text stringlengths 4 4.87k | entities list |
|---|---|
20.全面性癫痫伴热性惊厥附加症为常染色体显性遗传方式，是一多个基因受累（致病基因包括SCN1B、SCN1A、SCN2A和GABAG2）的单基因遗传癫痫。 | [
{
"id": 0,
"entity": "全面性癫痫伴热性惊厥附加症",
"start_offset": 3,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "单基因遗传癫痫",
"start_offset": 69,
"end_offset": 76,
"label": "dis"
}
] |
家族成员中存在热性惊厥或多种发作形式，如热性惊厥附加症、失神发作、肌阵挛发作以及部分性发作等，每个受累者可以有一种或多种发作形式。 | [
{
"id": 0,
"entity": "热性惊厥附加症",
"start_offset": 20,
"end_offset": 27,
"label": "sym"
},
{
"id": 1,
"entity": "失神发作",
"start_offset": 28,
"end_offset": 32,
"label": "sym"
},
{
"id": 2,
"entity": "肌阵挛发作",
"start_offset": 33,
"end_offset": 38,
"label": "sym"
}
] |
21.边缘叶癫痫和新皮层癫痫内侧颞叶癫痫为边缘叶癫痫，外侧颞叶癫痫、额叶癫痫、顶叶癫痫以及枕叶癫痫属于新皮层癫痫。 | [
{
"id": 0,
"entity": "边缘叶癫痫",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "新皮层癫痫",
"start_offset": 9,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "内侧颞叶癫痫",
"start_offset": 14,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "边缘叶癫痫",
"start_offset": 21,
"end_offset": 26,
"label": "dis"
},
{
"id": 4,
"entity": "外侧颞叶癫痫",
"start_offset": 27,
"end_offset": 33,
"label": "dis"
},
{
"id": 5,
"entity": "额叶癫痫",
"start_offset": 34,
"end_offset": 38,
"label": "dis"
},
{
"id": 6,
"entity": "顶叶癫痫",
"start_offset": 39,
"end_offset": 43,
"label": "dis"
},
{
"id": 7,
"entity": "枕叶癫痫",
"start_offset": 45,
"end_offset": 49,
"label": "dis"
},
{
"id": 8,
"entity": "新皮层癫痫",
"start_offset": 51,
"end_offset": 56,
"label": "dis"
}
] |
（四）癫痫持续状态是指癫痫发作持续30分钟以上，或反复发作，且发作间期意识不能恢复。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 3,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "癫痫",
"start_offset": 11,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "反复发作",
"start_offset": 25,
"end_offset": 29,
"label": "sym"
},
{
"id": 3,
"entity": "发作间期意识不能恢复",
"start_offset": 31,
"end_offset": 41,
"label": "sym"
}
] |
1.惊厥性癫痫持续状态是指阵发性或连续强直和（或）阵挛运动性发作，意识不恢复者，伴有两侧性脑电图的痫性放电，持续时间超过30分钟。 | [
{
"id": 0,
"entity": "惊厥性癫痫",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "阵发性或连续强直",
"start_offset": 13,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "阵挛运动性发作",
"start_offset": 25,
"end_offset": 32,
"label": "sym"
}
] |
全身性惊厥持续状态往往是儿科急诊，全面性强直-阵挛性发作、阵挛性发作、强直性发作以及肌阵挛发作均可持续癫痫持续状态；部分性惊厥发作也可呈局灶性惊厥癫痫持续状态。 | [
{
"id": 0,
"entity": "儿科",
"start_offset": 12,
"end_offset": 14,
"label": "dep"
},
{
"id": 1,
"entity": "全面性强直-阵挛性发作",
"start_offset": 17,
"end_offset": 28,
"label": "sym"
},
{
"id": 2,
"entity": "阵挛性发作",
"start_offset": 29,
"end_offset": 34,
"label": "sym"
},
{
"id": 3,
"entity": "强直性发作",
"start_offset": 35,
"end_offset": 40,
"label": "sym"
},
{
"id": 4,
"entity": "肌阵挛发作",
"start_offset": 42,
"end_offset": 47,
"label": "sym"
},
{
"id": 5,
"entity": "局灶性惊厥癫痫持续状态",
"start_offset": 68,
"end_offset": 79,
"label": "sym"
}
] |
2.非惊厥性癫痫持续状态是指持续发作的不同程度意识障碍、认知与行为异常，不伴有惊厥发生的脑功能障碍，伴有脑电图监护异常，行为异常、脑电图监护异常，持续时间大于30分钟者。 | [
{
"id": 0,
"entity": "非惊厥性癫痫",
"start_offset": 2,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "行为异常",
"start_offset": 60,
"end_offset": 64,
"label": "sym"
},
{
"id": 2,
"entity": "脑电图监护",
