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【疾病状态评估标准和影响预后因素】通常在治疗42～60天时需要评估肿瘤对治疗的反应，以评介治疗的有效性，并根据疗效反应对治疗方案作适当的修正。 | [
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疗效评介标准包括：①完全缓解（CR）：CT、骨扫描、脑脊液、及体检均未发现残留肿瘤迹象，骨髓涂片＜5%幼淋巴细胞、或经病理活检证实残留病灶无肿瘤细胞，并维持1个月以上；②部分缓解（PR）：肿瘤缩小＞50%，但未达CR，无新发或重新进展病灶，骨髓涂片＜5%幼淋巴细胞、脑脊液必须无肿瘤细胞，并维持在1个月以上；③好转：所有可检测病灶减少＜50%，无新发病灶或重新进展；④进展：原有疾病状态基础上的进展。 | [
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影响NHL预后的主要因素是初诊时肿瘤的负荷，LDH水平超过正常值2倍、存在中枢浸润和/或骨髓转移时提示肿瘤负荷高，预后相对不良，需要更强烈的治疗。 | [
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肿瘤对治疗早期的反应也常预示着预后，治疗反应不佳，治疗42～60天未能获得完全缓解者预后不良。 | [
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但影像学水平残留病灶并不一定代表残留病灶内存在活性肿瘤细胞，部分病例残留灶内及仅为坏死组织、纤维组织等非肿瘤性成分，因此有必要进行再次病理活检，以明确残留灶内是否存在肿瘤细胞，对后续治疗方案的确定十分重要，以避免过度治疗和治疗不足。 | [
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第三篇不同年龄儿童的生长发育特点第一章儿童生长发育特点连续不断的生长发育是小儿时期特有的生理现象，生长是由于细胞数量和大小的增加，引起个体体积增大的形态学改变，为“量”的变化。 | [
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发育则为细胞、组织、器官功能的成熟，为“质”的变化。 | [
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在生长发育中，经常联系到成熟（maturity）的概念，这是指机体的整体和局部，系统或器官在形态上、功能上逐渐达到正常成人的水平。 | [
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第一节体格生长特点（一）生长是一个连续过程生长是一个连续过程，但并不匀速，各年龄的生长速率各不相同，年龄越小，生长速率越快。 | [
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在整个生长期有两个生长高峰，一是婴儿期，到第一年末体重增加到出生体重的3倍，身长则增加到1.5倍。 | [
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（二）身体各系统和各部分生长不平衡身体各系统的生长发育先后和快慢各不相同，如神经系统发育较早，生长速度快，大脑在出生时约重390g，1岁时已达900g，8岁时已接近成人重量。 | [
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淋巴系统则先快后回缩，生殖系统发育最晚，皮下脂肪在年幼时发育较快，肌肉组织到学龄期才发育加速。 | [
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身体各部分的生长也各不相同，在整个生长期头部增长了1倍、躯干增长了2倍、上肢增长了3倍、下肢则增长了4倍。 | [
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从一个头大、四肢相对短小下肢修长、头部较小的成人体形。 | [
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五、呼吸功呼吸运动过程中，气道压力的变化使肺容积产生相应的变化。 | [
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呼吸功（WOB）=压力变化（△P）×容积变化（△V）。 | [
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呼吸功主要用于克服气道黏性阻力，组织弹性阻力，肺泡表面张力所做的功。 | [
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呼吸功主要是指吸气时。 | [
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足月新生儿呼吸功=1500g•cm/min。 | [
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肺顺应性降低（如肺表面活性物质缺乏）和胸廓顺应性降低（如肥胖）均可增加弹性功。 | [
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气道阻力增加（如哮喘），使克服气道的黏性阻力功上升。 | [
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第四节先天性巨结肠【发病率】先天性巨结肠（Hirschsprung’sdisease，HD）是一种比较常见的小儿消化道畸形，国外统计发病率为1/5000，其中男孩占70%～80%。 | [
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有一份报道描述了4个家族中的22例受累同胞，其中大多为长段型神经节细胞缺乏症。 | [
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患有神经节细胞缺乏症的母亲比患该病的父亲更易将此病传给子女，如果父母均患有全结肠神经节细胞缺乏症，则子女患病率为12.5%。 | [
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【病因】虽然早在1888年HaraldHirschsprung就首次详尽描述了先天性巨结肠这一疾病，且至今论述其病理生理改变的文章已有500多篇，但病因仍不明确。 | [
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目前比较一致的观点是位于10号染色体的RET基因（常染色体显性）、位于13号染色体的内皮素受体B基因（常染色体隐性）以及位于20号染色体的内皮素3（EDN3）基因（常染色体隐性）与巨结肠的发生有关。 | [
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然而，HD所具有的高散发性特征，同一受累家族中在神经节细胞缺乏症的类型及性别上的差异，均提示HD相关基因可能不止一个，而是多基因的复杂遗传模式。 | [
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常染色体不完全显性遗传可能与长段型神经节细胞缺乏症有关，而常染色体隐性或多基因遗传则是短段型HD的遗传方式。 | [
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现已发现，50%的家族性病例和10%～20%的散发病例具有RET酪氨酸酶受体基因突变，但仍不能完全证实遗传缺陷是导致神经嵴细胞增生缺陷和神经节细胞分布异常的根本原因，也就是说，至今仍无法明确巨结肠的病因。 | [
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【病理生理学】HD病理生理学的基础包括肠神经节细胞发育不良、神经节细胞缺乏或无神经节细胞，导致肠蠕动不良、肛门内括约肌不能松弛或松弛困难。 | [
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但必须指出，HD患儿神经支配异常仅仅是一种定量概念。 | [
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（一）蠕动反射肠蠕动是由位于肠腔内容团块上方的环肌收缩，而位于下端的肠段反射性松弛，以及肠管纵形肌同时收缩并向远端传递所构成。 | [
{
"id": 0,
"entity": "肠",
"start_offset": 7,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "肠腔",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "环肌",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "肠段",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
},
{
"id": 4,
"entity": "肠管纵形肌",
"start_offset": 44,
"end_offset": 49,
"label": "bod"
}
] |
该神经反射由肠管扩张和肠平滑肌中的起搏细胞同步去极化激发，胆碱能神经元将电冲动传至位于黏液下和肌间神经丛中的中间神经元。 | [
{
"id": 0,
"entity": "肠管",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "肠平滑肌",
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"label": "bod"
},
{
"id": 2,
"entity": "起搏细胞",
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"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "胆碱能",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "神经元",
