胞G-6-PD缺乏时可受外源性或内源性氧化剂作用诱发或自发发生新生儿溶血症，导致高胆红素血症。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "新生儿高胆红素血症"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "红细胞G-6-PD缺乏"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "新生儿溶血症"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "高胆红素血症"
+ }
+ ]
+ },
+ {
+ "text": "我国新生儿G-6-PD缺乏发生率约3.0%～8.7%，其中严重黄疸发生率为20%～50%。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "G-6-PD缺乏"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "感染或药物可使症状加重。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "感染"
+ }
+ ]
+ },
+ {
+ "text": "黄疸多出现在生后48～96小时内，也可迟至2周才出现黄疸。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "进展迅速，严重的于1周后发生胆红素脑病甚至死亡。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "胆红素脑病"
+ }
+ ]
+ },
+ {
+ "text": "（二）蚕豆病（favism）本病最初因食用蚕豆、及其制品后发生急性溶血性贫血、黄疸而得名，多见于我国南方以及地中海沿岸国家的某些人群。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "蚕豆病"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "favism"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "急性溶血性贫血"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "溶血的轻重与食用蚕豆的量也无关系。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "目前认为，蚕豆中含有大量左旋多巴，在酪氨酸酶的作用下，可变成多巴醌，后者可使GSH含量减少而发生溶血。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "左旋多巴"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "酪氨酸酶"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "多巴醌"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "GSH"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "本病大多发生在每年产新鲜蚕豆季节，在食用蚕豆或其制品、吸入蚕豆花粉、或吸吮乳母吃过蚕豆的乳汁后数小时至数天内发生不同程度的急性血管内溶血。",
+ "entities": [
+ {
+ "start_idx": 61,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "急性血管内溶血"
+ }
+ ]
+ },
+ {
+ "text": "血红蛋白迅速下降，多有黄疸。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "极重者甚至出现惊厥、休克、急性肾衰竭；如不及时治疗可于1～2天内死亡。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "惊厥"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "急性肾衰竭"
+ }
+ ]
+ },
+ {
+ "text": "溶血期大多持续1～2天，最长1周左右，然后进入恢复期。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "（三）药物诱发溶血性贫血服用具有氧化作用的药物如：①乙酰苯胺（acetanild）、氨基比林等退热药；②伯氨喹、扑疟喹等抗疟药；③磺胺类药物；④其他如呋喃唑酮、呋喃坦丁、萘（naphthalene）、苯肼等可引起溶血。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "溶血性贫血"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "乙酰苯胺"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 39,
+ "type": "dru",
+ "entity": "acetanild"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "dru",
+ "entity": "氨基比林"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "dru",
+ "entity": "伯氨喹"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "dru",
+ "entity": "扑疟喹"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "dru",
+ "entity": "抗疟药"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 78,
+ "type": "dru",
+ "entity": "呋喃唑酮"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dru",
+ "entity": "呋喃坦丁"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 85,
+ "type": "dru",
+ "entity": "萘"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 97,
+ "type": "dru",
+ "entity": "naphthalene"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 101,
+ "type": "dru",
+ "entity": "苯肼"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 107,
+ "type": "dru",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "具体某一药物对G-6-PD缺乏者诱发溶血作用并不一致，如服用氯霉素可诱发地中海沿岸重度G-6-PD缺乏者出现溶血，而在A-型或广东型的G-6-PD缺乏患者则不引起溶血。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "G-6-PD缺乏"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "溶血"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "氯霉素"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "溶血"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "G-6-PD缺乏"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "急性溶血期持续1～2周，血红蛋白多于1周末降至最低点，此时出现血红蛋白尿，高铁血红蛋白血症，血浆GSH和结合珠蛋白下降，周围血涂片可见红细胞轻度大小不等，红细胞碎片，异型或嗜多染红细胞增多等。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "血红蛋白尿"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "高铁血红蛋白血症"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "血浆GSH"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "结合珠蛋白"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "血涂片"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 91,
+ "type": "bod",
+ "entity": "嗜多染红细胞"
+ }
+ ]
+ },
+ {
+ "text": "肝、脾可轻度增大。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "肝、脾可轻度增大"
+ }
+ ]
+ },
+ {
+ "text": "2周后进入恢复期，网状红细胞、血红蛋白逐渐上升至正常，病情也明显好转，此时即使服用同类药物也无明显溶血，于4周后血红蛋白恢复正常。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "网状红细胞"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "血红蛋白"
+ }
+ ]
+ },
+ {
+ "text": "此后进入代偿稳定期，由于骨髓代偿功能良好，病人无贫血或黄疸，网织红细胞正常。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "网织红细胞"
+ }
+ ]
+ },
+ {
+ "text": "但若于2～3月后再服此药物可再次诱发溶血。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "溶血"
+ }
+ ]
+ },
+ {
+ "text": "（四）感染诱发的溶血性贫血G-6-PD缺乏患儿，在有些病毒和细菌感染如急性传染性肝炎、传染性单核细胞增多症、上呼吸道感染、肺炎、败血症、肠炎、菌痢、伤寒等情况下均可诱发与伯氨喹型药物相似的溶血性贫血，主要机制是由于急性感染过程中体内氧化产物如H2O2等堆积，造成红细胞破坏所致。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "溶血性贫血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "G-6-PD缺乏"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "急性传染性肝炎"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "传染性单核细胞增多症"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "上呼吸道感染"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "肠炎"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "菌痢"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "伤寒"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 90,
+ "type": "dru",
+ "entity": "伯氨喹型药物"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 98,
+ "type": "dis",
+ "entity": "溶血性贫血"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 110,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 143,
+ "end_idx": 145,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "【辅助检查】1.血象溶血发作时红细胞与血红蛋白迅速下降。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "血象溶血"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "血红蛋白"
+ }
+ ]
+ },
+ {
+ "text": "出现变形和嗜多色性红细胞及红细胞碎片，网织红细胞增多，大多在5%～15%之间，最高可达20%。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "嗜多色性红细胞"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "网织红细胞"
+ }
+ ]
+ },
+ {
+ "text": "白细胞可以增高，达10×109～20×109/L，甚至出现类白血病反应，血小板通常正常或偏高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "白血病"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "血小板"
+ }
+ ]
+ },
+ {
+ "text": "2.骨髓象粒细胞、红细胞系均增生，粒细胞增生程度与发病年龄呈负相关。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "骨髓象粒细胞"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "粒细胞"
+ }
+ ]
+ },
+ {
+ "text": "3.尿常规检查根据溶血程度的不同，肉眼观察可见尿呈酱油色、浓茶色、茶色或黄色，尿隐血试验60%～70%病例呈阳性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "尿常规检查"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "肉眼观察"
+ }
+ ]
+ },
+ {
+ "text": "严重时可导致肾功能损害，出现蛋白尿、红细胞尿及管型尿，尿胆原和尿胆红素增加。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "肾功能损害"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "红细胞尿"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "管型尿"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "尿胆红素"
+ }
+ ]
+ },
+ {
+ "text": "4.血清游离血红蛋白增加，结合珠蛋白降低。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "血清游离血红蛋白增加"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "结合珠蛋白"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "结合珠蛋白降低"
+ }
+ ]
+ },
+ {
+ "text": "5.变性珠蛋白小体试验用结晶紫将Heinz小体染成紫色，然后计数含Heinz小体的红细胞的百分比。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "变性珠蛋白小体"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "Heinz小体"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "Heinz小体"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "在发病48小时内均可检出Heinz小体，溶血停止后即呈阴性。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "Heinz小体"
+ }
+ ]
+ },
+ {
+ "text": "但此试验并非特异性，因不稳定血红蛋白病、血红蛋白H病和其他酶缺陷也可呈阳性。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "血红蛋白病"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "血红蛋白H病"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "6.高铁血红蛋白还原试验是目前常用的筛选试验。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "高铁血红蛋白还原试验"
+ }
+ ]
+ },
+ {
+ "text": "G-6-PD缺陷的患者由于NADPH生成减少，MHb的还原速度显著减慢，以此来间接测定G-6-PD活性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "G-6-PD缺陷"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "MHb"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "G-6-PD"
+ }
+ ]
+ },
+ {
+ "text": "定量法还原率大于75%为正常，74%～31%为中等度（杂合子）缺陷，小于31%为重度缺陷。",
+ "entities": [
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "重度缺陷"
+ }
+ ]
+ },
+ {
+ "text": "7.高铁血红蛋白洗脱法本试验是利用组织化学方法以观察每个红细胞中MHb被还原的能力，从而间接反映G-6-PD活性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "高铁血红蛋白洗脱法"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "G-6-PD"
+ }
+ ]
+ },
+ {
+ "text": "G-6-PD缺陷的红细胞中的MHb不易还原，可被H2O2洗脱成为不着色的红细胞空影。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "G-6-PD缺陷"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "MHb"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "正常人空影红细胞小于2%，若超过80%为显著缺陷；杂合子在50%左右。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "8.荧光斑点试验正常红细胞在紫外线波长340nm照射下可发生荧光，而患者的红细胞不发生荧光。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "荧光斑点试验"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "9.G-6-PD活性定量测定是一种直接测定法，对诊断有特异性。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "G-6-PD"
+ }
+ ]
+ },
+ {
+ "text": "患者G-6-PD活性多在正常人的10%以下。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "G-6-PD"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】根据急性溶血、血红蛋白尿、病史中找到明确的诱因，并有阳性家族史和既往发作史，再结合以上实验室检查，多可作出诊断。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "急性溶血"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "血红蛋白尿"
+ }
+ ]
+ },
+ {
+ "text": "继发于感染时，应结合各种感染的特点加以综合考虑。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "感染"
+ }
+ ]
+ },
+ {
+ "text": "本病需与不稳定血红蛋白病（uHb病）如HbH病、免疫性溶血性贫血等鉴别，前者在血红蛋白电泳时，可出现异常区带；后者Coombs试验阳性。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "血红蛋白病"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "uHb病"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "HbH病"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "免疫性溶血性贫血"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "血红蛋白电泳"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "Coombs试验"
+ }
+ ]
+ },
+ {
+ "text": "慢性溶血型应与其他遗传性溶血性疾病鉴别，可通过G-6-PD活性直接测定以资鉴别。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "遗传性溶血性疾病"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "G-6-PD"
+ }
+ ]
+ },
+ {
+ "text": "【治疗和预后】在高发病地区进行普查，凡证实有G-6-PD缺陷的，应避免食用蚕豆或具有氧化作用的药物，并应积极预防感染，以防止急性发作。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "G-6-PD缺陷"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "感染"
+ }
+ ]
+ },
+ {
+ "text": "急性发作时，应尽快去除诱因，贫血严重者（Hb＜40g/L）应输血或浓缩红细胞1～2次，注意水和电解质紊乱，纠正酸中毒，防止高钾血症，以及碱化尿液防止急性肾衰竭。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "水和电解质紊乱"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "高钾血症"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 71,
+ "type": "pro",
+ "entity": "碱化尿液"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 78,
+ "type": "dis",
+ "entity": "急性肾衰竭"
+ }
+ ]
+ },
+ {
+ "text": "新生儿时发病应注意同时防治高胆红素血症以及胆红素性脑病。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "高胆红素血症"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "胆红素性脑病"
+ }
+ ]
+ },
+ {
+ "text": "急性发作多呈自限性，因新生的红细胞G-6-PD活性正常，病情多于1周后逐渐稳定。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "红细胞G-6-PD"
+ }
+ ]
+ },
+ {
+ "text": "第六章胃炎胃炎（gastritis）是由多种病因引起的胃黏膜炎症，根据病程分为急性和慢性两类，前者多为继发性，后者以原发性多见。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "胃炎"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "胃炎"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "gastritis"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "胃黏膜炎症"
+ }
+ ]
+ },
+ {
+ "text": "近几年随着胃镜在儿科的普及应用，儿童胃炎的检出率明显增高。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "equ",
+ "entity": "胃镜"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "儿童胃炎"
+ }
+ ]
+ },
+ {
+ "text": "第一节急性胃炎急性胃炎（acutegastritis）系由不同病因引起的胃黏膜急性炎症。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "急性胃炎"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "急性胃炎"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "acutegastritis"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "胃黏膜急性炎症"
+ }
+ ]
+ },
+ {
+ "text": "病变严重者可累及黏膜下层与肌层，甚至深达浆膜层。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "黏膜下层与肌层"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "浆膜层"
+ }
+ ]
+ },
+ {
+ "text": "儿童中以单纯性与糜烂性多见。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "单纯性"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "糜烂性"
+ }
+ ]
+ },
+ {
+ "text": "【病因】（一）微生物感染或细菌感染进食污染微生物和细菌毒素的食物后引起的急性胃炎中，多见沙门菌属、嗜盐杆菌及某些病毒等。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "微生物感染"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "细菌感染"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "污染微生物"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "mic",
+ "entity": "细菌毒素"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "急性胃炎"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "mic",
+ "entity": "沙门菌属"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "mic",
+ "entity": "嗜盐杆菌"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "mic",
+ "entity": "某些病毒"
+ }
+ ]
+ },
+ {
+ "text": "（二）化学因素1.药物水杨酸盐类药物如阿司匹林及吲哚美辛等。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "水杨酸盐类药物"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "阿司匹林"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "吲哚美辛"
+ }
+ ]
+ },
+ {
+ "text": "2.误食强酸（如硫酸、盐酸和硝酸）及强碱（如氢氧化钠和氢氧化钾）引起胃壁腐蚀性损伤。",
+ "entities": [
+ {
+ "start_idx": 34,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "胃壁腐蚀性损伤"
+ }
+ ]
+ },
+ {
+ "text": "3.误食毒蕈、砷、灭虫药及杀鼠剂等化学毒物，均可刺激胃黏膜引起炎症。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "炎症"
+ }
+ ]
+ },
+ {
+ "text": "（三）物理因素进食过冷、过热的食品或粗糙食物均可损伤胃黏膜，引起炎症。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "炎症"
+ }
+ ]
+ },
+ {
+ "text": "（四）应激状态某些危重疾病如新生儿窒息、颅内出血、败血症、休克及大面积灼伤等使患儿处于严重的应激状态是导致急性糜烂性胃炎的主要原因。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "新生儿窒息"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "大面积灼伤"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "急性糜烂性胃炎"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制】1.外源性病因可严重破坏胃黏液屏障，导致氢离子及胃蛋白酶的逆向弥散，引起胃黏膜的损伤而发生糜烂、出血。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "胃黏液屏障"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "氢离子"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "胃蛋白酶"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "胃黏膜的损伤"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "糜烂"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "出血"
+ }
+ ]
+ },
+ {
+ "text": "2.应激状态使去甲肾上腺素和肾上腺素大量分泌，内脏血管收缩，胃血流量减少，缺血、缺氧进一步使黏膜上皮的线粒体功能降低，影响氧化磷酸化过程，使胃黏膜的糖原贮存减少。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "去甲肾上腺素和肾上腺素大量分泌"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "内脏血管收缩"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "胃血流量减少"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "缺血、缺氧"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "黏膜上皮的线粒体功能降低"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "胃黏膜的糖原贮存减少"
+ }
+ ]
+ },
+ {
+ "text": "而胃黏膜缺血时，不能清除逆向弥散的氢离子；缺氧和去甲���上腺素又使碳酸氢根离子分泌减少，前列腺素合成减少，削弱胃黏膜屏障功能，导致胃黏膜急性糜烂性炎症。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "氢离子"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "碳酸氢根离子分泌减少"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "前列腺素合成减少"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "削弱胃黏膜屏障功能"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 73,
+ "type": "dis",
+ "entity": "胃黏膜急性糜烂性炎症"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现及分型】（一）急性单纯性胃炎起病较急，多在进食污染食物数小时后或24小时发病，症状轻重不一，表现上腹部不适、疼痛，甚至剧烈的腹部绞痛。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "急性单纯性胃炎"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "上腹部不适、疼痛"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 70,
+ "type": "sym",
+ "entity": "剧烈的腹部绞痛"
+ }
+ ]
+ },
+ {
+ "text": "若为药物或刺激性食物所致，症状则较轻，局限上腹部，体格检查有上腹部或脐周压痛，肠鸣音可亢进。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "上腹部"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "上腹部或脐周压痛"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "肠鸣音可亢进"
+ }
+ ]
+ },
+ {
+ "text": "（二）急性糜烂性胃炎多在机体处在严重疾病应激状态下诱发，起病急骤，常以呕血或黑粪为突出症状，大量出血可引起晕厥或休克，伴重度贫血。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "急性糜烂性胃炎"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "呕血"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "黑粪"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "晕厥"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "重度贫血"
+ }
+ ]
+ },
+ {
+ "text": "（三）急性腐蚀性胃炎误服强酸、强碱史，除口腔黏膜糜烂、水肿外，中上腹剧痛、绞窄感、恶心、呕吐、呕血和黑粪，并发胃功能紊乱，急性期过后可遗留贲门或幽门狭窄，出现呕吐等梗阻症状。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "急性腐蚀性胃炎"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "口腔黏膜糜烂、水肿"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "中上腹剧痛"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "绞窄感"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "呕血"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "黑粪"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "胃功能紊乱"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 75,
+ "type": "sym",
+ "entity": "贲门或幽门狭窄"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 85,
+ "type": "sym",
+ "entity": "梗阻症状"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】感染因素引起者其末梢血白细胞计数一般增高，中性粒细胞比例增大。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 22,
+ "type": "ite",
+ "entity": "末梢血白细胞计数"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "中性粒细胞比例"
+ }
+ ]
+ },
+ {
+ "text": "【影像学检查】（一）内镜检查胃黏膜明显充血、水肿，黏膜表面覆盖厚的黏稠炎性渗出物，糜烂性胃炎则在上述病变上见到点、圆、片、线状或不规则形糜烂，中心为红色新鲜出血或棕红色陈旧性出血，伴白苔或黄苔，常为多发亦可为单个。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "内镜检查"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "胃黏膜明显充血、水肿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "黏膜表面覆盖厚的黏稠炎性渗出物"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "糜烂性胃炎"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 69,
+ "type": "sym",
+ "entity": "点、圆、片、线状或不规则形糜烂"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "中心为红色新鲜出血"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "棕红色陈旧性出血"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 92,
+ "type": "sym",
+ "entity": "白苔"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 95,
+ "type": "sym",
+ "entity": "黄苔"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 105,
+ "type": "sym",
+ "entity": "常为多发亦可为单个"
+ }
+ ]
+ },
+ {
+ "text": "做胃镜时应同时取胃黏膜做幽门螺杆菌检测。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "equ",
+ "entity": "胃镜"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "胃黏膜"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "幽门螺杆菌检测"
+ }
+ ]
+ },
+ {
+ "text": "（二）X线检查胃肠钡餐检查病变黏膜粗糙，局部压痛，但不能发现糜烂性病变，且不能用于急性或活动性出血患者。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "X线检查"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "胃肠钡餐"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "病变黏膜粗糙"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "局部压痛"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "糜烂性病变"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "急性或活动性出血"
+ }
+ ]
+ },
+ {
+ "text": "【诊断与鉴别诊断】急性胃炎无特征性临床表现，诊断主要依靠病史及内镜检查，以上腹痛为主要症状者应与下列疾病鉴别。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "急性胃炎"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "内镜检查"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "腹痛"
+ }
+ ]
+ },
+ {
+ "text": "（一）急性胰腺炎有突然发作的上腹部剧烈疼痛，放射至背部及腰部，血清淀粉酶升高，B超或CT显示胰腺肿大，严重患者腹腔穿刺可抽出血性液体且淀粉酶增高。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "急性胰腺炎"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "突然发作的上腹部剧烈疼痛"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "放射至背部及腰部"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "ite",
+ "entity": "血清淀粉酶"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "B超"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "pro",
+ "entity": "CT"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "胰腺肿大"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "pro",
+ "entity": "腹腔穿刺"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 65,
+ "type": "sym",
+ "entity": "可抽出血性液体"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "淀粉酶"
+ }
+ ]
+ },
+ {
+ "text": "（二）胆道蛔虫症骤然发生上腹部剧烈绞痛，可放射至左、右肩部及背部，发作时辗转不安，剑突下偏右压痛明显，可伴呕吐，有时吐出蛔虫，B超见胆总管内有虫体异物。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "胆道蛔虫症"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "骤然发生上腹部剧烈绞痛"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "可放射至左、右肩部及背部"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "发作时辗转不安"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "剑突下偏右压痛明显"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "吐出蛔虫"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "B超"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "胆总管"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】1.单纯性胃炎以对症治疗为主，去除病因，解痉止吐，口服黏膜保护剂，对细菌感染尤其伴有腹泻者可选用小檗碱、卡那霉素及氨苄西林等抗生素。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "单纯性胃炎"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "解痉止吐"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "口服黏膜保护剂"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "细菌感染"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "dru",
+ "entity": "小檗碱"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "卡那霉素"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "dru",
+ "entity": "氨苄西林"
+ }
+ ]
+ },
+ {
+ "text": "有幽门螺杆菌者，则应做清除治疗。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "幽门螺杆菌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "清除治疗"
+ }
+ ]
+ },
+ {
+ "text": "2.糜烂性胃炎应控制出血，去除应激因素，可用H2受体拮抗剂：西咪替丁20～40mg/（kg•d），法莫替丁0.4～0.8mg/（kg•d），或质子泵阻滞剂奥美拉唑0.6～0.8mg/（kg•d），以及应用止血药如立止血注射，凝血酶口服等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "糜烂性胃炎"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "控制出血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "去除应激因素"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dru",
+ "entity": "西咪替丁"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "dru",
+ "entity": "法莫替丁"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 86,
+ "type": "dru",
+ "entity": "质子泵阻滞剂奥美拉唑"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 110,
+ "type": "dru",
+ "entity": "止血药"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 116,
+ "type": "pro",
+ "entity": "立止血注射"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 122,
+ "type": "pro",
+ "entity": "凝血酶口服"
+ }
+ ]
+ },
+ {
+ "text": "3.腐蚀性胃炎应根据腐蚀剂性质给予相应中和药物，如口服镁乳氢氧化铝、牛奶和鸡蛋清等治疗强酸剂腐蚀。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "腐蚀性胃炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "中和药物"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "口服镁乳氢氧化铝、牛奶和鸡蛋清"
+ }
+ ]
+ },
+ {
+ "text": "第十三章常见的泌尿外科疾病第一节异位肾当肾脏未能正常发育到达肾窝的位置，即为肾脏异位。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "异位肾"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肾窝"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "肾脏异位"
+ }
+ ]
+ },
+ {
+ "text": "其与肾下垂的区别在于肾下垂的肾脏最初都是位于正常的位置，随后下垂而异常的，但异位肾的位置从来都是异常的。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "肾下垂"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肾下垂"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "异位肾"
+ }
+ ]
+ },
+ {
+ "text": "随着产前超声检查的应用，异位肾的检出率有提高之势。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "超声检查"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "异位肾"
+ }
+ ]
+ },
+ {
+ "text": "双侧异位肾很少见，仅占异位肾总数的10%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "双侧异位肾"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "异位肾"
+ }
+ ]
+ },
+ {
+ "text": "肾脏异位的原因尚未明了，其与输尿管芽发育不良、后肾发育异常、遗传异常、致畸因子作用以及母亲的某些疾病有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "肾脏异位"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "输尿管芽发育不良"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "后肾发育异常"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "遗传异常"
+ }
+ ]
+ },
+ {
+ "text": "肾脏异位的分类根据肾脏所处的具体位置而定。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "肾脏异位"
+ }
+ ]
+ },
+ {
+ "text": "异位肾在上述位置的分布上无明显突出之处，比较均匀。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "异位肾"
+ }
+ ]
+ },
+ {
+ "text": "异位肾一般较正常为小，外形上可与正常有一些区别，但结构多正常，一般是直立的，也可侧转90°呈水平位。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "异位肾"
+ }
+ ]
+ },
+ {
+ "text": "25%是由于Ⅲ级以上的膀胱输尿管反流引起的，另25%是由于肾旋转不良引起。",
+ "entities": [
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "肾旋转不良"
+ }
+ ]
+ },
+ {
+ "text": "异位肾的动脉供应依其所处的位置而定，可发自腹主动脉的末端或分叉处，也可来自髂总及髂外动脉。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "异位肾"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "腹主动脉"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "髂总"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "髂外动脉"
+ }
+ ]
+ },
+ {
+ "text": "患儿多伴生殖系统畸形，如女孩中的双角子宫、单角子宫、子宫缺如、阴道缺如和重复阴道等。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "生殖系统畸形"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "双角子宫"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "单角子宫"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "子宫缺如"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "阴道缺如"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "重复阴道"
+ }
+ ]
+ },
+ {
+ "text": "除了肾积水和肾结石外，异位肾并不意味具有更多的其他问题。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "肾积水"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肾结石"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "异位肾"
+ }
+ ]
+ },
+ {
+ "text": "但异位肾失去了肋骨的保护，易受外伤。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "异位肾"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肋骨"
+ }
+ ]
+ },
+ {
+ "text": "有报告提出由于异位肾的血供异常而出现肾血管性高血压。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "异位肾"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "肾血管性高血压"
+ }
+ ]
+ },
+ {
+ "text": "第九节链球菌感染一、A族链球菌感染A族链球菌（groupAstreptococcic，GAS）又称化脓性链球菌（streptococcuspyogenes），是一种常见的革兰阳性致病菌，GAS感染可以引起多种疾病，从急性咽炎、扁桃体炎到严重的侵袭性感染如坏死性筋膜炎和中毒性休克综合征，无菌性后遗症如风湿热、肾小球肾炎等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "链球菌感染"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "A族链球菌感染"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 41,
+ "type": "mic",
+ "entity": "groupAstreptococcic"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "mic",
+ "entity": "GAS"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 54,
+ "type": "mic",
+ "entity": "化脓性链球菌"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 76,
+ "type": "mic",
+ "entity": "streptococcuspyogenes"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 91,
+ "type": "mic",
+ "entity": "革兰阳性致病菌"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 97,
+ "type": "dis",
+ "entity": "GAS感染"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "急性咽炎"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 116,
+ "type": "dis",
+ "entity": "扁桃体炎"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 125,
+ "type": "dis",
+ "entity": "严重的侵袭性感染"
+ },
+ {
+ "start_idx": 127,
+ "end_idx": 132,
+ "type": "dis",
+ "entity": "坏死性筋膜炎"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 141,
+ "type": "dis",
+ "entity": "中毒性休克综合征"
+ },
+ {
+ "start_idx": 143,
+ "end_idx": 148,
+ "type": "dis",
+ "entity": "无菌性后遗症"
+ },
+ {
+ "start_idx": 150,
+ "end_idx": 152,
+ "type": "dis",
+ "entity": "风湿热"
+ },
+ {
+ "start_idx": 154,
+ "end_idx": 158,
+ "type": "dis",
+ "entity": "肾小球肾炎"
+ }
+ ]
+ },
+ {
+ "text": "【病原学】链球菌是革兰阳性球菌，常呈对状或链状生长，以它溶解红细胞的能力分类，可分为完全溶血（β溶血）、部分溶血（又称草绿色溶血，α溶血）和不溶血（γ溶血）三种。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "革兰阳性球菌"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "红细胞"
+ }
+ ]
+ },
+ {
+ "text": "因为溶血本身不构成致病性，兰斯菲尔德进一步按细胞壁的碳水化合物成分的不同将链球菌分为A-H和K-V族。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "细胞壁"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "碳水化合物成分"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "链球菌"
+ }
+ ]
+ },
+ {
+ "text": "A族β溶血性链球菌细胞壁由明显的三层结构所组成，外层部分包含几种抗原蛋白，其中非常重要的是M蛋白。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "A族β溶血性链球菌细胞壁"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "抗原蛋白"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "M蛋白"
+ }
+ ]
+ },
+ {
+ "text": "A族β溶血性链球菌按其M蛋白抗原的不同可分为80多个血清型，M蛋白是细菌主要的毒力因子，它可黏附于人类上皮细胞和抵抗吞噬作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "A族β溶血性链球菌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "M蛋白抗原"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "M蛋白"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "上皮细胞"
+ }
+ ]
+ },
+ {
+ "text": "细胞壁的另一种成分即脂胞壁酸，是另一种毒力因子，它可通过上皮细胞表面的纤维素加速细菌作用在黏膜、皮肤上。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "细胞壁"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "脂胞壁酸"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "纤维素"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "皮肤"
+ }
+ ]
+ },
+ {
+ "text": "而透明质酸荚膜抵抗吞噬作用，进一步增加细菌毒力。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "透明质酸荚膜"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "获得性免疫是直接针对M蛋白的。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "M蛋白"
+ }
+ ]
+ },
+ {
+ "text": "链球菌产生毒素、酶和溶血素，当在人体组织中生长时，A族β溶血性链球菌释放约有20多种细胞外抗原成分。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "毒素"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "溶血素"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "mic",
+ "entity": "A族β溶血性链球菌"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "mic",
+ "entity": "细胞外抗原"
+ }
+ ]
+ },
+ {
+ "text": "在这些细胞外产物中，致热性红斑毒素（A、B和C）、链球菌素O和S、链激酶、脱氧核糖核酸酶和蛋白酶，具有很重要的临床意义。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "致热性红斑毒素"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "链球菌素O"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "链激酶"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "脱氧核糖核酸酶"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "蛋白酶"
+ }
+ ]
+ },
+ {
+ "text": "致热性红斑毒素可引起猩红热的皮疹和中毒休克样综合征中的休克症状。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "致热性红斑毒素"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "猩红热"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "中毒休克样综合征"
+ }
+ ]
+ },
+ {
+ "text": "链球菌素S引起细胞的粘连，破坏中性粒细胞和血小板的膜壁结构。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "链球菌素S"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "中性粒细胞"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "血小板"
+ }
+ ]
+ },
+ {
+ "text": "链球菌素O溶解红细胞，并对中性粒细胞有毒性作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "链球菌素O"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "中性粒细胞"
+ }
+ ]
+ },
+ {
+ "text": "链球菌素O和S使得这一β溶血性链球菌菌株产生清楚的溶血环。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "链球菌素O"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "mic",
+ "entity": "β溶血性链球菌"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "溶血环"
+ }
+ ]
+ },
+ {
+ "text": "细胞外的消化酶使得该细菌能在组织中迅速蔓延，例如：链激酶溶解纤维蛋白，DNA酶帮助脓液液化，透明质酸酶可帮助细菌穿透基底膜组织，蛋白酶同严重侵袭性感染造成的组织损害有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "消化酶"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "链激酶溶解纤维蛋白"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "DNA酶"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "脓液"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "透明质酸酶"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "基底膜组织"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "蛋白酶"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 74,
+ "type": "dis",
+ "entity": "严重侵袭性感染"
+ }
+ ]
+ },
+ {
+ "text": "抗链球菌素O抗体（ASO）、抗DNaseB、透明质酸酶和链激酶抗体在A族链球菌疾病的血清学诊断中有一定作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "抗链球菌素O抗体"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "ASO"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "抗DNaseB"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "透明质酸酶"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "链激酶抗体"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "A族链球菌疾病"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "M型特异性抗体在感染后的4～8周可检测出来，而抗生素的治疗可阻断这一反应。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "M型特异性抗体"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "【流行病学】由A族链球菌引起化脓性和非化脓性并发症的发病率在20世纪80年代晚期和90年代呈增加趋势。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "非化脓性并发症"
+ }
+ ]
+ },
+ {
+ "text": "这种严重链球菌感染性疾病的复燃的确切原因尚不知道，可能同流行菌株较以前更具有毒力有关。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "严重链球菌感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "A族链球菌是人类正常口咽部的菌群，儿童带菌率是15%～20%，发病率取决于小儿的年龄、季节、气候和地理位置，以及和感染者接触的程度有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "口咽部"
+ }
+ ]
+ },
+ {
+ "text": "一般来说，婴儿期发病率最低，可能是经胎盘获得型特异性抗体的保护作用，也可能是婴儿期咽部尚缺乏同链球菌结合的受体。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "胎盘"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "特异性抗体"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "咽部"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "mic",
+ "entity": "链球菌"
+ }
+ ]
+ },
+ {
+ "text": "小于6岁儿童的链球菌皮肤感染是很常见的，5～15岁儿童链球菌性咽炎最常见，小于3岁的小儿链球菌疾病，包括猩红热不常见。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "链球菌皮肤感染"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "链球菌性咽炎"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "小儿链球菌疾病"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "猩红热"
+ }
+ ]
+ },
+ {
+ "text": "严重的侵袭性的A族链球菌感染可在任何年龄组出现。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "A族链球菌感染"
+ }
+ ]
+ },
+ {
+ "text": "链球菌咽炎在温带地区发病率较高，发病率和严重程度在寒冷季节增加，尤其在学龄儿童。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "链球菌咽炎"
+ }
+ ]
+ },
+ {
+ "text": "脓疱病在热带和温热气候时最易发生。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "脓疱病"
+ }
+ ]
+ },
+ {
+ "text": "A族β溶血性链球菌是经飞沫传播的，咽部带菌者是常见的传染源，感染也可经接触破损的皮肤伤口，或经食物、牛奶和水来传播。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "A族β溶血性链球菌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "咽部"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "皮肤"
+ }
+ ]
+ },
+ {
+ "text": "链球菌的感染常和家庭、学校、部队或拥挤的居住条件有关，破损的皮肤易于感染脓皮疹或脓疱疹，如水痘就可造成皮肤的破损，它不仅是链球菌感染的侵入途径，还使得宿主对其感染的反应性降低。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "脓皮疹"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "脓疱疹"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "水痘"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "链球菌感染"
+ }
+ ]
+ },
+ {
+ "text": "在链球菌感染的急性期3～5天内是极易传染给他人的。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "链球菌感染"
+ }
+ ]
+ },
+ {
+ "text": "而在带菌期传染力减弱，型特异性免疫力可以由带菌或明显感染所诱导，链球菌在成人期随着对更多流行的血清型产生了免疫力，患病的危险大大减少了。",
+ "entities": [
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制】在吸入或食入链球菌后，细菌通过表面原纤维、细胞壁脂胞壁酸附着在呼吸道上皮细胞上，原纤维含有抗吞噬细胞的特异性M蛋白的抗原决定簇，M蛋白同荚膜透明质酸一起抵抗吞噬作用，细胞外消化性酶通过干扰局部血栓形成（链球菌素）和脓液形成（DNA酶）使得感染的蔓延加快；同时蛋白酶、透明质酸酶增加了对结缔组织的消化。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "表面原纤维"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "细胞壁"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "脂胞壁酸"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "原纤维"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 65,
+ "type": "mic",
+ "entity": "抗吞噬细胞的特异性M蛋白的抗原"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "M蛋白"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "荚膜透明质酸"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 95,
+ "type": "bod",
+ "entity": "消化性酶"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 103,
+ "type": "bod",
+ "entity": "血栓"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 110,
+ "type": "bod",
+ "entity": "链球菌素"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 114,
+ "type": "bod",
+ "entity": "脓液"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 121,
+ "type": "bod",
+ "entity": "DNA酶"
+ },
+ {
+ "start_idx": 135,
+ "end_idx": 137,
+ "type": "bod",
+ "entity": "蛋白酶"
+ },
+ {
+ "start_idx": 139,
+ "end_idx": 143,
+ "type": "bod",
+ "entity": "透明质酸酶"
+ },
+ {
+ "start_idx": 148,
+ "end_idx": 151,
+ "type": "bod",
+ "entity": "结缔组织"
+ }
+ ]
+ },
+ {
+ "text": "局部炎症后的化脓性并发症如扁桃体周围脓肿咽后壁脓肿中耳炎、鼻窦炎、淋巴管（淋巴结炎）的蔓延和菌血症（败血症、肺炎、骨髓炎）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "局部炎症"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "化脓性并发症"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "扁桃体"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "扁桃体周围脓肿"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "咽后壁"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "咽后壁脓肿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "中耳炎"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "鼻窦炎"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "淋巴管"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "淋巴结炎"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "菌血症"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "骨髓炎"
+ }
+ ]
+ },
+ {
+ "text": "引起猩红热临床症状的链球菌同非致热原外毒素菌株相似，只是增加猩红热样皮疹，血清学明确的致热原外毒素（A～C），在无免疫力的个体产生皮疹，皮疹可因宿主产生特异性的抗毒素抗体而减少。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "猩红热"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 22,
+ "type": "mic",
+ "entity": "非致热原外毒素菌株"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "猩红热样皮疹"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 48,
+ "type": "mic",
+ "entity": "致热原外毒素"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "抗毒素抗体"
+ }
+ ]
+ },
+ {
+ "text": "这些毒素具有致热原性和细胞毒性，它们增加了外毒素的效果，并同中毒休克样症状产生有关。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "毒素"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "外毒素"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "中毒休克样症状"
+ }
+ ]
+ },
+ {
+ "text": "链球菌致热外毒素A有部分氨基酸同葡萄球菌肠毒素B同源，而后者同葡萄球菌中毒休克综合征的发生有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "致热外毒素"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "氨基酸"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "葡萄球菌肠毒素B"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "葡萄球菌中毒休克综合征"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】最常见的感染部位是呼吸道、皮肤、软组织和血液。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "软组织"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "血液"