"start_offset": 65,
"end_offset": 70,
"label": "pro"
}
] |
非惊厥性癫痫持续状态主要包括典型失神性癫痫状态、非典型失神癫痫状态或精神运动性癫痫状态，可由全身性与部分性发作发展而来，其共同的特点为意识模糊、精神错乱及行为的改变，发作期EEG脑电背景活动变慢，同时伴有痫性放电，而发作间期EEG脑电活动增快。 | [
{
"id": 0,
"entity": "非惊厥性癫痫",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "典型失神性癫痫",
"start_offset": 14,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "非典型失神癫痫",
"start_offset": 24,
"end_offset": 31,
"label": "dis"
},
{
"id": 3,
"entity": "精神运动性癫痫",
"start_offset": 34,
"end_offset": 41,
"label": "dis"
},
{
"id": 4,
"entity": "意识模糊",
"start_offset": 67,
"end_offset": 71,
"label": "sym"
},
{
"id": 5,
"entity": "精神错乱",
"start_offset": 72,
"end_offset": 76,
"label": "sym"
},
{
"id": 6,
"entity": "行为的改变",
"start_offset": 77,
"end_offset": 82,
"label": "sym"
},
{
"id": 7,
"entity": "EEG",
"start_offset": 86,
"end_offset": 89,
"label": "pro"
},
{
"id": 8,
"entity": "脑电背景活动变慢",
"start_offset": 89,
"end_offset": 97,
"label": "sym"
},
{
"id": 9,
"entity": "痫性放电",
"start_offset": 102,
"end_offset": 106,
"label": "sym"
},
{
"id": 10,
"entity": "EEG",
"start_offset": 112,
"end_offset": 115,
"label": "pro"
},
{
"id": 11,
"entity": "脑电活动增快",
"start_offset": 115,
"end_offset": 121,
"label": "sym"
}
] |
非惊厥性癫痫状态可导致永久性认知和记忆功能障碍。 | [
{
"id": 0,
"entity": "永久性认知",
"start_offset": 11,
"end_offset": 16,
"label": "sym"
},
{
"id": 1,
"entity": "记忆功能障碍",
"start_offset": 17,
"end_offset": 23,
"label": "sym"
}
] |
此外，对反复发作性症状的患儿，还应根据临床及脑电图检查鉴别其他非癫痫发作的疾病，如屏气发作、睡眠障碍、晕厥、习惯性阴部摩擦、多发性抽动以及心因性发作等。 | [
{
"id": 0,
"entity": "屏气发作",
"start_offset": 41,
"end_offset": 45,
"label": "sym"
},
{
"id": 1,
"entity": "睡眠障碍",
"start_offset": 46,
"end_offset": 50,
"label": "sym"
},
{
"id": 2,
"entity": "晕厥",
"start_offset": 51,
"end_offset": 53,
"label": "sym"
},
{
"id": 3,
"entity": "习惯性阴部摩擦",
"start_offset": 54,
"end_offset": 61,
"label": "sym"
},
{
"id": 4,
"entity": "多发性抽动",
"start_offset": 62,
"end_offset": 67,
"label": "sym"
},
{
"id": 5,
"entity": "心因性发作",
"start_offset": 69,
"end_offset": 74,
"label": "sym"
}
] |
（一）临床资料癫痫的诊断主要结合病史，临床表现各种形式的发作，具突然发生、反复发作以及自行缓解的特点。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
}
] |
（二）脑电图检查EEG检查对癫痫的诊断和分类有很大价值，可出现各种阵发性活动，如尖波、棘波、尖慢波、棘慢波、多棘波以及多棘慢波等。 | [
{
"id": 0,
"entity": "脑电图检查",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "EEG检查",
"start_offset": 8,
"end_offset": 13,
"label": "pro"
}
] |
一般常规脑电图阳性率接近50%左右；加上过度换气、闪光刺激及睡眠脑电图诱发试验可提高20%阳性率；一些多功能脑电图描记仪，Hoter脑电图仪，视屏智能化脑电图监测仪，观察与临床同步的痫性放电，使之阳性率提高至85%以上。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 4,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "脑电图描记仪",
"start_offset": 54,
"end_offset": 60,
"label": "equ"
},
{
"id": 2,
"entity": "Hoter脑电图仪",
"start_offset": 61,
"end_offset": 70,
"label": "equ"
},
{
"id": 3,
"entity": "视屏智能化脑电图监测仪",
"start_offset": 71,
"end_offset": 82,
"label": "equ"
}
] |
做脑电图时注意，原服的抗癫痫药物不需停用，以免诱发癫痫发作；脑电图阴性也不能完全排除癫痫，但仅有脑电图的痫样放电而无临床发作不能诊断为癫痫。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 30,
"end_offset": 33,
"label": "pro"
},
{
"id": 1,
"entity": "脑电图",
"start_offset": 48,
"end_offset": 51,
"label": "pro"
}
] |