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"end_offset": 35,
"label": "bod"
},
{
"id": 5,
"entity": "黏液",
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"end_offset": 45,
"label": "bod"
},
{
"id": 6,
"entity": "肌间神经丛",
"start_offset": 47,
"end_offset": 52,
"label": "bod"
},
{
"id": 7,
"entity": "中间神经元",
"start_offset": 54,
"end_offset": 59,
"label": "bod"
}
] |
该中间神经元是一种非肾上腺素能非胆碱能神经元，通过ATP、血管活性肠肽（VIP）和NO来直接抑制平滑肌细胞。 | [
{
"id": 0,
"entity": "中间神经元",
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"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "非肾上腺素能非胆碱能神经元",
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"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "ATP",
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"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "血管活性肠肽",
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"label": "bod"
},
{
"id": 4,
"entity": "VIP",
"start_offset": 36,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "NO",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
},
{
"id": 6,
"entity": "平滑肌细胞",
"start_offset": 48,
"end_offset": 53,
"label": "bod"
}
] |
每个肠壁神经丛的神经节含4～6个神经细胞，同时接受胆碱能和肾上腺素能神经支配，而肠壁外神经信号通过肾上腺素能纤维支配的血管实行调节作用，肾上腺素调节胆碱能突触释放乙酰胆胺。 | [
{
"id": 0,
"entity": "肠壁神经丛的神经节",
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"end_offset": 11,
"label": "bod"
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{
"id": 1,
"entity": "神经细胞",
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{
"id": 2,
"entity": "胆碱能和肾上腺素能神经",
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"end_offset": 36,
"label": "bod"
},
{
"id": 3,
"entity": "支配",
"start_offset": 36,
"end_offset": 38,
"label": "dis"
},
{
"id": 4,
"entity": "肾上腺素能纤维",
"start_offset": 49,
"end_offset": 56,
"label": "bod"
},
{
"id": 5,
"entity": "支配",
"start_offset": 56,
"end_offset": 58,
"label": "dis"
},
{
"id": 6,
"entity": "血管",
"start_offset": 59,
"end_offset": 61,
"label": "bod"
},
{
"id": 7,
"entity": "肾上腺素",
"start_offset": 68,
"end_offset": 72,
"label": "bod"
},
{
"id": 8,
"entity": "胆碱能",
"start_offset": 74,
"end_offset": 77,
"label": "bod"
},
{
"id": 9,
"entity": "乙酰胆胺",
"start_offset": 81,
"end_offset": 85,
"label": "bod"
}
] |
除了以上提到的神经纤维、黏液下和肌间神经丛，星形胶质细胞似乎也有相当重要的肠道肌肉调节作用。 | [
{
"id": 0,
"entity": "神经纤维",
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"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "黏液",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "肌间神经丛",
"start_offset": 16,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "星形胶质细胞",
"start_offset": 22,
"end_offset": 28,
"label": "bod"
},
{
"id": 4,
"entity": "肠道肌肉",
"start_offset": 37,
"end_offset": 41,
"label": "bod"
}
] |
最近有报道NO是介导胃肠道平滑肌松弛的一种神经传导介质，与NADPN-黄递酶相同，可作为HD的诊断标志物。 | [
{
"id": 0,
"entity": "NO",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "胃肠道平滑肌",
"start_offset": 10,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "NADPN-黄递酶",
"start_offset": 29,
"end_offset": 38,
"label": "bod"
},
{
"id": 3,
"entity": "HD",
"start_offset": 44,
"end_offset": 46,
"label": "dis"
}
] |
缺乏合成NO的神经元可能是无神经节细胞肠段无法松弛的原因。 | [
{
"id": 0,
"entity": "NO",
"start_offset": 4,
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{
"id": 1,
"entity": "神经元",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
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{
"id": 2,
"entity": "神经节细胞肠段",
"start_offset": 14,
"end_offset": 21,
"label": "bod"
}
] |
贮存神经肽如VIP、P物质、脑啡肽、神经激肽A、组胺、异亮氨酸及胃泌素释放肽等的神经元也参与蠕动反射，在HD及相关肠神经性疾病患者中已发现该神经元的缺乏或发育异常。 | [
{
"id": 0,
"entity": "VIP",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "P物质",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "脑啡肽",
"start_offset": 14,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "神经激肽A",
"start_offset": 18,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "组胺",
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"end_offset": 26,
"label": "bod"
},
{
"id": 5,
"entity": "异亮氨酸",
"start_offset": 27,
"end_offset": 31,
"label": "bod"
},
{
"id": 6,
"entity": "胃泌素释放肽",
"start_offset": 32,
"end_offset": 38,
"label": "bod"
},
{
"id": 7,
"entity": "神经元",
"start_offset": 40,
"end_offset": 43,
"label": "bod"
},
{
"id": 8,
"entity": "HD",
"start_offset": 52,
"end_offset": 54,
"label": "dis"
},
{
"id": 9,
"entity": "肠神经性疾病",
"start_offset": 57,
"end_offset": 63,
"label": "dis"
},
{
"id": 10,
"entity": "神经元",
"start_offset": 70,
"end_offset": 73,
"label": "bod"
}
] |
（二）肛门内括约肌内括约肌松弛类似于蠕动反射，开始排便时，位于粪团下方肠段松弛，肛管开放。 | [
{
"id": 0,
"entity": "肛门内括约肌",
"start_offset": 3,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "肠段",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