+ }
+ ]
+ },
+ {
+ "text": "常见的疾病有：咽炎、扁桃体炎、肺炎、皮肤感染、阴道炎、肛周疾病、败血症和菌血症，以及猩红热、链球菌中毒休克综合征、严重的侵袭性链球菌疾病。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "扁桃体炎"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "皮肤感染"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "阴道炎"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "肛周疾病"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "菌血症"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "猩红热"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "链球菌中毒休克综合征"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "严重的侵袭性链球菌疾病"
+ }
+ ]
+ },
+ {
+ "text": "（一）咽炎、扁桃体炎6个月～3岁的婴幼儿多见，主要表现为鼻咽炎、流清涕、低热，常见上唇周围表皮剥脱鼻咽炎临床上不易与其他病因的呼吸道感染鉴别。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "扁桃体炎"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "鼻咽炎"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "流清涕"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "低热"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "上唇"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "表皮"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "上唇周围表皮剥脱"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "鼻咽炎"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ }
+ ]
+ },
+ {
+ "text": "3～12岁小儿常患急性咽炎、急性滤泡性扁桃体炎、化脓性扁桃体炎，患儿有发热、咽痛、轻重不等的感染中毒全身症状。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "急性咽炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "急性滤泡性扁桃体炎"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "化脓性扁桃体炎"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "咽痛"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "轻重不等的感染中毒全身症状"
+ }
+ ]
+ },
+ {
+ "text": "（二）皮肤感染由A族β溶血性族链球菌引起的皮肤感染最常见的是表皮层脓疱病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "皮肤感染"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 17,
+ "type": "mic",
+ "entity": "A族β溶血性族链球菌"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "皮肤感染"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "表皮层脓疱病"
+ }
+ ]
+ },
+ {
+ "text": "细菌在无破损的皮肤上生长约10天，在虫咬、划伤、小的创伤后，细菌可在皮下繁殖，发展成为脓疱病、深脓疱和蜂窝织炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "皮下"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "脓疱病"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "深脓疱"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "蜂窝织炎"
+ }
+ ]
+ },
+ {
+ "text": "皮肤的脓疱病感染株常和患者咽部携带的菌株相同。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "脓疱病"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "咽部"
+ }
+ ]
+ },
+ {
+ "text": "深部软组织感染可以出现如丹毒，它是一种急性、易区别的皮肤感染，同时伴淋巴管炎，可以累及面部，常常和咽炎有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "深部软组织感染"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "丹毒"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "皮肤感染"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "淋巴管炎"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "面部"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "咽炎"
+ }
+ ]
+ },
+ {
+ "text": "（三）猩红热猩红热（scarletfever）常见于3岁以上小儿，为急性呼吸道传染病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "猩红热"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "猩红热"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "scarletfever"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "急性呼吸道传染病"
+ }
+ ]
+ },
+ {
+ "text": "以发热、咽炎及皮疹为特征，此病可由不同型的A族β溶血性链球菌引起，其细菌的致热毒素有A、B、C三种。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 29,
+ "type": "mic",
+ "entity": "A族β溶血性链球菌"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "毒素"
+ }
+ ]
+ },
+ {
+ "text": "感染其中一种后，再遇到其他任一种，仍可发生第二次或第三次猩红热，但这种机会很少。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "猩红热"
+ }
+ ]
+ },
+ {
+ "text": "起病急骤，有寒战、发热、全身不适、咽痛和皮肤出现弥漫性猩红色、约针头大小的丘疹，触之呈粗砂纸样。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "寒战"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "全身不适"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "咽痛"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "皮肤出现弥漫性猩红色"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "约针头大小的丘疹"
+ }
+ ]
+ },
+ {
+ "text": "体格检查：面颊部潮红口周围皮肤苍白口周苍白圈。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "体格检查"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "面颊部"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "面颊部潮红"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "口"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "口周围皮肤苍白"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "口周苍白圈"
+ }
+ ]
+ },
+ {
+ "text": "咽及扁桃体显著充血可见脓性渗出物。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "咽"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "扁桃体"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "咽及扁桃体显著充血"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "可见脓性渗出物"
+ }
+ ]
+ },
+ {
+ "text": "舌质红舌乳头红肿如草莓舌颈部及颌下淋巴结增大有触痛。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "舌质"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "舌质红"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "舌乳头"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "舌乳头红肿如草莓舌"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "颈部"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "颌下淋巴结"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "颈部及颌下淋巴结增大"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "有触痛"
+ }
+ ]
+ },
+ {
+ "text": "于皮肤皱褶处如腋窝、肘、腹股沟等处，皮疹密集、色深红，其间有针头大小出血点，形成深红色横行“帕氏症”（Pastia’ssign）。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "腋窝"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肘"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "腹股沟"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "皮疹密集、色深红"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "有针头大小出血点"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "帕氏症"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "Pastia’ssign"
+ }
+ ]
+ },
+ {
+ "text": "（四）链球菌中毒休克样综合征链球菌中毒休克样综合征（TSS）这一疾病是同菌株产生致热外毒素有关，其特征是低血压，伴随多器官、系统功能障碍葡萄球菌中毒休克综合征相区别。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "链球菌中毒休克样综合征"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "链球菌中毒休克样综合征"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "TSS"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "致热外毒素"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "低血压"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "器官"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 67,
+ "type": "sym",
+ "entity": "伴随多器官、系统功能障碍"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 78,
+ "type": "dis",
+ "entity": "葡萄球菌中毒休克综合征"
+ }
+ ]
+ },
+ {
+ "text": "经常是有A族链球菌感染的病灶，如菌血症、肺炎、蜂窝织炎，而咽炎常不存在，咽培养的结果可以是阴性的，但可以从其他部位分离出细菌。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "A族链球菌感染"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "菌血症"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "蜂窝织炎"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "（五）严重侵袭性链球菌疾病是一组非常严重的侵袭性A族链球菌疾病，包括脓毒败血症、重症的猩红热、坏死性筋膜炎、TSS和败血症，在世界范围内，它们的发病率已在增加，其原因可能是因为更有毒性的菌株的流行。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "严重侵袭性链球菌疾病"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "侵袭性A族链球菌疾病"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "脓毒败血症"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "重症的猩红热"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "坏死性筋膜炎"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "TSS"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "败血症"
+ }
+ ]
+ },
+ {
+ "text": "这些菌株可能同在18世纪引起世界范围内暴发性脓毒败血症的菌株相似。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "脓毒败血症"
+ }
+ ]
+ },
+ {
+ "text": "这些严重形式的A族链球菌疾病需要早期认识和有效的治疗。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "A族链球菌疾病"
+ }
+ ]
+ },
+ {
+ "text": "10%～20%的正常学龄儿童咽培养可有A族链球菌出现，这些携带者没有发生感染和风湿热的危险。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "风湿热"
+ }
+ ]
+ },
+ {
+ "text": "有30%患有咽痛的儿童咽培养可以阳性，仅有一半人���血清抗体增高，说明有感染，而不是带菌者。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "咽痛"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "血清抗体"
+ }
+ ]
+ },
+ {
+ "text": "链球菌咽炎患儿发病年龄多在5岁以上，有发热、咽部渗出物颈前淋巴结肿大猩红热样皮疹和A族链球菌暴露接触史。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "链球菌咽炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "咽部"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "咽部渗出物"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "颈"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "淋巴结"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "颈前淋巴结肿大"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "猩红热样皮疹"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "mic",
+ "entity": "A族链球菌"
+ }
+ ]
+ },
+ {
+ "text": "但是许多患有急性感染的小儿可能仅有轻度症状，通过临床不能判断患A族链球菌感染，需有咽培养和抗原检测来明确诊断。",
+ "entities": [
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "A族链球菌感染"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "pro",
+ "entity": "抗原检测"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）咽培养咽培养是非常有价值的实验室检查，帮助患有扁桃体炎和咽炎患者明确诊断。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "实验室检查"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "实验室检查"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "扁桃体炎"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "咽炎"
+ }
+ ]
+ },
+ {
+ "text": "扁桃体和咽后壁有力地拭抹对于获得足够的标本是必要的，选择培养基以羊血培养基效果好，在3%的双氧水中无气泡产生（触酶试验阴性），并有β溶血菌落可以定为链球菌，而A族链球菌的生长可被杆菌肽纸片抑制；乳胶凝集试验也可证实。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "扁桃体"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "咽后壁"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "双氧水"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "pro",
+ "entity": "触酶试验"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 69,
+ "type": "mic",
+ "entity": "β溶血菌落"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 83,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 93,
+ "type": "dru",
+ "entity": "杆菌肽纸片"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 102,
+ "type": "pro",
+ "entity": "乳胶凝集试验"
+ }
+ ]
+ },
+ {
+ "text": "因为溶血性链球菌常常栖居在正常儿童的咽部，因此，在咽炎患儿的咽部分离出A族链球菌不一定说明炎症就是由这一病原引起的。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "溶血性链球菌"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "咽部"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "咽部"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "A族链球菌"
+ }
+ ]
+ },
+ {
+ "text": "若细菌由中、重度渗出性咽炎的患儿标本中分离，并且他们的腭部有瘀斑和颈部淋巴结炎，这一诊断则是确定的。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "腭部"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "瘀斑"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "颈部淋巴结炎"
+ }
+ ]
+ },
+ {
+ "text": "到目前为止，细菌抗原的快速检测的敏感性尚不高，但特异性较好。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "mic",
+ "entity": "细菌抗原"
+ }
+ ]
+ },
+ {
+ "text": "（二）血常规周围血白细胞计数可以增高，也可以不增高，白细胞增加可出现在许多细菌感染性疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "血常规"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "血白细胞计数"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "细菌感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "同样，血沉和C反应蛋白的增高也不能作为诊断的依据。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "血沉"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "C反应蛋白"
+ }
+ ]
+ },
+ {
+ "text": "（三）免疫学反应1.ASO抗体水平的检测在病程的3～6周，80%链球菌咽炎患儿ASO抗体滴度大于166todd单位。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "ASO抗体"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "链球菌咽炎"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "ASO抗体滴度"
+ }
+ ]
+ },
+ {
+ "text": "通过早期、有效抗生素的应用，这一反应可以被减弱或消除。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "ASO滴度在风湿热患者可以很高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "ASO滴度"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "风湿热"
+ }
+ ]
+ },
+ {
+ "text": "相反，脓疱病患者这一抗体是弱阳性或很低。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "脓疱病"
+ }
+ ]
+ },
+ {
+ "text": "在肾小球肾炎的患者这一抗体反应个体差异较大。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "肾小球肾炎"
+ }
+ ]
+ },
+ {
+ "text": "2.抗DNA酶B抗体（ADB）水平的检测患有脓疱病的患儿可能对其链球菌细胞外产物的刺激具有强烈的反应。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "抗DNA酶B抗体"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "ADB"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "脓疱病"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "链球菌细胞外产物"
+ }
+ ]
+ },
+ {
+ "text": "感染发生6～8周时抗体水平在链球菌性脓疱病患儿开始增高，许多有链球菌咽炎者也可产生针对这一酶的抗体。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "链球菌性脓疱病"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "链球菌咽炎"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "3.脓疱病和咽炎患者也可产生针对透明质酸酶抗体反应，但这一反应不像ASO反应那样有规律。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "脓疱病"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "透明质酸酶抗体"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "ASO"
+ }
+ ]
+ },
+ {
+ "text": "当考虑患儿有近期感染时，应该测定多种链球菌产物的抗体反应滴度。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "链球菌"
+ }
+ ]
+ },
+ {
+ "text": "4.快速抗原检测法（rapidantigendetectiontest，RADT）诊断咽部GAS感染的正确性较高，具有简单快捷的优势，但对症状较轻或使用过抗生素治疗的患儿的诊断效能有所下降。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "快速抗原检测法"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "rapidantigendetectiontest"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "RADT"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "咽部GAS感染"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 81,
+ "type": "pro",
+ "entity": "抗生素治疗"
+ }
+ ]
+ },
+ {
+ "text": "【鉴别诊断】（一）病毒性咽炎咽部细菌培养常阴性，而特异病毒培养可以阳性，血清特异性抗体可增加。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "病毒性咽炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "咽部细菌培养"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "特异病毒培养"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "血清特异性抗体"
+ }
+ ]
+ },
+ {
+ "text": "（二）感染性单核细胞增多症其临床症状，末梢血非典型淋巴细胞存在，异嗜血细胞和EB病毒滴度增高都是此病的特征。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "感染性单核细胞增多症"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "末梢血非典型淋巴细胞"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "异嗜血细胞"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 43,
+ "type": "ite",
+ "entity": "EB病毒滴度"
+ }
+ ]
+ },
+ {
+ "text": "（三）其他病原引起的急性咽炎如白喉、支原体感染等适当的咽培养和血清学检测可以排出这些疾病。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "急性咽炎"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "白喉"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "支原体感染"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "血清学检测"
+ }
+ ]
+ },
+ {
+ "text": "（四）葡萄球菌皮肤感染链球菌性脓皮病应该同葡萄球菌皮肤感染相鉴别，两种细菌经常同时存在，培养是鉴别的最好方法。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "葡萄球菌皮肤感染"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "链球菌性脓皮病"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "葡萄球菌皮肤感染"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "（五）链球菌败血症、脑膜炎、化脓性关节炎和肺炎其病状无特异性，只有培养证实。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "链球菌败血症"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "脑膜炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "化脓性关节炎"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "【并发症】并发症一般反映链球菌从鼻咽部蔓延过程，引起鼻窦炎、中耳炎、乳突炎、颈淋巴结炎、咽后壁脓肿支气管肺炎。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "鼻咽部"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "鼻窦炎"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "中耳炎"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "乳突炎"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "颈淋巴结炎"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "咽后壁"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "咽后壁脓肿"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "支气管肺炎"
+ }
+ ]
+ },
+ {
+ "text": "链球菌血源性传播可引起脑膜炎、骨髓炎或化脓性关节炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "脑膜炎"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "骨髓炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "化脓性关节炎"
+ }
+ ]
+ },
+ {
+ "text": "非化脓性晚期并发症包括风湿热和肾小球肾炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "非化脓性晚期并发症"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "风湿热"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "肾小球肾炎"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】治疗的目的是减轻症状，预防败血症、化脓和非化脓性并发症。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "非化脓性并发症"
+ }
+ ]
+ },
+ {
+ "text": "青霉素是首选药物。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "迄今为止，所有A族链球菌菌株都对青霉素和许多头孢菌素敏感。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "头孢菌素"
+ }
+ ]
+ },
+ {
+ "text": "但在严重感染时推荐青霉素和克林霉素联合应用，对青霉素过敏时大环内酯类抗生素作为首选药物，但我国已经有大环内酯类高耐药率及高水平耐药的报道。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "克林霉素"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 36,
+ "type": "dru",
+ "entity": "环内酯类抗生素"
+ }
+ ]
+ },
+ {
+ "text": "对红霉素耐药程度在不同国家和地区有明显差异，它取决于应用红霉素的广泛程度；克林霉素耐药株少见。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "红霉素"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "红霉素"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "克林霉素"
+ }
+ ]
+ },
+ {
+ "text": "对于深部感染部位，A族链球菌生长缓慢时，青霉素治疗效果不好。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "mic",
+ "entity": "A族链球菌"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "在血液和组织中青霉素的杀菌浓度维持至少10天，以便彻底杀死链球菌。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "mic",
+ "entity": "链球菌"
+ }
+ ]
+ },
+ {
+ "text": "儿童链球菌咽炎青霉素250～500mg/次，一日2次或一日3次，疗程10天。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "链球菌"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "咽炎"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "青霉素G或青霉素V也可使用，后者更好些，因为即使在空腹时它也可达到满意的血浓度。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "青霉素G"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "青霉素V"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "ite",
+ "entity": "血浓度"
+ }
+ ]
+ },
+ {
+ "text": "单剂量肌内注射长效的苯唑青霉素G（22kg以下小儿，60万U/次；22kg以上儿童120万U/次），对于治疗和预防复发是非常有效的。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "单剂量肌内注射"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "苯唑青霉素G"
+ }
+ ]
+ },
+ {
+ "text": "红霉素40mg/（kg•d）、克林霉素30mg/（kg•d）或一代头孢菌素类可以用来治疗青霉素过敏的咽炎患者，一般来说，复发率是很低的。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "红霉素"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "克林霉素"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dru",
+ "entity": "头孢菌素"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "咽炎"
+ }
+ ]
+ },
+ {
+ "text": "四环素和磺胺嘧啶不能用于治疗。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "四环素"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "磺胺嘧啶"
+ }
+ ]
+ },
+ {
+ "text": "当一个疗程青霉素治疗后，仍有链球菌持续存在，被定义为治疗失败。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "mic",
+ "entity": "链球菌"
+ }
+ ]
+ },
+ {
+ "text": "这种情况在5%～20%的儿童中出现，且常出现在口服治疗的患者，可能是由于再感染、持续携带β内酰胺酶阳性的菌株、对青霉素耐药株的带菌状态。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "口服治��"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "β内酰胺酶"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "在高危人群，青霉素足疗程治疗后，应反复咽培养检查，对于咽培养再次阳性的患者，一些临床医生建议给予第二次治疗疗程。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "咽培养"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "咽培养"
+ }
+ ]
+ },
+ {
+ "text": "如果第二个疗程后仍是带菌状况，这时发展为风湿热的危险性很小，不需进一步治疗。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "风湿热"
+ }
+ ]
+ },
+ {
+ "text": "患有严重猩红热、链球菌菌血症、肺炎、脑膜炎、深部软组织感染、丹毒、链球菌中毒休克样综合征或链球菌咽炎并发症的病例，应该肌内或最好是静脉给予青霉素，其用量和疗程则依疾病的自然病程而定。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "猩红热"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "链球菌菌血症"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "脑膜炎"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "深部软组织感染"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "丹毒"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "链球菌中毒休克样综合征"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "链球菌咽炎"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "肌内"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "而非常严重感染的病例，应给予40万U/（kg•24h）的大剂量青霉素。",
+ "entities": [
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "有研究建议深部或坏死性感染可能需要增加一种二线抗生素，如克林霉素，以确保彻底杀死细菌。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "深部或坏死性感染"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "克林霉素"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "TSS也可能需要附加的治疗，包括早期积极的液体供应，静脉免疫球蛋白或糖皮质激素的应用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "TSS"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "静脉免疫球蛋白"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "糖皮质激素"
+ }
+ ]
+ },
+ {
+ "text": "【预防】如果在症状发生前应用青霉素，可以预防多数链球菌感染发生，对风湿热以外的其他感染化学药物预防效果尚不清。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "链球菌感染"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "风湿热"
+ }
+ ]
+ },
+ {
+ "text": "或者60万U苯唑青霉素连同60万U水剂普鲁卡因青霉素，给予一次性肌内注射，这一用法适用于一定范围内的流行。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "U苯唑青霉素"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "U水剂普鲁卡因青霉素"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "肌内"
+ }
+ ]
+ },
+ {
+ "text": "对无症状的恢复期患者的持续咽培养阳性可不必再次治疗，因为他们一般是带菌者，不会有持续的或者再发的感染存在。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "咽培养"
+ }
+ ]
+ },
+ {
+ "text": "一些携带者常患有病毒性呼吸道感染，很像链球菌感染，可能被认为是再发性链球菌感染。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "病毒性呼吸道感染"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "链球菌感染"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "链球菌感染"
+ }
+ ]
+ },
+ {
+ "text": "应用非青霉素类药物如头孢菌素类、红霉素、克林霉素对于消灭带菌症状是有效的，但是对一些少见病例应慎用。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "青霉素"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "头孢菌素"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "红霉素"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "克林霉素"
+ }
+ ]
+ },
+ {
+ "text": "目前尚无临床可应用的A族链球菌疫苗。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "mic",
+ "entity": "A族链球菌疫苗"
+ }
+ ]
+ },
+ {
+ "text": "【预后】经适当治疗的链球菌感染的预后是非常好的，多数化脓性并发症是可以预防和治疗的。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "链球菌感染"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "化脓性并发症"
+ }
+ ]
+ },
+ {
+ "text": "早期治疗是防止非化脓性并发症和完全治愈的关键。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "非化脓性并发症"
+ }
+ ]
+ },
+ {
+ "text": "尽管应用足够的疗程，但仍有少数病例如新生儿或有免疫缺陷的儿童患暴发性肺炎、败血症而发生死亡。",
+ "entities": [
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "败血症"
+ }
+ ]
+ },
+ {
+ "text": "二、肾小球功能检查肾小球功能主要为滤过和清除功能。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "肾小球功能检查"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肾小球"
+ }
+ ]
+ },
+ {
+ "text": "临床上常将血肌酐、尿素氮、尿酸以及肾小球滤过率（GFR）、血浆蛋白清除率等作为肾小球滤过和清除功能的指标。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "尿素氮"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "尿酸"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 22,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "ite",
+ "entity": "血浆蛋白清除率"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "肾小球"
+ }
+ ]
+ },
+ {
+ "text": "（一）血尿素氮及血肌酐血尿素氮（BUN）及血肌酐（Scr）来评估肾小球滤过率（GFR），已在临床得到广泛应用。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "血尿素氮"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "血尿素氮"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 37,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "BUN正常值新生儿为1.8～6.4mmol/L，婴儿及儿童为2.5～6.4mmol/L，青春期为2.9～7.5mmol/L。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "BUN"
+ }
+ ]
+ },
+ {
+ "text": "尿素主要由肾小球滤过，可以从BUN上升来评估GFR下降的程度。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "但尿素的产生不如肌酐恒定，受多种因素影响：①肝脏合成尿素是将未合成蛋白质的氨基酸脱氨后再合成尿素，当肝内氨基酸代谢增加时（如高蛋白饮食），以及组织分解代谢旺盛而蛋白合成减少时，尿素生成增加，BUN上升。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "蛋白质"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "氨基酸"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "肝"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "氨基酸"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "组织"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "蛋白"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 97,
+ "type": "ite",
+ "entity": "BUN"
+ }
+ ]
+ },
+ {
+ "text": "②严重肝病或低蛋白饮食时BUN会下降。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "严重肝病"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "BUN"
+ }
+ ]
+ },
+ {
+ "text": "③尿素排泄不仅决定于肾小球滤过，正常时约有40%～50%的尿素随着钠及水一起而被肾小管被动回吸收。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "钠"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "肾小管"
+ }
+ ]
+ },
+ {
+ "text": "血容量下降时，尿素可随着近曲小管钠的回吸收增加而增加使BUN升高，这时并不代表GFR下降。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "尿素"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "钠"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "④BUN与GFR之间的负相关并非直线关系而是呈反抛物线形式，只有当GFR下降至50%～60%以上才引起BUN上升。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "ite",
+ "entity": "BUN"
+ }
+ ]
+ },
+ {
+ "text": "因此，在用BUN评估肾脏病进展时必须考虑多方面因素的影响，尤其是饮食中蛋白质含量。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肾脏病"
+ }
+ ]
+ },
+ {
+ "text": "如GFR稳定时，饮食中蛋白质加倍，BUN将升高而造成肾功能下降的错觉。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "BUN"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肾"
+ }
+ ]
+ },
+ {
+ "text": "此外，小儿分解代谢旺盛如发热时也可出现一过性BUN升高。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "BUN"
+ }
+ ]
+ },
+ {
+ "text": "血肌酐（Scr）浓度不受蛋白质摄入量影响，是更可靠而有用的肾功能指标。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "蛋白质"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肾"
+ }
+ ]
+ },
+ {
+ "text": "肌酐是体内肌酸代谢的终产物，分子量为113D，因而正常人Scr浓度也极为恒定，人每日的动态变化小于10%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肌酸"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "ite",
+ "entity": "Scr"
+ }
+ ]
+ },
+ {
+ "text": "血肌酐的浓度直接与体内肌肉组织的总量有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肌肉组织"
+ }
+ ]
+ },
+ {
+ "text": "故Scr的正常值与性别、年龄和身长有关。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "Scr"
+ }
+ ]
+ },
+ {
+ "text": "可参照下列两个公式：男孩Scr（mg/dl）=0.35+0.03×年龄女孩Scr（mg/dl）=0.37+0.02×年龄或Scr（mg/dl）=0.004×身长（cm）小儿血肌酐正常值约为27～62μmol/L，随年龄增长及肌肉发育而增高。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 113,
+ "type": "bod",
+ "entity": "肌肉"
+ }
+ ]
+ },
+ {
+ "text": "正常小儿血肌酐初生时较高，接近成人水平，约2～4周下降至8.84～17.68μmol/L。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "血肌酐"
+ }
+ ]
+ },
+ {
+ "text": "当GFR降至正常70%以下时，Scr才可能升高。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "Scr"
+ }
+ ]
+ },
+ {
+ "text": "（二）肾小球滤过率肾小球滤过率（glomerularfiltrationrate，GFR）是指单位时间（分钟）内从双肾滤过的血浆毫升数。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "glomerularfiltrationrate"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "血浆"
+ }
+ ]
+ },
+ {
+ "text": "临床上常用清除率来表示GFR。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "清除率"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "清除率指每分钟多少毫升血中的某物质被肾小球滤过清除，当这种物质既不被肾小管重吸收，也不被肾小管分泌时，可以认定该物质的清除率与GFR相等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "清除率"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "清除率"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 65,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "菊粉（inulin）是从植物块基中提取的不带电荷的果糖聚合物，分子量5.2kD，只从肾小球滤过，不被肾小管重吸收和分泌，故菊粉清除率（Cin）=GFR，Cin被认为是测定GFR的金标准。",
+ "entities": [
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "ite",
+ "entity": "菊粉清除率"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "Cin"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 78,
+ "type": "ite",
+ "entity": "Cin"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 87,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "但菊粉需给病人静脉注入，然后分时段多次采血后以高效液相色谱法分析后才能计算出Cin，过程繁琐，程序复杂，因而临床上仍普遍以内生肌酐廓清率（Ccr）来代替Cin。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "菊粉"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "静脉注入"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "采血"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "高效液相色谱法分析"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "Cin"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 67,
+ "type": "ite",
+ "entity": "内生肌酐廓清率"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "ite",
+ "entity": "Ccr"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 78,
+ "type": "ite",
+ "entity": "Cin"
+ }
+ ]
+ },
+ {
+ "text": "内生肌酐由体内肌酸衍生而来，其产生及排泄均较稳定。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "内生肌酐"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肌酸"
+ }
+ ]
+ },
+ {
+ "text": "正常儿童尿中肌酐排出量约为［15+0.5×年龄（岁）］mg/（kg•24h），由肾小球滤过后，既不为肾小管回吸收，也不为肾脏代谢，但可由近曲小管少量分泌。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "肾小球"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "近曲小管"
+ }
+ ]
+ },
+ {
+ "text": "因而，正常人肌酐排泄量超过滤过量的10%～20%。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "肌酐排泄量"
+ }
+ ]
+ },
+ {
+ "text": "但在血浆中也有10%～20%非肌酐的色素物质可与肌酐一起用苦味酸比色法测出，故恰与尿中多出的抵消。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "非肌酐的色素物质"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "pro",
+ "entity": "苦味酸比色法"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "尿"
+ }
+ ]
+ },
+ {
+ "text": "因此，肌酐廓清率可准确反映肾小球滤过率（GFR）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "肌酐廓清率"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "ite",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "GFR下降至＜40ml/（min•1.73m2）时，滤过的肌酐减少，肾小管分泌的增加，此时Ccr将比实际GFR高出10%～40%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "肾小管"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "Ccr"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "GFR"
+ }
+ ]
+ },
+ {
+ "text": "肌酐廓清率的测定方法是测定同一时间内血及尿中的肌酐浓度，并准确测定尿量（留4小时或12小时尿），计算出肾脏每分钟清除血浆中肌酐的毫升数，再用患儿体表面积矫正即得出矫正肌酐廓清率：矫正廓清率=内生肌酐廓清率×1.73（m2）/小儿实际体表面积（m2）正常新生儿为25～27ml/（min•1.73m2），婴儿期60～80ml/（min1.73m2），2岁以后的小儿矫正内生肌酐廓清率为80～120ml/（min•1.73m2）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "肌酐廓清率"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "肌酐浓度"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "尿量"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "肌酐"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 87,
+ "type": "ite",
+ "entity": "矫正肌酐廓清率"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 93,
+ "type": "ite",
+ "entity": "矫正廓清率"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 101,
+ "type": "ite",
+ "entity": "内生肌酐廓清率"
+ },
+ {
+ "start_idx": 205,
+ "end_idx": 213,
+ "type": "ite",
+ "entity": "矫正内生肌酐廓清率"
+ }
+ ]
+ },
+ {
+ "text": "由于血肌酐浓度十分恒定，其变化与肾小球滤过率高低十分密切。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ }
+ ]
+ },
+ {
+ "text": "因此不少人试图以血肌酐来拟算肾小球滤过率。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "血肌酐"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ }
+ ]
+ },
+ {
+ "text": "Schwartz等研究Scr/GFR和身长间的关系，得出公式为：矫正Ccr=K×身长（cm）/Scr（mg/dl）式中K为单位体重排肌酐的常数，2～12岁小儿为0.55，≤1岁婴儿为0.45，≤1岁的低体重儿为0.33。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "GFR"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "Ccr"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "ite",
+ "entity": "Scr"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "肌酐"
+ }
+ ]
+ },
+ {
+ "text": "第十章小儿腹泻病在未明确病因前，大便性状改变与大便次数比平时增多，统称为腹泻病（diarrhealdisease）。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "小儿腹泻病"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "大便性状改变"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "大便次数比平时增多"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "腹泻病"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "diarrhealdisease"
+ }
+ ]
+ },
+ {
+ "text": "全球大约每年至少10亿人次发生腹泻，根据世界卫生组织调查，每天大约1万人死于腹泻。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "在我国，腹泻病同样是儿童的常见病，据有关资料，我国5岁以下儿童腹泻病的年发病率为201%，平均每年每个儿童年发病3.5次，其死亡率为0.51%。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "儿童腹泻病"
+ }
+ ]
+ },
+ {
+ "text": "因此，对小儿腹泻病的防治十分重要。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "小儿腹泻病"
+ }
+ ]
+ },
+ {
+ "text": "根据病程腹泻病分为：急性腹泻病（acutediarrhealdisease）病程在2周以内；迁延性腹泻病（persistentdiarrhealdisease）病程在2周～2个月；慢性腹泻病（chronicdiarrhealdisease）病程在2个月以上。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "腹泻病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "急性腹泻病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "acutediarrhealdisease"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "迁延性腹泻病"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 78,
+ "type": "dis",
+ "entity": "persistentdiarrhealdisease"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 94,
+ "type": "dis",
+ "entity": "慢性腹泻病"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 118,
+ "type": "dis",
+ "entity": "chronicdiarrhealdisease"
+ }
+ ]
+ },
+ {
+ "text": "按病情分为：轻型：无脱水，无中毒症状；中型：轻度至中度脱水或有中毒症状；重型：重度脱水或有明显中毒症状（烦躁、精神萎靡、嗜睡、面色苍白。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "轻度至中度脱水"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "中毒"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "有中毒症状"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "重度脱水"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "明显中毒症状"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "烦躁"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "精神萎靡"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "ite",
+ "entity": "面色"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 66,
+ "type": "sym",
+ "entity": "面色苍白"
+ }
+ ]
+ },
+ {
+ "text": "高热或体温不升以及白细胞计数明显增高痢疾、霍乱、病毒及其他感染性腹泻等；非感染性，包括食饵性（饮食性）腹泻；症状性腹泻，如过敏性腹泻；其他腹泻病如乳糖不耐症及糖原性腹泻等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "体温不升"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "白细胞计数"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "白细胞计数明显增高"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "痢疾"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "霍乱"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "感染性腹泻"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "食饵性（饮食性）腹泻"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "症状性腹泻"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "过敏性腹泻"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 71,
+ "type": "dis",
+ "entity": "其他腹泻病"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "乳糖不耐症"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 83,
+ "type": "dis",
+ "entity": "糖原性腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（一）内在因素1.消化系统发育不成熟婴幼儿时期，胃酸及消化酶分泌不足，消化酶的活性较低，神经系统对胃肠道调节功能较差，不易适应食物的质和量，且生长发育快，营养物质的需要相对较多，胃肠道负担较大，消化功能经常处于紧张状态，易发生消化功能紊乱。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "胃酸"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "消化酶"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "消化酶"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 91,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 118,
+ "type": "dis",
+ "entity": "消化功能紊乱"
+ }
+ ]
+ },
+ {
+ "text": "2.机体防御功能较差婴幼儿时期免疫功能相对不够成熟，血液中的免疫球蛋白和胃肠道sIgA均较低，胃肠屏障功能较弱，胃酸分泌量少，胃肠排空较快，对感染因素防御功能差。",
+ "entities": [
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "免疫球蛋白"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 42,
+ "type": "ite",
+ "entity": "胃肠道sIgA"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "胃酸"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "胃肠"
+ }
+ ]
+ },
+ {
+ "text": "另外，新生儿，出生后尚未建立完善的肠道正常菌群，对侵入肠道的病原微生物拮抗能力弱，人工喂养者食物中缺乏母乳含有的大量免疫物质，且食物和食具污染机会较多，肠道感染的发生率明显高于母乳喂养儿。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "病原微生物"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "母乳"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 89,
+ "type": "bod",
+ "entity": "母乳"
+ }
+ ]
+ },
+ {
+ "text": "3.体液分布特点婴儿细胞间质液较多，且水代谢旺盛，肾功能调节差，易发生体液紊乱。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "体液"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "细胞间质液"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "体液紊乱"
+ }
+ ]
+ },
+ {
+ "text": "（二）感染因素1.肠道感染主要由细菌和病毒引起。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "肠道感染"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "病毒"
+ }
+ ]
+ },
+ {
+ "text": "（1）细菌：除法定传染病外。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "①大肠杆菌（Escherichiacoli，E.Coli）：按其致病机制分类为致病性大肠杆菌（Entero-pathogenicE.Coli，EPEC）、产毒素性大肠杆菌（EnterotoxigenicE.Coli，ETEC）、侵袭性大肠杆菌（EnteroinvasiveE.Coli，EIEC）、出血性大肠杆菌（EnterohemorrhagicE.Coli，EHEC）以及黏附性大肠杆菌（EnteroadhesiveE.Coli，EAEC）；②空肠弯曲菌（Campylobacterjejuni）；③耶尔森菌（Yersiniaentero-colitica）；④其他：鼠伤寒沙门菌（Salmonellatyphimurium）、变形杆菌（proteus）、铜绿假单胞菌（Pseudomonasaeruginosa）、克雷伯菌（Klebsiella）、金黄色葡萄球菌（Staphlococcusaureus）以及难辨梭状芽胞杆菌（Clostridiumdifficile）等。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "大肠杆菌"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "Escherichiacoli"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "mic",
+ "entity": "E.Coli"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 45,
+ "type": "mic",
+ "entity": "致病性大肠杆菌"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 74,
+ "type": "mic",
+ "entity": "EPEC"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 84,
+ "type": "mic",
+ "entity": "产毒素性大肠杆菌"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 106,
+ "type": "mic",
+ "entity": "EnterotoxigenicE.Coli"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 111,
+ "type": "mic",
+ "entity": "ETEC"
+ },
+ {
+ "start_idx": 114,
+ "end_idx": 120,
+ "type": "mic",
+ "entity": "侵袭性大肠杆菌"
+ },
+ {
+ "start_idx": 122,
+ "end_idx": 141,
+ "type": "mic",
+ "entity": "EnteroinvasiveE.Coli"
+ },
+ {
+ "start_idx": 143,
+ "end_idx": 146,
+ "type": "mic",
+ "entity": "EIEC"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 155,
+ "type": "mic",
+ "entity": "出血性大肠杆菌"
+ },
+ {
+ "start_idx": 157,
+ "end_idx": 179,
+ "type": "mic",
+ "entity": "EnterohemorrhagicE.Coli"
+ },
+ {
+ "start_idx": 181,
+ "end_idx": 184,
+ "type": "mic",
+ "entity": "EHEC"
+ },
+ {
+ "start_idx": 188,
+ "end_idx": 194,
+ "type": "mic",
+ "entity": "黏附性大肠杆菌"
+ },
+ {
+ "start_idx": 196,
+ "end_idx": 215,
+ "type": "mic",
+ "entity": "EnteroadhesiveE.Coli"
+ },
+ {
+ "start_idx": 217,
+ "end_idx": 220,
+ "type": "mic",
+ "entity": "EAEC"
+ },
+ {
+ "start_idx": 224,
+ "end_idx": 228,
+ "type": "mic",
+ "entity": "空肠弯曲菌"
+ },
+ {
+ "start_idx": 230,
+ "end_idx": 248,
+ "type": "mic",
+ "entity": "Campylobacterjejuni"
+ },
+ {
+ "start_idx": 252,