（三）辅助检查各种实验室检查或神经影像学检查帮助寻找癫痫的病因和评价预后。 | [
{
"id": 0,
"entity": "实验室检查",
"start_offset": 9,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "神经影像学检查",
"start_offset": 15,
"end_offset": 22,
"label": "pro"
}
] |
（四）神经系统功能评价在儿童癫痫的诊断中还应关注神经系统其他方面异常的诊断及全身各系统并发疾病的诊断。 | [
{
"id": 0,
"entity": "儿童癫痫",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
}
] |
【治疗】癫痫的治疗目的是控制癫痫发作，提高患儿生活质量。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 4,
"end_offset": 6,
"label": "dis"
}
] |
癫痫的综合治疗包括药物治疗（以抗癫痫药物治疗为主）和非药物治疗（预防危险因素、心理治疗、外科治疗、酮源性饮食治疗及病因治疗等）。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "药物治疗",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "抗癫痫药物",
"start_offset": 15,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "非药物治疗",
"start_offset": 26,
"end_offset": 31,
"label": "pro"
},
{
"id": 4,
"entity": "预防危险因素",
"start_offset": 32,
"end_offset": 38,
"label": "pro"
},
{
"id": 5,
"entity": "心理治疗",
"start_offset": 39,
"end_offset": 43,
"label": "pro"
},
{
"id": 6,
"entity": "外科治疗",
"start_offset": 44,
"end_offset": 48,
"label": "pro"
},
{
"id": 7,
"entity": "酮源性饮食治疗",
"start_offset": 49,
"end_offset": 56,
"label": "pro"
},
{
"id": 8,
"entity": "病因治疗",
"start_offset": 57,
"end_offset": 61,
"label": "pro"
}
] |
2.根据发作类型选药药物选择目前主要根据癫痫的发作类型或癫痫综合征的类型选药，不合适的选药甚或加重癫痫发作（表16-16）。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 20,
"end_offset": 22,
"label": "dis"
},
{
"id": 1,
"entity": "癫痫综合征",
"start_offset": 28,
"end_offset": 33,
"label": "dis"
}
] |
3.提倡单药治疗尽量采用单一的抗癫痫药物，80%病例单药治疗满意，剂量从小至大，达到有效治疗剂量，特别是卡马西平、氯硝西泮、扑痫酮及新的抗癫痫药拉莫三嗪、妥吡酯等，可减少不良反应。 | [
{
"id": 0,
"entity": "卡马西平",
"start_offset": 52,
"end_offset": 56,
"label": "dru"
},
{
"id": 1,
"entity": "氯硝西泮",
"start_offset": 57,
"end_offset": 61,
"label": "dru"
},
{
"id": 2,
"entity": "扑痫酮",
"start_offset": 62,
"end_offset": 65,
"label": "dru"
},
{
"id": 3,
"entity": "拉莫三嗪",
"start_offset": 72,
"end_offset": 76,
"label": "dru"
},
{
"id": 4,
"entity": "妥吡酯",
"start_offset": 77,
"end_offset": 80,
"label": "dru"
}
] |
联合用药注意药物间相互作用，如肝酶诱导剂有苯妥英钠、卡马西平、苯巴比妥以及扑痫酮；肝酶抑制剂有丙戊酸钠，联合用药或从合用方案中撤除某一药物可引起错综复杂的血药浓度的变化，了解药物之间相互作用对指导癫痫治疗以及调整药物剂量甚为重要。 | [
{
"id": 0,
"entity": "苯妥英钠",
"start_offset": 21,
"end_offset": 25,
"label": "dru"
},
{
"id": 1,
"entity": "卡马西平",
"start_offset": 26,
"end_offset": 30,
"label": "dru"
},
{
"id": 2,
"entity": "苯巴比妥",
"start_offset": 31,
"end_offset": 35,
"label": "dru"
},
{
"id": 3,
"entity": "扑痫酮",
"start_offset": 37,
"end_offset": 40,
"label": "dru"
},
{
"id": 4,
"entity": "丙戊酸钠",
"start_offset": 47,
"end_offset": 51,
"label": "dru"
}
] |
有待评估；*</sup>首选用药7.疗程要长，停药要慢一般停止发作后需继续服用3～4年，脑电图监测正常后，经过1～2年逐渐减药至停药。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 44,
"end_offset": 47,
"label": "pro"
}
] |
当然不同病因、不同发作类型的癫痫服药疗程则不相同：失神发作控制后1～2年；新生儿癫痫控制后1/2年；脑炎、脑外伤继发癫痫，发作停止后1年；复杂部分性、失张力性发作或器质性病变引起全身性大发作者3～4年。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
}
] |
（二）预防复发寻找患者癫痫的病因和诱发因素，应避免各种诱发因素，如感染、外伤、过度兴奋、睡眠剥夺以及有害的感光刺激等，减少癫痫复发的几率。 | [
{
"id": 0,
"entity": "感染",
"start_offset": 33,
"end_offset": 35,
"label": "sym"
},
{
"id": 1,