}
] |
该反射存在即提示机体具有正常的神经传递，可排除HD。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
}
] |
调节肛门内括约肌的四种神经机制包括：1.α-肾上腺素能神经，主要存在于下腹下神经节及其纤维内，通过α受体维持括约肌的兴奋节律。 | [
{
"id": 0,
"entity": "肛门内括约肌",
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"label": "bod"
},
{
"id": 1,
"entity": "α-肾上腺素能神经",
"start_offset": 20,
"end_offset": 29,
"label": "bod"
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{
"id": 2,
"entity": "下腹下神经节",
"start_offset": 35,
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"label": "bod"
},
{
"id": 3,
"entity": "α受体",
"start_offset": 49,
"end_offset": 52,
"label": "bod"
}
] |
2.β-肾上腺素能抑制性受体，松弛平滑肌。 | [
{
"id": 0,
"entity": "β-肾上腺素能",
"start_offset": 2,
"end_offset": 9,
"label": "bod"
}
] |
3.胆碱能神经元，对括约肌作用尚不清楚。 | [
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"entity": "胆碱能",
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{
"id": 1,
"entity": "神经元",
"start_offset": 5,
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"label": "bod"
}
] |
4.非肾上腺素能非胆碱能神经元（NANC-中间神经元），通过NO、VIP和其他神经肽能神经元，松弛内括约肌。 | [
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"id": 0,
"entity": "非肾上腺素能非胆碱能神经元",
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{
"id": 1,
"entity": "NANC-中间神经元",
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"label": "bod"
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{
"id": 2,
"entity": "NO",
"start_offset": 30,
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"label": "bod"
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{
"id": 3,
"entity": "VIP",
"start_offset": 33,
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},
{
"id": 4,
"entity": "神经肽能神经元",
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"label": "bod"
},
{
"id": 5,
"entity": "松弛内括约肌",
"start_offset": 47,
"end_offset": 53,
"label": "bod"
}
] |
肠神经系统发育异常如胆碱能神经节缺乏、NANC-中间神经元缺乏、各种神经肽能纤维缺乏和可能存在的肠壁结缔组织缺乏是HD肠功能异常的原因。 | [
{
"id": 0,
"entity": "肠神经系统发育异常",
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"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "胆碱能神经节缺乏",
"start_offset": 10,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "NANC-中间神经元缺乏",
"start_offset": 19,
"end_offset": 31,
"label": "dis"
},
{
"id": 3,
"entity": "各种神经肽能纤维缺乏",
"start_offset": 32,
"end_offset": 42,
"label": "dis"
},
{
"id": 4,
"entity": "可能存在的肠壁结缔组织缺乏",
"start_offset": 43,
"end_offset": 56,
"label": "dis"
},
{
"id": 5,
"entity": "HD肠功能异常",
"start_offset": 57,
"end_offset": 64,
"label": "dis"
}
] |
骶副交感神经丛发出的胆碱能纤维进入肠壁，直接作用于平滑肌细胞，使之产生同步收缩，神经末梢释放的乙酰胆碱由等量乙酰胆碱酯酶灭活，这也就是乙酰胆碱酯酶染色这一诊断HD有效方法的基本原理。 | [
{
"id": 0,
"entity": "骶副交感神经丛",
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{
"id": 1,
"entity": "胆碱能纤维",
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"label": "bod"
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{
"id": 2,
"entity": "肠壁",
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"label": "bod"
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{
"id": 3,
"entity": "平滑肌细胞",
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},
{
"id": 4,
"entity": "神经末梢",
"start_offset": 40,
"end_offset": 44,
"label": "bod"
},
{
"id": 5,
"entity": "乙酰胆碱",
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"end_offset": 51,
"label": "bod"
},
{
"id": 6,
"entity": "乙酰胆碱酯酶",
"start_offset": 54,
"end_offset": 60,
"label": "bod"
},
{
"id": 7,
"entity": "乙酰胆碱酯酶",
"start_offset": 67,
"end_offset": 73,
"label": "bod"
},
{
"id": 8,
"entity": "染色",
"start_offset": 73,
"end_offset": 75,
"label": "pro"
},
{
"id": 9,
"entity": "HD",
"start_offset": 79,
"end_offset": 81,
"label": "dis"
}
] |
但活检组织乙酰胆碱酯酶染色有10%误诊率，尤其是长段型HD。 | [
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{
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] |
由于缺乏NANC中间神经元和NO，无神经节细胞肠段持续收缩、不能松弛，但该肠管本身固有弹性产生的一些不协调的肠蠕动，一定程度上仍可使排便成为可能，这也是某些HD患者较晚才被确诊的原因。 | [
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"id": 0,
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{
"id": 1,
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{
"id": 3,
"entity": "不能松弛",
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{
"id": 4,
"entity": "肠管本身固有弹性产生的一些不协调的肠蠕动",
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"label": "sym"
},
{
"id": 5,
"entity": "HD",
"start_offset": 78,
"end_offset": 80,
"label": "dis"
}
] |
存在神经细胞黏附分子减少和NADPH-黄递酶活性下降的神经节细胞减少症和肠神经发育不良症，之所以具有相似临床表现，亦因为此。 | [
{
"id": 0,
"entity": "神经细胞黏附分子减少",
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"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "NADPH-黄递酶活性下降",
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"end_offset": 26,
"label": "sym"