+ "end_idx": 255,
+ "type": "mic",
+ "entity": "耶尔森菌"
+ },
+ {
+ "start_idx": 257,
+ "end_idx": 279,
+ "type": "mic",
+ "entity": "Yersiniaentero-colitica"
+ },
+ {
+ "start_idx": 286,
+ "end_idx": 291,
+ "type": "mic",
+ "entity": "鼠伤寒沙门菌"
+ },
+ {
+ "start_idx": 293,
+ "end_idx": 313,
+ "type": "mic",
+ "entity": "Salmonellatyphimurium"
+ },
+ {
+ "start_idx": 316,
+ "end_idx": 319,
+ "type": "mic",
+ "entity": "变形杆菌"
+ },
+ {
+ "start_idx": 321,
+ "end_idx": 327,
+ "type": "mic",
+ "entity": "proteus"
+ },
+ {
+ "start_idx": 330,
+ "end_idx": 335,
+ "type": "mic",
+ "entity": "铜绿假单胞菌"
+ },
+ {
+ "start_idx": 337,
+ "end_idx": 357,
+ "type": "mic",
+ "entity": "Pseudomonasaeruginosa"
+ },
+ {
+ "start_idx": 360,
+ "end_idx": 363,
+ "type": "mic",
+ "entity": "克雷伯菌"
+ },
+ {
+ "start_idx": 365,
+ "end_idx": 374,
+ "type": "mic",
+ "entity": "Klebsiella"
+ },
+ {
+ "start_idx": 377,
+ "end_idx": 383,
+ "type": "mic",
+ "entity": "金黄色葡萄球菌"
+ },
+ {
+ "start_idx": 385,
+ "end_idx": 403,
+ "type": "mic",
+ "entity": "Staphlococcusaureus"
+ },
+ {
+ "start_idx": 407,
+ "end_idx": 414,
+ "type": "mic",
+ "entity": "难辨梭状芽胞杆菌"
+ },
+ {
+ "start_idx": 416,
+ "end_idx": 435,
+ "type": "mic",
+ "entity": "Clostridiumdifficile"
+ }
+ ]
+ },
+ {
+ "text": "（2）病毒：①轮状病毒（humanrotavirus），是引起婴幼儿腹泻的主要病原；②诺如病毒（Norovirus）；③肠道腺病毒（adenovirus）；④其他，如星状病毒（astrovirus）、杯状病毒（calicivirus）及冠状病毒（coronavirus）等。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "轮状病毒"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "humanrotavirus"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "婴幼儿腹泻"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "mic",
+ "entity": "诺如病毒"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 56,
+ "type": "mic",
+ "entity": "Norovirus"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "mic",
+ "entity": "肠道腺病毒"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 75,
+ "type": "mic",
+ "entity": "adenovirus"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 86,
+ "type": "mic",
+ "entity": "星状病毒"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 97,
+ "type": "mic",
+ "entity": "astrovirus"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "mic",
+ "entity": "杯状病毒"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 115,
+ "type": "mic",
+ "entity": "calicivirus"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 121,
+ "type": "mic",
+ "entity": "冠状病毒"
+ },
+ {
+ "start_idx": 123,
+ "end_idx": 133,
+ "type": "mic",
+ "entity": "coronavirus"
+ }
+ ]
+ },
+ {
+ "text": "（3）真菌和原虫：真菌感染主要为白色念珠菌（Candidaalbicans），一些原虫的感染如蓝氏贾第鞭毛虫（Giardialam-blia）、结肠小袋虫（Balantidiumcoli）、隐孢子虫（Cryptosporidi-um）及阿米巴原虫（Entamoebahistolytica）等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "真菌"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "原虫"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "真菌感染"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "白色念珠菌"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 36,
+ "type": "mic",
+ "entity": "Candidaalbicans"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 53,
+ "type": "mic",
+ "entity": "蓝氏贾第鞭毛虫"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 69,
+ "type": "mic",
+ "entity": "Giardialam-blia"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 76,
+ "type": "mic",
+ "entity": "结肠小袋虫"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 92,
+ "type": "mic",
+ "entity": "Balantidiumcoli"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 98,
+ "type": "mic",
+ "entity": "隐孢子虫"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 115,
+ "type": "mic",
+ "entity": "Cryptosporidi-um"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 122,
+ "type": "mic",
+ "entity": "阿米巴原虫"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 143,
+ "type": "mic",
+ "entity": "Entamoebahistolytica"
+ }
+ ]
+ },
+ {
+ "text": "2.肠道外感染小儿患上呼吸道感染、肺炎、肾盂肾炎、中耳炎、皮肤感染及其他急性感染性疾病时可伴有腹泻。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "肠道外感染"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "上呼吸道感染"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "肾盂肾炎"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "中耳炎"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "皮肤感染"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "其他急性感染性疾病"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "这是由于发热及病原体毒素的影响，使消化功能紊乱，酶分泌减少肠蠕动增加。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "mic",
+ "entity": "病原体"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "消化功能紊乱"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "酶分泌减少"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肠"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "肠蠕动增加"
+ }
+ ]
+ },
+ {
+ "text": "腹泻的主要原因之一。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "过多过早喂哺大量淀粉类、脂肪类食物，突然改变食物品种和断奶等均可导致腹泻。",
+ "entities": [
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "气候的突然变化，使肠蠕动增加，消化酶和胃酸分泌减少，可诱发腹泻。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肠"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "消化酶"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "胃酸"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "一些吸收不良综合征如乳糖不耐受症、糖原性腹泻、先天性氯化物性腹泻、遗传性果糖不耐受症、胰腺囊性纤维性变以及原发性肠吸收不良等都可引起腹泻。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "吸收不良综合征"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "乳糖不耐受症"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "糖原性腹泻"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "先天性氯化物性腹泻"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "遗传性果糖不耐受症"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "胰腺囊性纤维性变"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "原发性肠吸收不良"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 67,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "牛奶蛋白过敏者，吃牛乳后48小时发生水样泻。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "水样泻"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制】不同病因引起腹泻的机制不同，可通过以下几种机制致病。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（一）非感染因素主要是饮食的量和质不恰当，使婴儿消化道功能发生障碍，食物不能充分消化和吸收，积滞于肠道上部，同时酸度下降，有利于肠道下部细菌上移繁殖，使消化功能紊乱。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "肠道上部"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "ite",
+ "entity": "酸度"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "肠道下部"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 81,
+ "type": "dis",
+ "entity": "消化功能紊乱"
+ }
+ ]
+ },
+ {
+ "text": "肠道内产生大量的乳酸、乙酸等有机酸，使肠腔渗透压增强，引起腹泻。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "乳酸"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "乙酸"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "有机酸"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "肠腔渗透压"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（二）感染因素病原微生物能否引起肠道感染，取决于宿主防御功能的强弱、感染量的大小以及微生物毒力（黏附性、产毒性及侵袭性）、细胞毒性，其中微生物的黏附能力对于肠道感染至关重要。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "mic",
+ "entity": "病原微生物"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "肠道感染"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "感染量"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "mic",
+ "entity": "微生物"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "mic",
+ "entity": "微生物"
+ }
+ ]
+ },
+ {
+ "text": "1.细菌性肠炎主要通过细菌产生毒素作用及细菌侵袭性作用为主要发病机制。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "（1）肠毒素性肠炎：病原菌不侵入肠黏膜，不引起病理形态学上的变化，仅附着于完整的肠绒毛上，通过产生肠毒素致病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肠毒素性肠炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "病原菌"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肠黏膜"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "肠绒毛"
+ }
+ ]
+ },
+ {
+ "text": "典型的细菌为ETEC和霍乱弧菌。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "mic",
+ "entity": "ETEC"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "霍乱弧菌"
+ }
+ ]
+ },
+ {
+ "text": "其他细菌也可产生肠毒素，如耶尔森菌、鼠伤寒沙门菌、金黄色葡萄球菌、变形杆菌及空肠弯曲菌等。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "mic",
+ "entity": "耶尔森菌"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "鼠伤寒沙门菌"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 31,
+ "type": "mic",
+ "entity": "金黄色葡萄球菌"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "mic",
+ "entity": "变形杆菌"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "mic",
+ "entity": "空肠弯曲菌"
+ }
+ ]
+ },
+ {
+ "text": "以ETEC为例，通过其菌毛黏附在小肠微绒毛上，生长繁殖，产生大量肠毒素。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "ETEC"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "菌毛"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "小肠微绒毛"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "肠毒素"
+ }
+ ]
+ },
+ {
+ "text": "肠毒素有两种，即不耐热毒素（heatliabletoxin，LT）和耐热毒素（heatstabletoxin，ST）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "肠毒素"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "不耐热毒素"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 28,
+ "type": "mic",
+ "entity": "heatliabletoxin"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "mic",
+ "entity": "LT"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "mic",
+ "entity": "耐热毒素"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 53,
+ "type": "mic",
+ "entity": "heatstabletoxin"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "mic",
+ "entity": "ST"
+ }
+ ]
+ },
+ {
+ "text": "LT的理化性质、免疫状态及作用机制与霍乱毒素相同。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "LT"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "mic",
+ "entity": "霍乱毒素"
+ }
+ ]
+ },
+ {
+ "text": "LT与小肠上皮细胞上的受体神经节苷脂结合，激活腺苷酸环化酶，使肠上皮细胞内三磷酸腺苷（ATP）转化为环磷酸腺苷（cAMP）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "LT"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "小肠上皮细胞"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "受体神经节苷脂"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "腺苷酸环化酶"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肠上皮细胞"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "三磷酸腺苷"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "ATP"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "环磷酸腺苷"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "cAMP"
+ }
+ ]
+ },
+ {
+ "text": "ST通过激活鸟苷酸环化酶使三磷酸鸟苷（GTP）转化为环磷酸鸟苷（cGMP）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "ST"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "鸟苷酸环化酶"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "三磷酸鸟苷"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "GTP"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "环磷酸鸟苷"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "cGMP"
+ }
+ ]
+ },
+ {
+ "text": "二者均抑制肠黏膜对钠（同时对氯和水）的吸收，促进氯（同时对钠和水）的分泌。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肠黏膜"
+ }
+ ]
+ },
+ {
+ "text": "使水向肠腔内渗透，液体积聚于肠道，引起腹泻。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（2）侵袭性肠炎：病原侵入肠黏膜固有层，引起充血、水肿、炎症细胞浸润、渗出性炎症病变、糜烂及溃疡等，造成腹泻。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "侵袭性肠炎"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "病原"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肠黏膜固有层"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "充血"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "水肿"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "炎症细胞浸润"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "渗出性炎症病变"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "糜烂"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "溃疡"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "由各种侵袭性细菌所致，如志贺菌、沙门菌、EIEC、空肠弯曲菌、耶尔森菌和金黄色葡萄球菌等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "侵袭性细菌"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "志贺菌"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "mic",
+ "entity": "沙门菌"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "EIEC"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "mic",
+ "entity": "空肠弯曲菌"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "耶尔森菌"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 42,
+ "type": "mic",
+ "entity": "金黄色葡萄球菌"
+ }
+ ]
+ },
+ {
+ "text": "志贺菌、EIEC和金黄色葡萄球菌主要侵犯结肠；空肠弯曲菌主要病变在空肠和回肠，也可累及结肠；耶尔森菌多累及回肠；鼠伤寒沙门菌主要累及回肠和结肠。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "志贺菌"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "EIEC"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "金黄色葡萄球菌"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "mic",
+ "entity": "空肠弯曲菌"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "回肠"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "mic",
+ "entity": "耶尔森菌"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "回肠"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 61,
+ "type": "mic",
+ "entity": "鼠伤寒沙门菌"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "结肠"
+ }
+ ]
+ },
+ {
+ "text": "这类病原菌均能引起痢疾样症状，粪便水分不多有脓血黏液痉挛样腹痛；同时具肠毒素作用和侵袭作用的菌株则可引起毒素性水样腹泻和痢疾样症状。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "病原菌"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "粪便水分不多"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "脓血黏液"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "有脓血黏液"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "痉挛样腹痛"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "mic",
+ "entity": "肠毒素"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "mic",
+ "entity": "菌株"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "毒素性水样腹泻"
+ }
+ ]
+ },
+ {
+ "text": "2.病毒性肠炎（viralenteritis）目前对轮状病毒（rotavirus）研究较多。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "病毒性肠炎"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "viralenteritis"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "mic",
+ "entity": "轮状病毒"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "rotavirus"
+ }
+ ]
+ },
+ {
+ "text": "轮状病毒侵犯小肠上部，严重者累及整个小肠。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "轮状病毒"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "小肠"
+ }
+ ]
+ },
+ {
+ "text": "在小肠绒毛顶端的柱状上皮细胞内复制，细胞变性，微绒毛肿胀、不规则，从而使受累的小肠黏膜上皮细胞很快脱落。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "小肠绒毛顶端"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "柱状上皮细胞"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "小肠黏膜上皮细胞"
+ }
+ ]
+ },
+ {
+ "text": "小肠隐窝部立方上皮细胞（分泌细胞）不受损害，增殖上移修复受损的黏膜上皮，但新生的上皮细胞不够成熟，其酶活性和转运功能较差。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "小肠隐窝部立方上皮细胞"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "分泌细胞"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "黏膜上皮"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "上皮细胞"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "由于肠黏膜上皮细胞脱落，造成吸收面积减少，使水和电解质吸收减少，而且绒毛裸露，造成水、电解质回渗，导致腹泻；微绒毛上双糖酶，尤其是乳糖酶活性降低，造成双糖如（乳糖）吸收障碍，不能分解的营养物质在肠腔内滞留，被肠道细菌分解，增加肠内渗透压，使水进入肠腔，导致腹泻加重。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "肠黏膜上皮细胞"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "绒毛"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "微绒毛上双糖酶"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "乳糖酶"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "双糖如（乳糖）吸收障碍"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 98,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 107,
+ "type": "mic",
+ "entity": "肠道细菌"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 117,
+ "type": "ite",
+ "entity": "肠内渗透压"
+ },
+ {
+ "start_idx": 123,
+ "end_idx": 124,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 129,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "晚近国外研究发现，轮状病毒上的非结构蛋白NSP4引起类似于细菌毒素的作用，导致分泌性腹泻。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "轮状病毒"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "非结构蛋白NSP4"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "分泌性腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（三）脂肪、蛋白质和糖代谢紊乱由于肠道消化吸收功能减低，肠蠕动亢进，使营养素的消化和吸收发生障碍。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "脂肪、蛋白质和糖代谢紊乱"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肠"
+ }
+ ]
+ },
+ {
+ "text": "营养物质的丢失主要是酶功能紊乱引起同化功能障碍所致。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "酶功能紊乱"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "同化功能障碍"
+ }
+ ]
+ },
+ {
+ "text": "碳水化合物的吸收也受到影响，糖耐量试验曲线低。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "糖耐量试验"
+ }
+ ]
+ },
+ {
+ "text": "但在急性腹泻，患儿胃肠的消化吸收功能未完全丧失，对营养素的吸收可达正常的60%～90%。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "急性腹泻"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "胃肠"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】（一）消化道症状腹泻时大便次数增多，量增加，性质改变，大便每日3次以上，甚至10～20次/日可呈稀便、糊状便、水样便，或是黏液脓血便腹泻时粪便的形状比次数更重要。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "大便次数增多，量增加，性质改变"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "大便每日3次以上，甚至10～20次/日"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "稀便"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "糊状便"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "水样便"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "黏液脓血便"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "可呈稀便、糊状便、水样便，或是黏液脓血便"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "粪便"
+ }
+ ]
+ },
+ {
+ "text": "如果便次增多而大便成形，不是腹泻。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "便次增多"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "大便成形"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "人乳喂养儿每天排便2～4次呈糊状，也不是腹泻。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "每天排便2～4次呈糊状"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "恶心、呕吐是常见的伴发症状，严重者呕吐咖啡样物。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "咖啡样物"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "呕吐咖啡样物"
+ }
+ ]
+ },
+ {
+ "text": "腹痛、腹胀及食欲缺乏等症状。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "食欲缺乏"
+ }
+ ]
+ },
+ {
+ "text": "（二）全身症状病情严重者全身症状明显，大多数有发热，体温38～40℃，少数高达40℃以上，可出现面色苍白烦躁不安、精神萎靡、嗜睡、惊厥甚至昏迷等表现。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "体温"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "体温38～40℃"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "少数高达40℃以上"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "ite",
+ "entity": "面色"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "可出现面色苍白"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "烦躁不安"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "精神萎靡"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "sym",
+ "entity": "惊厥"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "sym",
+ "entity": "昏迷"
+ }
+ ]
+ },
+ {
+ "text": "随着全身症状加重，可引起神经系统、心、肝及肾功能失调。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "神经系统、心、肝及肾功能失调"
+ }
+ ]
+ },
+ {
+ "text": "（三）水、电解质及酸碱平衡紊乱酸碱平衡紊乱主要为脱水及代谢性酸中毒，有时还有低钾血症和低钙血症。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "酸碱平衡紊乱"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "代谢性酸中毒"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "低钾血症"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "低钙血症"
+ }
+ ]
+ },
+ {
+ "text": "1.脱水由于腹泻与呕吐丢失大量的水和电解质，使体内保留水分的能力减低；严重呕吐、禁食、食欲减低或拒食，使食物和液体摄入量均减少；患儿发热、呼吸加快、酸中毒者呼吸加深，使不显性失水增加。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "水"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "电解质"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "严重呕吐"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "禁食"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "食欲减低"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "拒食"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 67,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "sym",
+ "entity": "呼吸加快"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "呼吸加深"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 90,
+ "type": "sym",
+ "entity": "不显性失水增加"
+ }
+ ]
+ },
+ {
+ "text": "根据水、电解质损失的量及性质不同分为三种类型：等渗性脱水（血清钠浓度130～150mmol/L）、低渗性脱水（血清钠浓度＜130mmol/L）及高渗性脱水（血清钠浓度＞150mmol/L）。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "等渗性脱水"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "ite",
+ "entity": "血清钠"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "ite",
+ "entity": "血清钠"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "高渗性脱水"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 80,
+ "type": "ite",
+ "entity": "血清钠"
+ }
+ ]
+ },
+ {
+ "text": "大多数急性腹泻患儿为等渗性脱水。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "急性腹泻"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "等渗性脱水"
+ }
+ ]
+ },
+ {
+ "text": "一般表现为体重减轻，口渴不安，皮肤苍白前囟和眼眶凹陷黏膜干燥眼泪减少尿量减少。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "体重减轻"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "口渴不安"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "皮肤苍白"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "前囟"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "眼眶"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "眼眶凹陷"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "黏膜干燥"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "眼泪"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "眼泪减少"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "尿量减少"
+ }
+ ]
+ },
+ {
+ "text": "严重者可导致循环障碍。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "循环障碍"
+ }
+ ]
+ },
+ {
+ "text": "按脱水分为轻度、中度及重度。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "脱"
+ },
+ {
+ "start_idx": 1,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "脱"
+ }
+ ]
+ },
+ {
+ "text": "脱水的评估（表13-13）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "脱水"
+ }
+ ]
+ },
+ {
+ "text": "表13-5脱水及液体丢失量的估计2.代谢性酸中毒脱水大多有不同程度的代谢性酸中毒，产生原因为：大量的碱性物质随粪便丢失；脱水时肾血流量不足，尿量减少，体内酸性代谢产物不能及时排出；肠道消化和吸收功能不良、摄入热量不足，脂肪氧化增加，代谢不全，致酮体堆积且不能及时被肾脏排出；严重脱水者组织灌容不足，组织缺氧，乳酸堆积。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "液体丢失量"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "代谢性酸中毒"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "代谢性酸中毒"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "碱性物质"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 71,
+ "type": "ite",
+ "entity": "尿量"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 82,
+ "type": "bod",
+ "entity": "体内酸性代谢产物"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 91,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 122,
+ "end_idx": 123,
+ "type": "bod",
+ "entity": "酮体"
+ },
+ {
+ "start_idx": 132,
+ "end_idx": 133,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 137,
+ "end_idx": 140,
+ "type": "dis",
+ "entity": "严重脱水"
+ },
+ {
+ "start_idx": 154,
+ "end_idx": 155,
+ "type": "bod",
+ "entity": "乳酸"
+ }
+ ]
+ },
+ {
+ "text": "主要表现为精神萎靡、嗜睡、呼吸深长呈叹息状，口唇樱红意识不清。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "精神萎靡"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "呼吸深长呈叹息状"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "口唇"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "口唇樱红"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "意识不清"
+ }
+ ]
+ },
+ {
+ "text": "新生儿及小婴儿呼吸代偿功能差，呼吸节律改变不明显，主要表现为嗜睡、面色苍白拒食及衰弱等，应注意早期发现。",
+ "entities": [
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "面色"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "面色苍白"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "拒食"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "衰弱"
+ }
+ ]
+ },
+ {
+ "text": "3.低钾血症腹泻时水样便中钾浓度约在20～50mmol/L。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "低钾血症"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "水样便"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "钾"
+ }
+ ]
+ },
+ {
+ "text": "吐泻丢失过多以及摄入不足、钾不能补偿等可导致低血钾发生。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "低血钾"
+ }
+ ]
+ },
+ {
+ "text": "其症状多在脱水与酸中毒纠正，尿量增多酸中毒时细胞外液H+的进入细胞内，与K+交换，故细胞内K+下降，而血清钾不降低。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "尿量"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "尿量增多"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "细胞外液H+"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "K+"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "细胞内K+"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "血清钾"
+ }
+ ]
+ },
+ {
+ "text": "脱水时肾功能低下，钾由尿液排出减少。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "钾"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "尿液"
+ }
+ ]
+ },
+ {
+ "text": "在补液后，尤其是输入不含钾的溶液，血清钾被稀释并随尿排出增多，酸中毒纠正后钾又从细胞外转至细胞内，此时易出现低钾血症。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "不含钾的溶液"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "血清钾"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "钾"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "低钾血症"
+ }
+ ]
+ },
+ {
+ "text": "病程在1周以上时逐渐出现低钾血症。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "低钾血症"
+ }
+ ]
+ },
+ {
+ "text": "在脱水未纠正前，因血液浓缩、酸中毒及尿少等原因，血钾浓度尚可维持正常，此时很少出现低钾血症。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "血钾"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "低钾血症"
+ }
+ ]
+ },
+ {
+ "text": "而随着脱水和酸中毒逐步纠正和尿量的增多，再加补给钾含量不足从而逐渐出现。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "血清钾低于3.5mmol/L以下，表现为精神萎靡，肌张力减低腹胀临床表现心音低钝射减弱或消失。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "血清钾"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "心音低钝"
+ }
+ ]
+ },
+ {
+ "text": "严重者昏迷，肠麻痹呼吸肌麻痹心率减慢心尖部收缩期杂音，可危及生命。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "昏迷"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "肠"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "肠麻痹"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "呼吸肌"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "呼吸肌麻痹"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "心率"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "心率减慢"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "心尖部收缩期杂音"
+ }
+ ]
+ },
+ {
+ "text": "4.低钙血症和低镁血症一般不会出现。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "低钙血症"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "低镁血症"
+ }
+ ]
+ },
+ {
+ "text": "腹泻持久，原有佝偻病或营养不良患儿，当酸中毒纠正后，血清结合钙增多，离子钙减少，可出现低血钙症状低镁血症一般在低钠、低钾及低钙纠正后出现。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "佝偻病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "营养不良"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "血清结合钙"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "离子钙"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "血钙"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "低血钙症状"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "低镁血症"
+ }
+ ]
+ },
+ {
+ "text": "表现烦躁，手足搐搦惊厥。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "烦躁"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "手足"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "手足搐搦"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "惊厥"
+ }
+ ]
+ },
+ {
+ "text": "（四）几种常见感染性腹泻的临床表现特点1.轮状病毒性肠炎（rotavirusenteritis）好发于秋冬季，呈散发或小流行，病毒通过粪-口途径以及呼吸道传播。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "感染性腹泻"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "轮状病毒性肠炎"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "rotavirusenteritis"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "粪-口"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "呼吸道"
+ }
+ ]
+ },
+ {
+ "text": "潜伏期1～3天，常伴发热和上呼吸道感染症状，腹泻，大便呈水样或蛋花汤样，无腥臭，每日数次至十余次。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "上呼吸道"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "上呼吸道感染症状"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "大便呈水样或蛋花汤样"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "无腥臭"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "每日数次至十余次"
+ }
+ ]
+ },
+ {
+ "text": "病程1～3天内大量病毒从大便排出。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "大量病毒从大便排出"
+ }
+ ]
+ },
+ {
+ "text": "血清抗体一般3周后上升病毒较难分离，免疫电镜、ELISA或核酸电泳等均有助于诊断。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "血清抗体"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "血清抗体一般3周后上升"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "免疫电镜"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "ELISA"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "核酸电泳"
+ }
+ ]
+ },
+ {
+ "text": "2.诺如病毒肠炎多见于较大儿童及成年人，临床表现与轮状病毒肠炎相似。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "诺如病毒肠炎"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "轮状病毒肠炎"
+ }
+ ]
+ },
+ {
+ "text": "3.大肠杆菌肠炎（escherichiacolienteritis）常发生于5～8月份，病情轻重不一。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "大肠杆菌肠炎"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "escherichiacolienteritis"
+ }
+ ]
+ },
+ {
+ "text": "致病性大肠杆菌肠炎大便呈蛋花汤样腥臭，有较多的黏液偶见血丝或黏胨便。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "致病性大肠杆菌肠炎"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "大便呈蛋花汤样"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "腥臭"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "黏液"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "有较多的黏液"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "便"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "偶见血丝或黏胨便"
+ }
+ ]
+ },
+ {
+ "text": "产毒素性大肠杆菌肠炎，起病较急，主要症状为呕吐、腹泻，大便呈水样无白细胞常发生明显的水、电解质和酸碱平衡紊乱侵袭性大肠杆菌肠炎，起病急，高热，腹泻频繁，大便呈黏胨状，带脓血，常伴恶心、腹痛及里急后重等症状，有时可出现严重中毒症状，甚至休克。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "产毒素性大肠杆菌肠炎"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "大便呈水样"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "无白细胞"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "水"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "电解质"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "常发生明显的水、电解质和酸碱平衡紊乱"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "侵袭性大肠杆菌肠炎"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 66,
+ "type": "sym",
+ "entity": "起病急"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "sym",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "腹泻频繁"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "大便呈黏胨状"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 85,
+ "type": "sym",
+ "entity": "带脓血"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 90,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 98,
+ "type": "sym",
+ "entity": "里急后重"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "中毒"
+ },
+ {
+ "start_idx": 108,
+ "end_idx": 113,
+ "type": "sym",
+ "entity": "严重中毒症状"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 118,
+ "type": "sym",
+ "entity": "休克"
+ }
+ ]
+ },
+ {
+ "text": "出血性大肠杆菌肠炎，大便次数增多开始为黄色水样便后转为血水便有特殊臭味，大便镜检有大量红细胞，常无白细胞。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "出血性大肠杆菌肠炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "大便次数增多"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "水样便"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "开始为黄色水样便"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "血水便"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "后转为血水便"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "有特殊臭味"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "大便镜检"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "白细胞"
+ }
+ ]
+ },
+ {
+ "text": "4.空肠弯曲菌肠炎（campylobacterjejunienteritis）全年均可发病，多见于夏季��可散发或暴发流行。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "空肠弯曲菌肠炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "campylobacterjejunienteritis"
+ }
+ ]
+ },
+ {
+ "text": "发热、呕吐、腹痛、腹泻、大便呈黏液或脓血便，产毒菌株感染可引起水样便，大便镜检有大量白细胞及数量不等的红细胞，可并发严重的小肠结肠炎、败血症、肺炎、脑膜炎、心内膜炎及心包炎等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "大便呈黏液或脓血便"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "产毒菌株"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "水样便"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "大便镜检"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "ite",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "ite",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "小肠结肠炎"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "脑膜炎"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "dis",
+ "entity": "心内膜炎"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "心包炎"
+ }
+ ]
+ },
+ {
+ "text": "5.耶尔森菌小肠结肠炎多发生于冬春季节，以婴幼儿多见。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "耶尔森菌小肠结肠炎"
+ }
+ ]
+ },
+ {
+ "text": "5岁以下患儿以腹泻为主要症状，粪便为水样、黏液样、脓样或带血大便镜检有大量白细胞，多伴腹痛、发热、恶心和呕吐。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "粪便为水样、黏液样、脓样或带血"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "pro",
+ "entity": "大便镜检"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "5岁以上及青少年，以下腹痛、血白细胞增高，血沉加快为主要表现，酷似急性阑尾炎。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "血白细胞"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "血白细胞增高"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "血沉加快"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "急性阑尾炎"
+ }
+ ]
+ },
+ {
+ "text": "6.鼠伤寒沙门菌肠炎全年发病，以4～9月份发病率最高。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "鼠伤寒沙门菌肠炎"
+ }
+ ]
+ },
+ {
+ "text": "经口传播。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "口"
+ }
+ ]
+ },
+ {
+ "text": "主要临床表现为发热、恶心、呕吐、腹痛、腹胀及“喷射”样腹泻，大便次数可达30次以上，呈黄色或墨绿色稀便、水样便、黏液便或脓血便。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "“喷射”样腹泻"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "大便次数可达30次以上"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "呈黄色或墨绿色稀便"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "水样便"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "sym",
+ "entity": "黏液便"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "脓血便"
+ }
+ ]
+ },
+ {
+ "text": "大便镜检可见大量白细胞及不同数量的红细胞，严重者可出现脱水、酸中毒及全身中毒症状休克，也可引起败血症及脑脊髓膜炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "大便镜检"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "酸中毒"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "全身中毒"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "全身中毒症状"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "休克"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "脑脊髓膜炎"
+ }
+ ]
+ },
+ {
+ "text": "7.金黄色葡萄球菌肠炎很少为原发性，多继发于应用大量广谱抗生素后或继发于慢性疾病基础上。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "金黄色葡萄球菌肠炎"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "广谱抗生素"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "慢性疾病"
+ }
+ ]
+ },
+ {
+ "text": "起病急，中毒症状重发热、呕吐及频繁腹泻。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "sym",
+ "entity": "起病急"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "中毒"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "中毒症状重"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "频繁腹泻"
+ }
+ ]
+ },
+ {
+ "text": "不同程度脱水、电解质���乱，严重者发生休克。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "电解质紊乱"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "休克"
+ }
+ ]
+ },
+ {
+ "text": "病初大便为黄绿色，3～4日后多转变为腥臭，海水样便，黏液多大便镜检有大量脓细胞及革兰阳性菌。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "病初大便为黄绿色"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "3～4日后多转变为腥臭"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "海水样便"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "黏液"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "黏液多"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "大便镜检"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "脓细胞"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "mic",
+ "entity": "革兰阳性菌"
+ }
+ ]
+ },
+ {
+ "text": "大便培养有葡萄球菌生长，凝固酶阳性伪膜性肠炎多见长期使用抗生素后，由于长期使用抗生素导致肠道菌群紊乱，使难辨梭状芽胞杆菌大量繁殖，产生坏死毒素所致。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "大便培养"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "葡萄球菌"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "凝固酶"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "凝固酶阳性"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "伪膜性肠炎"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "肠道菌群紊乱"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "mic",
+ "entity": "梭状芽胞杆菌"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 70,
+ "type": "mic",
+ "entity": "坏死毒素"
+ }
+ ]
+ },
+ {
+ "text": "主要症状为腹泻，大便呈黄稀水样或黏液便少数带血，有伪膜排出（肠管状）伴有发热、腹胀及腹痛。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "大便呈黄稀水样或黏液便"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "少数带血"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "伪膜"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肠管状"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "有伪膜排出（肠管状）"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "伴有发热"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "腹痛"
+ }
+ ]
+ },
+ {
+ "text": "腹痛常先于腹泻或与腹泻同时出现。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "轻型患儿一般于停药后5～8天腹泻停止，严重者发生脱水、休克甚至死亡。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "腹泻停止"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "休克"
+ }
+ ]
+ },
+ {
+ "text": "如果患儿腹泻发生于停药后或腹泻出现后持续用抗生素，则病程常迁延。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "9.白色念珠菌肠炎（candidaalbicansenteritis）多发生于体弱及营养不良小儿，长期滥用广谱抗生素或肾上腺皮质肾上腺皮质激素腔内常伴有鹅口疮。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "白色念珠菌肠炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "candidaalbicansenteritis"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 70,
+ "type": "dru",
+ "entity": "肾上腺皮质激素"
+ }
+ ]
+ },
+ {
+ "text": "大便次数大便次数增多便或发绿，泡沫较多泡沫较多液，有时可见有时可见豆腐渣样细块（菌落）在镜下可见真菌孢子和假菌丝，做粪便真菌粪便真菌培养别。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "大便次数增多"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "泡沫较多"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "有时可见豆腐渣样细块（菌落）"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 67,
+ "type": "pro",
+ "entity": "粪便真菌培养"
+ }
+ ]
+ },
+ {
+ "text": "（五）小儿迁延性和慢性腹泻病因复杂，目前认为包括感染、过感染、先天性消化先天性消化酶缺陷缺陷、药物因素及先天畸形先天畸形中以感染后腹泻最为腹泻。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "先天性消化酶缺陷"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "先天畸形"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "对慢性腹泻患儿肠黏膜活肠黏膜活体组织检查，小肠黏膜结构和功能持续损害或正常修复机制受损是小儿腹泻小儿腹泻愈的重要原因。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "肠黏膜活体组织检查"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "小儿腹泻"
+ }
+ ]
+ },
+ {
+ "text": "但如宿主不能产生正常免疫反应，反复接触感染病原，或因感染严重损伤肠黏液，肠黏液性腹泻可转为慢性腹泻慢性腹泻因黏膜持续损伤致腹泻迁延腹泻愈，少数为感染原持续作用。",
+ "entities": [