"entity": "外伤",
"start_offset": 36,
"end_offset": 38,
"label": "sym"
},
{
"id": 2,
"entity": "过度兴奋",
"start_offset": 39,
"end_offset": 43,
"label": "sym"
},
{
"id": 3,
"entity": "睡眠剥夺",
"start_offset": 44,
"end_offset": 48,
"label": "sym"
},
{
"id": 4,
"entity": "有害的感光刺激",
"start_offset": 50,
"end_offset": 57,
"label": "sym"
}
] |
（三）外科治疗其适应证主要是长期药物治疗无效的难治性癫痫以及症状性部分性癫痫。 | [
{
"id": 0,
"entity": "癫痫",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
}
] |
掌握手术的适应证并进行术前各种检查如脑电图、硬膜下脑电图、SPECT及PET明确异常的部位，癫痫的起源；头部CT及MRI明确脑部结构改变；特别是新进开展的FMRI和IAP检查既可判断病灶的位置，还可确定脑部重要的皮层功能，对于手术的选择很有帮助。 | [
{
"id": 0,
"entity": "脑电图",
"start_offset": 18,
"end_offset": 21,
"label": "pro"
},
{
"id": 1,
"entity": "硬膜下脑电图",
"start_offset": 22,
"end_offset": 28,
"label": "pro"
},
{
"id": 2,
"entity": "SPECT",
"start_offset": 29,
"end_offset": 34,
"label": "pro"
},
{
"id": 3,
"entity": "PET",
"start_offset": 35,
"end_offset": 38,
"label": "pro"
},
{
"id": 4,
"entity": "头部CT",
"start_offset": 52,
"end_offset": 56,
"label": "pro"
},
{
"id": 5,
"entity": "MRI",
"start_offset": 57,
"end_offset": 60,
"label": "pro"
},
{
"id": 6,
"entity": "FMRI",
"start_offset": 77,
"end_offset": 81,
"label": "pro"
},
{
"id": 7,
"entity": "IAP",
"start_offset": 82,
"end_offset": 85,
"label": "pro"
},
{
"id": 8,
"entity": "脑部",
"start_offset": 101,
"end_offset": 103,
"label": "bod"
}
] |
至于手术种类常见有大脑半球切除术、皮层切除术、胼胝体切除术、立体定向手术及颞叶切除术等，以达到切除病灶或阻断癫痫放电通路。 | [
{
"id": 0,
"entity": "大脑半球切除术",
"start_offset": 9,
"end_offset": 16,
"label": "pro"
},
{
"id": 1,
"entity": "皮层切除术",
"start_offset": 17,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "胼胝体切除术",
"start_offset": 23,
"end_offset": 29,
"label": "pro"
},
{
"id": 3,
"entity": "立体定向手术",
"start_offset": 30,
"end_offset": 36,
"label": "pro"
},
{
"id": 4,
"entity": "颞叶切除术",
"start_offset": 37,
"end_offset": 42,
"label": "pro"
}
] |
（四）癫痫持续状态治疗惊厥性癫痫持续状态急救治疗见下章（小儿惊厥），是防治的重点；非惊厥性癫痫持续状态虽不会导致危及生命的全身并发症，但临床仍应积极处理，可用氯硝西泮等治疗。 | [
{
"id": 0,
"entity": "氯硝西泮",
"start_offset": 79,
"end_offset": 83,
"label": "dru"
}
] |
钙离子拮抗剂（尼莫地平和氟桂利嗪）可以抑制钙离子内流，保护受损神经细胞，同时可预防血管痉挛及防治其引起的脑局部缺血缺氧；辅以使用自由基清除剂及维生素E，具有稳定细胞膜作用；根据癫痫的神经免疫损伤机制，有人主张静脉注射丙种球蛋白添加治疗婴儿痉挛与Lennox-Gastaut综合征［0.4g/（kg•d）×5天/疗程］取得一定疗效。 | [
{
"id": 0,
"entity": "钙离子拮抗剂",
"start_offset": 0,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "尼莫地平",
"start_offset": 7,
"end_offset": 11,
"label": "dru"
},
{
"id": 2,
"entity": "氟桂利嗪",
"start_offset": 12,
"end_offset": 16,
"label": "dru"
},
{
"id": 3,
"entity": "自由基清除剂",
"start_offset": 64,
"end_offset": 70,
"label": "dru"
},
{
"id": 4,
"entity": "维生素E",
"start_offset": 71,
"end_offset": 75,
"label": "dru"
},
{
"id": 5,
"entity": "静脉注射",
"start_offset": 104,
"end_offset": 108,
"label": "pro"
},
{
"id": 6,
"entity": "丙种球蛋白",
"start_offset": 108,
"end_offset": 113,
"label": "dru"
},
{
"id": 7,
"entity": "婴儿痉挛",
"start_offset": 117,
"end_offset": 121,
"label": "dis"
},
{
"id": 8,
"entity": "Lennox-Gastaut综合征",
"start_offset": 122,
"end_offset": 139,
"label": "dis"
}
] |
②此外，部分癫痫患儿伴有不同程度的脑损害，对癫痫小儿发育迟缓、心理障碍、行为异常及学习教育研究已成为日渐关注的问题。 | [