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{
"id": 2,
"entity": "神经节细胞减少症",
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},
{
"id": 3,
"entity": "肠神经发育不良症",
"start_offset": 36,
"end_offset": 44,
"label": "dis"
}
] |
此外，直接作用于平滑肌细胞的兴奋性α-受体的肾上腺素能神经纤维正常，也使肛门内括约肌处于持续痉挛状态，不能舒张。 | [
{
"id": 0,
"entity": "平滑肌细胞",
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"end_offset": 13,
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},
{
"id": 1,
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{
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},
{
"id": 3,
"entity": "神经纤维",
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},
{
"id": 4,
"entity": "肛门内括约肌",
"start_offset": 36,
"end_offset": 42,
"label": "bod"
}
] |
（三）神经节细胞减少症在HD无神经节细胞肠段的近端，通常存在一神经节细胞减少区域。 | [
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"id": 0,
"entity": "神经节细胞减少症",
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{
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{
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{
"id": 3,
"entity": "肠段",
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{
"id": 4,
"entity": "一神经节细胞减少区域",
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"label": "sym"
}
] |
而神经节细胞减少症也可独立发病，肠壁神经节细胞数量和神经纤维密度显著减少，乙酰胆碱酯酶染色多为阴性。 | [
{
"id": 0,
"entity": "神经节细胞减少症",
"start_offset": 1,
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"label": "dis"
},
{
"id": 1,
"entity": "肠壁神经节细胞数量和神经纤维密度显著减少",
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},
{
"id": 2,
"entity": "乙酰胆碱酯酶",
"start_offset": 37,
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"label": "ite"
},
{
"id": 3,
"entity": "染色",
"start_offset": 43,
"end_offset": 45,
"label": "pro"
}
] |
肠肌间神经丛内的神经细胞数少于正常的50%，神经节间距为正常的2倍，神经节平均面积较正常小3倍。 | [
{
"id": 0,
"entity": "肠肌间神经丛内的神经细胞数少于正常的50%",
"start_offset": 0,
"end_offset": 21,
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},
{
"id": 1,
"entity": "神经节间距为正常的2倍",
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"label": "sym"
},
{
"id": 2,
"entity": "神经节平均面积较正常小3倍",
"start_offset": 34,
"end_offset": 47,
"label": "sym"
}
] |
单纯神经节细胞减少症与HD、肠神经发育不良（IND）伴发神经节细胞减少的组化检查相同。 | [
{
"id": 0,
"entity": "单纯神经节细胞减少症与HD、肠神经发育不良（IND）伴发神经节细胞减少的组化检查相同",
"start_offset": 0,
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] |
神经节细胞减少症通常仅累及一小段结肠，但偶可累及全部肠段。 | [
{
"id": 0,
"entity": "神经节细胞减少症",
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{
"id": 1,
"entity": "结肠",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "肠段",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
}
] |
因此，术中冷冻活检中发现少量神经节细胞并不能证明肠段神经发育或功能正常。 | [
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"id": 0,
"entity": "冷冻活检",
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{
"id": 1,
"entity": "少量神经节细胞",
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"end_offset": 19,
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}
] |
神经节细胞减少症往往存在肛门内括约肌松弛功能不全或缺如。 | [
{
"id": 0,
"entity": "神经节细胞减少症",
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{
"id": 1,
"entity": "肛门内括约肌松弛功能不全",
"start_offset": 12,
"end_offset": 24,
"label": "dis"
}
] |
（四）神经节细胞不成熟LDH染色可发现未成熟的单极小神经节细胞，胞浆内不含脱氧酶，因此不能与Schwann细胞区分。 | [
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"id": 0,
"entity": "神经节细胞",
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"end_offset": 8,
"label": "ite"
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{
"id": 1,
"entity": "LDH染色",
"start_offset": 11,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "单极小神经节细胞",
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},
{
"id": 3,
"entity": "胞浆内不含脱氧酶",
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"end_offset": 40,
"label": "sym"
},
{
"id": 4,
"entity": "Schwann细胞",
"start_offset": 46,
"end_offset": 55,
"label": "bod"
}
] |
琥珀酸脱氢酶（SDH）反应可测定神经节细胞成熟度，正常新生儿生后一周内琥珀酸脱氢酶活性较低；而神经节细胞完全成熟需2～4年。 | [
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"id": 0,
"entity": "琥珀酸脱氢酶",
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{
"id": 1,
"entity": "SDH",
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{
"id": 2,
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{
"id": 3,
"entity": "琥珀酸脱氢酶",
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},
{
"id": 4,
"entity": "神经节细胞",
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"end_offset": 52,
"label": "bod"
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] |
IND或神经节细胞减少症患儿肠段内均可见不成熟神经节细胞。 | [
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"id": 0,
"entity": "IND",
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{
"id": 1,
"entity": "神经节细胞减少症",
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"label": "dis"