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "肠黏液"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "慢性腹泻"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "十二指肠、空肠黏膜变薄，肠绒毛萎缩、溢出、脱落增加，微绒毛变性上皮细胞更新加速，这可能与肠黏膜表面肠黏膜物的黏附有关。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "十二指肠、空肠黏膜"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "十二指肠、空肠黏膜变薄"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肠绒毛"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "肠绒毛萎缩、溢出、脱落增加"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "微绒毛"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "微绒毛变性"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "肠黏膜"
+ }
+ ]
+ },
+ {
+ "text": "由于黏膜再生黏膜不足，这些新生的上皮细胞类似于隐窝细胞隐窝细胞能低下。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "隐窝细胞"
+ }
+ ]
+ },
+ {
+ "text": "双糖酶尤其是乳糖酶活性乳糖酶刷状缘肽酶活性降低，加上有效吸收面积的减少，引起各种营养物质的消化吸收不良。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "乳糖酶"
+ }
+ ]
+ },
+ {
+ "text": "另外，肠黏膜损肠黏膜损伤对病原因子和大分子物质的通透性，使黏膜对外来抗原致敏。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肠黏膜损伤"
+ }
+ ]
+ },
+ {
+ "text": "②营养不良营养不良腹泻时小肠上段小肠上段所有细菌都显著增多肠内厌氧菌和酵母菌过度繁殖。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "营养不良"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "小肠上段"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "小肠上段所有细菌都显著增多"
+ }
+ ]
+ },
+ {
+ "text": "由于大量细菌对胆细菌的脱结合作用，使游离胆酸增高。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "游离胆酸"
+ }
+ ]
+ },
+ {
+ "text": "高浓度游离胆酸有损害小肠细胞，还阻碍脂肪微粒的形成。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "小肠细胞"
+ }
+ ]
+ },
+ {
+ "text": "严重营养不良免疫功能缺陷，分泌型抗体分泌型抗体胞功能和补体水平补体，因而增加了对病原及食物蛋白抗原的易感性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "严重营养不良"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "分泌型抗体"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "补体"
+ }
+ ]
+ },
+ {
+ "text": "总之，持续腹泻易发生营养不良，而营养不良又易使腹泻迁延腹泻愈，两者互为因果，形成恶性循环。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "营养不良"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】（一）粪便常规检查大便显微镜检查有无脓细胞、白细胞、与吞噬细胞，注意有无虫卵、寄生虫、和菌丝。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "大便显微镜检查"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "吞噬细胞"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "mic",
+ "entity": "虫卵"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "mic",
+ "entity": "寄生虫"
+ }
+ ]
+ },
+ {
+ "text": "有菌丝需反复几次才有意义，有助于腹泻病的病因和病原学诊断。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "菌丝"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "腹泻病"
+ }
+ ]
+ },
+ {
+ "text": "（二）大便培养大便培养腹泻病原有重要意义。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "大便培养"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "大便培养"
+ }
+ ]
+ },
+ {
+ "text": "1次粪便培养较低，需多做几次，新鲜标本立即培养可提高阳性检出率。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "粪便培养"
+ }
+ ]
+ },
+ {
+ "text": "（三）大便乳胶凝集试验对某些病毒性肠炎价值，如轮状病毒及肠道腺病毒较好的敏感性和特异性，对空肠弯曲菌肠炎的诊断有帮助。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "大便乳胶凝集试验"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "病毒性肠炎"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "mic",
+ "entity": "轮状病毒"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "mic",
+ "entity": "肠道腺病毒"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "空肠弯曲菌肠炎"
+ }
+ ]
+ },
+ {
+ "text": "（四）酶联免疫吸附试验病毒有高度敏感性和特异性。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "酶联免疫吸附试验"
+ }
+ ]
+ },
+ {
+ "text": "有助于轮状病毒肠炎诊断。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "轮状病毒肠炎"
+ }
+ ]
+ },
+ {
+ "text": "（五）聚丙烯酰凝胶GE）电泳试验检测出轮状病毒亚群及不同电泳型，有助于轮状病毒分类研究。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "equ",
+ "entity": "聚丙烯酰凝胶"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "电泳试验"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "mic",
+ "entity": "轮状病毒"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "mic",
+ "entity": "轮状病毒"
+ }
+ ]
+ },
+ {
+ "text": "（六）粪便还原糖检查双糖消化吸收不良时，粪便还原呈阳性，pH值＜6.0。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "粪便还原糖检查"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "粪便"
+ }
+ ]
+ },
+ {
+ "text": "还原糖检查可用改良斑氏试剂或nitest试纸比色。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "斑氏试剂"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "equ",
+ "entity": "nitest试纸"
+ }
+ ]
+ },
+ {
+ "text": "继发性双糖酶缺乏发性多见，原发性者以蔗糖-异麦芽糖酶缺乏最常见。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "继发性双糖酶缺乏"
+ }
+ ]
+ },
+ {
+ "text": "（七）粪便电镜检查病毒性肠炎有诊断价值，如轮状病毒性肠炎等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "粪便电镜检查"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "病毒性肠炎"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "轮状病毒性肠炎"
+ }
+ ]
+ },
+ {
+ "text": "（八）血白细胞计数病毒性肠炎白细胞总数不增高。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "血白细胞计数"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "病毒性肠炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "白细胞"
+ }
+ ]
+ },
+ {
+ "text": "细菌性肠炎白细胞总数增高或不增高，半数以上的患儿有杆状核增高，杆状核＞杆状核，有助于细菌感染的诊断。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "细菌性肠炎"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "白细胞"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "ite",
+ "entity": "杆状核"
+ }
+ ]
+ },
+ {
+ "text": "（九）血培养血培养痢疾、大肠杆菌和大肠杆菌等细菌性肠炎细菌性肠炎意义，血液细菌培养阳性者有助于诊断。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "血培养"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "mic",
+ "entity": "大肠杆菌"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "细菌性肠炎"
+ }
+ ]
+ },
+ {
+ "text": "（十）血生化检查较重的患儿，应及时检查血pH、血pH碳结合力、碳酸氢根、碳酸氢根、血钾、血血钾及血渗透压血渗透压断及治疗均有重要意义。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "血生化检查"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "血pH"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "碳酸氢根"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "ite",
+ "entity": "血钾"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 55,
+ "type": "ite",
+ "entity": "血渗透压"
+ }
+ ]
+ },
+ {
+ "text": "（十一）其他对迁延性和慢性腹泻者，必要时做乳糖、蔗乳糖、蔗糖或葡萄糖耐量试验试验（一种定量非侵入性测定碳水化合物吸收不良的方法，有条件可以应用），也可作纤维结肠镜纤维结肠镜检查诊断】根据发病季节、年龄、大便性状以及排便次数做出初步诊断，对于脱水程度和性质，有无酸中毒以酸中毒、钠等电解质缺乏，进行判断。",
+ "entities": [
+ {
+ "start_idx": 25,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "乳糖、蔗糖或葡萄糖耐量试验"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 87,
+ "type": "pro",
+ "entity": "纤维结肠镜检查"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 136,
+ "type": "dis",
+ "entity": "酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "必要时进行细菌、病细菌以及寄生虫等寄生虫检查，作为病因诊断。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "mic",
+ "entity": "寄生虫"
+ }
+ ]
+ },
+ {
+ "text": "注意与以下疾病相鉴别：（一）生理性腹泻小儿外观小儿外观虚胖后不久大便次数即较多、稀薄，呈金黄色，但不伴呕吐不伴呕吐增加正常。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "小儿外观虚胖"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "不伴呕吐"
+ }
+ ]
+ },
+ {
+ "text": "至添加辅食添加辅食后大便逐渐转为正常二）急性坏死性小肠炎急性坏死性急性坏死性小肠炎变态反应是发病的重要因素。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "添加辅食后大便逐渐转为正常"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "急性坏死性小肠炎"
+ }
+ ]
+ },
+ {
+ "text": "本病具有腹泻、腹胀、便血、高热及呕高热五大症状。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "高热"
+ }
+ ]
+ },
+ {
+ "text": "大便初为大便初为水样便转暗红色、果酱样或血便，腹胀多较腹胀多较严重期出现休克，甚至昏迷、惊昏迷。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "大便初为水样便"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "腹胀多较严重"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "sym",
+ "entity": "昏迷"
+ }
+ ]
+ },
+ {
+ "text": "（三）急性细菌性急性细菌性痢疾痢疾夏季发病率高，患儿多有不洁食物史，潜伏期24～72小时。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "急性细菌性痢疾"
+ }
+ ]
+ },
+ {
+ "text": "大多数患者起病急，起病急、腹痛、呕腹痛、腹泻、里腹泻，大便多呈大便多呈黏液脓血便次数每天数次至十多次。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "起病急"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "大便多呈黏液脓血便"
+ }
+ ]
+ },
+ {
+ "text": "中毒性菌痢中毒性菌痢高热惊厥、嗜睡或嗜睡，甚至休克等症休克。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "中毒性菌痢"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "休克"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】腹泻病的腹泻疗原则为预防脱水，纠正脱水纠正脱水饮食，合理用合理用药一）急性腹泻的治疗1.脱水的防脱水的防治预防和纠正在腹泻治疗腹泻占极重要的地位，世界卫生组织（WHO）推荐的口服补液盐（ORS）ORS服补液疗法具有有效、简便、价廉、安全等优点，已成为主要的补液途径，是腹泻治疗腹泻一个重要进展。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "纠正脱水"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "合理用药"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "pro",
+ "entity": "脱水的防治"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 103,
+ "type": "dru",
+ "entity": "ORS"
+ },
+ {
+ "start_idx": 142,
+ "end_idx": 143,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "口服补液治疗是基于小肠的N小肠葡萄糖偶联葡萄糖机制。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "葡萄糖"
+ }
+ ]
+ },
+ {
+ "text": "小肠微绒毛上皮细胞刷状缘上存在Na+和葡萄糖比例适当，有利于Na+和水的吸收。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "ORS"
+ }
+ ]
+ },
+ {
+ "text": "ORS中含有钾和碳酸氢盐，可补充腹泻时钾的丢失钾和纠正酸中毒。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "钾"
+ }
+ ]
+ },
+ {
+ "text": "（1）预防脱水预防脱水导致体内大量的水与电解水丢失。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "预防脱水"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "水"
+ }
+ ]
+ },
+ {
+ "text": "因此，患儿一开始腹泻，就腹泻该给口服足够的液体并继续给小儿喂养，尤其是婴幼儿母乳喂养，以防脱水。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "选用以下方法：①ORS：ORS体为2/3张溶液，用于预防脱水时加等量或半量水稀释以降低电解质的张力。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "ORS"
+ }
+ ]
+ },
+ {
+ "text": "��次腹泻后，腹泻岁以下服50～100ml，2～10岁服100～200ml，大于10岁的能喝多少就给多少。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "②米汤加盐米汤加盐溶液500ml+细盐1.75g或炒米粉25g+细盐1.75g+水500ml，煮2～3分钟。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "米汤加盐溶液"
+ }
+ ]
+ },
+ {
+ "text": "③糖盐水：白开水纠正脱水+蔗糖10g+细盐1.75g。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "纠正脱水"
+ }
+ ]
+ },
+ {
+ "text": "（2）纠正脱水：小儿腹泻发生的脱水，大脱水可通过口服补液疗法纠正。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "脱水"
+ }
+ ]
+ },
+ {
+ "text": "重度脱水重度脱水补液。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "重度脱水"
+ }
+ ]
+ },
+ {
+ "text": "1）口服补液口服补液于轻度、中度脱水者。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "口服补液"
+ }
+ ]
+ },
+ {
+ "text": "有严重腹胀严重腹胀、心肾功能不心肾功能其他较重的并发症以及新生儿，均不宜口服补液。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "严重腹胀"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "心肾功能"
+ }
+ ]
+ },
+ {
+ "text": "分两个阶段，即纠正脱水纠正脱水维持治疗阶段。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "纠正脱水"
+ }
+ ]
+ },
+ {
+ "text": "纠正脱水纠正脱水S；补充累积损失量，轻度脱水轻度脱水ml/kg，中度脱水50～80ml/kg，少量多次口服，以免呕吐影响疗效，所需液量在4～6小时内服完。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "纠正脱水"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "轻度脱水"
+ }
+ ]
+ },
+ {
+ "text": "脱水纠正后，ORS以ORS水稀释补充继续丢失量，随丢随补，也可按每次10ml/kg计算。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "ORS"
+ }
+ ]
+ },
+ {
+ "text": "2）静脉补液静脉补液脱水和新生儿腹泻患儿均宜静脉补液。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "静脉补液"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "新生儿腹泻"
+ }
+ ]
+ },
+ {
+ "text": "第一天补液：包补液累积损失量、继续损失量和生理需要量。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "补液"
+ }
+ ]
+ },
+ {
+ "text": "累积损失量根据脱水程度计算，轻度脱水轻度脱水/kg，中度脱水50～100ml/kg，重度脱水重度脱水120ml/kg。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "轻度脱水"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "重度脱水"
+ }
+ ]
+ },
+ {
+ "text": "溶液电解质和非电解质比例（即溶液种类）根据脱水性质而定，等渗性脱水用1/2～2/3张含钠液含钠液脱水用2/3等张含钠液，含钠液脱水用1/3张含钠液含钠液滴速宜稍快，一般在8～12小时补完，约每小时8～10ml/kg。",
+ "entities": [
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "含钠液"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "dru",
+ "entity": "含钠液"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 75,
+ "type": "dru",
+ "entity": "含钠液"
+ }
+ ]
+ },
+ {
+ "text": "对重度脱水合并周围循环周围循环障碍2∶1等张液20ml/kg，于30～60分钟内静脉推注或快速滴注快速滴注增加血容量，改善循环和肾脏功能。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "周围循环障碍"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "快速滴注"
+ }
+ ]
+ },
+ {
+ "text": "在扩容后根据脱水性质选用前述不同溶液继续静脉滴注静脉滴注扣除扩容量。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "静脉滴注"
+ }
+ ]
+ },
+ {
+ "text": "继续丢失量和生理需要量能口服则口服，对于不能口服、呕吐频繁呕吐频繁者，给予静脉补液静脉补液需要量每日60～80ml/kg，用1/5张含钠液补充，继续损失量是按“失多少补多少”，用1/3～1/2含钠溶液补充钠溶液两者合并，在余12～16小时补完，一般约每小时5ml/kg。",
+ "entities": [
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "呕吐频繁"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "静脉补液"
+ },
+ {
+ "start_idx": 102,
+ "end_idx": 104,
+ "type": "dru",
+ "entity": "钠溶液"
+ }
+ ]
+ },
+ {
+ "text": "需静脉补液静脉补液生理需要量和继续丢失量两部分液体（计算方法同上所述）一并在24小时均匀补充。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "静脉补液"
+ }
+ ]
+ },
+ {
+ "text": "3）纠正酸中毒：轻、中度轻、中度酸中毒纠正，因为在输入的溶液中已含有一部分碱性溶液碱性溶液经过输液后循环和肾功能改善，酸中毒随即纠正。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "轻、中度酸中毒"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dru",
+ "entity": "碱性溶液"
+ }
+ ]
+ },
+ {
+ "text": "严重酸中严重酸中毒后仍表现有酸中毒症状酸中毒，则需要用碱性药物。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "严重酸中毒"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "酸中毒"
+ }
+ ]
+ },
+ {
+ "text": "常用的碱性药物有碳酸氢钠和碳酸氢钠。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "碳酸氢钠"
+ }
+ ]
+ },
+ {
+ "text": "在无实验室检查条件时，可按5%碳酸氢钠5碳酸氢钠/kg或11.2乳酸钠3ml/kg，可提高CO2结合力5mmol/L。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "碳酸氢钠"
+ }
+ ]
+ },
+ {
+ "text": "需要同时扩充血容量者可直接用1.4%碳酸氢钠2碳酸氢钠/kg代替2∶1等张液，兼扩容和加快酸中毒纠正的作用。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "碳酸氢钠"
+ }
+ ]
+ },
+ {
+ "text": "已测知血气分析者，按以下公式计算：需补碱性液数（mmol）=（60-CO2结合力）×0.3×体重（kg）/2.24=BE×0.3×体重（kg）5%碳酸氢钠（碳酸氢钠）=BE×体重（kg）/2碱性药物先用半量。",
+ "entities": [
+ {
+ "start_idx": 84,
+ "end_idx": 87,
+ "type": "dru",
+ "entity": "碳酸氢钠"
+ }
+ ]
+ },
+ {
+ "text": "4）钾的补充：低钾的低钾一般按KCl2～4mmol/（kg•d）或10%KCl3ml/（kg•d），浓度常为0.15%～0.3%，切勿超过0.3%，速度不宜过快，至少在6小时以上补给。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "低钾"
+ }
+ ]
+ },
+ {
+ "text": "但在重度脱水重度脱水较大量的钾丢失，补液后循环得到改善，血钾被稀血钾酸中毒纠正，钾向细胞钾内转移，所以易造成低血钾。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "重度脱水"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "ite",
+ "entity": "血钾"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "钾"
+ }
+ ]
+ },
+ {
+ "text": "低血钾脱水特别是原有营养不良营养不良长，多日不进食的患儿，及时补钾更必要。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "低血钾"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "营养不良"
+ }
+ ]
+ },
+ {
+ "text": "一般补钾4补钾天，严重缺钾者适当延长补钾时间补钾5）钙和镁的补充：一般患儿无须常规服用钙剂，对合并营养不良营养不良的患儿应早期给钙。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "补钾"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "补钾"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "营养不良"
+ }
+ ]
+ },
+ {
+ "text": "在输液过程输液如出现抽搐，可给予10%葡萄糖酸钙葡萄糖酸钙0ml，静脉缓注，必要时重复使用。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "输液"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "葡萄糖酸钙"
+ }
+ ]
+ },
+ {
+ "text": "个别抽搐患儿用钙剂无效钙剂应考虑到低镁血症的可能，经血镁测定血镁测定后可给25%硫酸镁，每次给0.2ml/kg，每天2～3次，深部肌内深部肌内注射消失后停药。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "钙剂"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "pro",
+ "entity": "血镁测定"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 72,
+ "type": "pro",
+ "entity": "深部肌内注射"
+ }
+ ]
+ },
+ {
+ "text": "强调腹泻患儿继续喂养，饮食需适应患儿的消化吸收功能，根据个体情况，分别对待，最好参考患儿食欲及腹泻等情腹泻结合平时饮食习惯，采取循序渐进的原则，并适当补充微量元素和维生素。",
+ "entities": [
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "维生素喂养者应继续母乳喂养，暂停辅食，缩短每次喂乳时间，少量多次喂哺。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "维生素"
+ }
+ ]
+ },
+ {
+ "text": "轻症腹泻轻症腹泻方牛奶（formulformulamilk大多耐受良好。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "轻症腹泻"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "formulamilk"
+ }
+ ]
+ },
+ {
+ "text": "严重腹泻者，消化吸收消化吸收功能障碍双糖酶（尤其乳糖酶尤其乳糖酶受损，乳糖吸收不良，全乳喂养可加重腹泻症状腹泻甚至可引起酸中毒，先以稀释奶、发酵奶、奶谷类混合物及去乳糖配方奶喂哺，每天喂6次，保证足够的热量，逐渐增至全奶。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "消化吸收功能障碍"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "尤其乳糖酶"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "母乳喂养或牛奶喂养者，如大便量、大便量、次数明显增多样稀便，带酸臭味带酸臭味，腹胀，肠腹胀亢进，又引起较严重的脱水和酸脱水毒，停止喂哺后症状减轻，测大便pH大便pH，还原物质＞0.5%，考虑急性腹泻急性腹泻继发性乳糖酶缺乏吸收不良，改稀释牛奶、发酵奶或去乳糖配方奶（不含乳糖）喂养，并密切观察，一旦小儿能耐受即应恢复正常饮食。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "大便量、次数明显增多"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "带酸臭味"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 81,
+ "type": "ite",
+ "entity": "大便pH"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 110,
+ "type": "dis",
+ "entity": "急性腹泻继发性乳糖酶缺乏"
+ }
+ ]
+ },
+ {
+ "text": "遇脱水严重脱水严重频繁的患儿，宜暂禁食，先纠正水和电解质紊乱，病情好转后恢复喂养。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "脱水严重"
+ }
+ ]
+ },
+ {
+ "text": "必要时对重症腹泻重症腹泻不良者采用静脉营养静脉营养停止后，应提供富有热量和营养价值高的饮食，并应超过平时需要量的10%～100%，一般2周内每日加餐一次，以较快地补偿生长发育，赶上正常生长。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "重症腹泻"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "静脉营养"
+ }
+ ]
+ },
+ {
+ "text": "3.药物治疗药物治疗抗生素治疗：根据感染性腹泻感染性腹泻和部分细菌性腹泻有自愈倾向的特点，WHO提出90%的腹泻不需腹泻抗菌药物治疗，国内专家提出大约70%的腹泻病不腹泻病也不应该用抗生素，抗生素适用于侵袭性细侵袭性细菌感染（约30%）。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "药物治疗"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "感染性腹泻"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "腹泻病"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 97,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "侵袭性细菌感染"
+ }
+ ]
+ },
+ {
+ "text": "临床指征为：①血便；②有里急后重有里急后重便镜检白细胞满视野；④大便pH7大便pH7以上袭性细菌性腹泻重症、新生儿、小婴儿和原有严重消耗性疾病者如肝硬化、肝硬化、血液病及血液病等，使用抗生素指征抗生素。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "有里急后重"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "大便pH7以上"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "肝硬化"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "血液病"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 99,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "1）喹诺酮类药：治疗腹泻抗菌药腹泻首选药物。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "常用诺氟沙星（诺氟沙星）和环丙沙星。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "诺氟沙星"
+ }
+ ]
+ },
+ {
+ "text": "环丙沙星于细菌性痢疾，大肠杆菌、大肠杆菌曲菌、弧菌、耶弧菌菌及气单胞菌等气单胞菌的肠炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "环丙沙星"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "mic",
+ "entity": "大肠杆菌"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "mic",
+ "entity": "弧菌"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "气单胞菌"
+ }
+ ]
+ },
+ {
+ "text": "由于动物试验发现此类药物可致胚胎关节胚胎关节软骨损伤在儿童剂量不宜过大，疗程不宜过长（一般不超过1周）。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "胚胎关节软骨损伤"
+ }
+ ]
+ },
+ {
+ "text": "常规剂量：诺氟沙星每日15～20mg/kg，分2～3次口服；环丙沙星每环丙沙星0～15mg/kg，分2次口服或静脉滴注静脉滴注）小檗碱：用于轻型细菌性轻型细菌性肠炎稳定，不易耐药，不良反应小，与某些药物联合治疗，可提高疗效。",
+ "entities": [
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "环丙沙星"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "pro",
+ "entity": "静脉滴注"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 81,
+ "type": "dis",
+ "entity": "轻型细菌性肠炎"
+ }
+ ]
+ },
+ {
+ "text": "口服）呋喃唑酮：每日5～7mg/kg，分3～4次口服。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "口服"
+ }
+ ]
+ },
+ {
+ "text": "在口服道可保持高药物浓度，不易产生耐药性。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "pro",
+ "entity": "口服"
+ }
+ ]
+ },
+ {
+ "text": "有恶心、头恶心、皮疹、溶皮疹贫血及黄疸等不黄疸反应。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "皮疹"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "黄疸"
+ }
+ ]
+ },
+ {
+ "text": "4）氨基糖苷类：本类药临床疗效仅次于第三代头孢菌素与头孢菌素星，但对儿童副作用大，主要为肾及耳神肾及耳神经损害素已很少应用。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "头孢菌素"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "肾及耳神经损害"
+ }
+ ]
+ },
+ {
+ "text": "阿米卡星（阿米卡星那霉素）每日10～15mg/kg，分次肌内注射肌内注射滴注。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "阿米卡星"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "肌内注射"
+ }
+ ]
+ },
+ {
+ "text": "妥布霉素3妥布霉素mg/kg，分2次静脉滴注或肌内注射肌内注射米星4～16mg/kg，1次或分2次静脉滴注静脉滴注）第三代头孢菌素及氧头孢烯类氧头孢烯类腹泻的病原菌普遍病原菌对本类药敏感，包括治疗最为困难的多重耐药鼠伤寒沙门菌及志贺菌。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "妥布霉素"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "肌内注射"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "pro",
+ "entity": "静脉滴注"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 75,
+ "type": "dru",
+ "entity": "氧头孢烯类"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "mic",
+ "entity": "病原菌"
+ }
+ ]
+ },
+ {
+ "text": "志贺菌疗效好，副作用少，但价格贵，需注射给药，故不作为临床第一线用药，仅用于重症及难治性患者。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "志贺菌"
+ }
+ ]
+ },
+ {
+ "text": "常用有头孢噻肟、头孢噻肟肟、头孢三嗪及头孢三嗪孢等。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "头孢噻肟"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "头孢三嗪"
+ }
+ ]
+ },
+ {
+ "text": "6）复方新诺明复方新诺明～50mg/（kg•d），分2～3次口服。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "复方新诺明"
+ }
+ ]
+ },
+ {
+ "text": "7）其他类抗其他类抗生素是治疗空肠弯曲菌空肠弯曲菌肠炎药，25～30mg/（kg•d），分4次口服或一次静脉滴注静脉滴注7天。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "其他类抗生素"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "空肠弯曲菌肠炎"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "pro",
+ "entity": "静脉滴注"
+ }
+ ]
+ },
+ {
+ "text": "隐孢子虫肠炎口服大蒜素口服。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "口服"
+ }
+ ]
+ },
+ {
+ "text": "真菌性采用制霉菌素、制霉菌素或克霉唑。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "制霉菌素"
+ }
+ ]
+ },
+ {
+ "text": "克霉唑肠炎停用原来抗生素，抗生素甲硝唑、万古霉素及万古霉素口服。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "克霉唑"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "万古霉素"
+ }
+ ]
+ },
+ {
+ "text": "（2）肠黏膜保护剂肠黏膜保护剂石是一种天然的铝和镁的硅酸盐，能改善肠黏液的肠黏液量，加强肠黏膜屏障，吸附和固定各种细菌、病细菌及其毒素，有毒素受损肠黏膜修复和再生。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "肠黏膜保护剂"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "肠黏液"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "mic",
+ "entity": "毒素"
+ }
+ ]
+ },
+ {
+ "text": "临床证明其治疗腹泻具止腹泻、收敛和抑病毒作用，能缩短病程。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（3）微生态疗法微生态疗法在于恢复肠道正常菌群的生态平衡，起到生物屏障作用，抵御病原菌的定植和侵入，有利于腹泻的恢腹泻。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "微生态疗法"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "常用药：①乳酶生，也称表飞明，表飞明燥乳酸杆菌片剂，每次0.3g，每日3次；②口服嗜酸乳口服胶囊（LactobLactobacillusAcidophilusCapsule灭活的嗜酸乳酸杆菌及其代谢产物，每包含菌50亿，每次50亿～100亿，每日2次；③双歧杆菌活双歧杆菌活菌制剂胶囊含双歧杆菌0.5亿，每次1粒，每日2～3次；④枯草杆菌、枯草杆菌、肠球菌二联活菌多维颗粒维颗粒，为活菌制剂，每袋含粪链球菌1粪链球菌和枯草杆菌0.15亿，每次1袋，每日2～3次；⑤口服双歧杆口服、嗜酸乳杆菌、肠球菌三联活菌胶囊，为双歧杆菌、双歧杆菌、乳酸杆菌和肠球菌三联活菌制剂每次1～2粒，散剂每次1/2～1包，每日2～3次。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "表飞明"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 85,
+ "type": "dru",
+ "entity": "LactobacillusAcidophilusCapsule"
+ },
+ {
+ "start_idx": 132,
+ "end_idx": 139,
+ "type": "dru",
+ "entity": "双歧杆菌活菌制剂"
+ },
+ {
+ "start_idx": 170,
+ "end_idx": 185,
+ "type": "dru",
+ "entity": "枯草杆菌、肠球菌二联活菌多维颗粒"
+ },
+ {
+ "start_idx": 204,
+ "end_idx": 207,
+ "type": "mic",
+ "entity": "粪链球菌"
+ },
+ {
+ "start_idx": 237,
+ "end_idx": 238,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 262,
+ "end_idx": 280,
+ "type": "dru",
+ "entity": "双歧杆菌、乳酸杆菌和肠球菌三联活菌制剂"
+ }
+ ]
+ },
+ {
+ "text": "注意喂水和口喂水补液。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "喂水"
+ }
+ ]
+ },
+ {
+ "text": "防止呕吐后误呕吐入肺内。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "呕吐"
+ }
+ ]
+ },
+ {
+ "text": "勤换尿布，大便后冲洗臀部，以臀部防上行性尿路感染、尿布疹及尿布疹感染。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "臀部"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "尿布疹"
+ }
+ ]
+ },
+ {
+ "text": "（二）迁延性和迁延性和慢性腹泻1.预防、治疗脱水治疗脱水水、电解质和酸碱平衡紊乱。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "迁延性和慢性腹泻"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "治疗脱水"
+ }
+ ]
+ },
+ {
+ "text": "2.营养治疗此类患者多有营养障碍营养障碍黏膜持续损害、营养不良营养不良继发免疫功能低下循环是主要的发病因素。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "营养障碍"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "营养不良继发免疫功能低下"
+ }
+ ]
+ },
+ {
+ "text": "饮食的选择，应考虑到患儿的消化功能及经济状况，母乳为合适饮食，或选用价格低廉、可口的乳类食品，具体参照“急性腹泻急性腹泻治疗。",
+ "entities": [
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "急性腹泻"
+ }
+ ]
+ },
+ {
+ "text": "要素饮食是慢性腹泻患儿最理想食品，含已消化的简单的氨基酸、葡萄糖和脂肪，仅需少量肠腔内和肠腔黏液消化，在严重小肠严重小肠黏液损害消化酶缺乏的情况下仍可吸收和耐受。",
+ "entities": [
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "严重小肠黏液损害"
+ }
+ ]
+ },
+ {
+ "text": "每天6～7次，经口摄入或胃管重力胃管重力间歇滴喂泻停止，体重增加，逐步恢复普通饮食。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "胃管重力间歇滴喂"
+ }
+ ]
+ },
+ {
+ "text": "对仅表现乳糖不耐乳糖不耐受乳糖配方奶、豆浆和酸豆浆。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "乳糖不耐受"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "豆浆"
+ }
+ ]
+ },
+ {
+ "text": "对严重腹泻严重腹泻素饮食营养治疗后腹泻仍持续、营养状况恶化，需静脉营养。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "严重腹泻"
+ }
+ ]
+ },
+ {
+ "text": "静脉营养（TPN）TPN分是葡萄糖、脂肪、蛋脂肪、水溶性和水溶性维生素、电解质及电解质素。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "静脉营养"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "TPN"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "脂肪"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "水溶性"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dru",
+ "entity": "电解质"
+ }
+ ]
+ },
+ {
+ "text": "中国腹泻病方腹泻推荐配方为每日脂肪乳剂2～3g/kg，复方结晶复方结晶氨基酸.5g/g，葡萄糖12～15mg/kg，液体120～150ml/kg，热量209.2～376.6kJ/kg（70～90kcal/kg）。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 37,
+ "type": "dru",
+ "entity": "复方结晶氨基酸"
+ }
+ ]
+ },
+ {
+ "text": "葡萄糖是葡萄糖供能物质，浓度8%～12%，输注速度每分钟4～6mg/kg，最大可达12～15mg/kg。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "葡萄糖"
+ }
+ ]
+ },
+ {
+ "text": "氨基酸是蛋白质基本单位，是静脉营养静脉营养主要来源，小儿氨基酸代谢与成人不同，选用小儿专用氨基酸较氨基酸，目前小儿专用氨基酸配方有国产（18-AA-650）和德国产（16-AA-600），使用时从小量开始，每日0.5g/kg，每日递增0.25～0.5g/kg，至2.5～3.0g/kg。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "静脉营养"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "dru",
+ "entity": "氨基酸"
+ }
+ ]
+ },
+ {
+ "text": "氨基酸可氨基酸葡萄糖共同输入。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "氨基酸"
+ }
+ ]
+ },
+ {
+ "text": "10%脂肪乳剂1脂肪乳剂20ml/kg，第3天起可增至20～40ml/kg，静脉输注＞6小时，最好24小时均匀输入。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "脂肪乳剂"
+ }
+ ]
+ },
+ {
+ "text": "在应用上述营养液同时，还应补充电解质、电解质及微量元素（微量元素3-13）。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "电解质"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "微量元素"
+ }
+ ]
+ },
+ {
+ "text": "已有TPN专用的维生素和维生素素的剂型，水乐维他加水乐维他氨基酸中，维他利匹特维他利匹特乳剂中。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "维生素"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "水乐维他"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 43,
+ "type": "dru",
+ "entity": "维他利匹特"
+ }
+ ]
+ },
+ {
+ "text": "微量元素，微量元素5kg儿童选用安达美（addameaddamelN15kg者选用派达益儿（ped-ped-el表13-7静脉营养时电解质、电解质、微量元素的微量元素需要量长期TPN会导致肠黏液萎缩肠黏液萎缩分泌减少及胆汁黏稠胆汁黏稠长期输注葡萄糖，会影响食欲。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "微量元素"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "addamelN"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 55,
+ "type": "dru",
+ "entity": "ped-el"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 72,
+ "type": "dru",
+ "entity": "电解质"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "dru",
+ "entity": "微量元素"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 103,
+ "type": "sym",
+ "entity": "肠黏液萎缩"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 116,
+ "type": "sym",
+ "entity": "胆汁黏稠"
+ }
+ ]
+ },
+ {
+ "text": "也可采用部分经口喂，部口喂静脉供给营养素和营养素。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "口喂"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "营养素"
+ }
+ ]
+ },
+ {
+ "text": "3.抗生素要抗生素分慎重，用于分离出特异病原的感染，并根据药敏试验药敏试验临床用药。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "药敏试验"
+ }
+ ]
+ },
+ {
+ "text": "4.蒙脱石散具体见“急性腹泻急性腹泻5.微生态疗法具体见“急性腹泻急性腹泻6.中医治疗对慢性腹泻治疗有一定的疗效。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "急性腹泻"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "急性腹泻"
+ }
+ ]
+ },
+ {
+ "text": "四、机械通气的辅助给药（一）镇静剂常用的有水合氯醛、地西泮和巴比妥类药品。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "镇静剂"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "水合氯醛"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "地西泮"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "巴比妥类"
+ }
+ ]
+ },
+ {
+ "text": "地西泮剂量在静脉给药时为0.1mg/kg，苯巴比妥静脉注射1～2mg/kg。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "地西泮"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "静脉给药"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "苯巴比妥"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "静脉注射"
+ }
+ ]
+ },
+ {
+ "text": "一般可以间断4～6小时使用，不良反应主要为呼吸抑制。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "呼吸抑制"
+ }
+ ]
+ },
+ {
+ "text": "在自主呼吸没有时，不必使用。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "自主呼吸没有"
+ }
+ ]
+ },
+ {
+ "text": "也有采用吗啡类镇痛药如芬太尼的，剂量为0.5～2mg/kg。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "吗啡类镇痛药"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "芬太尼"
+ }
+ ]
+ },
+ {
+ "text": "给药过快可以造成呼吸停止，要同时准备气道通气复苏设备。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "呼吸停止"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "equ",
+ "entity": "气道通气复苏设备"
+ }
+ ]
+ },
+ {
+ "text": "对于比较烦躁的小儿，使用镇静剂是急救病房常规的手段，避免由于刺激和烦躁，造成血压和颅内压的骤然升降，导致血管破裂出血，或气道压过高，造成气胸和气道身体损伤。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "镇静剂"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "ite",
+ "entity": "颅内压"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "血压和颅内压的骤然升降"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "血管"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "血管破裂出血"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 62,
+ "type": "ite",
+ "entity": "气道压"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "气道身体损伤"
+ }
+ ]
+ },
+ {
+ "text": "（二）肌松剂常用的有潘可罗宁（pancuroniumbromide）和琥珀胆碱（succinylcholine）。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "潘可罗宁"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "pancuroniumbromide"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "dru",
+ "entity": "琥珀胆碱"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 54,
+ "type": "dru",
+ "entity": "succinylcholine"
+ }
+ ]
+ },
+ {
+ "text": "静脉注射前者为0.1mg/kg，后者为1～2mg/kg。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "静脉注射"
+ }
+ ]
+ },
+ {
+ "text": "以往由于呼吸机没有同步触发功能，在小儿烦躁时，为避免人机对抗造成的气胸、颅内出血、低氧血症等并发症，肌松剂使用很频繁。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "烦躁"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "dru",
+ "entity": "肌松剂"
+ }
+ ]
+ },
+ {
+ "text": "现在由于有了同步触发装置，特别是智能化的供气气流调节装置调节装置，使肌松剂的使用限制在较低程度。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "equ",
+ "entity": "同步触发装置"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 27,
+ "type": "equ",
+ "entity": "智能化的供气气流调节装置"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "dru",
+ "entity": "肌松剂"
+ }
+ ]
+ },
+ {
+ "text": "一般在用SIMV和A/C方式通气不能得到有效通气、或在测定呼吸力学参数时使用，以短时间消除自主呼吸对测定的干扰。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "测定呼吸力学参数"
+ }
+ ]
+ },
+ {
+ "text": "��使用肌松剂后，喉部肌肉的松弛，可以造成气道插管周围的漏气增加，在临床上要加以关注。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "肌松剂"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "喉部肌肉"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "sym",
+ "entity": "松弛"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "equ",
+ "entity": "气道插管"
+ }
+ ]
+ },
+ {
+ "text": "绝对不可在没有气道插管、复苏和呼吸机支持的条件下给予肌松剂。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "equ",
+ "entity": "气道插管"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "equ",
+ "entity": "复苏"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "equ",
+ "entity": "呼吸机"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "肌松剂"
+ }
+ ]
+ },
+ {
+ "text": "（三）利尿剂肺水肿时常用利尿剂为呋塞米，可以经静脉或气道给予，均可以起利尿和减少肺液潴留的问题，静脉给药剂量为1～2mg/kg，最大为5mg/kg。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "利尿剂"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肺水肿"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "利尿剂"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "呋塞米"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "静脉或气道给予"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "肺液潴留"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "pro",
+ "entity": "静脉给药"
+ }
+ ]
+ },
+ {
+ "text": "气道内给予呋塞米剂量为0.5mg/kg，对呼吸功能不全有迅速排尿和改善肺顺应性的作用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "呋塞米"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "呼吸功能不全"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肺"
+ }
+ ]
+ },
+ {
+ "text": "第四节伤寒【流行病学】人类是伤寒（typhoid）杆菌的唯一自然传染源，直接或间接地同感染的人群接触是造成感染的原因。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "伤寒"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "伤寒"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "typhoid"
+ }
+ ]
+ },
+ {
+ "text": "细菌主要通过粪-口途径传播，一些污染水中放养的水生的贝壳类动物和牡蛎也是感染播散的方式。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "粪"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "口"
+ }
+ ]
+ },
+ {
+ "text": "伤寒带菌期可长达数十年，小儿带菌者少。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "伤寒带菌"
+ }
+ ]
+ },
+ {
+ "text": "苍蝇不仅可将带菌者的粪便带至食物上，而且本身还可带菌，从粪便中排菌而污染食物。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "粪便"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制】病菌经口入胃，未被胃酸消灭者进入小肠的淋巴组织，再由淋巴管进入血液，引起第一次菌血症，病菌随血流进入多种脏器的单核-吞噬细胞系统，部分未被吞噬的细菌再次入血，出现��二次菌血症期，并出现临床症状。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "口"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "胃"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "胃酸"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "淋巴组织"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "淋巴管"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "菌血症"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "血流"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "脏器"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "单核-吞噬细胞系统"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 79,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 92,
+ "type": "dis",
+ "entity": "菌血症"
+ }
+ ]
+ },
+ {
+ "text": "受累最严重的部位是集合淋巴结、肝、脾、骨髓等，病理表现有肠壁损伤、肝脾肿大、骨髓受到抑制，肝内病菌从肝管向肠腔排出时，通过胆囊，并在此繁殖。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "淋巴结"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "肝"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "脾"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "肠壁损伤"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "肝脾肿大"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "骨髓受到抑制"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肝"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "mic",
+ "entity": "病菌"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "肝管"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "胆囊"
+ }
+ ]
+ },
+ {
+ "text": "当细菌栓塞末梢血管时造成血管炎，皮肤可见玫瑰疹；细菌进入肾脏并可由尿中排出，细菌在生长繁殖过程中，可释放大量内毒素，引起内毒素血症。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "末梢血管"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "血管炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "玫瑰疹"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肾脏"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "内毒素血症"
+ }
+ ]
+ },
+ {
+ "text": "伤寒杆菌表面的Vi荚膜抗原干扰吞噬作用，它是通过防止补体C3在细胞表面的凝集来完成的，细菌在被巨噬细胞吞噬后可在其内生存，这是它的重要毒力物质即循环内毒素，是脂多糖细菌细胞壁成分，是延长发热和导致中毒症状的主要原因。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "mic",
+ "entity": "伤寒杆菌"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "mic",
+ "entity": "细菌"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ }
+ ]
+ },
+ {
+ "text": "内毒素诱导由巨噬细胞产生的细胞因子，可引起全身症状。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "巨噬细胞"
+ }
+ ]
+ },
+ {
+ "text": "细胞介导的免疫在人类抵抗伤寒病中起主要作用。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "伤寒病"
+ }
+ ]
+ },
+ {
+ "text": "T细胞数的减少是伤寒患者患病的关键原因，携带者的白细胞移动抑制试验显示对伤寒抗原的细胞反应受损，带菌者可将大量的病菌通过肠道，随粪便排泄，而不进入宿主的上皮细胞。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "T细胞"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "伤寒"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "白细胞移动抑制试验"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "伤寒"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "bod",
+ "entity": "上皮细胞"
+ }
+ ]
+ },
+ {
+ "text": "年长儿表现与成人相似，起病即伴发热，逐渐升高，在第5～9天时超过39℃，如无并发症，在第2周开始下降，但也可持续发热1个月者，同时伴有头痛、肌痛、腹痛、厌食、乏力、腹胀、面色苍白、精神不振、相对缓脉。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "sym",
+ "entity": "头痛"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "肌痛"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "sym",
+ "entity": "厌食"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 80,
+ "type": "sym",
+ "entity": "乏力"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 83,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "面色苍白"
+ },
+ {
+ "start_idx": 90,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "精神不振"
+ },
+ {
+ "start_idx": 95,
+ "end_idx": 98,
+ "type": "sym",
+ "entity": "相对缓脉"
+ }
+ ]
+ },
+ {
+ "text": "第1周末出现肝脾肿大，重者伴黄疸，约在第2周，躯干部分见玫瑰斑疹。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肝脾"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "肝脾肿大"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "躯干"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "躯干部分见玫瑰斑疹"
+ }
+ ]
+ },
+ {
+ "text": "婴幼儿症状不典型，无相对缓脉，症状较轻，轻度发热，似病毒感染，而腹泻较常见，常被误诊为急性肠炎。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "相对缓脉"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "轻度发热"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "病毒感染"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "急性肠炎"
+ }
+ ]
+ },
+ {
+ "text": "其他表现可有呼吸道感染的症状和体征。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ }
+ ]
+ },
+ {
+ "text": "新生儿往往是母婴垂直传播引起，生后3天出现症状，以呕吐、腹泻、腹胀常见，体温变化不一；但可高达40℃，可抽搐、贫血、黄疸、肝大和体重明显减轻。",
+ "entities": [
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "腹胀"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "体温变化不一"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "高达40℃"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "sym",
+ "entity": "抽搐"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "sym",
+ "entity": "黄疸"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "肝大"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 69,
+ "type": "sym",
+ "entity": "体重明显减轻"
+ }
+ ]
+ },
+ {
+ "text": "【并发症】肠出血和肠穿孔近年已见减少，胆道感染、胆囊穿孔、腮腺炎、中毒性脑病、伤寒杆菌脑膜炎都是少见的并发症。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "肠出血"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肠穿孔"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "胆道感染"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "胆囊穿孔"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "腮腺炎"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "中毒性脑病"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "伤寒杆菌脑膜炎"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】培养出伤寒杆菌可明确诊断。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "mic",