{
"id": 0,
"entity": "小儿发育迟缓",
"start_offset": 24,
"end_offset": 30,
"label": "sym"
},
{
"id": 1,
"entity": "心理障碍",
"start_offset": 31,
"end_offset": 35,
"label": "sym"
},
{
"id": 2,
"entity": "行为异常",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
}
] |
第三章甲状腺功能亢进症【概述】甲状腺功能亢进症（hyperthyroidism，甲亢）是指由于甲状腺激素分泌过多所致的临床综合征，常伴有甲状腺肿大、眼球外突及基础代谢率增高等表现。 | [
{
"id": 0,
"entity": "甲状腺功能亢进症",
"start_offset": 3,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "甲状腺功能亢进症",
"start_offset": 15,
"end_offset": 23,
"label": "dis"
},
{
"id": 2,
"entity": "hyperthyroidism",
"start_offset": 24,
"end_offset": 39,
"label": "dis"
},
{
"id": 3,
"entity": "甲亢",
"start_offset": 40,
"end_offset": 42,
"label": "dis"
},
{
"id": 4,
"entity": "甲状腺激素分泌过多",
"start_offset": 47,
"end_offset": 56,
"label": "sym"
},
{
"id": 5,
"entity": "甲状腺肿大、眼球外突及基础代谢率增高",
"start_offset": 68,
"end_offset": 86,
"label": "sym"
}
] |
患有Graves病孕妇的胎儿约有2%在出生后会呈现甲亢症状，这是由于母体内高浓度的促甲状腺素受体刺激性抗体经胎盘进入胎儿所致，新生儿甲亢通常在生后3个月左右逐渐缓解。 | [
{
"id": 0,
"entity": "Graves病",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "甲亢",
"start_offset": 25,
"end_offset": 27,
"label": "dis"
},
{
"id": 2,
"entity": "促甲状腺素受体刺激性抗体",
"start_offset": 41,
"end_offset": 53,
"label": "ite"
},
{
"id": 3,
"entity": "胎盘",
"start_offset": 54,
"end_offset": 56,
"label": "bod"
},
{
"id": 4,
"entity": "新生儿甲亢",
"start_offset": 63,
"end_offset": 68,
"label": "dis"
}
] |
【流行病学】根据一项20年回顾性统计，甲亢在成年女性中的发病率约1∶1000/年。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
}
] |
15岁以下儿童甲亢约占总甲亢发生率5%，多见于青少年。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "甲亢",
"start_offset": 12,
"end_offset": 14,
"label": "dis"
}
] |
【病理生理和发病机制】弥漫性毒性甲状腺肿是一种自身免疫性疾病，约15%患者亲属中患有同样疾病，近半数亲属中呈现抗甲状腺抗体阳性。 | [
{
"id": 0,
"entity": "弥漫性毒性甲状腺肿",
"start_offset": 11,
"end_offset": 20,
"label": "dis"
},
{
"id": 1,
"entity": "自身免疫性疾病",
"start_offset": 23,
"end_offset": 30,
"label": "dis"
},
{
"id": 2,
"entity": "抗甲状腺抗体阳性",
"start_offset": 55,
"end_offset": 63,
"label": "sym"
}
] |
患者及其亲属HLA的某些类型的等位基因分布频率增高。 | [
{
"id": 0,
"entity": "HLA",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "等位基因",
"start_offset": 15,
"end_offset": 19,
"label": "bod"
}
] |
国内外资料都已证实本病与HLA-Ⅱ类抗原的某些等位基因类型及自身免疫有关。 | [
{
"id": 0,
"entity": "HLA-Ⅱ类抗原",
"start_offset": 12,
"end_offset": 20,
"label": "bod"
},
{
"id": 1,
"entity": "等位基因",
"start_offset": 23,
"end_offset": 27,
"label": "bod"
}
] |
在白种人中，Graves病与HLA-B8和HLA-DR3有关，后者发生甲亢的危险增加7倍。 | [
{
"id": 0,
"entity": "Graves病",
"start_offset": 6,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "HLA-B8",
"start_offset": 14,
"end_offset": 20,
"label": "bod"
},
{
"id": 2,
"entity": "HLA-DR3",
"start_offset": 21,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "甲亢",
"start_offset": 35,
"end_offset": 37,
"label": "dis"
}
] |
该病还可并发其他与之相关的疾病，例如Addison病、重症肌无力、1型糖尿病、全身性红斑狼疮、类风湿性关节炎、白癜风、特发性血小板减少性紫癜和恶性贫血等。 | [
{
"id": 0,
"entity": "Addison病",
"start_offset": 18,
"end_offset": 26,
"label": "dis"
},
{
"id": 1,
"entity": "重症肌无力",
"start_offset": 27,
"end_offset": 32,
"label": "dis"
},
{
"id": 2,
"entity": "1型糖尿病",