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{
"id": 2,
"entity": "可见不成熟神经节细胞",
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"label": "sym"
}
] |
神经节细胞减少症和神经节发育不成熟统称神经节发育不全。 | [
{
"id": 0,
"entity": "神经节细胞减少症",
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{
"id": 1,
"entity": "神经节发育不成熟",
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},
{
"id": 2,
"entity": "神经节发育不全",
"start_offset": 19,
"end_offset": 26,
"label": "dis"
}
] |
（五）肠神经发育不良（IND）与神经节细胞缺乏症和神经节细胞减少症相同，肠肌间丛神经节细胞发育不良既可并发于典型HD，亦可独立发生，导致肠梗阻，可分为以支配血管的肾上腺素能神经异常为特征的A型，以及以黏液下神经丛受累为主的B型。 | [
{
"id": 0,
"entity": "肠神经发育不良",
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"end_offset": 10,
"label": "dis"
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{
"id": 1,
"entity": "IND",
"start_offset": 11,
"end_offset": 14,
"label": "dis"
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{
"id": 2,
"entity": "神经节细胞缺乏症",
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"label": "dis"
},
{
"id": 3,
"entity": "神经节细胞减少症",
"start_offset": 25,
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"label": "dis"
},
{
"id": 4,
"entity": "肠肌间丛神经节细胞发育不良",
"start_offset": 36,
"end_offset": 49,
"label": "dis"
},
{
"id": 5,
"entity": "HD",
"start_offset": 56,
"end_offset": 58,
"label": "dis"
},
{
"id": 6,
"entity": "肠梗阻",
"start_offset": 68,
"end_offset": 71,
"label": "dis"
},
{
"id": 7,
"entity": "黏液下神经丛受累为主",
"start_offset": 100,
"end_offset": 110,
"label": "sym"
}
] |
肠壁内发现LDH染色阳性的巨大神经节是B型IND的诊断依据，多为7～10个，偶尔可达16个。 | [
{
"id": 0,
"entity": "肠壁",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "LDH染色",
"start_offset": 5,
"end_offset": 10,
"label": "ite"
},
{
"id": 2,
"entity": "巨大神经节",
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"label": "bod"
},
{
"id": 3,
"entity": "IND",
"start_offset": 21,
"end_offset": 24,
"label": "dis"
}
] |
这些巨大神经节占所见全部神经节的60%，可呈异常的树芽状，并有串珠样神经纤维，一般不累及直肠远端。 | [
{
"id": 0,
"entity": "巨大神经节",
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{
"id": 1,
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{
"id": 2,
"entity": "神经纤维",
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"label": "bod"
},
{
"id": 3,
"entity": "直肠远端",
"start_offset": 44,
"end_offset": 48,
"label": "bod"
}
] |
此外，黏液肌层与固有层常可发现异位神经细胞或神经节。 | [
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"id": 0,
"entity": "黏液肌层",
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{
"id": 1,
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},
{
"id": 2,
"entity": "神经节",
"start_offset": 22,
"end_offset": 25,
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}
] |
权威认定必须观察连续40张切片的LDH反应，其中30%～55%切片黏液下层无神经节，1/4切片有巨大神经节，且至少要观察到4个巨大神经节才能确诊。 | [
{
"id": 0,
"entity": "黏液",
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{
"id": 1,
"entity": "神经节",
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"label": "bod"
},
{
"id": 2,
"entity": "巨大神经节",
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"label": "bod"
},
{
"id": 3,
"entity": "巨大神经节",
"start_offset": 63,
"end_offset": 68,
"label": "bod"
}
] |
但是，至今仍无统一标准，因而给IND的诊断带来了困难。 | [
{
"id": 0,
"entity": "IND",
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}
] |
4岁以上患儿IND往往与神经节细胞减少症、肌间神经丛发育不良和异位相伴发。 | [
{
"id": 0,
"entity": "患儿IND",
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{
"id": 1,
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{
"id": 2,
"entity": "肌间神经丛发育不良和异位",
"start_offset": 21,
"end_offset": 33,
"label": "dis"
}
] |
对肛门闭锁患儿的研究显示，先天性肠梗阻部位近端亦存在IND，表现为神经肌肉肥大。 | [
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"entity": "肛门闭锁",
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{
"id": 1,
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{
"id": 2,
"entity": "IND",
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},
{
"id": 3,
"entity": "神经肌肉肥大",
"start_offset": 33,
"end_offset": 39,
"label": "sym"
}
] |
A型罕见，仅占肠神经异常疾病的2%，特点是肠肌间神经丛、动脉血管和黏液肾上腺素能神经缺乏或发育不成熟。 | [
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"id": 0,
"entity": "肠神经异常",
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"label": "dis"
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{
"id": 1,
"entity": "肠肌间神经丛、动脉血管和黏液肾上腺素能神经缺乏或发育不成熟",
"start_offset": 21,
"end_offset": 50,
"label": "sym"
}
] |
（六）结肠结缔组织病近年来认为结肠结缔组织病是导致神经节细胞异位的原因之一，表现为肠管肌层的结缔组织完全或部分缺损，导致肠道蠕动功能受损。 | [
{
"id": 0,
"entity": "结肠结缔组织病",
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"label": "dis"
},
{
"id": 1,
"entity": "结肠结缔组织病",
"start_offset": 15,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "神经节细胞",
"start_offset": 25,
"end_offset": 30,
"label": "ite"
},
{
"id": 3,