+ "entity": "伤寒杆菌"
+ }
+ ]
+ },
+ {
+ "text": "疾病的早期，40%～60%的患者血培养阳性，粪便和尿培养在1周后转为阳性，粪便培养有时可在潜伏期已是阳性。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "血培养"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "血培养阳性"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "粪便和尿培养"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "粪便和尿培养在1周后转为阳性"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "粪便培养"
+ }
+ ]
+ },
+ {
+ "text": "由于是间歇性和低水平的菌血症，对可疑病例应反复取血培养。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "菌血症"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "间歇性和低水平的菌血症"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "血培养"
+ }
+ ]
+ },
+ {
+ "text": "在疾病的后期当血培养转阴性时骨髓培养常可有阳性结果，此时小肠淋巴结、肝脾组织培养都可有阳性结果。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "血培养"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "血培养转阴性"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "pro",
+ "entity": "骨髓培养"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "骨髓培养常可有阳性结果"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "小肠淋巴结"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "肝脾组织培养"
+ }
+ ]
+ },
+ {
+ "text": "骨髓培养阳性率高，且可持续较长时间，是最敏感的诊断方法，阳性率可高达85%～90%，且不受早期抗生素的影响。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "骨髓培养"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "在慢性带菌者，粪便或尿培养也可出现阳性，有些病例十二指肠引流液培养也有助于明确诊断。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "pro",
+ "entity": "粪便或尿培养"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 32,
+ "type": "pro",
+ "entity": "十二指肠引流液培养"
+ }
+ ]
+ },
+ {
+ "text": "早期快速诊断方法是使用单克隆抗体直接检测血中伤寒杆菌的和尿中伤寒杆菌Vi多糖抗原。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "单克隆抗体直接检测"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "伤寒杆菌"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "mic",
+ "entity": "伤寒杆菌"
+ }
+ ]
+ },
+ {
+ "text": "应用PCR技术测定血中特定伤寒基因片段，这种方法敏感性大大高于细菌培养。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "PCR技术"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "伤寒"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "mic",
+ "entity": "细菌"
+ }
+ ]
+ },
+ {
+ "text": "血清肥达试验是测定血清抗O和H抗原的抗体，由于这一试验易出现假阴性和假阳性结果，所以易误诊。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "血清肥达试验"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】外周血白细胞总数减少，急性期不出现嗜酸性粒细胞，一旦出现说明病情有好转。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "外周血白细胞"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "外周血白细胞总数减少"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "嗜酸性粒细胞"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "急性期不出现嗜酸性粒细胞"
+ }
+ ]
+ },
+ {
+ "text": "极期时可出现蛋白尿和管型。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "蛋白尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "管型"
+ }
+ ]
+ },
+ {
+ "text": "肠出血时粪便潜血试验阳性，严重时可出现柏油样大便。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "肠出血"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "粪便潜血试验"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "柏油样大便"
+ }
+ ]
+ },
+ {
+ "text": "【鉴别诊断】在病程的初期，要与胃���炎、病毒感染综合征、支气管炎或支气管肺炎鉴别。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "胃肠炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "病毒感染综合征"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "支气管炎"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "支气管肺炎"
+ }
+ ]
+ },
+ {
+ "text": "随着病情进展应同其他病原所致败血症及结核病等鉴别。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "败血症"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "结核病"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】1.抗菌治疗抗生素是治疗伤寒的关键，由于细菌对抗生素耐药性增加，如何选用恰当的抗生素治疗是很重要的，也是人们争论之焦点。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "目前推荐用药量：氯霉素50mg/（kg•d），口服，或75mg/（kg•d），分4次静脉注射；氨苄西林100mg/（kg•d），分4～6次静脉滴注；阿莫西林100mg/（kg•d），分3次口服；复方磺胺甲唑（SMX）50mg/（kg•d），分2次口服。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "氯霉素"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "静脉注射"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "氨苄西林"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "pro",
+ "entity": "静脉滴注"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 77,
+ "type": "dru",
+ "entity": "阿莫西林"
+ },
+ {
+ "start_idx": 94,
+ "end_idx": 95,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 102,
+ "type": "dru",
+ "entity": "复方磺胺甲唑"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 106,
+ "type": "dru",
+ "entity": "SMX"
+ }
+ ]
+ },
+ {
+ "text": "青霉素目前虽然可快速杀菌，但是容易复发和引起不良反应。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "青霉素"
+ }
+ ]
+ },
+ {
+ "text": "氯霉素是首选药。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "氯霉素"
+ }
+ ]
+ },
+ {
+ "text": "2.短程激素治疗仅用于中毒症状严重者，地塞米松3mg/kg首次剂量，随后1mg/kg每6小时一次，共用48小时。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "地塞米松"
+ }
+ ]
+ },
+ {
+ "text": "第三种疫苗是Vi荚膜多糖疫苗，对2岁以上小儿注射应用。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "Vi荚膜多糖疫苗"
+ }
+ ]
+ },
+ {
+ "text": "第七节卡氏肺孢子虫肺炎卡氏肺孢子虫肺炎（pneumocystisCariniipneumonia）又称为间质性浆细胞肺炎（interstitialplasmacellpneumonia），是宿主存在免疫缺陷的基础上发生的机会感染性疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "卡氏肺孢子虫肺炎"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "卡氏肺孢子虫肺炎"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "pneumocystisCariniipneumonia"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "间质性浆细胞肺炎"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 91,
+ "type": "dis",
+ "entity": "interstitialplasmacellpneumonia"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 116,
+ "type": "dis",
+ "entity": "机会感染性疾病"
+ }
+ ]
+ },
+ {
+ "text": "卡氏肺孢子虫是原虫的一种。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "卡氏肺孢子虫"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "原虫"
+ }
+ ]
+ },
+ {
+ "text": "外周血白细胞计数正常或稍高，偶见嗜酸性粒细胞增高，血气分析示PaO2显著降低，而PaCO2不增高。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "外周血白细胞计数"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "嗜酸性粒细胞"
+ }
+ ]
+ },
+ {
+ "text": "呼吸道分泌物或肺组织，用环六亚甲基四胺硝酸银染色，可查见直径4～6μm的黑褐色圆形或椭圆形囊体。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "呼吸道分泌物"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肺组织"
+ }
+ ]
+ },
+ {
+ "text": "胸部X线摄片早期改变轻微，主要为肺纹理增多、肺门周围及下肺野可出现斑片状阴影。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "胸部X线摄片"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "肺纹理增多"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "肺门周围及下肺野可出现斑片状阴影"
+ }
+ ]
+ },
+ {
+ "text": "胸膜少受累，但可发生气胸、纵隔气肿。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "sym",
+ "entity": "胸膜少受累"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "纵隔气肿"
+ }
+ ]
+ },
+ {
+ "text": "肺部阴影自肺门向周围伸展，两上肺病变较少。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "肺部阴影自肺门向周围伸展"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "两上肺病变较少"
+ }
+ ]
+ },
+ {
+ "text": "确诊有赖于痰或气道吸出物中查到病原体。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "痰"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "吸出物"
+ }
+ ]
+ },
+ {
+ "text": "本病治疗首选SMZ100mg/（kg•d），加TMP20mg/（kg•d），每日4次口服，亦可静脉滴注。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "SMZ"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "TMP"
+ }
+ ]
+ },
+ {
+ "text": "艾滋病患儿疗程3周，其他患儿2周。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "艾滋病"
+ }
+ ]
+ },
+ {
+ "text": "SMZ/TMP还可用于本病高危儿的预防。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "SMZ/TMP"
+ }
+ ]
+ },
+ {
+ "text": "以上药物无效或无法耐受者可选用喷他脒，但副作用较大。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "喷他脒"
+ }
+ ]
+ },
+ {
+ "text": "第三章儿科用药特点药物是治疗儿科疾病的很重要手段，而其副反应、过敏反应和毒性作用则常会对机体产生不良影响。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dep",
+ "entity": "儿科"
+ }
+ ]
+ },
+ {
+ "text": "此外，新生儿期体液占体重的比例较大、肝脏酶系统发育不成熟肾清除率低血浆白蛋白含量低肝脏代谢药物的主要酶系统活性已成熟；肾小球滤过率和肾血流量在6～12个月可达到成人水平。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "肝脏酶系统"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "肝脏酶系统发育不成熟"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "肾清除率低"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "血浆白蛋白"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "血浆白蛋白含量低"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 64,
+ "type": "ite",
+ "entity": "肾小球滤过率"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "肾血流量"
+ }
+ ]
+ },
+ {
+ "text": "由于这一时期生长迅速，要密切注意药物通过不同的机制影响小儿的发育，如长期类固醇激素的应用可影响生长发育，中枢抑制性药物对智力有损害等。",
+ "entities": [
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "类固醇激素"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 58,
+ "type": "dru",
+ "entity": "中枢抑制性药物"
+ }
+ ]
+ },
+ {
+ "text": "假如把身体划分为两部分，药物进入体内后首先迅速地分布于血液及血流供应充分的组织，如心、肝、肾、肺等，然后再由这些部位向血流不足的组织如肌肉、脂肪、皮肤等组织转运，达到平衡，这种模型称为“二室模型”。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "心"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "肝"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "肾"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 47,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "脂肪"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "皮肤"
+ }
+ ]
+ },
+ {
+ "text": "这一成比例的特性，结合对病人的监测，常被临床上用于调整药物的剂量；相反，某些药物如奥美拉唑、西咪替丁、水杨酸盐、茶碱、卡马西平、苯妥因钠等血液中药物浓度的变化与使用剂量不成比例，即呈非线性动力学特征。",
+ "entities": [
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dru",
+ "entity": "奥美拉唑"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "dru",
+ "entity": "西咪替丁"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dru",
+ "entity": "水杨酸盐"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "dru",
+ "entity": "茶碱"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "dru",
+ "entity": "卡马西平"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "dru",
+ "entity": "苯妥因钠"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "血液"
+ }
+ ]
+ },
+ {
+ "text": "在通常情况下，这些药物在低剂量时遵循一级动力学过程，但随剂量增加由于与吸收有关的转运蛋白被饱和、血浆/组织蛋白结合过程被饱和、药物代谢酶被饱和、肾小管主动重吸收等任何过程被饱和都可以导致体内药物浓度增加，这时剂量稍有增加，常可导致血药浓度不成比例地增高，引起不良反应甚至中毒，并且由于半衰期延长，清除率明显降低，由非线性动力学而导致的血药浓度过高，可能产生严重的后果。",
+ "entities": [
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "转运蛋白"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "组织蛋白"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 67,
+ "type": "bod",
+ "entity": "药物代谢酶"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "bod",
+ "entity": "肾小管"
+ }
+ ]
+ },
+ {
+ "text": "这一差异是药动学和药效学个体差异及许多生物变异的结果，如代谢、病理生理及遗传差异。",
+ "entities": [
+ {
+ "start_idx": 31,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "病"
+ }
+ ]
+ },
+ {
+ "text": "由于存在药物疗效及毒性的个体差异，对特殊病人需调整给药方案，尤其是对某些药物，如血管活性药的剂量可根据患儿出现的即刻、易定量（如血压、心率等）的临床反应进行调整。",
+ "entities": [
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "dru",
+ "entity": "血管活性药"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "ite",
+ "entity": "血压"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "ite",
+ "entity": "心率"
+ }
+ ]
+ },
+ {
+ "text": "而一种药物的药理或毒理反应可能直接与特异血清浓度范围有关。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "这些治疗范围代表了平均值，仅49%的人群包括在均数±2SD范围内，因此血清药物浓度的临床监测只能作为药物干预和剂量调整的参考，使用时必须注意到个体化。",
+ "entities": [
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "例如：一个病人的某药物血清浓度在低于有效治疗窗时即有完全的临床反应，而另一个病人，同一种疾病，用同一种药物，可能需要血清浓度在治疗浓度范围以上，才能获得相同程度的阳性治疗反应。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "因此，血清药物浓度的治疗范围只能作为治疗的指导，最终必须通过临床反应来评价药物有效性。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "血清"
+ }
+ ]
+ },
+ {
+ "text": "体液中药物浓度测定有助于减少药物毒性反应，同时达到最理想的治疗效果，为评价疾病治疗过程或药物相互作用对药物分布的影响提供了有效方法。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "体液"
+ }
+ ]
+ },
+ {
+ "text": "治疗性药物浓度监测并非对所有药物都是必须、必要和实用的。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "治疗性药物浓度监测"
+ }
+ ]
+ },
+ {
+ "text": "对药效学已较为清楚的药物，如利尿剂的利尿效果、抗高血压药降低血压作用等，并不需要常规监测血浓度。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "利尿剂"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "抗高血压药"
+ }
+ ]
+ },
+ {
+ "text": "应用血清药物浓度监测以指导治疗时，应首先了解该药物的药动学特性，以便确定用药后适当的采血时间及合理解释药物浓度和治疗反应。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "血清药物浓度监测"
+ }
+ ]
+ },
+ {
+ "text": "【钙】钙是人体内含量最多的元素之一，其中99%的钙集中在骨骼和牙齿，只有1%的钙以游离或结合的离子状态存在于其他组织和体液内，正常情况下，后者与骨骼内的钙维持动态平衡。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "骨骼"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "牙齿"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "bod",
+ "entity": "组织"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "体液"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "骨骼"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 76,
+ "type": "bod",
+ "entity": "钙"
+ }
+ ]
+ },
+ {
+ "text": "钙主要在小肠内吸收，维生素D、乳糖和蛋白质可促进钙的吸收，而植物中的植酸、草酸、膳食纤维和脂���酸与钙结合可影响钙的吸收。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "钙"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "维生素D"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "蛋白质"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "钙"
+ }
+ ]
+ },
+ {
+ "text": "粪便是钙的主要排泄途径，其次是尿液，少量经汗液排出。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "钙"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "汗液"
+ }
+ ]
+ },
+ {
+ "text": "钙不仅是小儿骨骼和牙齿生长发育不可缺少的，而且还是维持肌肉神经兴奋性的重要物质，当血钙过低时，小儿容易哭闹和夜惊，甚至于出现手足抽搐等兴奋性增高的现象。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 0,
+ "type": "bod",
+ "entity": "钙"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "小儿骨骼"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "牙齿"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肌肉神经"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "ite",
+ "entity": "血钙"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 55,
+ "type": "sym",
+ "entity": "小儿容易哭闹和夜惊"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "甚至于出现手足抽搐等兴奋性增高的现象"
+ }
+ ]
+ },
+ {
+ "text": "另外，钙还能激活体内多种酶的活性，如激活凝血酶原，使之成为凝血酶而发挥凝血功能。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "激活凝血酶原"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "凝血酶"
+ }
+ ]
+ },
+ {
+ "text": "体内磷元素约80%存在于骨骼和牙齿中，是构成核酸、磷脂、酶等的原料，参与重要的生理代谢活动。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "骨骼"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "牙齿"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "核酸"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "磷脂"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "维生素D有助于磷的吸收。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "维生素D"
+ }
+ ]
+ },
+ {
+ "text": "我国2000年全国学生体质健康调研显示6～18岁人群中缺铁性贫血的患病率为18.4%～22.4%。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "缺铁性贫血"
+ }
+ ]
+ },
+ {
+ "text": "2岁以下的婴幼儿患病率则更高（参见营养性疾病铁缺乏章节）。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "营养性疾病铁缺乏"
+ }
+ ]
+ },
+ {
+ "text": "新生婴儿由于体内铁元素的储存少，但此期生长发育快，因此，早产儿在出生2个月后，足月儿在出生4个月后，体内储存的铁元素已基本耗尽，再加上母乳中的铁含量低，牛奶中的铁吸收率低，很容易发生缺铁性贫血，故需及时补充铁元素。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "铁元素"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 95,
+ "type": "dis",
+ "entity": "缺铁性贫血"
+ }
+ ]
+ },
+ {
+ "text": "【锌】微量元素锌分布于人体所有组织、器官、体液和分泌物中，95%以上存在于细胞内。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "组织"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "器官"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "体液"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "分泌物"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "细胞"
+ }
+ ]
+ },
+ {
+ "text": "锌也主要经小肠吸收，动物食物中的锌比植物食物中的锌容易吸收，铁可与锌竞争肠黏膜细胞上的受体而抑制其吸收。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "小肠"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肠黏膜细胞"
+ }
+ ]
+ },
+ {
+ "text": "【碘】碘是组成甲状腺素的重要成分，甲状腺素有调节人体能量代谢以及三大营养素的合成和分解的作用，促进小儿生长发育。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "甲状腺素"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "甲状腺素"
+ }
+ ]
+ },
+ {
+ "text": "胎儿和新生儿缺碘不仅使生长发育迟缓，还可导致智力低下。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "缺碘"
+ }
+ ]
+ },
+ {
+ "text": "硒广泛分布在脂肪组织以外的所有组织，是机体内一种非特异抗氧化物质谷胱甘肽过氧化酶的重要成分之一，有清除体内过氧化物和自由基的作用，从而保护细胞膜和细胞器（如线粒体、微粒体和溶酶体）的膜。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "脂肪组织"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "非特异抗氧化物质谷胱甘肽过氧化酶"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "过氧化物"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "自由基"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "细胞膜"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "细胞器"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "线粒体"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 84,
+ "type": "bod",
+ "entity": "微粒体"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "溶酶体"
+ }
+ ]
+ },
+ {
+ "text": "许多动物和临床流行病学研究显示硒对心血管和眼的健康有保护作用；而且与维生素E有重要的协同作用。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "心血管"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "眼"
+ }
+ ]
+ },
+ {
+ "text": "血硒浓度受土壤、水质和食物中硒含量的影响；海产品、动物肝脏、肾和肌肉及整粒谷类、洋葱等是硒的良好食物来源。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "血硒浓度"
+ }
+ ]
+ },
+ {
+ "text": "铜的生理功能有：参与结缔组织的合成，对骨骼、血管壁的健全起重要作用；参与铁代谢和造血功能；与中枢神经系统正常结构和功能有关；也与黑色素合成有关。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "结缔组织"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "骨骼"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "血管壁"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "黑色素"
+ }
+ ]
+ },
+ {
+ "text": "【铬】铬在人体内的含量仅6mg，其主要的生理功能是促进胰岛素的作用，从而影响糖、脂肪和蛋白质的代谢。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "胰岛素"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "糖"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "脂肪"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "蛋白质"
+ }
+ ]
+ },
+ {
+ "text": "铬缺乏多发生在蛋白质-能量营养不良的儿童和应用全肠外营养的患者。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "铬缺乏"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "蛋白质-能量营养不良"
+ }
+ ]
+ },
+ {
+ "text": "第四节哮喘持续状态哮喘持续状态是指对常规哮喘治疗反应差，呈急性进行性加重的严重发作，如不及时处理会发展成呼吸衰竭。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "常规哮喘治疗"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "急性进行性加重的严重发作"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "疾病初期气道阻力非匀称增加，V/Q比例失调引起低氧血症，并代偿性出现PaCO2下降；气道阻进一步增加，代偿机制恶化，通气量明显下降，引起严重低氧血症和高碳酸血症；最后可以出现混合性酸中毒，肺动脉高压和右心功能及中枢神经系统功能异常。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "阻力非匀称增加"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "V/Q比例失调"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "高碳酸血症"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 98,
+ "type": "dis",
+ "entity": "混合性酸中毒"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 104,
+ "type": "dis",
+ "entity": "肺动脉高压"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 120,
+ "type": "dis",
+ "entity": "右心功能及中枢神经系统功能异常"
+ }
+ ]
+ },
+ {
+ "text": "【诱发因素】如患儿哮喘治疗不当，长期应用β2受体激动剂，而未进行抗感染治疗；以及短期内吸入大量的过敏物质或强烈理化气体（如油漆）可以引起哮喘重度发作；此外脱水引起气道分泌物干燥分泌物干燥，痰栓阻塞气道；伴有各种并发症出现（气胸、肺不张等），造成哮喘治疗困难。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "β2受体激动剂"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "pro",
+ "entity": "抗感染治疗"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "哮喘"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 84,
+ "type": "dis",
+ "entity": "脱水"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 93,
+ "type": "sym",
+ "entity": "气道分泌物干燥"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 105,
+ "type": "sym",
+ "entity": "痰栓阻塞气道"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 113,
+ "type": "dis",
+ "entity": "并发症"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 118,
+ "type": "dis",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 122,
+ "type": "dis",
+ "entity": "肺���张"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 131,
+ "type": "pro",
+ "entity": "哮喘治疗"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】除了明显喘憋、面色苍白、口唇发绀烦躁外，体格检查有助于判断疾病的严重程度：①呼吸是伴有明显的三凹征，提示FEV1和呼气流速峰值低于正常的50%；②奇脉血压超过2.93kPa（22mmHg）常提示PaCO2升高；③有呼气动作，但呼气音低，听不到哮鸣音，表明喘憋严重。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "明显喘憋"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "面色苍白"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "口唇"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "口唇发绀"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "烦躁外"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "体格检查"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "呼吸是伴有明显的三凹征"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "FEV1"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 68,
+ "type": "ite",
+ "entity": "呼气流速峰值"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "ite",
+ "entity": "奇脉血压"
+ },
+ {
+ "start_idx": 118,
+ "end_idx": 122,
+ "type": "sym",
+ "entity": "有呼气动作"
+ },
+ {
+ "start_idx": 124,
+ "end_idx": 128,
+ "type": "sym",
+ "entity": "但呼气音低"
+ },
+ {
+ "start_idx": 130,
+ "end_idx": 135,
+ "type": "sym",
+ "entity": "听不到哮鸣音"
+ },
+ {
+ "start_idx": 139,
+ "end_idx": 140,
+ "type": "dis",
+ "entity": "喘憋"
+ }
+ ]
+ },
+ {
+ "text": "表8-26Wood临床评分标准注：≥5分，为呼吸功能不全；≥7分，伴PaCO2＞8.7kPa为呼吸衰竭【治疗】1.吸氧给予吸入经湿化后的30%～50%浓度的氧，维持PaO260～80mmHg，SaO292%～95%。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "呼吸功能不全"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "pro",
+ "entity": "吸氧"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 84,
+ "type": "pro",
+ "entity": "给予吸入经湿化后的30%～50%浓度的氧"
+ },
+ {
+ "start_idx": 86,
+ "end_idx": 124,
+ "type": "pro",
+ "entity": "维持PaO260～80mmHg，SaO292%～95%"
+ }
+ ]
+ },
+ {
+ "text": "2.保持呼吸道湿润补充足够的液体，但补液速度不能过快；同时要避免环境过分干燥。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "保持呼吸道湿润"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "补充足够的液体"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "但补液速度不能过快"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "同时要避免环境过分干燥"
+ }
+ ]
+ },
+ {
+ "text": "3.支气管扩张药静脉用β受体兴奋剂的心血管不良反应较大，现已少用；目前多采用喷射式雾化吸入方法；吸入沙丁胺醇2.5～5mg/次，第一小时每20分钟一次，连用3次，然后每小时一次，根据喘息缓解情况，逐渐延长用药间隔。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "支气管扩张药"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "β受体兴奋剂"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "心血管"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "心血管不良反应较大"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 46,
+ "type": "pro",
+ "entity": "喷射式雾化吸入方法"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 53,
+ "type": "pro",
+ "entity": "吸入沙丁胺醇"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 74,
+ "type": "pro",
+ "entity": "第一小时每20分钟一次"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "pro",
+ "entity": "连用3次"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 87,
+ "type": "pro",
+ "entity": "然后每小时一次"
+ },
+ {
+ "start_idx": 98,
+ "end_idx": 105,
+ "type": "pro",
+ "entity": "逐渐延长用药间隔"
+ }
+ ]
+ },
+ {
+ "text": "反复用药时要监测心血管功能和血钾，保持心率＜180次/分，无室性异位节律发生。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "反复用药时要监测心血管功能和血钾"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "保持心率＜180次/分"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "无室性异位节律发生"
+ }
+ ]
+ },
+ {
+ "text": "同时可加用氨茶碱静脉注射；以每1mg/kg的负荷剂量增加血中氨茶碱浓度大约2μg/ml计算，对那些以前从未接受氨茶碱或口服茶碱制剂的患者，首次给予4～6mg/kg的氨茶碱负荷剂量以取得12μg/ml的水平；然后用维持量，剂量为每小时0.8～1mg/kg，严密观察毒性反应（胃不适、心律失常、抽搐）和氨茶碱水平，尽量维持在13～16μg/ml的稳定状态。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "氨茶碱"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "静脉注射"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "血"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "氨茶碱"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "dru",
+ "entity": "氨茶碱"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 64,
+ "type": "dru",
+ "entity": "口服茶碱制剂"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 88,
+ "type": "pro",
+ "entity": "给予4～6mg/kg的氨茶碱负荷剂量"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 108,
+ "type": "pro",
+ "entity": "用维持量"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 125,
+ "type": "pro",
+ "entity": "剂量为每小时0.8～1mg/kg"
+ },
+ {
+ "start_idx": 127,
+ "end_idx": 134,
+ "type": "pro",
+ "entity": "严密观察毒性反应"
+ },
+ {
+ "start_idx": 136,
+ "end_idx": 138,
+ "type": "sym",
+ "entity": "胃不适"
+ },
+ {
+ "start_idx": 140,
+ "end_idx": 143,
+ "type": "sym",
+ "entity": "心律失常"
+ },
+ {
+ "start_idx": 145,
+ "end_idx": 146,
+ "type": "sym",
+ "entity": "抽搐"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 151,
+ "type": "dru",
+ "entity": "氨茶碱"
+ },
+ {
+ "start_idx": 155,
+ "end_idx": 174,
+ "type": "pro",
+ "entity": "尽量维持在13～16μg/ml的稳定状态"
+ }
+ ]
+ },
+ {
+ "text": "除了喷射雾化吸入β2受体兴奋剂外，还可同时吸入抗胆碱能药物气道炎症够减轻气道炎症引起的局部迷走神经反射，与β2受体兴奋剂合用有互补作用。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "喷射雾化"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "β2受体兴奋剂外"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "抗胆碱能药物"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "气道炎症"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "局部迷走神经反射"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 65,
+ "type": "dru",
+ "entity": "β2受体兴奋剂"
+ }
+ ]
+ },
+ {
+ "text": "具体剂量见表8-8，可以与β受体兴奋剂同时吸入。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "β受体兴奋剂"
+ }
+ ]
+ },
+ {
+ "text": "硫酸镁：每次25mg/kg+100ml生理盐水静脉滴注20～30分钟，有低血压、心动过缓、面色潮红等不良反应。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "硫酸镁"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "生理盐水"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "pro",
+ "entity": "静脉滴注"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "低血压"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "sym",
+ "entity": "心动过缓"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "面色潮红"
+ }
+ ]
+ },
+ {
+ "text": "4.应用糖皮质激素静脉用甲基泼尼松龙，第1次剂量2mg/kg，然后每6小时1次，每次1mg/kg；或氢化可的松，每6～8小时1次，每次5～10mg/kg。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "应用糖皮质激素"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "静脉"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "甲基泼尼松龙"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "第1次剂量2mg/kg"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "每6小时1次"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 47,
+ "type": "pro",
+ "entity": "每次1mg/kg"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 54,
+ "type": "dru",
+ "entity": "氢化可的松"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 63,
+ "type": "pro",
+ "entity": "每6～8小时1次"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 75,
+ "type": "pro",
+ "entity": "每次5～10mg/kg"
+ }
+ ]
+ },
+ {
+ "text": "可同时吸入Budesonide，每次1mg。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "Budesonide"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "每次1mg"
+ }
+ ]
+ },
+ {
+ "text": "5.控制感染尽管目前还有争论，但由于气道分泌物增加、环境条件差，加上大量糖皮质激素应用，应用抗生素有一定的合理性。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "气道分泌物"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "糖皮质激素"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "6.观察和监护随访血气分析，分析气道阻塞程度；对长期应用β受体兴奋剂患儿要监测血电解质，注意低钾血症发生；对治疗效果不明显或病情恶化患儿，要注意肺部并发症存在，摄胸片观察是否伴有肺不张、气胸、气道异物。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "β受体兴奋剂"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "ite",
+ "entity": "血电解质"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "低钾血症"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 60,
+ "type": "sym",
+ "entity": "治疗效果不明显"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 65,
+ "type": "sym",
+ "entity": "病情恶化"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 76,
+ "type": "dis",
+ "entity": "肺部并发症"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 82,
+ "type": "ite",
+ "entity": "摄胸片"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 91,
+ "type": "dis",
+ "entity": "肺不张"
+ },
+ {
+ "start_idx": 93,
+ "end_idx": 94,
+ "type": "dis",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 96,
+ "end_idx": 99,
+ "type": "dis",
+ "entity": "气道异物"
+ }
+ ]
+ },
+ {
+ "text": "7.机械通气对经过以上处理病情不能改善，呼吸衰竭持续存在的情况下应考虑机械通气。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "机械通气"
+ }
+ ]
+ },
+ {
+ "text": "机械通气指征：持续严重的呼吸困难，哮鸣音和呼吸音明显减弱；呼吸肌极度疲劳；在吸入纯氧下PaO2＜8kPa（60mmHg），PaCO2＞6.65kPa（50mmHg）；有并发症（气胸、纵隔气肿等）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "持续严重的呼吸困难"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "哮鸣音和呼吸音明显减弱"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "呼吸肌极度疲劳"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "pro",
+ "entity": "吸入纯氧"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 108,
+ "type": "dis",
+ "entity": "并发症"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 111,
+ "type": "dis",
+ "entity": "气胸"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 116,
+ "type": "dis",
+ "entity": "纵隔气肿"
+ },
+ {
+ "start_idx": 105,
+ "end_idx": 118,
+ "type": "sym",
+ "entity": "有并发症（气胸、纵隔气肿等）"
+ }
+ ]
+ },
+ {
+ "text": "机械通气原则：①在尽量减少气压伤的基础上，维持足够的氧合和通气量直至其他治疗充分起效；②用定容型呼吸模式，以利控制合适的潮气量；③长呼气时间，低呼吸频率，保证足够的呼气时间；④呼气末正压应保持在低值，⑤通过呼吸机管路，吸入β受体兴奋药物；⑥机械通气下，伴有代酸患儿，可用NaHCO3纠酸。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 107,
+ "type": "equ",
+ "entity": "呼吸机管路"
+ },
+ {
+ "start_idx": 111,
+ "end_idx": 117,
+ "type": "dru",
+ "entity": "β受体兴奋药物"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 123,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 128,
+ "end_idx": 129,
+ "type": "dis",
+ "entity": "代酸"
+ },
+ {
+ "start_idx": 135,
+ "end_idx": 152,
+ "type": "dru",
+ "entity": "NaHCO3"
+ }
+ ]
+ },
+ {
+ "text": "二、咽旁脓肿咽旁脓肿（lateralpharyngealabscess）病原学与咽后壁脓肿相同。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "咽旁脓肿"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "咽旁脓肿"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "lateralpharyngealabscess"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "咽后壁脓肿"
+ }
+ ]
+ },
+ {
+ "text": "患儿病情常严重，伴高热、牙关紧闭、咽痛、吞咽困难，常有颈淋巴结肿大。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "高热、牙关紧闭、咽痛、吞咽困难"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "颈淋巴结"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "颈淋巴结肿大"
+ }
+ ]
+ },
+ {
+ "text": "由于受累部位肌肉痉挛引起斜颈。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "受累部位肌肉痉挛"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "斜颈"
+ }
+ ]
+ },
+ {
+ "text": "治疗常需切开引流。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "切开引流"
+ }
+ ]
+ },
+ {
+ "text": "第三节Q热Q热（Qfever）是无皮疹的热性疾病，有急性型和慢性型两种。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "Q热"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "Q热"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "Qfever"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "无皮疹"
+ }
+ ]
+ },
+ {
+ "text": "【病原及流行病学】贝纳立克次体是本病的病原体，习惯上称Q热立克次体。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "mic",
+ "entity": "贝纳立克次体"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "mic",
+ "entity": "Q热立克次体"
+ }
+ ]
+ },
+ {
+ "text": "贝纳立克次体是革兰染色阴性、嗜酸、耐热、专性细胞内寄生菌。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "贝纳立克次体"
+ }
+ ]
+ },
+ {
+ "text": "对人类的感染性特别强，在外界环境中存活久，是立克次体中唯一可不借助媒介节肢动物而通过气溶胶使人和动物发生感染的病原体，因而分布十分广泛。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "立克次体"
+ }
+ ]
+ },
+ {
+ "text": "全世界均有Q热报道。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "Q热"
+ }
+ ]
+ },
+ {
+ "text": "近年来以心内膜炎为特征的慢性Q热病例日益增多，其病情严重，抗生素疗效不佳，应引起足够重视。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "心内膜炎"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "慢性Q热"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "贝纳立克次体对人类和动物高度易感，少到一个病原体即可致病。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "贝纳立克次体"
+ }
+ ]
+ },
+ {
+ "text": "受感染动物和人的尿液、粪便、羊水、乳汁中均含有立克次体，经空气、食物、皮肤进入人体。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "尿液"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "羊水"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "乳汁"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "mic",
+ "entity": "立克次体"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "皮肤"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】急性Q热潜伏期2～3周。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "急性Q热"
+ }
+ ]
+ },
+ {
+ "text": "发病较急，病初即有发热，发热1～3周，同时有畏寒、全身乏力、酸痛、头痛，偶伴关节痛。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "发热"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "发热1～3周"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "畏寒"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "全身乏力"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "酸痛"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "关节痛"
+ }
+ ]
+ },
+ {
+ "text": "X线肺部检查见节段性和大叶性模糊阴影，多在肺下叶；肺门及支气管周围纹理增厚及有浸润影，肺炎经2～4周消失。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "X线肺部检查"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "肺下叶"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "节段性和大叶性模糊阴影，多在肺下叶"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肺门"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "支气管"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "肺门及支气管周围纹理增厚及有浸润影"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "肺炎"
+ }
+ ]
+ },
+ {
+ "text": "儿童很少有慢性Q热。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "慢性Q热"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】注意流行病学资料，临床症状无特异性，Q热的确诊在于得到Ⅰ和Ⅱ相抗原的间接免疫荧光血清抗体滴定度增高或补体结合抗体滴定度增高。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "Q热"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 64,
+ "type": "sym",
+ "entity": "补体结合抗体滴定度增高"
+ }
+ ]
+ },
+ {
+ "text": "单独Ⅱ相抗体的滴定度升高对急性Q热有特殊诊断价值。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "单独Ⅱ相抗体的滴定度升高"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "急性Q热"
+ }
+ ]
+ },
+ {
+ "text": "Ⅰ和Ⅱ相抗体持续升高用于诊断慢性Q热，Ⅰ相IgA抗体升高对诊断Q热心内膜炎有帮助。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "Ⅰ和Ⅱ相抗体持续升高"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "慢性Q热"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "Ⅰ相IgA抗体升高"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "Q热心内膜炎"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】采用四环素或多西环素治疗，但应争取早期治疗，过晚治疗对于缩短急性起病程没有作用。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "四环素"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "多西环素"
+ }
+ ]
+ },
+ {
+ "text": "第七章神经母细胞瘤神经母细胞瘤（neuroblastoma，NB）从原始神经嵴细胞演化而来，交感神经链、肾上腺髓质是最常见的原发部位。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "神经母细胞瘤"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "神经母细胞瘤"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "neuroblastoma"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "原始神经嵴细胞"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "交感神经链"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "肾上腺髓质"
+ }
+ ]
+ },
+ {
+ "text": "不同年龄、肿瘤发生部位及不同的组织分化程度使其生物特性及临床表现有很大差异，部分可自然消退或转化成良性肿瘤，但另一部分病人却又十分难治，预后不良。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "肿瘤"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "组织"
+ }
+ ]
+ },
+ {
+ "text": "在过去的30年中，婴儿型或早期NB预后有了明显的改善，但大年龄晚期病人预后仍然十分恶劣。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "婴儿型或早期NB"
+ }
+ ]
+ },
+ {
+ "text": "在NB中有许多因素可影响预后，年龄、分期和N-MYC扩增仍然是最重要的因素。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "N-MYC"
+ }
+ ]
+ },
+ {
+ "text": "【发病率】NB是儿童最常见的颅外实体瘤，占所有儿童肿瘤的8%～10%，一些高发地区如法国、以色列、瑞士、新西兰等的年发病率达11/100万（0～15岁），美国为25/100万，中国和印度的报告低于5/100万。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "颅外实体瘤"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "儿童肿瘤"
+ }
+ ]
+ },
+ {
+ "text": "【病理学】NB来自起源于神经嵴的原始多能交感神经细胞，形态为蓝色小圆细胞。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "神经嵴"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "多能交感神经细胞"
+ }
+ ]
+ },
+ {
+ "text": "从神经嵴移行后细胞的分化程度、类型及移行部位形成不同的交感神经系统正常组织，包括脊髓交感神经节、肾上腺嗜铬细胞。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "神经嵴"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "交感神经系统"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "脊髓交感神经节"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "肾上腺嗜铬细胞"
+ }
+ ]
+ },
+ {
+ "text": "NB组织学亚型与交感神经系统的正常分化模型相一致。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "交感神经系统"
+ }
+ ]
+ },
+ {
+ "text": "典型的NB由一致的小细胞组成，约15%～50%的病例，母细胞周围有嗜酸性神经纤维网。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "小细胞"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "母细胞"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "神经纤维网"
+ }
+ ]
+ },
+ {
+ "text": "另一种完全分化的、良性NB为神经节细胞瘤，由成熟的节细胞、神经纤维网及Schwann细胞组成。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "神经节细胞瘤"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "节细胞"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "神经纤维网"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "Schwann细胞"
+ }
+ ]
+ },
+ {
+ "text": "神经节母细胞瘤介于前两者之间，含有神经母细胞和节细胞混杂成分。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "神经节母细胞瘤"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "神经母细胞"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "节细胞"
+ }
+ ]
+ },
+ {
+ "text": "4个亚型即包括NB（Schwannin少基质型）；GNB混合型（基质丰富型）；GN成熟型和GNB结节型（包括少基质型和基质丰富型）。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "GNB结节型"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "基质"
+ }
+ ]
+ },
+ {
+ "text": "前三型代表了NB的成熟过程，而最后一型则为多克隆性。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "NB"
+ }
+ ]
+ },
+ {
+ "text": "对NB而言，细胞分化分为3级，包括未分化、分化不良、分化型；细胞的有丝分裂指数（MKI）也分为低、中、高3级。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "细胞"
+ }
+ ]
+ },
+ {
+ "text": "Shimada分类综合肿瘤细胞的分化程度、有丝分裂指数和年龄，将NB分为临床预后良好组（FH）和预后不良组（UFH），FH包括以下各类：①NB，MKI为低中度，年龄＜1.5岁；②分化型NB，MKI为低度，年龄1.5～5岁；③GNB混合型；④GN。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肿瘤细胞"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 93,
+ "type": "dis",
+ "entity": "分化型NB"
+ }
+ ]
+ },
+ {
+ "text": "UFH包括①NB，MKI高级；②NB，MKI为中级，年龄1.5～5岁；③未分化或分化不良型NB，年龄1.5～5岁；④所有＞5岁的NB；⑤GNB结节型。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "不良型NB"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 73,
+ "type": "dis",
+ "entity": "GNB结节型"
+ }
+ ]
+ },
+ {
+ "text": "在病理上，除HE染色外，可进一步作免疫组化电镜检查来与其他小圆细胞肿瘤相鉴别，NB时神经特异性酯酶（NSE）阳性，电镜下可见典型的致密核，结合于膜上的神经分泌颗粒，在神经纤维网中有微丝和平行排列的微管。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "HE染色"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "免疫组化电镜检查"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "小圆细胞肿瘤"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "神经特异性酯酶"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "NSE"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 58,