"start_offset": 33,
"end_offset": 38,
"label": "dis"
},
{
"id": 3,
"entity": "全身性红斑狼疮",
"start_offset": 39,
"end_offset": 46,
"label": "dis"
},
{
"id": 4,
"entity": "类风湿性关节炎",
"start_offset": 47,
"end_offset": 54,
"label": "dis"
},
{
"id": 5,
"entity": "白癜风",
"start_offset": 55,
"end_offset": 58,
"label": "dis"
},
{
"id": 6,
"entity": "特发性血小板减少性紫癜",
"start_offset": 59,
"end_offset": 70,
"label": "dis"
},
{
"id": 7,
"entity": "恶性贫血",
"start_offset": 71,
"end_offset": 75,
"label": "dis"
}
] |
患者的甲状腺功能状态与甲状腺自身抗体关系密切，可在体内测到多种甲状腺自身抗体。 | [
{
"id": 0,
"entity": "甲状腺",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "甲状腺自身抗体",
"start_offset": 11,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "甲状腺自身抗体",
"start_offset": 31,
"end_offset": 38,
"label": "bod"
}
] |
据报道，80%～100%的患者可测到TSH受体抗体，此抗体为甲状腺刺激免疫球蛋白，能产生刺激甲状腺功能作用，使甲状腺对碘的摄取增加，cAMP介导的甲状腺激素合成和甲状腺球蛋白合成增加，促进蛋白质合成与细胞生长。 | [
{
"id": 0,
"entity": "TSH受体抗体",
"start_offset": 18,
"end_offset": 25,
"label": "bod"
},
{
"id": 1,
"entity": "抗体",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 2,
"entity": "甲状腺刺激免疫球蛋白",
"start_offset": 30,
"end_offset": 40,
"label": "bod"
},
{
"id": 3,
"entity": "甲状腺",
"start_offset": 46,
"end_offset": 49,
"label": "bod"
},
{
"id": 4,
"entity": "使甲状腺对碘的摄取增加",
"start_offset": 54,
"end_offset": 65,
"label": "sym"
},
{
"id": 5,
"entity": "cAMP",
"start_offset": 66,
"end_offset": 70,
"label": "bod"
},
{
"id": 6,
"entity": "甲状腺激素",
"start_offset": 73,
"end_offset": 78,
"label": "bod"
},
{
"id": 7,
"entity": "甲状腺球蛋白",
"start_offset": 81,
"end_offset": 87,
"label": "bod"
},
{
"id": 8,
"entity": "促进蛋白质合成与细胞生长",
"start_offset": 92,
"end_offset": 104,
"label": "sym"
}
] |
甲亢经治疗后随着TSH受体阻断抗体的升高，疾病也逐步缓解。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "TSH受体阻断抗体",
"start_offset": 8,
"end_offset": 17,
"label": "ite"
}
] |
在部分甲亢病例中可发现一些其他抗甲状腺的抗体，如甲状腺球蛋白抗体（TGAb）及甲状腺过氧化物酶抗体（TPOAb）。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 3,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "甲状腺",
"start_offset": 16,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "抗体",
"start_offset": 20,
"end_offset": 22,
"label": "dis"
},
{
"id": 3,
"entity": "甲状腺球蛋白抗体",
"start_offset": 24,
"end_offset": 32,
"label": "dis"
},
{
"id": 4,
"entity": "TGAb",
"start_offset": 33,
"end_offset": 37,
"label": "dis"
},
{
"id": 5,
"entity": "甲状腺过氧化物酶抗体",
"start_offset": 39,
"end_offset": 49,
"label": "dis"
},
{
"id": 6,
"entity": "TPOAb",
"start_offset": 50,
"end_offset": 55,
"label": "dis"
}
] |
这些抗体在部分正常人中也可存在，其特异性不如TSH受体抗体。 | [
{
"id": 0,
"entity": "抗体",
"start_offset": 2,
"end_offset": 4,
"label": "dis"
}
] |
【病理】Graves病的甲状腺腺体呈对称性肿大，滤泡细胞增多，由立方形变为柱状，滤泡内胶质丧失或仅少量染色极浅的胶质，在上皮及胶质间有大量排列成行的空泡，血管明显增多，淋巴组织也增多，有大量淋巴细胞浸润。 | [
{
"id": 0,
"entity": "Graves病",
"start_offset": 4,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "甲状腺腺体呈对称性肿大，滤泡细胞增多，由立方形变为柱状，滤泡内胶质丧失或仅少量染色极浅的胶质，在上皮及胶质间有大量排列成行的空泡，血管明显增多，淋巴组织也增多，有大量淋巴细胞浸润",
"start_offset": 12,
"end_offset": 101,
"label": "pro"
}
] |
在电镜下可见滤泡细胞内高尔基体肥大，内浆网和核蛋白体增多，微绒毛数量增多而且变长，呈分泌活跃的表现。 | [
{
"id": 0,
"entity": "电镜",