"entity": "肠管",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
},
{
"id": 4,
"entity": "结缔组织",
"start_offset": 46,
"end_offset": 50,
"label": "bod"
},
{
"id": 5,
"entity": "肠道蠕动功能受损",
"start_offset": 60,
"end_offset": 68,
"label": "sym"
}
] |
（七）获得性神经节细胞损害获得性无神经节细胞症和神经节细胞减少症的原因可分为血管性或非血管性：非血管性疾病包括美洲锥虫病（Chagasdisease，恰加斯病）、维生素B1</sub>缺乏症以及慢性感染（如结核病等）。 | [
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"id": 0,
"entity": "获得性神经节细胞损害",
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"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "获得性无神经节细胞症",
"start_offset": 13,
"end_offset": 23,
"label": "dis"
},
{
"id": 2,
"entity": "神经节细胞减少症",
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"end_offset": 32,
"label": "dis"
},
{
"id": 3,
"entity": "非血管性疾病",
"start_offset": 47,
"end_offset": 53,
"label": "dis"
},
{
"id": 4,
"entity": "美洲锥虫病",
"start_offset": 55,
"end_offset": 60,
"label": "dis"
},
{
"id": 5,
"entity": "Chagasdisease",
"start_offset": 61,
"end_offset": 74,
"label": "dis"
},
{
"id": 6,
"entity": "恰加斯病",
"start_offset": 75,
"end_offset": 79,
"label": "dis"
},
{
"id": 7,
"entity": "维生素B1</sub>缺乏症",
"start_offset": 81,
"end_offset": 95,
"label": "dis"
},
{
"id": 8,
"entity": "慢性感染",
"start_offset": 97,
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"label": "dis"
},
{
"id": 9,
"entity": "结核病",
"start_offset": 103,
"end_offset": 106,
"label": "dis"
}
] |
缺血性神经节细胞损害可由于拖出肠段血供不足引起，如HD根治术拖出肠段有张力，动静脉血管受牵拉，或肠系膜血管受损等。 | [
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"id": 0,
"entity": "缺血性神经节细胞损害",
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"end_offset": 10,
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{
"id": 1,
"entity": "肠段血供不足引起",
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"label": "sym"
},
{
"id": 2,
"entity": "HD",
"start_offset": 25,
"end_offset": 27,
"label": "dis"
},
{
"id": 3,
"entity": "肠段",
"start_offset": 32,
"end_offset": 34,
"label": "bod"
},
{
"id": 4,
"entity": "肠段有张力",
"start_offset": 32,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "动静脉血管受牵拉",
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"end_offset": 46,
"label": "sym"
},
{
"id": 6,
"entity": "肠系膜血管受损",
"start_offset": 48,
"end_offset": 55,
"label": "sym"
}
] |
Swenson、Duhame和Soave手术均需拖出结肠，因此，术中注意保护血供相当重要。 | [
{
"id": 0,
"entity": "Swenson",
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},
{
"id": 1,
"entity": "Duhame",
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"end_offset": 14,
"label": "pro"
},
{
"id": 2,
"entity": "Soave手术",
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"end_offset": 22,
"label": "pro"
},
{
"id": 3,
"entity": "结肠",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
}
] |
【伴发畸形】11%～30%的HD患儿有伴发畸形。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
}
] |
但对HD患儿进行临床遗传学筛查则发现伴发畸形可高达48%。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 2,
"end_offset": 4,
"label": "dis"
}
] |
对一组203例患儿调查发现其中11%有相关家族史，35%有伴发畸形，其中泌尿生殖道（11%）最为常见，其次为心血管系统（6%）和胃肠道系统（6%）畸形，另有8%为其他系统，包括白内障、四肢残疾或脑组织缺损等；HD患儿中10%为早产儿。 | [
{
"id": 0,
"entity": "畸形",
"start_offset": 31,
"end_offset": 33,
"label": "dis"
},
{
"id": 1,
"entity": "心血管系统（6%）和胃肠道系统（6%）畸形",
"start_offset": 54,
"end_offset": 75,
"label": "dis"
},
{
"id": 2,
"entity": "白内障",
"start_offset": 88,
"end_offset": 91,
"label": "dis"
},
{
"id": 3,
"entity": "四肢残疾",
"start_offset": 92,
"end_offset": 96,
"label": "dis"
},
{
"id": 4,
"entity": "脑组织缺损",
"start_offset": 97,
"end_offset": 102,
"label": "dis"
},
{
"id": 5,
"entity": "HD",
"start_offset": 104,
"end_offset": 106,
"label": "dis"
}
] |
HD患者还可能因直肠扩张压迫膀胱颈，导致膀胱颈梗阻、膀胱增大，引起排尿异常。 | [
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"id": 0,
"entity": "HD",
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},
{
"id": 1,
"entity": "直肠",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "膀胱颈",
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"label": "bod"
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{
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"entity": "膀胱颈梗阻",
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},
{
"id": 4,
"entity": "膀胱增大",
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"label": "sym"
},
{
"id": 5,
"entity": "排尿异常",
"start_offset": 33,
"end_offset": 37,
"label": "sym"
}
] |
患儿的膀胱功能类似于脊髓损伤患者，术后可能仍需导尿。 | [
{
"id": 0,
"entity": "脊髓损伤",
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"label": "dis"
},
{
"id": 1,
"entity": "导尿",
"start_offset": 23,
"end_offset": 25,
"label": "pro"
}
] |
正常人群心血管异常的发生率为0.5%～1%，而HD患者为2%～8%，主要与部分患者伴发Down综合征，常有心内膜垫发育异常有关。 | [
{
"id": 0,
"entity": "心血管异常",