+ "type": "equ",
+ "entity": "电镜"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 67,
+ "type": "sym",
+ "entity": "电镜下可见典型的致密核"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 72,
+ "type": "bod",
+ "entity": "膜"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "神经分泌颗粒"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 80,
+ "type": "sym",
+ "entity": "结合于膜上的神经分泌颗粒"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 87,
+ "type": "bod",
+ "entity": "神经纤维网"
+ },
+ {
+ "start_idx": 98,
+ "end_idx": 99,
+ "type": "bod",
+ "entity": "微管"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 99,
+ "type": "sym",
+ "entity": "在神经纤维网中有微丝和平行排列的微管"
+ }
+ ]
+ },
+ {
+ "text": "其他常见部位为胸腔和颈部。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "胸腔"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "颈部"
+ }
+ ]
+ },
+ {
+ "text": "原发于腹部时以肾上腺及脊柱两侧交感神经链原发多见，一般在肿块较大时才出现症状，可有腹痛、腹围增大腰背部饱满扪及肿块、胃肠道症状胸腔时有纵隔压迫相关症状及呼吸道症状气促、咳嗽等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肾上腺"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "脊柱"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "交感神经链"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "腹"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "腹围增大"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "腰背部"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "腰背部饱满"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 62,
+ "type": "sym",
+ "entity": "扪及肿块、胃肠道症状"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "bod",
+ "entity": "胸腔"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "纵隔"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 78,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 80,
+ "type": "sym",
+ "entity": "胸腔时有纵隔压迫相关症状及呼吸道症状"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "气促"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 85,
+ "type": "sym",
+ "entity": "咳嗽"
+ }
+ ]
+ },
+ {
+ "text": "晚期病人常有肢体疼痛贫血、发热、消瘦、眼眶部转移眼眶部转移形成具有特征性的熊猫眼，表现为眼球突出眶周青紫高血压及肿块部位相关压迫症状，如有椎管内浸润压迫时出现运动障碍大小便失禁等。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肢体"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "肢体疼痛"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "贫血"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "消瘦"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "眼眶部"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "眼眶部转移"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "眼眶部"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "眼球"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "眼球突出"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "眶"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "眶周青紫"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 65,
+ "type": "sym",
+ "entity": "高血压及肿块部位相关压迫症状"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 70,
+ "type": "bod",
+ "entity": "椎管"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "椎管内浸润压迫时出现运动障碍"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 88,
+ "type": "sym",
+ "entity": "大小便失禁等"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查】尽量争取病理活检以明确诊断及分型。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "病理活检"
+ }
+ ]
+ },
+ {
+ "text": "85%～90%患儿尿中儿茶酚胺代谢产物同型香酸（HVA）、香草基杏仁酸（VMA）增高。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "儿茶酚胺"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "同型香酸"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "HVA"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "香草基杏仁酸"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "VMA"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "患儿尿中儿茶酚胺代谢产物同型香酸（HVA）、香草基杏仁酸（VMA）增高"
+ }
+ ]
+ },
+ {
+ "text": "细胞遗传学检查可发现1p-。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "细胞遗传学检查"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "1p"
+ }
+ ]
+ },
+ {
+ "text": "【诊断及分期】组织病理学检查是NB诊断的最重要手段，有时需结合免疫组织化学、电镜以明确诊断。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "equ",
+ "entity": "电镜"
+ }
+ ]
+ },
+ {
+ "text": "影像学检查发现有与NB特征相符合的肿块，同时骨髓中发现NB肿瘤细胞，有明显增高的儿茶酚胺代谢产物（HVA或VMA）也可作出诊断。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "影像学检查"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "肿块"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "骨髓"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "NB肿瘤细胞"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "儿茶酚胺"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 51,
+ "type": "bod",
+ "entity": "HVA"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "VMA"
+ }
+ ]
+ },
+ {
+ "text": "如病理诊断有困难时，染色体检查发现有1p-缺失或N-myc扩增支持NB诊断。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "染色体检查"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "1p"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "NB"
+ }
+ ]
+ },
+ {
+ "text": "（二）生物学特征在NB中常见有N-myc扩增，N-myc对细胞分裂有正向调节作用，维A酸（RA）对N-myc表达有负向调节作用以致NB细胞停止增殖并分化，N-myc扩增＞10倍为预后不良因素。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "维A酸"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "RA"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "NB细胞"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 81,
+ "type": "bod",
+ "entity": "N-myc"
+ }
+ ]
+ },
+ {
+ "text": "1p36.3缺失是易复发的因素，1p可能有肿瘤抑制因子，即使无N-myc扩增，1p36.3缺失仍有意义。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "1p36.3"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "1p"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "肿瘤抑制因子"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "1p36.3"
+ }
+ ]
+ },
+ {
+ "text": "17q获得（gain）时预后差。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "17q"
+ }
+ ]
+ },
+ {
+ "text": "NB表达酪胺酸激酶（Trk）家族受体激酶的研究进展较快，预后良好型表达TrkA、C；而预后不良型、N-myc扩增型表达TrkB。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "酪胺酸激酶"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "Trk"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "TrkA、C"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 62,
+ "type": "bod",
+ "entity": "TrkB"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】由于NB预后差异大，部分病人如小年龄、早期NB预后明显优于大年龄晚期组，因此应根据病人的预后因素如年龄、分期、N-myc扩增、1p缺失等采用分级治疗。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 63,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "1p"
+ }
+ ]
+ },
+ {
+ "text": "早期病人无N-myc扩增及1p缺失，可仅做手术，手术后随访。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "1p"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "手术"
+ }
+ ]
+ },
+ {
+ "text": "而大年龄、晚期，伴有N-myc扩增，1p缺失者需接受强化疗和手术，直至骨髓移植。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "N-myc"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "1p"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "强化疗"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "骨髓移植"
+ }
+ ]
+ },
+ {
+ "text": "手术、化疗、放疗仍为NB治疗的三大主要手段，根据其临床预后因素采用不同强度的治疗方案。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "化疗"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "放疗"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "NB"
+ }
+ ]
+ },
+ {
+ "text": "一般对局限性肿瘤主张先手术切除，再化疗。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "手术切除"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "化疗"
+ }
+ ]
+ },
+ {
+ "text": "而对估计手术不能切除者采用先化疗、再手术、再化疗或加放疗的策略。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "化疗"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "化疗"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "放疗"
+ }
+ ]
+ },
+ {
+ "text": "对NB敏感的药物有环磷酰胺、长春新碱、Vp-16、卡铂、顺铂、抗肿瘤抗生素（阿霉素）、异环磷酰胺等，各个协作组采用不同药物组合对晚期病人强化疗，但预后改善仍未令人满意。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "NB"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "环磷酰胺"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "长春新碱"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "Vp-16"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "卡铂"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "顺铂"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "dru",
+ "entity": "抗肿瘤抗生素"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dru",
+ "entity": "阿霉素"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "异环磷酰胺"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "pro",
+ "entity": "强化疗"
+ }
+ ]
+ },
+ {
+ "text": "异基因移植与自体移植间结果无差异。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "异基因移植"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "自体移植"
+ }
+ ]
+ },
+ {
+ "text": "自体外周血干细胞移植时造血功能恢复要比骨髓干细胞移植快，并且肿瘤细胞污染的机会相对减少。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "自体外周血干细胞移植"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "骨髓干细胞移植"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "肿瘤细胞"
+ }
+ ]
+ },
+ {
+ "text": "美国儿童肿瘤协作组对晚期病人在自身干细胞移植后随机分组进行13-顺维A酸治疗研究，一组病人接受160mg/（m2•d），每月用2周，共3～6月，另一组病人停化疗后不用药。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "自身干细胞移植"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "13-顺维A酸"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 85,
+ "type": "pro",
+ "entity": "化疗"
+ }
+ ]
+ },
+ {
+ "text": "结果为接受维A酸组3年EFS为47%，未接受组为25%，P=0.013。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "维A酸"
+ }
+ ]
+ },
+ {
+ "text": "在Ⅳ期病人及高危Ⅲ期病人中维A酸作用更为明显，分别为40%对22%，和77%对49%。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "维A酸"
+ }
+ ]
+ },
+ {
+ "text": "常用参考化疗方案（表11-11），一般21～28天为一疗程。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "化疗"
+ }
+ ]
+ },
+ {
+ "text": "表11-20NB时常用参考化疗方案说明：当环磷酰胺剂量＞1.0g/m2时，应水化1500～2000ml/m2，并同时给予美斯纳1～2次，每次0.4g/m2。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "化疗"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "环磷酰胺"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "pro",
+ "entity": "水化"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 74,
+ "type": "dru",
+ "entity": "美斯纳"
+ }
+ ]
+ },
+ {
+ "text": "使用顺铂时需给予高渗盐水稀释（2～3张盐水），同时给予水化并补充钙、钾、镁以防电解质紊乱。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "顺铂"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "水化"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "电解质"
+ }
+ ]
+ },
+ {
+ "text": "阿霉素累积剂量＞320mg/m2，需谨慎应用。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "阿霉素"
+ }
+ ]
+ },
+ {
+ "text": "病人＜1岁，或Ⅰ、Ⅱ期，以OPEC、OPAC治疗为主，化疗剂量减25%。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "化疗"
+ }
+ ]
+ },
+ {
+ "text": "第二节肺容量和通气一、肺容量肺容量（图8-8）是指肺内容纳的气体量，是呼吸道和肺泡的总容量，反映了外呼吸的空间。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "肺容量"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "ite",
+ "entity": "肺容量"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "肺容量"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "呼吸道"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "图8-7肺容量示意图TV：潮气量，IRV：补吸气量，ERV：补呼气量，RV：残气量，IC：深吸气量，FRC：功能残气量，VC：肺活量，TLC：肺总量（一）潮气量平静呼吸时，每次吸入或呼出的气量为潮气量（tidalvolume，VT）。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "肺容量"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "TV"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "IRV"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "补吸气量"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "ite",
+ "entity": "ERV"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "ite",
+ "entity": "补呼气量"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "RV"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "残气量"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "ite",
+ "entity": "IC"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "ite",
+ "entity": "深吸气量"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "ite",
+ "entity": "FRC"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 58,
+ "type": "ite",
+ "entity": "功能残气量"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "VC"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 65,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "TLC"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 73,
+ "type": "ite",
+ "entity": "肺总量"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 79,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 97,
+ "end_idx": 99,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 111,
+ "type": "ite",
+ "entity": "tidalvolume"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 114,
+ "type": "ite",
+ "entity": "VT"
+ }
+ ]
+ },
+ {
+ "text": "可用呼吸流速仪或肺量计测定。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "equ",
+ "entity": "呼吸流速仪"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "equ",
+ "entity": "肺量计"
+ }
+ ]
+ },
+ {
+ "text": "为了校正体重对潮气量的影响，一般以ml/kg体重来表示。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "体重"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "体重"
+ }
+ ]
+ },
+ {
+ "text": "小儿潮气量一般为6～10ml/kg。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "潮气量"
+ }
+ ]
+ },
+ {
+ "text": "小儿往往用“浅快型”方式呼吸以弥补潮气量、肺泡通气量不足和降低呼吸功。",
+ "entities": [
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "肺泡通气量"
+ }
+ ]
+ },
+ {
+ "text": "影响潮气量的主要因素是吸气肌功能，尤其是膈肌的活动。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "吸气肌"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "膈肌"
+ }
+ ]
+ },
+ {
+ "text": "由于肺的通气储备极大，许多肺部疾病患者（如肺不张、肺实变及脓胸等），肺活量已明显减小，但潮气量仍无明显变化。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "肺不张"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "肺实变"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "脓胸"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "ite",
+ "entity": "潮气量"
+ }
+ ]
+ },
+ {
+ "text": "只有当通气功能受损较严重或通气调节障碍时才会出现。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "通气功能受损较严重"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "通气调节障碍"
+ }
+ ]
+ },
+ {
+ "text": "在安静时，儿童仅用肺活量的12.5%来呼吸，而婴儿则需用30%左右，说明相比于大年龄儿童而言，婴儿的容量储备较差。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "肺活量"
+ }
+ ]
+ },
+ {
+ "text": "这也就是婴儿在呼吸道感染严重时易出现呼吸衰竭的原因。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "呼吸道感染"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "（二）补吸气量平静吸气后所能再吸入的最大气量为补吸气量（inspiratoryreservevolume，IRV）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "补吸气量"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "补吸气量"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "inspiratoryreservevolume"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "ite",
+ "entity": "IRV"
+ }
+ ]
+ },
+ {
+ "text": "（三）补呼气量平静呼气后所能继续呼出的最大气量为补呼气量（expiratoryreservevolume，ERV）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "补呼气量"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "补呼气量"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "expiratoryreservevolume"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "ite",
+ "entity": "ERV"
+ }
+ ]
+ },
+ {
+ "text": "体位对其有显著影响，在阻塞性通气障碍患者，细支气管在呼气相提早闭陷，补呼气量降低。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "阻塞性通气障碍"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "细支气管"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "ite",
+ "entity": "补呼气量"
+ }
+ ]
+ },
+ {
+ "text": "（四）残气量补呼气后肺内不能呼出的残留气量为残气量（residualvolume，RV）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "残气量"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "残气量"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "residualvolume"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 42,
+ "type": "ite",
+ "entity": "RV"
+ }
+ ]
+ },
+ {
+ "text": "可以用体描仪和氦气稀释法或氮气洗出法测定。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "equ",
+ "entity": "体描仪"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "氦气稀释法"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "氮气洗出法"
+ }
+ ]
+ },
+ {
+ "text": "婴幼儿残气量一般是肺总量的25%，它可以对吸入肺泡内的空气起缓冲作用。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "残气量"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "肺总量"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "（五）深吸气量平静呼气后所能吸入的最大气量为深吸气量（inspiratorycapacityIC）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "深吸气量"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "深吸气量"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 47,
+ "type": "ite",
+ "entity": "inspiratorycapacityIC"
+ }
+ ]
+ },
+ {
+ "text": "由VT+IRV组成。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "VT"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "IRV"
+ }
+ ]
+ },
+ {
+ "text": "它是每分最大通气量和肺活量的主要成分（约占肺活量的75%），当深吸气量降低时，往往提示有限制性通气障碍可能。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "每分最大通气量"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "ite",
+ "entity": "深吸气量"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "限制性通气障碍"
+ }
+ ]
+ },
+ {
+ "text": "若每分最大通气量降低，而深吸气量正常时，可能与体质衰弱使呼吸肌无力有关。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "每分最大通气量"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "深吸气量"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "体质衰弱"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "呼吸肌"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "呼吸肌无力"
+ }
+ ]
+ },
+ {
+ "text": "（六）肺活量最大吸气后能呼出的最大气量为肺活量（vitalcapacity，VC）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "vitalcapacity"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "VC"
+ }
+ ]
+ },
+ {
+ "text": "由IC+ERV组成，大致在50～70ml/kg。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "IC"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "ite",
+ "entity": "ERV"
+ }
+ ]
+ },
+ {
+ "text": "肺活量在婴幼儿测定难度大，有人提出用哭吵测定肺活量，但不准确，对于婴幼儿的实际意义并不很大。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "肺活量"
+ }
+ ]
+ },
+ {
+ "text": "相对潮气量而言，肺活量虽有5～10倍的代偿潜力，但在病理情况下，婴幼儿的残气量增高加上无效腔大、基础呼吸快、气道易堵塞等因素使VC很难发挥应有的代偿效果。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "潮气量"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "ite",
+ "entity": "肺活量"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "ite",
+ "entity": "残气量"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "无效腔"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "气道"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 64,
+ "type": "ite",
+ "entity": "VC"
+ }
+ ]
+ },
+ {
+ "text": "因此临床上婴幼儿肺炎呼吸衰竭的发生率远远高于年长儿。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "肺炎呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "（七）功能残气量平静呼气后肺内所含有的气量为功能残气量（functionalresidualcapacity，FRC），由ERV+RV组成。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "ite",
+ "entity": "功能残气量"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "功能残气量"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 53,
+ "type": "ite",
+ "entity": "functionalresidualcapacity"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 57,
+ "type": "ite",
+ "entity": "FRC"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "ite",
+ "entity": "ERV"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "ite",
+ "entity": "RV"
+ }
+ ]
+ },
+ {
+ "text": "可以用体描仪和氦气稀释法或氮气洗出法测定。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "equ",
+ "entity": "体描仪"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "氦气稀释法"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "氮气洗出法"
+ }
+ ]
+ },
+ {
+ "text": "功能残气位时，吸气肌和呼气肌都处于松弛状态，此刻胸廓向外的牵张力与肺泡向内的弹性回缩力以及表面张力平衡，肺泡内压为零。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "吸气肌"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "呼气肌"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "胸廓"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "功能残气在生理上起着稳定肺泡气体分压的作用，减小了通气间歇对肺泡内气体交换的影响。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "功能残气"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "肺泡"
+ }
+ ]
+ },
+ {
+ "text": "FRC一般是肺总量的50%左右，足月儿20～30ml/kg，相当于出生时肺液的含量（15～20ml）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "ite",
+ "entity": "FRC"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "ite",
+ "entity": "肺总量"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "肺液"
+ }
+ ]
+ },
+ {
+ "text": "出生后最初几次呼吸时的压力-容积变化可以反映FRC的形成。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "ite",
+ "entity": "FRC"
+ }
+ ]
+ },
+ {
+ "text": "RDS时应用肺表面活性物质（PS）或机械通气后期的肺恢复期体内自行产生的PS，可以提高FRC。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "RDS"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "肺表面活性物质"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "PS"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "PS"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "ite",
+ "entity": "FRC"
+ }
+ ]
+ },
+ {
+ "text": "机械通气时应用呼气末正压（PEEP）也可以提高FRC。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "呼气末正压"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "pro",
+ "entity": "PEEP"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "ite",
+ "entity": "FRC"
+ }
+ ]
+ },
+ {
+ "text": "研究表明，婴幼儿的功能残气与体表面积、身高、体重及胸围均明显相关，尤其与身高呈直线相关，而与性别无相关。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "功能残气"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "体表面积"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "身高"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "ite",
+ "entity": "体重"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "胸围"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "ite",
+ "entity": "身高"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 47,
+ "type": "ite",
+ "entity": "性别"
+ }
+ ]
+ },
+ {
+ "text": "测FRC最常用技术是氦稀释技术，这项技术的原理是在未知肺容量和已知氦容积之间的气体平衡的基础上建立的。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "FRC"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "氦稀释"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "ite",
+ "entity": "肺容量"
+ }
+ ]
+ },
+ {
+ "text": "通过氦浓度的变化即可计算出肺容量。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "ite",
+ "entity": "肺容量"
+ }
+ ]
+ },
+ {
+ "text": "同样肺容积也可通过氮清洗技术获得。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "ite",
+ "entity": "肺容积"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "氮清洗"
+ }
+ ]
+ },
+ {
+ "text": "测试时让婴儿吸入无氮气体，冲洗出肺泡内的氮气，通过快速反应的氮分析仪测定清洗出的氮量，最后计算出功能残气。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "肺泡"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "equ",
+ "entity": "氮分析仪"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "功能残气"
+ }
+ ]
+ },
+ {
+ "text": "现在较新的方法是用超声波流速仪和气体质谱技术，以惰性气体SF6洗入-洗出法来检测。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "equ",
+ "entity": "超声波流速仪"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "气体质谱技术"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 36,
+ "type": "ite",
+ "entity": "惰性气体SF6洗入-洗出法"
+ }
+ ]
+ },
+ {
+ "text": "（八）肺总量深吸气后肺内所含有的总气量为肺总量（totallungcapacity，TLC），由VC+RV组成。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "肺总量"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "肺"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "ite",
+ "entity": "肺总量"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "totallungcapacity"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "ite",
+ "entity": "TLC"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "ite",
+ "entity": "VC"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "ite",
+ "entity": "RV"
+ }
+ ]
+ },
+ {
+ "text": "四、并发症处理和临床转归（一）发展为严重肺损伤和急性呼吸窘迫综合征中枢性呼吸衰竭可以发展为呼吸机相关性肺炎和肺损伤。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "肺损伤"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "急性呼吸窘迫综合征"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "中枢性呼吸衰竭"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "呼吸机相关性肺炎"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "肺损伤"
+ }
+ ]
+ },
+ {
+ "text": "持续机械通气时，呼吸管理不善，可以导致气道肺泡发育不良，呼吸道细菌感染，发展为肺炎，加重呼吸衰竭。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "机械通气"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "气道肺泡发育不良"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "呼吸道细菌感染"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ }
+ ]
+ },
+ {
+ "text": "化疗和免疫抑制时、肠道缺血缺氧-再灌注性损伤性损伤等可以导致严重肺部感染性损伤，并发展为ARDS。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "化疗"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "免疫抑制"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "肠道缺血缺氧-再灌注性损伤"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "严重肺部感染性损伤"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "ARDS"
+ }
+ ]
+ },
+ {
+ "text": "（二）发展为肺外脏器功能衰竭呼吸衰竭时持续低氧血症可以导致肺部和肺外脏器功能衰竭。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肺外脏器"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "呼吸衰竭"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "低氧血症"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "肺部"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肺外脏器"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "功能衰竭"
+ }
+ ]
+ },
+ {
+ "text": "主要由于肺部炎症细胞大量集聚，释放促炎症介质进入循环，攻击肺外脏器，导致肺外脏器的多脏器结构损害，可以发展为多脏器功能��碍和衰竭。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "肺部炎症细胞"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "促炎症介质"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肺外脏器"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "肺外脏器"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "多脏器"
+ }
+ ]
+ },
+ {
+ "text": "第八节阿米巴病【病原】阿米巴病（amoebiasis）是由溶组织阿米巴原虫所引起的疾病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "阿米巴病"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "阿米巴病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "amoebiasis"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 36,
+ "type": "mic",
+ "entity": "溶组织阿米巴原虫"
+ }
+ ]
+ },
+ {
+ "text": "溶组织阿米巴（entamoebahistolytica）可分为滋养体和包囊两期。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "溶组织阿米巴"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 26,
+ "type": "mic",
+ "entity": "entamoebahistolytica"
+ }
+ ]
+ },
+ {
+ "text": "滋养体直径为20～40μm，有伪足，可侵入肠组织，可于患者肠组织及稀粪便中见到。",
+ "entities": [
+ {
+ "start_idx": 29,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "肠"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "稀粪便"
+ }
+ ]
+ },
+ {
+ "text": "不能侵入肠组织的滋养体在肠腔中形成包囊，由粪便排出体外。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "粪便"
+ }
+ ]
+ },
+ {
+ "text": "溶组织阿米巴的生活史：包囊通过污染的食物及饮水进入人的消化道，在小肠下段由于胰蛋白酶的消化作用，囊壁被破坏形成小阿米巴（滋养体），继续分裂繁殖，侵犯组织，形成包囊排出体外。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "mic",
+ "entity": "溶组织阿米巴"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "小肠下段"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "胰蛋白酶"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "mic",
+ "entity": "小阿米巴"
+ }
+ ]
+ },
+ {
+ "text": "【发病机制及病理】在人机体免疫正常情况下，阿米巴在结肠腔内呈共栖状态，并不侵犯肠组织；当机体免疫受损，营养不良时，溶组织阿米巴侵入肠壁组织，致临床发病。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "mic",
+ "entity": "阿米巴"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "结肠腔"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "肠组织"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "机体免疫受损"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "营养不良"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 62,
+ "type": "mic",
+ "entity": "溶组织阿米巴"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "肠壁组织"
+ }
+ ]
+ },
+ {
+ "text": "病变部位主要在大肠，以粪便停留较长的回盲部、升结肠、乙状结肠与直肠为多，有时也可侵犯回肠。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "大肠"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "回盲部"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "升结肠"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "乙状结肠"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "直肠"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "回肠"
+ }
+ ]
+ },
+ {
+ "text": "肠壁黏膜充血、水肿或溃疡溃疡呈底大、口小如烧瓶样。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "肠壁黏膜"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "肠壁黏膜充血、水肿或溃疡"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "溃疡呈底大、口小如烧瓶样"
+ }
+ ]
+ },
+ {
+ "text": "严重病变可穿过浆膜层，引起肠穿孔及腹膜炎。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "浆膜层"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "肠穿孔"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "腹膜炎"
+ }
+ ]
+ },
+ {
+ "text": "慢性期出现肠黏膜上皮增生溃疡底出现肉芽组织，致肠壁增厚、狭窄。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "肠黏膜"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "肠黏膜上皮增生"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 20,
+ "type": "sym",
+ "entity": "溃疡底出现肉芽组织"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "肠壁"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "肠壁增厚、狭窄"
+ }
+ ]
+ },
+ {
+ "text": "如原虫进入门脉系统，可引起肝炎、肝脓肿。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "门脉系统"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "肝炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "肝脓肿"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】潜伏期为一周至数月不等，症状轻重不一，主要取决于阿米巴原虫所侵犯的组织和器官。",
+ "entities": [
+ {
+ "start_idx": 30,
+ "end_idx": 34,
+ "type": "mic",
+ "entity": "阿米巴原虫"
+ }
+ ]
+ },
+ {
+ "text": "肠道是最常见的初发病变部位，原虫侵入大肠后引起以痢疾为主的症状。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "肠道"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "mic",
+ "entity": "原虫"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "大肠"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "痢疾"
+ }
+ ]
+ },
+ {
+ "text": "轻者只有腹部不适食欲缺乏。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "腹部不适"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "食欲缺乏"
+ }
+ ]
+ },
+ {
+ "text": "典型表现为腹痛，腹泻，大便如猪肝酱样每天大便5～6次，里急后重不明显。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "大便"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "大便如猪肝酱样"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "每天大便5～6次，里急后重不明显"
+ }
+ ]
+ },
+ {
+ "text": "迁徙性感染可遍及全身各个器官和部位，出现相应的症状，如在眼睛可致棘阿米巴角膜炎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "迁徙性感染"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "眼睛"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "棘阿米巴角膜炎"
+ }
+ ]
+ },
+ {
+ "text": "【并发症】（一）肝炎及肝脓肿以右叶多见，出现弛张型高热，腹痛，肝脏肿大，经皮肝穿刺能抽出牛奶咖啡样脓液能从脓汁中找到阿米巴滋养体。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "肝炎"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "肝脓肿"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "右叶"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "弛张型高热"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "腹痛"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "肝脏肿大"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "pro",
+ "entity": "皮肝穿刺"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "经皮肝穿刺能抽出牛奶咖啡样脓液"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 63,
+ "type": "mic",
+ "entity": "阿米巴滋养体"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "能从脓汁中找到阿米巴滋养体"
+ }
+ ]
+ },
+ {
+ "text": "（二）肺脓肿和脑脓肿偶见于血行播散的病儿，多在病程终末期或幼儿自母亲传染者。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "肺脓肿"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "脑脓肿"
+ }
+ ]
+ },
+ {
+ "text": "（三）腹膜炎较少见。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "腹膜炎"
+ }
+ ]
+ },
+ {
+ "text": "【实验室诊断】（一）肠阿米巴病以粪便中找到阿米巴原虫为最可靠依据，送检粪便应新鲜，挑选有黏液、脓血的部分，至少送检4～6次；若粪便检查屡阴性而临床不能排出本病时，可做阿米巴培养，或用乙状结肠镜直接观察黏膜溃疡，必要时取活检。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "肠阿米巴病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "阿米巴原虫"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 45,
+ "type": "bod",
+ "entity": "黏液"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "脓血"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 69,
+ "type": "sym",
+ "entity": "粪便检查屡阴性"
+ },
+ {
+ "start_idx": 91,
+ "end_idx": 95,
+ "type": "equ",
+ "entity": "乙状结肠镜"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 101,
+ "type": "bod",
+ "entity": "黏膜"
+ },
+ {
+ "start_idx": 109,
+ "end_idx": 110,
+ "type": "pro",
+ "entity": "活检"
+ }
+ ]
+ },
+ {
+ "text": "（二）肠外阿米巴病可结合血清学查抗体，如间接荧光抗体、酶免疫方法及B超检查。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "肠外阿米巴病"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "间接荧光抗体"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "pro",
+ "entity": "酶免疫方法"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "B超检查"
+ }
+ ]
+ },
+ {
+ "text": "【鉴别诊断】需要鉴别的疾病有细菌性痢疾、细菌性肝脓肿及胆道蛔虫症等。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "细菌性痢疾"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "细菌性肝脓肿"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "胆道蛔虫症"
+ }
+ ]
+ },
+ {
+ "text": "（二）病因治疗1.阿米巴痢疾急性期病例甲硝唑（灭滴灵）为首选，儿童35～50mg/（kg•d），每天最大剂量2200mg，分3次口服，5～7天为一疗程。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "阿米巴痢疾"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "甲硝唑"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "灭滴灵"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "口服"
+ }
+ ]
+ },
+ {
+ "text": "对于不能服药的重型病例，可用吐根碱，2～5岁每次5～20mg，5～10岁30～45mg，每天1次，深层皮下注射；也可按1mg/（kg•d），分1～2次注射，疗程8～10天。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "吐根碱"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 54,
+ "type": "pro",
+ "entity": "深层皮下注射"
+ }
+ ]
+ },
+ {
+ "text": "慢性期或复发的病例常用有机碘制剂。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "dru",
+ "entity": "有机碘制剂"
+ }
+ ]
+ },
+ {
+ "text": "如喹碘仿，口服为每次20～25mg/kg，一日3次，8～10天为一疗程；也可灌肠，1～2g溶于100～200ml生理盐水内，保留灌肠，每天1次，连用8～10天。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 3,
+ "type": "dru",
+ "entity": "喹碘仿"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "pro",
+ "entity": "口服"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "pro",
+ "entity": "灌肠"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 65,
+ "type": "pro",
+ "entity": "灌肠"
+ }
+ ]
+ },
+ {
+ "text": "另外，氯碘喹每次10～20mg/kg，每天3～4次，连服10天。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dru",
+ "entity": "氯碘喹"
+ }
+ ]
+ },
+ {
+ "text": "2.阿米巴肝脓肿甲硝唑为首选，剂量同前，10天为一疗程；磷酸氯喹，每次10mg/kg，每天2次，连服2天后改为每天1次，连服2周或更久。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "阿米巴肝脓肿"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "甲硝唑"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "磷酸氯喹"
+ }
+ ]
+ },
+ {
+ "text": "上述两种药可轮换应用，若有细菌感染，应同时加用抗生素。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "细菌感染"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "抗生素"
+ }
+ ]
+ },
+ {
+ "text": "脓肿大时，可同时穿刺抽脓。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "穿刺抽脓"
+ }
+ ]
+ },
+ {
+ "text": "3.胸、腹部阿米巴病的治疗诊断有困难时，可用吐根碱试验治疗，如3天内热度下降，既可给予全程治疗。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "胸、腹部阿米巴病"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "吐根碱"
+ }
+ ]
+ },
+ {
+ "text": "4.阿米巴包囊携带者的治疗选用一种作用于肠腔阿米巴药物，如甲硝唑、氯碘喹等，剂量同前。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "mic",
+ "entity": "阿米巴"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "肠腔"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "mic",
+ "entity": "阿米巴"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "甲硝唑"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "氯碘喹"
+ }
+ ]
+ },
+ {
+ "text": "【预防】包括：①注意饮食卫生，饭前洗手，水果及生吃的蔬菜要洗净；②治疗有阿米巴包囊携带者；③加强卫生宣教。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "pro",
+ "entity": "注意饮食卫生"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "pro",
+ "entity": "饭前洗手"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "水果及生吃的蔬菜要洗净"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "pro",
+ "entity": "加强卫生宣教"
+ }
+ ]
+ },
+ {
+ "text": "第二节无菌性脑膜炎无菌性脑膜炎（asepticmeningitis）又称浆液性脑膜炎、淋巴细胞性脑膜炎或病毒性脑膜炎，是多种病毒性神经系统感染的常见表现。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "无菌性脑膜炎"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "无菌性脑膜炎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "asepticmeningitis"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "浆液性脑膜炎"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "淋巴细胞性脑膜炎"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "病毒性神经系统感染"
+ }
+ ]
+ },
+ {
+ "text": "一般无严重的脑实质损害症状，如瘫痪、昏迷或惊厥持续状态。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "脑实质损害症状"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "瘫痪"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "昏迷"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "惊厥"
+ }
+ ]
+ },
+ {
+ "text": "病毒性无菌性脑膜类的病程一般为数日至2周。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "病毒性无菌性脑膜类"
+ }
+ ]
+ },
+ {
+ "text": "多数病人急性期过后恢复完全，但有些病人在随后的几周内可仍有头晕、疲乏以及间歇性头痛等症状，个别甚至持续数月或数年。",
+ "entities": [
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "头晕"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 33,
+ "type": "sym",
+ "entity": "疲乏"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "间歇性头痛"
+ }
+ ]
+ },
+ {
+ "text": "远期随访还发现，病情恢复后数年内此类患儿出现学习困难、行为异常以及复发性惊厥等神经精神症状的危险性较高。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "学习困难"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "行为异常"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "复发性惊厥"
+ }
+ ]
+ },
+ {
+ "text": "复发性无菌性脑膜炎少见，Mollaret脑膜炎属其中之一。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "复发性无菌性脑膜炎"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "Mollaret脑膜炎"
+ }
+ ]
+ },
+ {
+ "text": "该病的临床表现以良性复发性无菌性脑膜炎为特征。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "以良性复发性无菌性脑膜炎为特征"
+ }
+ ]
+ },
+ {
+ "text": "脑脊液表现与病毒性脑膜炎相似，但可见到内皮样细胞（Mollaret细胞），其体积较大，在体外很快溶解消失，故怀疑本病时应取新鲜脑脊液送检。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "病毒性脑膜炎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "内皮样细胞"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "Mollaret细胞"
+ }
+ ]
+ },
+ {
+ "text": "本病病因尚未完全明确，可能与单纯疱疹病毒4型（HSV-4）或EBV有关。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "单纯疱疹病毒4型"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "EBV"
+ }
+ ]
+ },
+ {
+ "text": "【实验室检查与诊断】无菌性脑膜炎的脑脊液多有异常改变，通常表现为轻度细胞和/或蛋白增多，糖和氯化物一般正常。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "无菌性脑膜炎"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "bod",
+ "entity": "蛋白"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "轻度细胞和/或蛋白增多"
+ }
+ ]
+ },
+ {
+ "text": "早期脑脊液炎性细胞中可以中性粒细胞为主，以后则以淋巴细胞为主。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "脑脊液炎性细胞"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "中性粒细胞"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ }
+ ]
+ },
+ {
+ "text": "可于发病早期采集标本（脑脊液、粪便、血液、尿液、呼吸道黏膜，或必要时脑活检组织等）分离病毒。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 13,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "粪便"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "尿液"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "呼吸道黏膜"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "pro",