"start_offset": 1,
"end_offset": 3,
"label": "equ"
},
{
"id": 1,
"entity": "滤泡细胞内高尔基体",
"start_offset": 6,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "内浆网",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "核蛋白体",
"start_offset": 22,
"end_offset": 26,
"label": "bod"
},
{
"id": 4,
"entity": "在电镜下可见滤泡细胞内高尔基体肥大，内浆网和核蛋白体增多，微绒毛数量增多而且变长，呈分泌活跃的表现",
"start_offset": 0,
"end_offset": 49,
"label": "sym"
}
] |
致密的淋巴样集合物内以辅助T细胞（CD4+</sup>）为主，在细胞密度较低的区域内则以细胞毒性T细胞（CD8+</sup>）为主。 | [
{
"id": 0,
"entity": "辅助T细胞",
"start_offset": 11,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "CD4+",
"start_offset": 17,
"end_offset": 21,
"label": "bod"
},
{
"id": 2,
"entity": "细胞密度",
"start_offset": 32,
"end_offset": 36,
"label": "ite"
},
{
"id": 3,
"entity": "细胞毒性T细胞",
"start_offset": 44,
"end_offset": 51,
"label": "bod"
},
{
"id": 4,
"entity": "CD8+",
"start_offset": 52,
"end_offset": 56,
"label": "bod"
}
] |
甲状腺内浸润的活化B淋巴细胞的百分率高于在周围血管中者。 | [
{
"id": 0,
"entity": "甲状腺内",
"start_offset": 0,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "活化B淋巴细胞",
"start_offset": 7,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "血管中",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
}
] |
推测是由于T抑制细胞的功能障碍，使得T辅助细胞得以表达，被TSH抗原所激活，然后与B细胞发生反应。 | [
{
"id": 0,
"entity": "T抑制细胞",
"start_offset": 5,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "T辅助细胞",
"start_offset": 18,
"end_offset": 23,
"label": "bod"
},
{
"id": 2,
"entity": "TSH抗原",
"start_offset": 29,
"end_offset": 34,
"label": "bod"
},
{
"id": 3,
"entity": "B细胞",
"start_offset": 41,
"end_offset": 44,
"label": "bod"
}
] |
这些细胞分化成为浆细胞，产生促甲状腺激素受体刺激抗体。 | [
{
"id": 0,
"entity": "细胞",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "浆细胞",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "促甲状腺激素受体刺激抗体",
"start_offset": 14,
"end_offset": 26,
"label": "bod"
}
] |
目前认为Graves病浸润性突眼发生机制是抗甲状腺抗体和抗眼眶肌肉抗体与眼外肌和眼眶内成纤维细胞结合，产生毒性反应。 | [
{
"id": 0,
"entity": "Graves病",
"start_offset": 4,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "浸润性突眼",
"start_offset": 11,
"end_offset": 16,
"label": "sym"
},
{
"id": 2,
"entity": "抗甲状腺抗体",
"start_offset": 21,
"end_offset": 27,
"label": "bod"
},
{
"id": 3,
"entity": "抗眼眶肌肉抗体",
"start_offset": 28,
"end_offset": 35,
"label": "bod"
},
{
"id": 4,
"entity": "眼外肌",
"start_offset": 36,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "眼眶内成纤维细胞",
"start_offset": 40,
"end_offset": 48,
"label": "bod"
}
] |
亦有人认为浸润性突眼是眼眶肌肉内沉积甲状腺球蛋白-抗甲状腺球蛋白免疫复合物，引起免疫复合物的炎性反应。 | [
{
"id": 0,
"entity": "浸润性突眼",
"start_offset": 5,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "眼眶肌肉内",
"start_offset": 11,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "甲状腺球蛋白-抗甲状腺球蛋白免疫复合物",
"start_offset": 18,
"end_offset": 37,
"label": "bod"
},
{
"id": 3,
"entity": "免疫复合物",
"start_offset": 40,
"end_offset": 45,
"label": "bod"
},
{
"id": 4,
"entity": "炎性反应",
"start_offset": 46,
"end_offset": 50,
"label": "sym"
}
] |
能引起儿童甲状腺功能亢进的其他病因有慢性淋巴性甲状腺炎、亚急性甲状腺炎、甲状腺腺瘤、McCuneAlbright综合征、甲状腺癌、碘过多诱发甲亢、TSH分泌过多、垂体性腺瘤、下丘脑性甲亢以及医源性甲亢等。 | [
{
"id": 0,
"entity": "儿童甲状腺功能亢进",