"start_offset": 4,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "HD",
"start_offset": 23,
"end_offset": 25,
"label": "dis"
},
{
"id": 2,
"entity": "Down综合征",
"start_offset": 43,
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"label": "dis"
},
{
"id": 3,
"entity": "心内膜垫",
"start_offset": 53,
"end_offset": 57,
"label": "bod"
}
] |
HD患者眼发育异常发生率为12%，包括小眼畸形和无眼畸形。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "小眼畸形",
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"label": "dis"
},
{
"id": 2,
"entity": "无眼畸形",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
}
] |
（一）21-三体综合征（Down综合征）据报道3%的HD患儿患有Down综合征，是正常人群发病率的4倍。 | [
{
"id": 0,
"entity": "21-三体综合征",
"start_offset": 3,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "Down综合征",
"start_offset": 12,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "HD",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
}
] |
而Down综合征患儿也可因甲状腺功能减退、肌无力或精神发育迟缓导致便秘，给鉴别带来困难。 | [
{
"id": 0,
"entity": "Down综合征",
"start_offset": 1,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "甲状腺功能减退",
"start_offset": 13,
"end_offset": 20,
"label": "sym"
},
{
"id": 2,
"entity": "肌无力",
"start_offset": 21,
"end_offset": 24,
"label": "sym"
},
{
"id": 3,
"entity": "精神发育迟缓",
"start_offset": 25,
"end_offset": 31,
"label": "sym"
},
{
"id": 4,
"entity": "便秘",
"start_offset": 33,
"end_offset": 35,
"label": "sym"
}
] |
（二）瓦登伯格（Waardenburg）和其他综合征胃肠道交感神经节起源于神经外胚层细胞，神经嵴细胞从神经管迁徙至胃肠道形成肠神经系统（ENS），以来自第4、5体节的为主；位于第3体节尾端的神经嵴则发育为结肠ENS。 | [
{
"id": 0,
"entity": "瓦登伯格",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "Waardenburg",
"start_offset": 8,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "胃肠道交感神经节",
"start_offset": 26,
"end_offset": 34,
"label": "bod"
},
{
"id": 3,
"entity": "神经外胚层细胞",
"start_offset": 37,
"end_offset": 44,
"label": "bod"
},
{
"id": 4,
"entity": "神经嵴细胞",
"start_offset": 45,
"end_offset": 50,
"label": "bod"
},
{
"id": 5,
"entity": "神经管",
"start_offset": 51,
"end_offset": 54,
"label": "bod"
},
{
"id": 6,
"entity": "胃肠道",
"start_offset": 57,
"end_offset": 60,
"label": "bod"
},
{
"id": 7,
"entity": "肠神经系统",
"start_offset": 62,
"end_offset": 67,
"label": "bod"
},
{
"id": 8,
"entity": "ENS",
"start_offset": 68,
"end_offset": 71,
"label": "bod"
},
{
"id": 9,
"entity": "神经嵴",
"start_offset": 95,
"end_offset": 98,
"label": "bod"
},
{
"id": 10,
"entity": "结肠ENS",
"start_offset": 102,
"end_offset": 107,
"label": "bod"
}
] |
研究表明，ENS前体可能沿腹外侧途径迁徙，而由菱脑神经嵴至第3体节尾端来源的细胞则经背外侧途径迁徙至咽弓。 | [
{
"id": 0,
"entity": "ENS",
"start_offset": 5,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "菱脑神经嵴",
"start_offset": 23,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "第3体节尾端来源的细胞",
"start_offset": 29,
"end_offset": 40,
"label": "bod"
}
] |
当神经嵴细胞迁徙至胃肠道时，在肠道组织发出信号的指引下，在适当的时间与部位停止迁徙，开始形成神经节。 | [
{
"id": 0,
"entity": "神经嵴细胞",
"start_offset": 1,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "胃肠道",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "肠道组织",
"start_offset": 15,
"end_offset": 19,
"label": "bod"
},
{
"id": 3,
"entity": "神经节",
"start_offset": 46,
"end_offset": 49,
"label": "bod"
}
] |
存在于黏液肌层、浆膜上皮与肠道平滑肌层内的层粘连蛋白可能即是此类信号之一，属于细胞外基质分子。 | [
{
"id": 0,
"entity": "黏液肌层",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "浆膜上皮",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "肠道平滑肌层内的层粘连蛋白",
"start_offset": 13,
"end_offset": 26,
"label": "bod"
},
{
"id": 3,
"entity": "细胞外基质分子",
"start_offset": 39,
"end_offset": 46,
"label": "bod"
}
] |
当神经嵴细胞迁徙至肠道时即获得层粘连蛋白受体，并与层粘连蛋白相互作用，决定神经嵴细胞的停留位置，但究竟如何指导形成神经节细胞，机制尚未明了。 | [
{
"id": 0,
"entity": "神经嵴细胞",
"start_offset": 1,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "肠道",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "层粘连蛋白受体",
"start_offset": 15,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "层粘连蛋白",
"start_offset": 25,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "神经嵴细胞",
"start_offset": 37,
"end_offset": 42,
"label": "bod"
},
{
"id": 5,
"entity": "神经节细胞",
"start_offset": 57,
"end_offset": 62,
"label": "ite"
}
] |
Waardenburg综合征患者几乎所有的神经嵴细胞均形成黑素细胞，因此临床特征表现为色素沉着异常，此外还有内耳失听及面部发育异常。 | [
{
"id": 0,
"entity": "Waardenburg综合征",
"start_offset": 0,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "神经嵴细胞",
"start_offset": 21,
"end_offset": 26,
"label": "bod"
},
{
"id": 2,
"entity": "黑素细胞",
"start_offset": 29,
"end_offset": 33,
"label": "bod"
},
{
"id": 3,
"entity": "色素沉着异常",
"start_offset": 43,
"end_offset": 49,
"label": "sym"
},
{
"id": 4,
"entity": "内耳失听",
"start_offset": 54,
"end_offset": 58,
"label": "sym"
},
{
"id": 5,
"entity": "面部发育异常",
"start_offset": 59,
"end_offset": 65,
"label": "sym"
}
] |
Shah-Waardenburg综合征是伴发HD的一型Waardenburg综合征，主要由SOX10基因突变所致，可能属于常染色体显性遗传。 | [