+ "entity": "脑活检"
+ }
+ ]
+ },
+ {
+ "text": "某些病毒感染，如腮腺炎病毒和巨细胞病毒等，可于极期送检标本，检测早期IgM抗体，如为阳性则有助于早期确诊。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "mic",
+ "entity": "腮腺炎病毒"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "mic",
+ "entity": "巨细胞病毒"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "送检标本"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】多数病毒引起的无菌性脑膜炎缺乏特异性治疗。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "mic",
+ "entity": "病毒"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "无菌性脑膜炎"
+ }
+ ]
+ },
+ {
+ "text": "第三章神经管畸形畸形如果妇女怀孕3个月之内，胚胎发育时神经管闭合过程受到影响即产生胎儿脑或脊髓发育异常儿童颅脑的畸形神经管畸形（neuraltubedefects，NTDs）。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "神经管畸形"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "畸形"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "神经管"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "脑"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "脊髓"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "脑或脊髓发育异常"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "颅脑"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "dis",
+ "entity": "畸形"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "儿童颅脑的畸形"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "神经管畸形"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 80,
+ "type": "dis",
+ "entity": "neuraltubedefects"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "NTDs是世界范围内的一个重要公共卫生问题，中国是世界上已知的NTDs高发国家。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "NTDs是造成孕妇流产及死胎主要原因之一，也是造成婴儿死亡和患者终身残疾的主要原因之一。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "流产"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "死胎"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "残疾"
+ }
+ ]
+ },
+ {
+ "text": "目前NTDs的防治已被高度重视。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "【流行病学】NTDs属于世界范围内的一种先天神经发育异常疾病，其发病率在各国、各地区是不同的，且同一地区各种族NTDs发病率也有所不同。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "先天神经发育异常疾病"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "我国主要出生缺陷发生率顺位变化显示，1986—2006年NTDs发生率呈现下降趋势，从3.25‰降至0.72‰，从居各种出生缺陷之首降至第四。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "出生缺陷"
+ }
+ ]
+ },
+ {
+ "text": "产前超声检查可对NTDs做出早期诊断，无脑畸形的准确度可达90%以上，脊柱裂达70%。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "pro",
+ "entity": "超声检查"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "脊柱裂"
+ }
+ ]
+ },
+ {
+ "text": "此外孕母血清或羊水甲胎蛋白（AFP）的增高也有助于产前诊断。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "血清"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "羊水甲胎蛋白"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "AFP"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "产前诊断"
+ }
+ ]
+ },
+ {
+ "text": "普通人群生育NTDs儿的风险为0.1%～0.3%。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "已生过一胎NTDs再发风险为4%～5%，生过两胎缺陷者为10%，故再次怀孕前应进行遗传咨询。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "美国2006年全球出生缺陷报告NTDs患儿达32.4万，居全球前5位常见严重出生缺陷第二位。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "出生缺陷"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "严重出生缺陷"
+ }
+ ]
+ },
+ {
+ "text": "其中南美发病率最高，高达2‰，NTDs次高发的国家依次为墨西哥、挪威和法国，发病率分别为1.34‰、1.19‰和1.15‰。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "与其他国家比较，我国NTDs发病率为0.82‰。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "根据国际出生缺陷监测情报所统计资料，世界20多个国家近20年左右的NTDs发病率波动在0.3‰～2.1‰，据此推算全世界每年大约有30万～40万NTDs病例发生，其中女性发病要多于男性。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "出生缺陷"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "北京医科大学中国妇婴保健中心与美国疾病控制中心合作，于1992年3月～1993年8月在河北、山西、江苏和浙江省等30个市、县进行的出生缺陷监测结果显示，北方地区NTDs发生率约为7‰，南方地区约为1.5‰。",
+ "entities": [
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "这些资料表明，根据已有的报告数字，我国NTDs发病率在世界上是最高的国家之一。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "我国NTDs发病率的分布具有北方高于南方，农村高于城市，夏秋季高于冬春季三大特点。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "世界上英国NTDs发病率也很高，尤以北爱尔兰为多，1976年北爱尔兰NTDs发病率为6.4‰，其中贝尔法斯特市高达8.7‰。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "NTDs次高发的国家和地区是以色列、拉丁美洲和匈牙利等，NTDs较低发的国家和地区是丹麦、瑞典、芬兰和法国等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "在NTDs类型上，根据我国1996—2006年31个省市自治区出生缺陷监测结果，我国是以无脑畸形居首位，占51.2%左右，脊柱裂占34.6%左右，脑膨出占14.2%左右。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "脑膨出"
+ }
+ ]
+ },
+ {
+ "text": "而国际出生缺陷监测交换所19个国家和地区，以及欧洲共同体16个地区和澳大利亚新南威尔士则是脊柱裂占首位（均在50%以上），无脑畸形次之，脑膨出等更次之。",
+ "entities": [
+ {
+ "start_idx": 45,
+ "end_idx": 47,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 70,
+ "type": "dis",
+ "entity": "脑膨出"
+ }
+ ]
+ },
+ {
+ "text": "许多统计资料也显示了NTDs的长期变化趋势，近几十年来NTDs发病率有逐渐下降的趋势，这个现象在世界上许多国家和地区都已观察到，例如英国和美国西北部NTDs在20世纪20年代有一个发病率高峰，到40年代下降，进入70年代又有所下降。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 77,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "究其原因是广泛提高了孕期诊断技术而使NTDs发病率下降，并强烈显示出环境因素在NTDs发病中的作用，特别是多种维生素和叶酸的使用。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "另外，随着时间推移，NTDs临床医学和流行病学特征的改变，也提示了NTDs的病因异质性（不同临床表型之间存在的病因差异）。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dep",
+ "entity": "临床医学"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "【病因与发病机制】研究NTDs病因，有必要搞清楚神经胚胎发育的正常过程。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "神经胚胎"
+ }
+ ]
+ },
+ {
+ "text": "在人类胚胎发育第16天脊索上方外胚层增厚形成神经板两侧神经板增高形成神经褶并向中线靠拢融合形成神经管神经管融合最初出现在第22天，位于第3体节水平，即未来脑干形成区域，融合是从视原基部位开始，并自脑干和视原基部位向头和尾两个方向发展。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "神经板"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "脊索上方外胚层增厚形成神经板"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "两侧神经板"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "神经褶"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "两侧神经板增高形成神经褶并向中线靠拢"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "神经管"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 49,
+ "type": "sym",
+ "entity": "融合形成神经管"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "神经管"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "bod",
+ "entity": "脑干"
+ },
+ {
+ "start_idx": 98,
+ "end_idx": 99,
+ "type": "bod",
+ "entity": "脑干"
+ }
+ ]
+ },
+ {
+ "text": "前神经管于胚胎发育第23～26天闭合，若闭合不全则形成颅裂及无脑畸形。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "前神经管"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "颅裂"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "无脑畸形"
+ }
+ ]
+ },
+ {
+ "text": "而后神经管于胚胎发育第26～30天闭合，若闭合不全则形成脊柱裂。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "神经管"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "脊柱裂"
+ }
+ ]
+ },
+ {
+ "text": "NTDs是一种多基因遗传病，其病因是极其复杂的，发病原因可能是多方面的，许多因素的干扰都会影响发病过程，根据动物实验、临床观察和流行病学研究认为NTDs是遗传因素和环境因素（子宫内环境）共同作用的结果。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "多基因遗传病"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 87,
+ "end_idx": 88,
+ "type": "bod",
+ "entity": "子宫"
+ }
+ ]
+ },
+ {
+ "text": "（一）遗传因素在NTDs病因研究中，���难把多基因或多因素作用与复杂的环境因素作用区别开来，如某些家族可能与共同生活的环境有关。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "这样，在病因中通常把某些特征归结为基因因素作用的结果，诸如不同地区和种族人群NTDs发病率的改变，近亲婚配NTDs发病率高，NTDs家族内的复发危险度高等。",
+ "entities": [
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 65,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "家系研究表明，有NTDs家族史的孕妇，其NTDs婴儿的出生概率比一般人群高。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "有过2次及以上NTDs生育经历的母亲再生育NTDs婴儿的危险性则提高10%。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "另外，双胎中NTDs的发病率比一般人群要高，且单卵双胎又比双卵双胎NTDs发病率高。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "这些研究结果均支持遗传因素对NTDs的作用。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "有关NTDs的遗传学研究结果不能用孟德尔遗传法则的单基因突变来解释，而是有多对基因遗传的基础，即微效基因。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "单基因突变"
+ }
+ ]
+ },
+ {
+ "text": "（二）环境因素环境致畸因子在妊娠早期，通常在3个月内作用于母体，导致神经管发育过程中出现障碍而发生畸形。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "妊娠"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "神经管"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 50,
+ "type": "dis",
+ "entity": "畸形"
+ }
+ ]
+ },
+ {
+ "text": "研究较多的是母亲孕早期叶酸和其他多种维生素（包括维生素A、B1、B2、C、D、E以及尼克酸等）的缺乏与NTDs发生的关系，尤其是叶酸与NTDs关系自80年代以来已取得突破性进展，现已确定妇女怀孕早期叶酸缺乏是NTDs发生的主要原因。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "维生素"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "维生素A"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "ite",
+ "entity": "B1"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 39,
+ "type": "ite",
+ "entity": "B2"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 47,
+ "type": "ite",
+ "entity": "C"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 49,
+ "type": "ite",
+ "entity": "D"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "E"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "ite",
+ "entity": "尼克酸"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 77,
+ "type": "bod",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 116,
+ "end_idx": 119,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "摄入不足、吸收不良、代谢障碍或需要增加等多种原因都可导致叶酸缺乏，致使DNA合成障碍，从而影响细胞分裂与增殖。",
+ "entities": [
+ {
+ "start_idx": 28,
+ "end_idx": 31,
+ "type": "sym",
+ "entity": "叶酸缺乏"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "DNA"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "细胞"
+ }
+ ]
+ },
+ {
+ "text": "叶酸是一种水溶性维生素，是胎儿早期神经发育必需的一种营养物质。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "叶酸"
+ }
+ ]
+ },
+ {
+ "text": "怀孕早期正值胚胎分化以及胎盘形成阶段，细胞生长和分裂十分旺盛，如果孕妇叶酸缺乏，将影响胎儿神经系统雏形——神经管的正常发育，以后则将使颅骨或脊椎骨融合不良，出现NTDs，而引起自发性流产和死胎。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "细胞"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "叶酸缺乏"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "神经管"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 92,
+ "type": "sym",
+ "entity": "自发性流产"
+ }
+ ]
+ },
+ {
+ "text": "其他微量元素如铜、钙和硒等的摄入不足也可诱发NTDs，但其确切作用尚不清楚。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "病毒学研究表明，母亲孕早期感染巨细胞病毒或A型流感病毒胎儿中枢神经系统发育障碍NTDs。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "mic",
+ "entity": "巨细胞病毒"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "mic",
+ "entity": "A型流感病毒"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "感染巨细胞病毒或A型流感病毒"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "胎儿中枢神经系统发育障碍"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "母亲孕早期腹部或盆腔接受射线照射，其胎儿中枢神经系统发育往往受到影响，有的发生NTDs。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "腹部"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "盆腔"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "患有癫痫的孕妇服用丙戊酸、苯巴比妥和苯妥英钠等抗癫痫药物，其后代容易发生NTDs。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "癫痫"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "丙戊酸"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "苯巴比妥"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "苯妥英钠"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "孕早期口服避孕药，服用某些抗肿瘤药物如氨甲蝶呤、维生素B4和巯基嘌呤等，以及大量或持续应用可的松或泼尼松龙，均可以诱发NTDs。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "避孕药"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "氨甲蝶呤"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "维生素B4"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dru",
+ "entity": "巯基嘌呤"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "dru",
+ "entity": "可的松"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "dru",
+ "entity": "泼尼松龙"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】NTDs是一组具有多种不同临床表型的先天畸形，主要包括无脑畸形、脑膨出及脊柱裂等。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "dis",
+ "entity": "先天畸形"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "脑膨出"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "脊柱裂"
+ }
+ ]
+ },
+ {
+ "text": "现将常见的几种NTDs分述如下。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "（一）无脑畸形无脑畸形（anencephaly）是一种严重的NTDs，为脑的全部或大部缺如。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "anencephaly"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "脑的全部或大部缺如"
+ }
+ ]
+ },
+ {
+ "text": "头颅的缺损从顶部开始，可延伸到其与枕骨大孔的任何部位。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "头颅"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "枕骨大孔"
+ }
+ ]
+ },
+ {
+ "text": "患儿因颅骨穹隆缺如造成面部特殊外貌前颅窝缩短和眼眶变浅眼球向前突出下颌紧贴胸骨口半张开，耳廓很厚，前突出于头的两侧呈非常奇特的“蛙状脸”。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "颅骨穹隆缺如"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "面部"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "面部特殊外貌"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "前颅窝"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "眼眶"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "前颅窝缩短和眼眶变浅"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "眼球"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "眼球向前突出"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "下颌"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "sym",
+ "entity": "下颌紧贴胸骨"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "口半张开"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "头"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "前突出于头的两侧"
+ },
+ {
+ "start_idx": 57,
+ "end_idx": 67,
+ "type": "sym",
+ "entity": "呈非常奇特的“蛙状脸”"
+ }
+ ]
+ },
+ {
+ "text": "几乎都伴有母体羊水过多颅裂、脑膜膨出与��脑膜膨出颅裂纯属先天颅骨发育异常，表现为颅缝闭合不全而遗有缺损，形成一个缺口。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "羊水"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "母体羊水过多"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "颅裂"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "颅裂"
+ }
+ ]
+ },
+ {
+ "text": "一般多发生在颅盖骨或颅底骨的中线，少数偏于一侧。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "颅盖骨"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "颅底骨的中线"
+ }
+ ]
+ },
+ {
+ "text": "如果从裂孔处无脑膜或脑组织膨出，则称为隐性颅裂。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "dis",
+ "entity": "隐性颅裂"
+ }
+ ]
+ },
+ {
+ "text": "反之，在颅裂的基础上，有脑膜或脑组织膨出则称囊性（显性）颅裂，其中囊内容物仅为脑脊液者称为脑膜膨出；囊内容物含有脑组织者称为脑脑膜膨出。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "颅裂"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "囊性（显性）颅裂"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 66,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ }
+ ]
+ },
+ {
+ "text": "其实脑膜膨出和脑脑膜膨出是脑膨出中最多见的两种类型。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "脑膨出"
+ }
+ ]
+ },
+ {
+ "text": "隐性颅裂在临床上多无症状，大多在做头颅X线检查时偶然发现，可见边缘光滑的颅骨缺损神经受损症状。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "隐性颅裂"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 22,
+ "type": "pro",
+ "entity": "头颅X线检查"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "颅骨缺损"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 39,
+ "type": "sym",
+ "entity": "边缘光滑的颅骨缺损"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "神经受损症状"
+ }
+ ]
+ },
+ {
+ "text": "囊性颅裂的脑膜膨出或脑脑膜膨出，可以有以下三方面的表现①局部症状：一般多为圆形或椭圆形的囊性膨出包块，如位于鼻根多为扁平状包块，其大小各异，大者近似儿头，小者直径可几厘米，有的生后即很大，有的逐渐长大厚者触之软而有弹性感，有的表面似有瘢痕状而较硬。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "囊性颅裂"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "鼻根"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 99,
+ "type": "sym",
+ "entity": "一般多为圆形或椭圆形的囊性膨出包块，如位于鼻根多为扁平状包块，其大小各异，大者近似儿头，小者直径可几厘米，有的生后即很大，有的���渐长大"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 122,
+ "type": "sym",
+ "entity": "厚者触之软而有弹性感，有的表面似有瘢痕状而较硬"
+ }
+ ]
+ },
+ {
+ "text": "其基底部可为细的带状或为广阔基底。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "其基底部可为细的带状或为广阔基底"
+ }
+ ]
+ },
+ {
+ "text": "有的可触及骨缺损的边缘。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "骨缺损"
+ }
+ ]
+ },
+ {
+ "text": "囊性包块透光试验阳性，在脑脑膜膨出时有可能见到膨出的脑组织阴影。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "脑组织"
+ }
+ ]
+ },
+ {
+ "text": "如发生在鼻根部时，可一侧或双侧嗅觉丧失，如膨出突入眶内Ⅱ、Ⅲ、Ⅳ、Ⅵ颅神经及第Ⅴ颅神经的第一支受累。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "鼻根部"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "一侧或双侧嗅觉丧失"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "眶内"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "sym",
+ "entity": "膨出突入眶内"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "Ⅱ、Ⅲ、Ⅳ、Ⅵ颅神经及第Ⅴ颅神经的第一支受累"
+ }
+ ]
+ },
+ {
+ "text": "如发生在枕部的脑脑膜膨出，可有皮质盲及小脑受损症状器官的受压表现：膨出位于鼻根部者，常引起颜面畸形，鼻根扁宽，眼距加大，眶腔变小，有时眼睛呈三角形，双眼球被挤向外侧，可累及泪腺致泪囊炎。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "枕部"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "小脑"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "皮质盲及小脑受损症状"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "器官"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "bod",
+ "entity": "鼻根部"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "sym",
+ "entity": "颜面畸形"
+ }
+ ]
+ },
+ {
+ "text": "突入鼻腔可影响呼吸或侧卧时才呼吸通畅。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "鼻腔"
+ }
+ ]
+ },
+ {
+ "text": "膨出突入眶内时，可致眼球突出及移位脊柱裂、脊膜膨出与脊髓脊膜膨出脊柱裂是胚胎早期椎弓发育障碍，椎管闭合不全。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "眶内"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "眼球"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "眼球突出及移位"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "脊髓脊膜膨出"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 45,
+ "type": "dis",
+ "entity": "椎弓发育障碍"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "椎管闭合不全"
+ }
+ ]
+ },
+ {
+ "text": "可发生在脊椎的任何部位，如颈椎、胸椎、腰椎和骶椎，以腰骶部最常见。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "脊椎"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "颈椎"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "胸椎"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "腰椎"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "骶椎"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "腰骶部"
+ }
+ ]
+ },
+ {
+ "text": "脊柱裂分为隐性与显性两类，前者是指有脊柱裂而无椎管内容物膨出；后者由于椎板闭合不全，椎管内容物通过缺损处向椎管外膨出，在背部皮下形成囊性包块。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "无椎管内容物膨出"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 40,
+ "type": "dis",
+ "entity": "椎板闭合不全"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "椎管"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "背部"
+ }
+ ]
+ },
+ {
+ "text": "显性脊柱裂又称为囊性脊柱裂，以脊膜膨出和脊髓脊膜膨出两种类型为多见，其中脊膜膨出的囊内充满脑脊液，无神经组织；而脊髓脊膜膨出的囊内既有脑脊液又有脊髓及其脊神经突入隐性脊柱裂大部分临床上无症状，大多是在X线检查中无意发现的，可见脊椎椎板缺损未闭合下肢无力、遗尿或大小便失禁等，缘于神经根与裂孔处有纤维带粘连或压迫所致。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "显性脊柱裂"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "囊性脊柱裂"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "脊髓脊膜膨出"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 61,
+ "type": "dis",
+ "entity": "脊髓脊膜膨出"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "脊髓"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 80,
+ "type": "bod",
+ "entity": "脊神经突入"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 80,
+ "type": "sym",
+ "entity": "囊内既有脑脊液又有脊髓及其脊神经突入"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 85,
+ "type": "dis",
+ "entity": "隐性脊柱裂"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 103,
+ "type": "pro",
+ "entity": "X线检查"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 116,
+ "type": "bod",
+ "entity": "脊椎椎板"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 121,
+ "type": "sym",
+ "entity": "脊椎椎板缺损未闭合"
+ },
+ {
+ "start_idx": 122,
+ "end_idx": 125,
+ "type": "sym",
+ "entity": "下肢无力"
+ },
+ {
+ "start_idx": 127,
+ "end_idx": 128,
+ "type": "sym",
+ "entity": "遗尿"
+ },
+ {
+ "start_idx": 130,
+ "end_idx": 134,
+ "type": "sym",
+ "entity": "大小便失禁"
+ }
+ ]
+ },
+ {
+ "text": "脊膜膨出和脊髓脊膜膨出的临床表现分为三个方面：①局部包块：患儿出生时，在背部中线颈、胸或腰骶部可见一大小不等的囊性包块，呈圆形或椭圆形，多数基底较宽，少数为带状表面皮肤正常，也有时为瘢痕样，而且菲薄婴儿哭闹时包块膨大，压迫包块则前囟门膨隆，显示膨出包块与蛛网膜下腔相通包块透光试验，单纯的脊膜膨出，透光程度高，而内含脊髓与神经根者，可见包块内有阴影。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "脊髓脊膜膨出"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "局部包块"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "背部"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "胸"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "在背部中线颈、胸或腰骶部可见一大小不等的囊性包块，呈圆形或椭圆形，多数基底较宽，少数为带状"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 83,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 98,
+ "type": "sym",
+ "entity": "表面皮肤正常，也有时为瘢痕样，而且菲薄"
+ },
+ {
+ "start_idx": 114,
+ "end_idx": 116,
+ "type": "bod",
+ "entity": "前囟门"
+ },
+ {
+ "start_idx": 127,
+ "end_idx": 131,
+ "type": "bod",
+ "entity": "蛛网膜下腔"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 133,
+ "type": "sym",
+ "entity": "婴儿哭闹时包块膨大，压迫包块则前囟门膨隆，显示膨出包块与蛛网膜下腔相通"
+ },
+ {
+ "start_idx": 134,
+ "end_idx": 139,
+ "type": "ite",
+ "entity": "包块透光试验"
+ },
+ {
+ "start_idx": 144,
+ "end_idx": 147,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 149,
+ "end_idx": 153,
+ "type": "sym",
+ "entity": "透光程度高"
+ },
+ {
+ "start_idx": 158,
+ "end_idx": 159,
+ "type": "bod",
+ "entity": "脊髓"
+ },
+ {
+ "start_idx": 161,
+ "end_idx": 163,
+ "type": "bod",
+ "entity": "神经根"
+ },
+ {
+ "start_idx": 166,
+ "end_idx": 173,
+ "type": "sym",
+ "entity": "可见包块内有阴影"
+ }
+ ]
+ },
+ {
+ "text": "②神经损害症状：单纯的脊膜膨出，可以无神经系统症状。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "神经损害症状"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "神经系统"
+ }
+ ]
+ },
+ {
+ "text": "③其他症状：少数脊膜膨出向胸腔、腹腔以及盆腔内伸长，出现包块及压迫内脏的症状脊膜膨出患儿合并脑积水和其他畸形，出现相应症状。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "胸腔"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "腹腔"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "盆腔"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "内脏"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "少数脊膜膨出向胸腔、腹腔以及盆腔内伸长，出现包块及压迫内脏的症状"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "脑积水"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "畸形"
+ }
+ ]
+ },
+ {
+ "text": "【诊断】无脑畸形患儿的临床表现一目了然，无需做CT或MRI检查即可进行临床诊断。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "pro",
+ "entity": "CT"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "pro",
+ "entity": "MRI检查"
+ }
+ ]
+ },
+ {
+ "text": "但CT或MRI检查对产前诊断是有帮助的，特别是MRI，可显示宫内胎儿颅脑发育情况，如颅盖缺如脑组织缺如羊水过多。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 2,
+ "type": "pro",
+ "entity": "CT"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "pro",
+ "entity": "MRI检查"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "MRI"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "宫内"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "颅脑"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "颅盖"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 45,
+ "type": "sym",
+ "entity": "颅盖缺如"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "sym",
+ "entity": "脑组织缺如"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "羊水过多"
+ }
+ ]
+ },
+ {
+ "text": "头颅X线片可发现有大小不等的颅骨缺损头颅CT平扫可显示颅骨缺损脑脊液同样密度的囊性肿物，如合并脑脑膜膨出则可见囊内有脑组织密度影。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "头颅X线片"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "颅骨"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "颅骨缺损"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "头颅CT平扫"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "颅骨"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "颅骨缺损"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 33,
+ "type": "bod",
+ "entity": "脑脊液"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 51,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 60,
+ "type": "bod",
+ "entity": "脑组织"
+ }
+ ]
+ },
+ {
+ "text": "头颅CT增强扫描可显示囊内脑组织强化，囊与蛛网膜下腔相交通头颅MRI扫描可见颅骨缺损及由此膨出的脑脊液、脑组织、脑血管及硬脑膜组织信号的肿物，并可见颅内其他结构的改变及畸形。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "pro",
+ "entity": "头颅CT"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "蛛网膜下腔"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "囊内脑组织强化，囊与蛛网膜下腔相交通"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "头颅MRI扫描"
+ }
+ ]
+ },
+ {
+ "text": "脊柱X线片显示椎板棘突缺如，椎弓根间距增宽，骨质缺损部位与软组织肿物相连接CT及MRI扫描可发现脊髓、脊神经及脊膜的膨出情况，以及局部粘连等病变。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "pro",
+ "entity": "脊柱X线片"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "椎板棘突"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "椎弓根"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "软组织"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 36,
+ "type": "sym",
+ "entity": "椎板棘突缺如，椎弓根间距增宽，骨质缺损部位与软组织肿物相连接"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 38,
+ "type": "pro",
+ "entity": "CT"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "MRI扫描"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "脊髓、脊神经及脊膜的膨出情况，以及局部粘连等病变"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】无脑畸形患儿不能外科手术治疗。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "外科手术"
+ }
+ ]
+ },
+ {
+ "text": "单纯颅裂一般无需特殊治疗。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "颅裂"
+ }
+ ]
+ },
+ {
+ "text": "当合并脑膜膨出或脑脑膜膨出时，一般均需手术治疗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "pro",
+ "entity": "手术"
+ }
+ ]
+ },
+ {
+ "text": "手术时间过去认为在生后6～12个月为宜，近年来主张尽早手术，可在生后数天或数周内进行。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "pro",
+ "entity": "手术"
+ }
+ ]
+ },
+ {
+ "text": "手术目的是切除膨出的囊，还纳膨出的脑组织等内容物，封闭颅骨缺损巨大脑膜膨出或脑脑膜膨出，合并神经系统症状，智力低下及明显的脑积水者，无需手术治疗。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "囊"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "脑组织"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "颅骨"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "sym",
+ "entity": "颅骨缺损"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "巨大脑膜膨出"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "脑脑膜膨出"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "智力低下"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 63,
+ "type": "dis",
+ "entity": "脑积水"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "pro",
+ "entity": "手术"
+ }
+ ]
+ },
+ {
+ "text": "脊髓脊膜膨出手术时，通常需要向上、向下扩大椎板切开范围，以探查脊髓与神经向脊膜囊内膨出的情况，有利于膨出的神经组织还纳于椎管内。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "脊髓脊膜膨出"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "椎板"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "脊髓"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "神经"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 56,
+ "type": "bod",
+ "entity": "神经组织"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "bod",
+ "entity": "椎管"
+ }
+ ]
+ },
+ {
+ "text": "【预防】（一）增补叶酸迄今为止，对NTDs的研究已经历了30多年之久，积累了丰富的临床医学、流行病学及遗传学等方面的资料，特别是对叶酸预防NTDs的研究取得了突破性进展。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "dep",
+ "entity": "临床医学"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 49,
+ "type": "dep",
+ "entity": "流行病学"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 53,
+ "type": "dep",
+ "entity": "遗传学"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 66,
+ "type": "bod",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "妇女怀孕早期体内叶酸缺乏是NTDs发生的主要原因；妇女如果能在怀孕前和怀孕早期及时增补叶酸，便可有效地预防大部分NTDs的发生。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "叶酸缺乏"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 44,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "近年来研究发现5，10-亚甲基四氢叶酸还原酶（MTHFR）是叶酸代谢过程中的一种关键酶，MTHFR的酶活性降低，可引起体内一种胚胎毒性物质同型半胱氨酸蓄积，可能是NTDs发生的危险因素，而妇女在怀孕前和怀孕早期服用叶酸可以弥补MTHFR酶活性的缺陷，使体内的5-甲基四氢叶酸（活性叶酸）增多，达到预防NTDs发生之目的。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 21,
+ "type": "bod",
+ "entity": "5，10-亚甲基四氢叶酸还原酶"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "MTHFR"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 42,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "MTHFR"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 84,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 108,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 113,
+ "end_idx": 117,
+ "type": "bod",
+ "entity": "MTHFR"
+ },
+ {
+ "start_idx": 129,
+ "end_idx": 136,
+ "type": "bod",
+ "entity": "5-甲基四氢叶酸"
+ },
+ {
+ "start_idx": 138,
+ "end_idx": 141,
+ "type": "bod",
+ "entity": "活性叶酸"
+ },
+ {
+ "start_idx": 150,
+ "end_idx": 153,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "我国卫生部决定从1995年10月起，在全国实施妇女增补叶酸预防NTDs工作。",
+ "entities": [
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "至于我国育龄妇女体内叶酸缺乏的主要原因是膳食中摄入叶酸量较少，富含叶酸的食物如绿色蔬菜和水果等摄入量不足，另外由于烹调习惯的关系，使得食物中的叶酸大部分受到破坏。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "叶酸缺乏"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 72,
+ "type": "dru",
+ "entity": "叶酸"
+ }
+ ]
+ },
+ {
+ "text": "需要指出的是，不能用普通的药用叶酸代替，因为那种片剂每片含叶酸5mg（5000μg），如果天天服用，由于剂量过大，可能反而影响胎儿发育。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "药用叶酸"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "叶酸"
+ }
+ ]
+ },
+ {
+ "text": "另一类为复合制剂，专为孕产妇设计，其中不仅包含叶酸，同时还含有多种维生素、矿物质和微量元素。",
+ "entities": [
+ {
+ "start_idx": 23,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "维生素"
+ }
+ ]
+ },
+ {
+ "text": "这类制剂能够补充孕、产妇的全面营养，除能预防NTDs外，还有利于胎儿和婴儿营养需求，同时也有利于母婴的均衡营养。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "（二）遗传咨询NTDs的遗传咨询主要包括婚前、孕前及孕期咨询，了解夫妇双方的家族史、孕妇既往的妊娠史、此次妊娠的饮食、服药情况和接触放射线、有害化学物质以及致病微生物等情况，对孕妇进行卫生保健以减少NTDs患儿的发生。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 99,
+ "end_idx": 102,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "（三）产前检查NTDs的产前检查内容主要包括羊水、母亲血清甲胎蛋白（AFP）检测及B超检查等。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "pro",
+ "entity": "B超检查"
+ }
+ ]
+ },
+ {
+ "text": "B超可扫描胎儿的头颅形状及大小或脊柱部位的结构，如无脑畸形胎儿表现为胎头圆形光环消失，脑膜膨出胎儿在胎头的颅骨壁缺损处可见一囊性肿物与其连接，脊柱裂胎儿可发现脊柱裂口，脊膜膨出胎儿可在脊椎部发现边界规则而清晰的囊性膨出物等。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "B超"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "头颅"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "脊柱"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "无脑畸形"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 41,
+ "type": "sym",
+ "entity": "胎头圆形光环消失"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 46,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 69,
+ "type": "sym",
+ "entity": "胎头的颅骨壁缺损处可见一囊性肿物与其连接"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 73,
+ "type": "dis",
+ "entity": "脊柱裂"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 82,
+ "type": "sym",
+ "entity": "脊柱裂口"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 92,
+ "end_idx": 109,
+ "type": "sym",
+ "entity": "脊椎部发现边界规则而清晰的囊性膨出物"
+ }
+ ]
+ },
+ {
+ "text": "一旦产前检查发现胎儿NTDs，应立即终止妊娠，以减少NTDs患儿出生。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "NTDs"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "NTDs"
+ }
+ ]
+ },
+ {
+ "text": "【预后】无脑畸形患儿预后极差，绝大多数于出生时即为死胎，仅25%的患儿为活产，但极少能存活一周，多数于生后数小时死亡。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "无脑畸形"
+ }
+ ]
+ },
+ {
+ "text": "单纯的脑膜膨出，经过手术治疗后，一般效果较好，可减少或缓解神经系统的损害症状，降低死亡率。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "脑膜膨出"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "pro",
+ "entity": "手术"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "神经系统"
+ }
+ ]
+ },
+ {
+ "text": "单纯的脊膜膨出，手术治疗疗效好，可以达到临床治愈。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "脊膜膨出"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "pro",
+ "entity": "手术"
+ }
+ ]
+ },
+ {
+ "text": "三、新生儿出血症新生儿出血症（hemorrhagicdiseaseofthenewborn，HDN）为维生素K依赖的凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ减少而引起的出血，又称新生儿自然出血症、维生素K依赖性出血症、新生儿低凝血酶原血症。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "新生儿出血症"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "新生儿出血症"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 44,
+ "type": "dis",
+ "entity": "hemorrhagicdiseaseofthenewborn"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 48,
+ "type": "dis",
+ "entity": "HDN"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 76,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 87,
+ "type": "dis",
+ "entity": "新生儿自然出血症"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 98,
+ "type": "dis",
+ "entity": "维生素K依赖性出血症"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 109,
+ "type": "dis",
+ "entity": "新生儿低凝血酶原血症"
+ }
+ ]
+ },
+ {
+ "text": "【病因与发病机制】病因为维生素K缺乏。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 17,
+ "type": "sym",
+ "entity": "维生素K缺乏"
+ }
+ ]
+ },
+ {
+ "text": "维生素K缺乏的原因有：①摄入不足：孕母维生素K只有10%可通过胎盘达到胎儿，胎儿维生素K贮量少，母乳中维生素K的含量（15μg/L）仅为牛奶（60μg/L）的1/4，初生母乳量又不足，母乳喂养者发病率较牛奶喂养者高15～20倍。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "维生素K缺乏"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "胎盘"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "②合成不足：维生素K主要由正常肠道菌群合成，初生新生儿肠道菌群尚未建立，影响维生素K的合成。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 30,
+ "type": "mic",
+ "entity": "肠道菌群"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "抗生素抑制肠道菌群，使维生素K合成不足。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "抗生素"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "mic",
+ "entity": "肠道菌群"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "凝血因子Ⅱ、Ⅻ、Ⅸ、Ⅹ的谷氨酸残基需要羧化为γ-羧基谷氨酸，增加钙结合位点，才具有凝血活性。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 10,
+ "type": "bod",
+ "entity": "凝血因子Ⅱ、Ⅻ、Ⅸ、Ⅹ"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "谷氨酸"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "羧化为γ-羧基谷氨酸"
+ }
+ ]
+ },
+ {
+ "text": "这一羧化过程需要维生素K的参与，如发生维生素K缺乏早发性出血比较少见，生后24小时内发病，与孕母用药有关，如抗凝药（双香豆素）、抗癫痫药（苯妥英钠、苯巴比妥）及抗结核药（利福平、异烟肼）等，这些药物可干扰胎儿维生素K的功能。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "维生素K"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "维生素K缺乏"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "早发性出血"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "抗凝药"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "dru",
+ "entity": "双香豆素"
+ },
+ {
+ "start_idx": 64,
+ "end_idx": 67,
+ "type": "dru",
+ "entity": "抗癫痫药"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 72,
+ "type": "dru",
+ "entity": "苯妥英钠"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 77,
+ "type": "dru",
+ "entity": "苯巴比妥"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 83,
+ "type": "dru",
+ "entity": "抗结核药"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 87,
+ "type": "dru",
+ "entity": "利福平"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 91,
+ "type": "dru",
+ "entity": "异烟肼"
+ },
+ {
+ "start_idx": 104,
+ "end_idx": 107,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "出血程度轻重不一，出血部位除皮肤外，也可有颅内、胸腔或腹腔出血。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "胸腔"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "腹腔"
+ }
+ ]
+ },
+ {
+ "text": "2.典型的新生儿出血症近年已较少见，生后2～7天发病，早产儿可迟至2周。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "新生儿出血症"
+ }
+ ]
+ },
+ {
+ "text": "多见于母乳喂养儿，出血部位以胃肠道（便血和呕血）最常见，其他有脐带残端、皮肤、帽状腱膜下、颅内、注射部位或手术伤口的渗血等，早产儿可发生颅内出血。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "便血"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "呕血"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "脐带残端"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 37,
+ "type": "bod",
+ "entity": "皮肤"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "帽状腱膜下"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "颅内"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 69,
+ "type": "bod",
+ "entity": "颅内"
+ },
+ {
+ "start_idx": 68,
+ "end_idx": 71,
+ "type": "sym",
+ "entity": "颅内出血"
+ }
+ ]
+ },
+ {
+ "text": "出血程度轻重不等，但有些轻度出血可为严重致命出血（如颅内出血）的前驱症状，少数病例可发生消化道或脐端大出血导致休克。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "sym",
+ "entity": "出血"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "轻度出血"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "严重致命出血"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "sym",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "bod",
+ "entity": "消化道"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "脐端"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "脐端大出血"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 56,
+ "type": "sym",
+ "entity": "休克"
+ }
+ ]
+ },
+ {
+ "text": "3.晚发性维生素K缺乏出血生后2周～3个月发病，发生率约为1/1万～10/1万活产儿。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "晚发性维生素K缺乏出血"
+ }
+ ]
+ },
+ {
+ "text": "此外，与肝胆疾病、腹泻、使用广谱抗生素（抑制肠道菌群）、长期禁食或静脉营养时未补充维生素K有关。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "bod",
+ "entity": "肝胆"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "腹泻"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "广谱抗生素"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 25,
+ "type": "mic",
+ "entity": "肠道菌群"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 44,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "出血部位主要为颅内出血，约占60%～80%。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "颅内"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "sym",
+ "entity": "颅内出血"
+ }
+ ]
+ },
+ {
+ "text": "患儿出现惊厥、嗜睡、昏迷、前囟隆起脑疝，瞳孔固定、不等大，病死率高，后遗症多。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "惊厥"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "嗜睡"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "昏迷"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 14,
+ "type": "bod",
+ "entity": "前囟"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "前囟隆起"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "sym",
+ "entity": "脑疝"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "瞳孔固定"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "不等大"
+ }
+ ]
+ },
+ {
+ "text": "【诊断与鉴别诊断】健康新生儿生后2～5天发生自然出血现象，血小板和出血时间正常，可考虑本病，若凝血酶原时间和部分凝血活酶时间延长、凝血时间正常或轻度延长，但出血时间正常，则可确诊。",
+ "entities": [
+ {
+ "start_idx": 29,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "血小板"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "凝血酶原"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 59,
+ "type": "bod",
+ "entity": "凝血活酶"
+ }
+ ]
+ },
+ {
+ "text": "注射维生素K1或输新鲜血浆等治疗有效，可为辅助诊断。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "新鲜血浆"
+ }
+ ]
+ },
+ {
+ "text": "1.胃肠道出血应与咽下综合征、应激性溃疡、消化道畸形和感染引起的消化道出血鉴别，这些患儿无凝血障碍。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "sym",
+ "entity": "胃肠道出血"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "咽下综合征"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "应激性溃疡"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "消化道畸形"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 36,
+ "type": "dis",
+ "entity": "消化道出血"
+ }
+ ]
+ },
+ {