{
"id": 0,
"entity": "Shah-Waardenburg综合征",
"start_offset": 0,
"end_offset": 19,
"label": "dis"
},
{
"id": 1,
"entity": "HD",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "Waardenburg综合征",
"start_offset": 27,
"end_offset": 41,
"label": "dis"
},
{
"id": 3,
"entity": "SOX10基因",
"start_offset": 45,
"end_offset": 52,
"label": "bod"
},
{
"id": 4,
"entity": "常染色体显性遗传",
"start_offset": 61,
"end_offset": 69,
"label": "sym"
}
] |
（三）肠道伴发畸形HD、神经节细胞缺乏症及IND也可伴有先天性小肠或结肠闭锁、胎粪性腹膜炎或无肛等。 | [
{
"id": 0,
"entity": "肠道伴发畸形HD",
"start_offset": 3,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "神经节细胞缺乏症",
"start_offset": 12,
"end_offset": 20,
"label": "dis"
},
{
"id": 2,
"entity": "IND",
"start_offset": 21,
"end_offset": 24,
"label": "dis"
},
{
"id": 3,
"entity": "先天性小肠",
"start_offset": 28,
"end_offset": 33,
"label": "dis"
},
{
"id": 4,
"entity": "结肠闭锁",
"start_offset": 34,
"end_offset": 38,
"label": "dis"
},
{
"id": 5,
"entity": "胎粪性腹膜炎",
"start_offset": 39,
"end_offset": 45,
"label": "dis"
},
{
"id": 6,
"entity": "无肛",
"start_offset": 46,
"end_offset": 48,
"label": "dis"
}
] |
一组伴有小肠闭锁的19例HD患者，其中5例为神经节细胞减少症，2例为IND。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 12,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "神经节细胞减少症",
"start_offset": 22,
"end_offset": 30,
"label": "dis"
}
] |
52例肛门直肠畸形患者中，一半以上存在ENS异常，9例直肠活体组织检查标本为无神经节细胞症，11例为神经节细胞减少症，4例为B型IND，3例为神经节发育不良，仅2例患者（4%）的瘘管和直肠标本的神经支配正常。 | [
{
"id": 0,
"entity": "肛门直肠畸形",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "ENS异常",
"start_offset": 19,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "直肠活体组织检查",
"start_offset": 27,
"end_offset": 35,
"label": "pro"
},
{
"id": 3,
"entity": "神经节细胞症",
"start_offset": 39,
"end_offset": 45,
"label": "dis"
},
{
"id": 4,
"entity": "神经节细胞减少症",
"start_offset": 50,
"end_offset": 58,
"label": "dis"
},
{
"id": 5,
"entity": "B型IND",
"start_offset": 62,
"end_offset": 67,
"label": "dis"
},
{
"id": 6,
"entity": "神经节发育不良",
"start_offset": 71,
"end_offset": 78,
"label": "dis"
},
{
"id": 7,
"entity": "瘘管",
"start_offset": 89,
"end_offset": 91,
"label": "bod"
},
{
"id": 8,
"entity": "直肠",
"start_offset": 92,
"end_offset": 94,
"label": "bod"
},
{
"id": 9,
"entity": "神经支配",
"start_offset": 97,
"end_offset": 101,
"label": "dis"
}
] |
【临床表现】便秘是巨结肠最主要的症状，但严重程度存在明显的个体差异。 | [
{
"id": 0,
"entity": "巨结肠",
"start_offset": 9,
"end_offset": 12,
"label": "dis"
}
] |
有些患儿由于腹胀和粪块积聚导致厌食及恶病质等，出现贫血和低蛋白血症，影响生长发育。 | [
{
"id": 0,
"entity": "腹胀",
"start_offset": 6,
"end_offset": 8,
"label": "sym"
},
{
"id": 1,
"entity": "粪块积聚",
"start_offset": 9,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "厌食及恶病质",
"start_offset": 15,
"end_offset": 21,
"label": "sym"
},
{
"id": 3,
"entity": "贫血",
"start_offset": 25,
"end_offset": 27,
"label": "dis"
},
{
"id": 4,
"entity": "低蛋白血症",
"start_offset": 28,
"end_offset": 33,
"label": "dis"
}
] |
生后3个月以内诊断为HD的患儿，约1/3常有腹泻，可能与小肠结肠炎有关。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "小肠结肠炎",
"start_offset": 28,
"end_offset": 33,
"label": "dis"
}
] |
由于至今尚无HD相关小肠结肠炎的确切定义，有人认为单纯腹泻即是较轻度的小肠结肠炎，而另一些作者则认为只有出现黏液溃疡和败血症才能称之为小肠结肠炎。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 6,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "小肠结肠炎",
"start_offset": 10,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "腹泻",
"start_offset": 27,
"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "小肠结肠炎",
"start_offset": 35,
"end_offset": 40,
"label": "dis"
},
{
"id": 4,
"entity": "黏液溃疡",
"start_offset": 54,
"end_offset": 58,
"label": "dis"
},
{
"id": 5,
"entity": "败血症",
"start_offset": 59,
"end_offset": 62,
"label": "dis"
},
{
"id": 6,
"entity": "小肠结肠炎",
"start_offset": 67,
"end_offset": 72,
"label": "dis"
}
] |
HD患者小肠结肠炎的发生率为12%～58%。 | [
{
"id": 0,
"entity": "HD",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "小肠结肠炎",
"start_offset": 4,
"end_offset": 9,
"label": "dis"
}
] |
相关的发病机制有多种假说，如粪便积聚致黏液缺血和细菌侵入与移位、黏蛋白成分变化和黏液防御机制丧失、小肠神经内分泌细胞数量改变、前列腺素E1</sub>活性增高和难辨梭状芽孢杆菌或轮状病毒感染等。 | [
{
"id": 0,
"entity": "细菌",
"start_offset": 24,
"end_offset": 26,
"label": "mic"
},
{
"id": 1,
"entity": "黏蛋白",
"start_offset": 32,
"end_offset": 35,
"label": "bod"
},
{
"id": 2,
"entity": "黏液",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
},
{
"id": 3,
"entity": "小肠神经内分泌细胞",
"start_offset": 49,
"end_offset": 58,
"label": "bod"
},
{
"id": 4,
"entity": "前列腺素E1",
"start_offset": 63,
"end_offset": 69,
"label": "bod"
},
{
"id": 5,
"entity": "难辨梭状芽孢杆菌",
"start_offset": 80,
"end_offset": 88,
"label": "bod"
},
{
"id": 6,
"entity": "轮状病毒感染",
"start_offset": 89,
"end_offset": 95,
"label": "bod"
}
] |
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