+ "text": "咽下综合征是新生儿出生时咽下母亲产道的血液或带血的羊水等，于生后不久即发生呕吐，呕吐物呈棕色，也可有血便，但血量均微，洗胃后可止吐。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "咽下综合征"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 20,
+ "type": "bod",
+ "entity": "血液"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 51,
+ "type": "sym",
+ "entity": "血便"
+ }
+ ]
+ },
+ {
+ "text": "另外，碱变性试验（Apt试验）有助于鉴别母血及儿血，取1份呕吐物加水5份，混匀后离心，取上清液5份加1%氢氧化钠（0.25N）1份，混匀后静置2分钟，上清液仍为粉红色，说明血中含较多胎儿血红蛋白（HbF），出血来自新生儿；如上清液转变为棕黄色，则是吞入的母血。",
+ "entities": [
+ {
+ "start_idx": 93,
+ "end_idx": 96,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 98,
+ "end_idx": 100,
+ "type": "bod",
+ "entity": "HbF"
+ }
+ ]
+ },
+ {
+ "text": "因为新生儿Hb的80%～90%为FHb，成人的Hb97%为成人血红蛋白（HbA），HbF具有抗碱作用。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "Hb"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "HbA"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "HbF"
+ }
+ ]
+ },
+ {
+ "text": "2.产伤性出血多发生于分娩的先露部位，生后即出现。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dis",
+ "entity": "产伤性出血"
+ }
+ ]
+ },
+ {
+ "text": "3.其他如脐部出血应与脐带接扎不紧、脐部感染或肉芽肿等所致出血鉴别。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 6,
+ "type": "bod",
+ "entity": "脐部"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "脐带"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "脐部感染"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "pro",
+ "entity": "肉芽肿"
+ }
+ ]
+ },
+ {
+ "text": "遗传性毛细血管扩张症可在新生儿早期发生消化道出血。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "遗传性毛细血管扩张症"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "消化道出血"
+ }
+ ]
+ },
+ {
+ "text": "【预防】出生后常规给维生素K11mg肌注1次，可有效防止本病的发生。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "维生素K1"
+ }
+ ]
+ },
+ {
+ "text": "母乳喂养者，哺乳母亲应多进食含维生素K丰富的食物，在生后2～3周再给新生儿注射维生素K15mg，以预防晚发性出血。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "前几年曾认为注射维生素K会增加致癌几率，但经过临床对照研究这种观点已被否定。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "维生素K"
+ }
+ ]
+ },
+ {
+ "text": "【治疗】一旦怀疑本病，应立即给维生素K1治疗，治疗量为每次1～5mg缓慢静脉注射（1mg/min），注射速度过快可引起面色潮红、支气管痉挛、心动过速及血压下降等不良反应，静脉注射奏效最快，一般在注射后4小时内凝血酶原时间即可趋于正常。",
+ "entities": [
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "sym",
+ "entity": "面色潮红"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 74,
+ "type": "sym",
+ "entity": "支气管痉挛"
+ },
+ {
+ "start_idx": 76,
+ "end_idx": 79,
+ "type": "sym",
+ "entity": "心动过速"
+ },
+ {
+ "start_idx": 81,
+ "end_idx": 84,
+ "type": "sym",
+ "entity": "血压下降"
+ }
+ ]
+ },
+ {
+ "text": "应避免采用肌内注射，因易引起注射部位大量出血。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "注射部位大量出血"
+ }
+ ]
+ },
+ {
+ "text": "也可采用皮下注射，药物能被较快吸收，注射后可采用压迫止血。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "pro",
+ "entity": "皮下注射"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "pro",
+ "entity": "压迫止血"
+ }
+ ]
+ },
+ {
+ "text": "出血量较多的患儿，会导致急性失血性贫血和失血性休克，应立即给生理盐水纠正休克，同时根据患儿血红蛋白水平，给予输血，每次输新鲜血10～20ml/kg。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "急性失血性贫血"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "失血性休克"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 33,
+ "type": "dru",
+ "entity": "生理盐水"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 48,
+ "type": "bod",
+ "entity": "血红蛋白"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "pro",
+ "entity": "输血"
+ }
+ ]
+ },
+ {
+ "text": "轻者可输库存血浆以补充凝血因子。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "血浆"
+ }
+ ]
+ },
+ {
+ "text": "早产儿肝功能不成熟，肝脏不能合成凝血因子，虽用维生素K1治疗，常不能迅速奏效，最好同时输新鲜血治疗。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "肝功能"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "肝功能不成熟"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "凝血因子"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 35,
+ "type": "pro",
+ "entity": "维生素K1治疗"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "pro",
+ "entity": "输新鲜血"
+ }
+ ]
+ },
+ {
+ "text": "脐部出血要做好包扎。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "bod",
+ "entity": "脐部"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "脐部出血"
+ }
+ ]
+ },
+ {
+ "text": "穿刺部位出血要压迫止血。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "穿刺部位"
+ },
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "穿刺部位出血"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 10,
+ "type": "pro",
+ "entity": "压迫止血"
+ }
+ ]
+ },
+ {
+ "text": "出血过多、治疗延误者可导致死亡，颅内出血者预后差，重者死亡，幸存者常留后遗症。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "sym",
+ "entity": "出血过多"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 17,
+ "type": "bod",
+ "entity": "颅内"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "颅内出血"
+ }
+ ]
+ },
+ {
+ "text": "五、幕上高度恶性胶质瘤幕上高度恶性胶质瘤相当于Kernohan分类中的Ⅲ、Ⅳ级，属于恶性程度很高的一类肿瘤。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 10,
+ "type": "dis",
+ "entity": "幕上高度恶性胶质瘤"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "幕上高度恶性胶质瘤"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "dis",
+ "entity": "肿瘤"
+ }
+ ]
+ },
+ {
+ "text": "这类肿瘤占儿童神经系统肿瘤的7%～11%，主要位于大脑半球（66%），少部分位于间脑（20%）及后颅窝（14%），平均发病年龄为9～10岁。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "肿瘤"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 12,
+ "type": "dis",
+ "entity": "儿童神经系统肿瘤"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 28,
+ "type": "bod",
+ "entity": "大脑半球"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 41,
+ "type": "bod",
+ "entity": "间脑"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "后颅窝"
+ }
+ ]
+ },
+ {
+ "text": "有条件者亦可行立体定向放射治疗，如X-刀或γ-刀，可延长生存期。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 14,
+ "type": "pro",
+ "entity": "立体定向放射治疗"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "pro",
+ "entity": "X-刀"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 23,
+ "type": "pro",
+ "entity": "γ-刀"
+ }
+ ]
+ },
+ {
+ "text": "化疗的作用和治疗方案的选择目前尚处于摸索阶段，应用价值还有争议。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "pro",
+ "entity": "化疗"
+ }
+ ]
+ },
+ {
+ "text": "第十一章颅内出血颅内出血（intracranialhemorrhage，ICH）又称为出血性脑血管病或出血性卒中，系因脑血管破裂使血液外溢至颅腔所致。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "颅内出血"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 34,
+ "type": "dis",
+ "entity": "intracranialhemorrhage"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "ICH"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "出血性脑血管病"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 55,
+ "type": "dis",
+ "entity": "出血性卒中"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 63,
+ "type": "sym",
+ "entity": "脑血管破裂"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 68,
+ "type": "sym",
+ "entity": "血液外溢"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "颅腔"
+ }
+ ]
+ },
+ {
+ "text": "国外文献报道15岁以下儿童脑出血和蛛网膜下腔出血的发病率为2.5/10万。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 15,
+ "type": "sym",
+ "entity": "儿童脑出血"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 19,
+ "type": "bod",
+ "entity": "蛛网膜"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 23,
+ "type": "sym",
+ "entity": "蛛网膜下腔出血"
+ }
+ ]
+ },
+ {
+ "text": "无论何种原因所致的小儿ICH，其临床表现有颇多相似之处，但预后则视不同病因而有很大差异，且诊断与治疗是否及时也是直接影响预后的关键因素。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "小儿ICH"
+ }
+ ]
+ },
+ {
+ "text": "一、病因许多血液病、脑血管发育异常及颅内外其他病变均与小儿ICH的发生有关，其病因可以是单一的，亦可由多种病因联合所致。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "血液病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 12,
+ "type": "bod",
+ "entity": "脑血管"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "脑血管发育异常"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 24,
+ "type": "sym",
+ "entity": "颅内外其他病变"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dis",
+ "entity": "小儿ICH"
+ }
+ ]
+ },
+ {
+ "text": "（一）脑血管畸形脑动静脉畸形是儿童时期ICH的常见原因之一，可分为先天性、感染性与外伤性。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 7,
+ "type": "sym",
+ "entity": "脑血管畸形"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "bod",
+ "entity": "脑动静脉"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "脑动静脉畸形"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "ICH"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "先天性"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 39,
+ "type": "dis",
+ "entity": "感染性"
+ },
+ {
+ "start_idx": 41,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "外伤性"
+ }
+ ]
+ },
+ {
+ "text": "（二）血液病血液病是小儿脑血管病的重要病因，在尸检的血液病例中有50%发现自发性脑出血。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "血液病"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "血液病"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "小儿脑血管病"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 42,
+ "type": "dis",
+ "entity": "自发性脑出血"
+ }
+ ]
+ },
+ {
+ "text": "血友病患儿中2.2%～7.4%发生ICH。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dis",
+ "entity": "血友病"
+ }
+ ]
+ },
+ {
+ "text": "（三）颅内其他原因包括颅脑外伤，颅内肿瘤，脑动脉炎，中毒性脑病等。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "颅内"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dis",
+ "entity": "颅脑外伤"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "颅内肿瘤"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dis",
+ "entity": "脑动脉炎"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dis",
+ "entity": "中毒性脑病"
+ }
+ ]
+ },
+ {
+ "text": "（四）颅外其他原因包括维生素K缺乏症，维生素C缺乏症，肝病，高血压，感染或结缔组织病等其他各种原因所致的ICH。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "颅外"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "维生素C缺乏症"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "肝病"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dis",
+ "entity": "高血压"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "sym",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 41,
+ "type": "dis",
+ "entity": "结缔组织病"
+ },
+ {
+ "start_idx": 52,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "ICH"
+ }
+ ]
+ },
+ {
+ "text": "（五）新生儿颅内出血原因新生儿颅内出血（neonatalintracranialhemorrhage，NICH）有其特殊的病因，主要发病因素为两大方面，即产伤及缺氧引起，前者正逐渐减少，后者有增加趋势。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "新生儿颅内出血"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 18,
+ "type": "dis",
+ "entity": "新生儿颅内出血"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 49,
+ "type": "dis",
+ "entity": "neonatalintracranialhemorrhage"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 54,
+ "type": "dis",
+ "entity": "NICH"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "sym",
+ "entity": "产伤"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 81,
+ "type": "sym",
+ "entity": "缺氧"
+ }
+ ]
+ },
+ {
+ "text": "NICH的发病率依不同的检测及统计方法不同而不同，其中在孕周＜34周、出生体重＜1500g的未成熟儿高达40%～50%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "dis",
+ "entity": "NICH"
+ }
+ ]
+ },
+ {
+ "text": "（六）其他尚有部分小儿ICH的原因不明。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 13,
+ "type": "dis",
+ "entity": "小儿ICH"
+ }
+ ]
+ },
+ {
+ "text": "有文献报道尸检发现小儿特发性脑出血系由微小动脉瘤样血管畸形破裂所致，因此并非真正的原因不明。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "小儿特发性脑出血"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 28,
+ "type": "dis",
+ "entity": "微小动脉瘤样血管畸形"
+ }
+ ]
+ },
+ {
+ "text": "只是因这种动脉瘤太小，用CT扫描和脑血管造影等神经影像学检查不能发现而已。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 15,
+ "type": "pro",
+ "entity": "CT扫描"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 21,
+ "type": "pro",
+ "entity": "脑血管造影"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 29,
+ "type": "pro",
+ "entity": "影像学检查"
+ }
+ ]
+ },
+ {
+ "text": "第六节维生素B6缺乏症维生素B6有三种形式，即吡哆醇（pyridoxine，PN）、吡哆醛（pyridoxal，PA或PL）和吡哆胺（pyridoxamine，PM）。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "维生素B6缺乏症"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 46,
+ "type": "dru",
+ "entity": "吡哆醇"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 57,
+ "type": "dru",
+ "entity": "pyridoxine"
+ },
+ {
+ "start_idx": 59,
+ "end_idx": 60,
+ "type": "dru",
+ "entity": "PN"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 65,
+ "type": "dru",
+ "entity": "吡哆醛"
+ },
+ {
+ "start_idx": 67,
+ "end_idx": 75,
+ "type": "dru",
+ "entity": "pyridoxal"
+ },
+ {
+ "start_idx": 77,
+ "end_idx": 78,
+ "type": "dru",
+ "entity": "PA"
+ },
+ {
+ "start_idx": 80,
+ "end_idx": 81,
+ "type": "dru",
+ "entity": "PL"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "dru",
+ "entity": "吡哆胺"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 99,
+ "type": "dru",
+ "entity": "pyridoxamine"
+ },
+ {
+ "start_idx": 101,
+ "end_idx": 102,
+ "type": "dru",
+ "entity": "PM"
+ }
+ ]
+ },
+ {
+ "text": "这三种形式通过酶可互相转换。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 7,
+ "type": "bod",
+ "entity": "酶"
+ }
+ ]
+ },
+ {
+ "text": "PL及PM磷酸化后变为辅酶磷酸吡哆醛（PLP）及磷酸吡哆胺（PMP）。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 1,
+ "type": "dru",
+ "entity": "PL"
+ },
+ {
+ "start_idx": 13,
+ "end_idx": 17,
+ "type": "dru",
+ "entity": "磷酸吡哆醛"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "PLP"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "磷酸吡哆胺"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "PMP"
+ }
+ ]
+ },
+ {
+ "text": "吡哆醇为人工合成的产品，在植物中也有；在动物体内，多以辅酶PLP及PMP的形式存在。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "吡哆醇"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "辅酶PLP"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "PMP"
+ }
+ ]
+ },
+ {
+ "text": "【流行病学】1934年，Gyorgy首次证实吡哆醇即维生素B6，并于1938年阐明其化学结构与人工合成方法。",
+ "entities": [
+ {
+ "start_idx": 22,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "吡哆醇"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "原发性缺乏罕见，因为大多数食物中都含有维生素B6，但是人工喂养儿因配制奶中维生素B6缺乏可致病。",
+ "entities": [
+ {
+ "start_idx": 19,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "血液生化分析的结果显示维生素B6缺乏率约为12%～19%。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 5,
+ "type": "ite",
+ "entity": "血液生化分析"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "【病因】（一）膳食组成的影响因为5-磷酸吡哆醛氨基酸代谢中许多酶的辅酶，故蛋白质代谢需要维生素B6的参与，当膳食中蛋白质的摄入量高时，维生素B6的需要量也多，如以蛋白质摄入量为基础计算，摄取100g蛋白质，每天需摄入维生素B61.5～2.5mg。",
+ "entities": [
+ {
+ "start_idx": 16,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "5-磷酸吡哆醛"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 31,
+ "type": "bod",
+ "entity": "酶"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 58,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "（二）摄入不足婴儿由于母亲维生素B6摄入不足，引起乳汁中维生素B6的分泌量减少，或者人工喂养的婴儿，牛乳经过多次加热、煮沸，造成维生素B6的破坏，均可造成婴儿的维生素B6缺乏。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 35,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "乳汁"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 93,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 119,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 126,
+ "type": "sym",
+ "entity": "维生素B6缺乏"
+ }
+ ]
+ },
+ {
+ "text": "如小儿患结核、水痘、肺炎以及高热时，维生素B6的消耗增加，如未予及时补充，则造成维生素B6的缺乏。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "dis",
+ "entity": "结核"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "水痘"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "dis",
+ "entity": "肺炎"
+ },
+ {
+ "start_idx": 14,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "高热"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "患甲状腺功能亢进时，维生素B6辅酶活力降低，维生素B6的需要量增加。",
+ "entities": [
+ {
+ "start_idx": 1,
+ "end_idx": 7,
+ "type": "dis",
+ "entity": "甲状腺功能亢进"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 26,
+ "type": "bod",
+ "entity": "维生素B6辅酶"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 41,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "（四）药物影响异烟肼、环丝氨酸、L-多巴、肼苯达嗪、D-青霉胺、四环素等均可导致维生素B6缺乏。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "异烟肼"
+ },
+ {
+ "start_idx": 11,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "环丝氨酸"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 19,
+ "type": "dru",
+ "entity": "L-多巴"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "dru",
+ "entity": "肼苯达嗪"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "D-青霉胺"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "四环素"
+ }
+ ]
+ },
+ {
+ "text": "异烟肼、肼苯达嗪与维生素B6形成非活性衍生物，加速了维生素B6排泄；青酶胺、环丝氨酸是维生素B6的抗代谢剂，均会加重维生素B6缺乏。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "异烟肼"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 7,
+ "type": "dru",
+ "entity": "肼苯达嗪"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "青酶胺"
+ },
+ {
+ "start_idx": 58,
+ "end_idx": 61,
+ "type": "dru",
+ "entity": "环丝氨酸"
+ }
+ ]
+ },
+ {
+ "text": "（五）吸收障碍如患有消化系统疾病，如慢性腹泻、肠道感染、肠吸收不良综合征等疾病均可减少维生素B6的吸收。",
+ "entities": [
+ {
+ "start_idx": 10,
+ "end_idx": 15,
+ "type": "dis",
+ "entity": "消化系统疾病"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "慢性腹泻"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 26,
+ "type": "dis",
+ "entity": "肠道感染"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 35,
+ "type": "dis",
+ "entity": "肠吸收不良综合征"
+ }
+ ]
+ },
+ {
+ "text": "【临床表现】虽然明显缺乏维生素B6的症状较为少见，但是轻度缺乏却比较多见。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "明显缺乏"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "轻度缺乏"
+ }
+ ]
+ },
+ {
+ "text": "当人体缺乏维生素B6时，常伴有其他营养素的缺乏，尤其是其他水溶性维生素的缺乏��特别是维生素B2，因维生素B2参与维生素B6的代谢。",
+ "entities": [
+ {
+ "start_idx": 39,
+ "end_idx": 44,
+ "type": "dru",
+ "entity": "水溶性维生素"
+ }
+ ]
+ },
+ {
+ "text": "（一）生长发育不良维生素B6缺乏的患儿，氨基酸、蛋白质代谢异常，在婴儿期表现为生长发育迟缓。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 8,
+ "type": "dis",
+ "entity": "生长发育不良"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 25,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "氨基酸、蛋白质代谢异常"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "生长发育迟缓"
+ }
+ ]
+ },
+ {
+ "text": "还可出现贫血。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "贫血"
+ }
+ ]
+ },
+ {
+ "text": "（二）皮肤脂溢性皮炎维生素B6缺乏可致眼、口腔和鼻周围皮肤脂溢性皮炎，并可向面部、前额、耳后等扩展。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 9,
+ "type": "dis",
+ "entity": "皮肤脂溢性皮炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 19,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "眼"
+ },
+ {
+ "start_idx": 31,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "口腔"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 34,
+ "type": "bod",
+ "entity": "鼻"
+ },
+ {
+ "start_idx": 37,
+ "end_idx": 43,
+ "type": "dis",
+ "entity": "皮肤脂溢性皮炎"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "bod",
+ "entity": "面部"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 52,
+ "type": "bod",
+ "entity": "前额"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "耳后"
+ }
+ ]
+ },
+ {
+ "text": "也可导致舌炎、口炎、口唇干裂。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 5,
+ "type": "sym",
+ "entity": "舌炎"
+ },
+ {
+ "start_idx": 7,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "口炎"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "口唇干裂"
+ }
+ ]
+ },
+ {
+ "text": "（三）神经精神系统症状个别伴有神经系统症状，如兴奋性增高、尖声哭叫、全身抽搐。",
+ "entities": [
+ {
+ "start_idx": 15,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "兴奋性增高"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "sym",
+ "entity": "尖声哭叫"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "全身抽搐"
+ }
+ ]
+ },
+ {
+ "text": "6个月内的小儿可因频繁抽搐而导致智力发育障碍。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 12,
+ "type": "sym",
+ "entity": "频繁抽搐"
+ },
+ {
+ "start_idx": 16,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "智力发育障碍"
+ }
+ ]
+ },
+ {
+ "text": "（四）消化系统症状常伴有一些胃肠道症状，如恶心、呕吐、腹泻等。",
+ "entities": [
+ {
+ "start_idx": 14,
+ "end_idx": 16,
+ "type": "bod",
+ "entity": "胃肠道"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "恶心"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "sym",
+ "entity": "呕吐"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 28,
+ "type": "sym",
+ "entity": "腹泻"
+ }
+ ]
+ },
+ {
+ "text": "（五）感染维生素B6对免疫系统也有影响。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 4,
+ "type": "dis",
+ "entity": "感染"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 24,
+ "type": "bod",
+ "entity": "免疫系统"
+ }
+ ]
+ },
+ {
+ "text": "维生素B6缺乏，细胞介导免疫系统受损。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 9,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "细胞介导免疫系统"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 27,
+ "type": "sym",
+ "entity": "细胞介导免疫系统受损"
+ }
+ ]
+ },
+ {
+ "text": "Talbot和Meydani等人研究发现，如补充吡哆醇，对淋巴细胞增殖会产生有利的作用。",
+ "entities": [
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "吡哆醇"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 32,
+ "type": "bod",
+ "entity": "淋巴细胞"
+ }
+ ]
+ },
+ {
+ "text": "研究表明，维生素B6缺乏会损害DNA的合成，故对维持免疫功能很重要。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 5,
+ "end_idx": 21,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "DNA"
+ }
+ ]
+ },
+ {
+ "text": "因此，如维生素B6缺乏，抗体生成减少，容易发生感染。",
+ "entities": [
+ {
+ "start_idx": 4,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 22,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "抗体"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 34,
+ "type": "sym",
+ "entity": "感染"
+ }
+ ]
+ },
+ {
+ "text": "（一）直接法1.血浆磷酸吡哆醛（PLP）浓度测定血浆5-磷酸吡哆醛是肝脏维生素B6的主要存在形式，并且反映组织中的储存，但是血浆5-磷酸吡哆醛对该种维生素摄入量的反应相当缓慢，需要10天才能达到一个新的稳定状态。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 9,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "磷酸吡哆醛（PLP）浓度"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 25,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 32,
+ "type": "dru",
+ "entity": "5-磷酸吡哆醛"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 35,
+ "type": "bod",
+ "entity": "肝脏"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 45,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 73,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 74,
+ "end_idx": 80,
+ "type": "dru",
+ "entity": "5-磷酸吡哆醛"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "dru",
+ "entity": "维生素"
+ }
+ ]
+ },
+ {
+ "text": "但在评价时应考虑可能影响PLP浓度的各种因素，如蛋白质的摄入增加、AKP药物的活性升高都可使血浆PLP浓度下降。",
+ "entities": [
+ {
+ "start_idx": 12,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "PLP浓度"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 26,
+ "type": "dru",
+ "entity": "蛋白质"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "AKP药物的活性"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 42,
+ "type": "sym",
+ "entity": "AKP药物的活性升高"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 52,
+ "type": "ite",
+ "entity": "血浆PLP浓度"
+ }
+ ]
+ },
+ {
+ "text": "目前是以20nmolL血浆PLP浓度为评价维生素B6营养状况的指标。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 17,
+ "type": "ite",
+ "entity": "血浆PLP浓度"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 30,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "但胎儿体内5-PLP浓度非常高，出生后第一年内迅速降低，然后降低缓慢。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 11,
+ "type": "ite",
+ "entity": "5-PLP浓度"
+ }
+ ]
+ },
+ {
+ "text": "所以，评价新生儿及婴儿维生素B6的营养状况较困难。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "2.血浆总维生素B6浓度测定（包括游离维生素B6及吡哆醇磷酸盐）本方法较为简单，是了解体内维生素B6营养状况的敏感指标，但是测定值的波动较大，因此限制了它的使用价值。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 21,
+ "type": "ite",
+ "entity": "血浆总维生素B6浓度"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 39,
+ "type": "dru",
+ "entity": "游离维生素B6<"
+ },
+ {
+ "start_idx": 45,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "吡哆醇磷酸盐"
+ },
+ {
+ "start_idx": 65,
+ "end_idx": 74,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "3.尿中维生素B6浓度测定尿中维生素B6排泄，特别是4-吡哆酸的排泄，已被广泛用于研究维生素B6的需要量。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 2,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 13,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 20,
+ "type": "ite",
+ "entity": "维生素B6浓度"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 23,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 25,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "4-吡哆酸"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 72,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "吡哆酸的排泄量约占维生素B6摄入量的50%，4-吡哆酸的排出量反映近期膳食维生素B6摄入量的变化，正常尿内排泄4-吡哆酸大于0.8mgd，如果少于0.2mgd，即表明维生素B6缺乏。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "吡哆酸"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 40,
+ "type": "ite",
+ "entity": "4-吡哆酸的排出量"
+ },
+ {
+ "start_idx": 47,
+ "end_idx": 56,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 79,
+ "type": "ite",
+ "entity": "4-吡哆酸"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 112,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 103,
+ "end_idx": 119,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ }
+ ]
+ },
+ {
+ "text": "（二）间接法1.尿中色氨酸降解产物的水平（尿色氨酸负荷试验）尿中黄尿酸的排出量是维生素B6缺乏的最早标记物之一。",
+ "entities": [
+ {
+ "start_idx": 8,
+ "end_idx": 8,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 19,
+ "type": "ite",
+ "entity": "色氨酸降解产物的水平"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 26,
+ "type": "ite",
+ "entity": "尿色氨酸负荷"
+ },
+ {
+ "start_idx": 30,
+ "end_idx": 30,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 38,
+ "type": "ite",
+ "entity": "黄尿酸的排出量"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 56,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ }
+ ]
+ },
+ {
+ "text": "正常情况下，黄尿酸是一种微量的色氨酸降解产物，色氨酸降解的主要途径是通过5-磷酸吡哆醛依存的犬尿氨酸酶。",
+ "entities": [
+ {
+ "start_idx": 6,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "黄尿酸"
+ },
+ {
+ "start_idx": 15,
+ "end_idx": 21,
+ "type": "dru",
+ "entity": "色氨酸降解产物"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 25,
+ "type": "dru",
+ "entity": "色氨酸"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 42,
+ "type": "dru",
+ "entity": "5-磷酸吡哆醛"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 50,
+ "type": "dru",
+ "entity": "犬尿氨酸酶"
+ }
+ ]
+ },
+ {
+ "text": "微量黄尿酸也涉及5-磷酸吡哆醛依存的酶。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "dru",
+ "entity": "黄尿酸"
+ },
+ {
+ "start_idx": 8,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "5-磷酸吡哆醛"
+ }
+ ]
+ },
+ {
+ "text": "维生素B6缺乏时，色氨酸代谢产物及衍生物生成增加，由尿排出体外。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 16,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "衍生物"
+ },
+ {
+ "start_idx": 36,
+ "end_idx": 36,
+ "type": "bod",
+ "entity": "尿"
+ }
+ ]
+ },
+ {
+ "text": "黄尿酸能可靠地反映维生素B6的营养状况，给予色氨酸负荷剂量（色氨酸50～100mgkg，配成溶液，总量＜2g），通过测定色氨降解产物来评价维生素B6的营养状况，维生素B6缺乏患者的尿中黄尿酸排出量＞50mg。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 2,
+ "type": "dru",
+ "entity": "黄尿酸"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "色氨酸"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 42,
+ "type": "dru",
+ "entity": "色氨酸"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 88,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 109,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 120,
+ "end_idx": 120,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 122,
+ "end_idx": 127,
+ "type": "ite",
+ "entity": "黄尿酸排出量"
+ }
+ ]
+ },
+ {
+ "text": "2.红细胞内依赖性维生素B6酶活性的测定红细胞内需要PLP酶，如谷丙酮酸转氨酶（EGPT）、谷草酰乙酸转氨酶（EGOT）、天门冬氨酸转氨酶（α-EAST）等，也是评价体内维生素B6营养状况的敏感指标。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 6,
+ "end_idx": 16,
+ "type": "ite",
+ "entity": "依赖性维生素B6酶活性"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 22,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 29,
+ "type": "bod",
+ "entity": "PLP酶"
+ },
+ {
+ "start_idx": 32,
+ "end_idx": 38,
+ "type": "bod",
+ "entity": "谷丙酮酸转氨酶"
+ },
+ {
+ "start_idx": 40,
+ "end_idx": 43,
+ "type": "bod",
+ "entity": "EGPT"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 53,
+ "type": "bod",
+ "entity": "谷草酰乙酸转氨酶"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 58,
+ "type": "bod",
+ "entity": "EGOT"
+ },
+ {
+ "start_idx": 61,
+ "end_idx": 68,
+ "type": "bod",
+ "entity": "天门冬氨酸转氨酶"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "α-EAST"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 94,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "常将红细胞加和不加PLP之比作为评价维生素B6营养状况的指标，加上PLP测定谷丙或谷草转氨酶活性，如活性上升20%以上，表明维生素B6缺乏疾病。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 4,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 9,
+ "end_idx": 11,
+ "type": "dru",
+ "entity": "PLP"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 27,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 45,
+ "type": "dru",
+ "entity": "PLP"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 49,
+ "type": "dru",
+ "entity": "谷丙"
+ },
+ {
+ "start_idx": 51,
+ "end_idx": 57,
+ "type": "ite",
+ "entity": "谷草转氨酶活性"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 61,
+ "type": "ite",
+ "entity": "活性"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 81,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "EGOT指数=EGOT+PLPEGOT-PLPEGPT指数=EGPT+PLPEGPT-PLPEGOT活性指数≤1.80为正常，EGPT活性指数≤1.25为正常。",
+ "entities": [
+ {
+ "start_idx": 0,
+ "end_idx": 3,
+ "type": "ite",
+ "entity": "EGOT"
+ },
+ {
+ "start_idx": 23,
+ "end_idx": 28,
+ "type": "ite",
+ "entity": "EGPT指数"
+ },
+ {
+ "start_idx": 46,
+ "end_idx": 51,
+ "type": "ite",
+ "entity": "EGOT活性"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 66,
+ "type": "dru",
+ "entity": "EGPT"
+ },
+ {
+ "start_idx": 63,
+ "end_idx": 68,
+ "type": "ite",
+ "entity": "EGPT活性"
+ }
+ ]
+ },
+ {
+ "text": "最近也有人测定天门冬氨酸酶的活性作为评价维生素B6营养状况的指标，但测定数值变异较大，使其应用受到了限制。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 12,
+ "type": "ite",
+ "entity": "测定天门冬氨酸酶"
+ },
+ {
+ "start_idx": 20,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "3.血浆高半胱氨酸的含量最近提出以血浆高半胱氨酸作为评价维生素B6营养状况的指标。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 3,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 4,
+ "end_idx": 8,
+ "type": "dru",
+ "entity": "高半胱氨酸"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 18,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 19,
+ "end_idx": 23,
+ "type": "dru",
+ "entity": "高半胱氨酸"
+ },
+ {
+ "start_idx": 28,
+ "end_idx": 37,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "因为高半胱氨酸的降解开始于转硫化到半胱氨酸的过程，涉及5-PLP依存酶。",
+ "entities": [
+ {
+ "start_idx": 2,
+ "end_idx": 6,
+ "type": "dru",
+ "entity": "高半胱氨酸"
+ },
+ {
+ "start_idx": 17,
+ "end_idx": 20,
+ "type": "dru",
+ "entity": "半胱氨酸"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 31,
+ "type": "dru",
+ "entity": "5-PLP"
+ },
+ {
+ "start_idx": 27,
+ "end_idx": 34,
+ "type": "dru",
+ "entity": "5-PLP依存酶"
+ }
+ ]
+ },
+ {
+ "text": "但最近有研究表明，叶酸和维生素B12与血浆高半胱氨酸的水平关系更密切。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 10,
+ "type": "dru",
+ "entity": "叶酸"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 22,
+ "type": "dru",
+ "entity": "维生素B12"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 38,
+ "type": "ite",
+ "entity": "血浆高半胱氨酸的水平"
+ }
+ ]
+ },
+ {
+ "text": "患儿是否有摄入不足、偏食厌食；是否合理膳食，各营养素的比例是否合理；有无妨碍吸收和利用的疾病，如慢性消耗疾病、胃肠道疾病等影响吸收的疾病；患者是否存在需要量增加的因素，如生长发育速度较快、发热等；近来是否服用影响维生素B6活性的药物。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 8,
+ "type": "sym",
+ "entity": "摄入不足"
+ },
+ {
+ "start_idx": 10,
+ "end_idx": 11,
+ "type": "sym",
+ "entity": "偏食"
+ },
+ {
+ "start_idx": 12,
+ "end_idx": 13,
+ "type": "sym",
+ "entity": "厌食"
+ },
+ {
+ "start_idx": 48,
+ "end_idx": 53,
+ "type": "dis",
+ "entity": "慢性消耗疾病"
+ },
+ {
+ "start_idx": 55,
+ "end_idx": 59,
+ "type": "dis",
+ "entity": "胃肠道疾病"
+ },
+ {
+ "start_idx": 85,
+ "end_idx": 92,
+ "type": "sym",
+ "entity": "生长发育速度较快"
+ },
+ {
+ "start_idx": 106,
+ "end_idx": 115,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "（二）临床表现婴儿有无生长发育不良，惊厥、抽搐等神经系统表现，以及末梢神经炎、皮炎、口腔、鼻周围皮肤脂溢性皮炎和贫血等表现。",
+ "entities": [
+ {
+ "start_idx": 11,
+ "end_idx": 16,
+ "type": "sym",
+ "entity": "生长发育不良"
+ },
+ {
+ "start_idx": 18,
+ "end_idx": 19,
+ "type": "sym",
+ "entity": "惊厥"
+ },
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "抽搐"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 27,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 37,
+ "type": "sym",
+ "entity": "末梢神经炎"
+ },
+ {
+ "start_idx": 39,
+ "end_idx": 40,
+ "type": "sym",
+ "entity": "皮炎"
+ },
+ {
+ "start_idx": 42,
+ "end_idx": 54,
+ "type": "sym",
+ "entity": "口腔、鼻周围皮肤脂溢性皮炎"
+ },
+ {
+ "start_idx": 56,
+ "end_idx": 57,
+ "type": "sym",
+ "entity": "贫血"
+ }
+ ]
+ },
+ {
+ "text": "（三）实验室检验可通过测定血浆中磷酸吡哆醛（PLP）浓度、血浆总维生素B6浓度、尿中的维生素B6浓度、尿中色氨酸降解产物的水平、红细胞内依赖性维生素B6酶活性、血浆高半胱氨酸的含量等方法帮助诊断。",
+ "entities": [
+ {
+ "start_idx": 13,
+ "end_idx": 27,
+ "type": "ite",
+ "entity": "血浆中磷酸吡哆醛（PLP）浓度"
+ },
+ {
+ "start_idx": 29,
+ "end_idx": 48,
+ "type": "ite",
+ "entity": "血浆总维生素B6浓度"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 50,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 53,
+ "end_idx": 69,
+ "type": "ite",
+ "entity": "维生素B6浓度"
+ },
+ {
+ "start_idx": 71,
+ "end_idx": 71,
+ "type": "bod",
+ "entity": "尿"
+ },
+ {
+ "start_idx": 73,
+ "end_idx": 82,
+ "type": "ite",
+ "entity": "色氨酸降解产物的水平"
+ },
+ {
+ "start_idx": 84,
+ "end_idx": 86,
+ "type": "bod",
+ "entity": "红细胞"
+ },
+ {
+ "start_idx": 88,
+ "end_idx": 108,
+ "type": "ite",
+ "entity": "依赖性维生素B6酶活性"
+ },
+ {
+ "start_idx": 110,
+ "end_idx": 111,
+ "type": "bod",
+ "entity": "血浆"
+ },
+ {
+ "start_idx": 112,
+ "end_idx": 119,
+ "type": "ite",
+ "entity": "高半胱氨酸的含量"
+ }
+ ]
+ },
+ {
+ "text": "【预防及治疗】（一）去除病因询问病史，了解患儿喂养情况及辅食添加情况，查明缺乏维生素B6的原因，治疗消化道疾病、慢性消耗性疾病及感染等造成维生素B6缺乏的疾病，以去除病因。",
+ "entities": [
+ {
+ "start_idx": 39,
+ "end_idx": 48,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 60,
+ "end_idx": 64,
+ "type": "dis",
+ "entity": "消化道疾病"
+ },
+ {
+ "start_idx": 66,
+ "end_idx": 72,
+ "type": "dis",
+ "entity": "慢性消耗性疾病"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 88,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 79,
+ "end_idx": 95,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ }
+ ]
+ },
+ {
+ "text": "（二）调整饮食维生素B6推荐的每天适宜摄入量：6个月以下的婴儿为0.1mg，较大婴儿增加为0.3mg；1～3岁为0.5mg，4～6岁为0.6mg，7～13岁为0.7～0.9mg，14岁以后为1.1～1.2mg，乳母为1.9mg。",
+ "entities": [
+ {
+ "start_idx": 7,
+ "end_idx": 16,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "合理补充含维生素B6丰富的食物，并注意合理搭配。",
+ "entities": [
+ {
+ "start_idx": 5,
+ "end_idx": 14,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "高蛋白质、低碳水化合物饮食时，应适当增加维生素B6的摄入，如果乳母维生素B6缺乏，应及时予以补充，避免婴儿发生维生素B6缺乏症。",
+ "entities": [
+ {
+ "start_idx": 20,
+ "end_idx": 29,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 52,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 84,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 75,
+ "end_idx": 92,
+ "type": "dis",
+ "entity": "维生素B6缺乏症"
+ }
+ ]
+ },
+ {
+ "text": "人工喂养的婴儿，牛乳不宜经过多次加热、煮沸，避免造成维生素B6的破坏，造成婴儿的维生素B6缺乏。",
+ "entities": [
+ {
+ "start_idx": 26,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 50,
+ "end_idx": 59,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "如存在维生素B6缺乏，应多摄入含维生素B6丰富的食物，如肉类、水果、蔬菜、谷类食物，都含有一定量的维生素B6。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 12,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 3,
+ "end_idx": 19,
+ "type": "dis",
+ "entity": "维生素B6缺乏"
+ },
+ {
+ "start_idx": 26,
+ "end_idx": 35,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 69,
+ "end_idx": 78,
+ "type": "dru",
+ "entity": "维生素B6"
+ }
+ ]
+ },
+ {
+ "text": "（三）维生素B6治疗【维生素B6依赖症】（一）维生素B6依赖性惊厥这种疾病可能由于在神经系统中，PLP与谷氨酸脱氨酶的辅基酶蛋白不能合成，使γ-氨基丁酸（GABA）合成减少，GABA是中枢神经系统抑制性神经递质，其脑内浓度降低，造成惊厥阈降低。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "维生素B6依赖症"
+ },
+ {
+ "start_idx": 43,
+ "end_idx": 62,
+ "type": "dis",
+ "entity": "维生素B6依赖性惊厥"
+ },
+ {
+ "start_idx": 72,
+ "end_idx": 75,
+ "type": "bod",
+ "entity": "神经系统"
+ },
+ {
+ "start_idx": 78,
+ "end_idx": 80,
+ "type": "dru",
+ "entity": "PLP"
+ },
+ {
+ "start_idx": 82,
+ "end_idx": 87,
+ "type": "dru",
+ "entity": "谷氨酸脱氨酶"
+ },
+ {
+ "start_idx": 89,
+ "end_idx": 93,
+ "type": "dru",
+ "entity": "辅基酶蛋白"
+ },
+ {
+ "start_idx": 100,
+ "end_idx": 105,
+ "type": "dru",
+ "entity": "γ-氨基丁酸"
+ },
+ {
+ "start_idx": 107,
+ "end_idx": 110,
+ "type": "dru",
+ "entity": "GABA"
+ },
+ {
+ "start_idx": 117,
+ "end_idx": 120,
+ "type": "dru",
+ "entity": "GABA"
+ },
+ {
+ "start_idx": 122,
+ "end_idx": 127,
+ "type": "bod",
+ "entity": "中枢神经系统"
+ },
+ {
+ "start_idx": 131,
+ "end_idx": 134,
+ "type": "bod",
+ "entity": "神经递质"
+ },
+ {
+ "start_idx": 137,
+ "end_idx": 137,
+ "type": "bod",
+ "entity": "脑"
+ }
+ ]
+ },
+ {
+ "text": "多发生于出生数小时～3个月的婴儿，出现反复惊厥，抗癫痫药物治疗无效，静脉注射维生素B6后可缓解，通常使用维生素B65～10mg静脉注射，维持剂量为10～25mgd，该病治疗需维持终身。",
+ "entities": [
+ {
+ "start_idx": 21,
+ "end_idx": 22,
+ "type": "sym",
+ "entity": "惊厥"
+ },
+ {
+ "start_idx": 24,
+ "end_idx": 28,
+ "type": "dru",
+ "entity": "抗癫痫药物"
+ },
+ {
+ "start_idx": 34,
+ "end_idx": 37,
+ "type": "pro",
+ "entity": "静脉注射"
+ },
+ {
+ "start_idx": 38,
+ "end_idx": 47,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 62,
+ "end_idx": 71,
+ "type": "dru",
+ "entity": "维生素B6"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 86,
+ "type": "pro",
+ "entity": "静脉注射"
+ }
+ ]
+ },
+ {
+ "text": "如患儿出生后不积极予以治疗，可能出现智力低下。",
+ "entities": [
+ {
+ "start_idx": 18,
+ "end_idx": 21,
+ "type": "sym",
+ "entity": "智力低下"
+ }
+ ]
+ },
+ {
+ "text": "（二）维生素B6依赖性小细胞低色素性贫血（三）高胱氨酸尿症患儿表现为智力低下、骨骼畸形、肌肉发育不良，其中80%患儿伴有视力障碍，30%患儿有类似Marfan综合征的心脏病。",
+ "entities": [
+ {
+ "start_idx": 3,
+ "end_idx": 29,
+ "type": "dis",
+ "entity": "维生素B6依赖性小细胞低色素性贫血"
+ },
+ {
+ "start_idx": 33,
+ "end_idx": 38,
+ "type": "dis",
+ "entity": "高胱氨酸尿症"
+ },
+ {
+ "start_idx": 44,
+ "end_idx": 47,
+ "type": "sym",
+ "entity": "智力低下"
+ },
+ {
+ "start_idx": 49,
+ "end_idx": 52,
+ "type": "sym",
+ "entity": "骨骼畸形"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 55,
+ "type": "bod",
+ "entity": "肌肉"
+ },
+ {
+ "start_idx": 54,
+ "end_idx": 59,
+ "type": "sym",
+ "entity": "肌肉发育不良"
+ },
+ {
+ "start_idx": 70,
+ "end_idx": 73,
+ "type": "sym",
+ "entity": "视力障碍"
+ },
+ {
+ "start_idx": 83,
+ "end_idx": 91,
+ "type": "dis",
+ "entity": "Marfan综合征"
+ }
+ ]
+ },
+ {
+ "text": "部分病例给予大剂量维生素B6治疗，高胱氨酸尿消失，但也有部分病例无效。",
+ "entities": [
+ {
+ "start_idx": 9,
+ "end_idx": 18,
+ "type": "dru",
+ "entity": "维生素B