"start_offset": 3,
"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "慢性淋巴性甲状腺炎",
"start_offset": 18,
"end_offset": 27,
"label": "dis"
},
{
"id": 2,
"entity": "亚急性甲状腺炎",
"start_offset": 28,
"end_offset": 35,
"label": "dis"
},
{
"id": 3,
"entity": "甲状腺腺瘤",
"start_offset": 36,
"end_offset": 41,
"label": "dis"
},
{
"id": 4,
"entity": "McCuneAlbright综合征",
"start_offset": 42,
"end_offset": 59,
"label": "dis"
},
{
"id": 5,
"entity": "甲状腺癌",
"start_offset": 60,
"end_offset": 64,
"label": "dis"
},
{
"id": 6,
"entity": "TSH分泌过多",
"start_offset": 73,
"end_offset": 80,
"label": "dis"
},
{
"id": 7,
"entity": "垂体性腺瘤",
"start_offset": 81,
"end_offset": 86,
"label": "dis"
},
{
"id": 8,
"entity": "下丘脑性甲亢",
"start_offset": 87,
"end_offset": 93,
"label": "dis"
},
{
"id": 9,
"entity": "医源性甲亢",
"start_offset": 95,
"end_offset": 100,
"label": "dis"
}
] |
典型的症状与体征有以下表现：1.交感神经兴奋性增加，基础代谢率增加如消瘦、多汗、怕热、低热及食欲增加，但体重下降，大便次数增多，睡眠障碍和易于疲乏等。 | [
{
"id": 0,
"entity": "交感神经兴奋性增加，基础代谢率增加",
"start_offset": 16,
"end_offset": 33,
"label": "sym"
},
{
"id": 1,
"entity": "消瘦、多汗、怕热、低热及食欲增加，但体重下降，大便次数增多，睡眠障碍和易于疲乏",
"start_offset": 34,
"end_offset": 73,
"label": "sym"
}
] |
因交感神经系统过于兴奋，出现心率加快、脾气急躁，大龄儿童常感到心悸，严重病例可出现心律紊乱，心房颤动。 | [
{
"id": 0,
"entity": "因交感神经系统过于兴奋，出现心率加快、脾气急躁，大龄儿童常感到心悸，严重病例可出现心律紊乱，心房颤动",
"start_offset": 0,
"end_offset": 50,
"label": "sym"
}
] |
两手常有细微而迅速的震颤。 | [
{
"id": 0,
"entity": "两手常有细微而迅速的震颤",
"start_offset": 0,
"end_offset": 12,
"label": "sym"
}
] |
2.所有患儿都有甲状腺肿大肿大程度不一，一般为左右对称，质地柔软，表面光滑，边界清楚，可随吞咽动作上、下移动。 | [
{
"id": 0,
"entity": "甲状腺",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "甲状腺肿大",
"start_offset": 8,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "肿大程度不一，一般为左右对称，质地柔软，表面光滑，边界清楚，可随吞咽动作上、下移动",
"start_offset": 13,
"end_offset": 54,
"label": "sym"
}
] |
在肿大的甲状腺上有时可听到收缩期杂音或者扪及震颤。 | [
{
"id": 0,
"entity": "甲状腺",
"start_offset": 4,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "在肿大的甲状腺上有时可听到收缩期杂音或者扪及震颤",
"start_offset": 0,
"end_offset": 24,
"label": "sym"
}
] |
结节性肿大者可扪及大小不一、质硬、单个或多个结节。 | [
{
"id": 0,
"entity": "结节性肿大者可扪及大小不一、质硬、单个或多个结节",
"start_offset": 0,
"end_offset": 24,
"label": "sym"
}
] |
有时患者表现有颈部不适，压迫感，吞咽困难。 | [
{
"id": 0,
"entity": "颈部",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "有时患者表现有颈部不适，压迫感，吞咽困难",
"start_offset": 0,
"end_offset": 20,
"label": "sym"
}
] |
3.眼部变化是甲亢特有表现，由于眼球突出常作凝视状，不常瞬目，上眼睑挛缩，眼向下看时上眼睑不能随眼球立即下落，上眼睑外翻困难。 | [
{
"id": 0,
"entity": "眼部变化",
"start_offset": 2,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "甲亢",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "眼球",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "上眼睑",
"start_offset": 31,
"end_offset": 34,
"label": "bod"
},
{
"id": 4,
"entity": "上眼睑",
"start_offset": 42,
"end_offset": 45,
"label": "bod"
},
{
"id": 5,
"entity": "眼球",
"start_offset": 48,
"end_offset": 50,
"label": "bod"
},
{
"id": 6,
"entity": "上眼睑",
"start_offset": 55,
"end_offset": 58,
"label": "bod"
},
{
"id": 7,
"entity": "眼球突出常作凝视状，不常瞬目，上眼睑挛缩，眼向下看时上眼睑不能随眼球立即下落，上眼睑外翻困难",
"start_offset": 16,
"end_offset": 62,
"label": "sym"
}
] |
4.其他可有青春期性发育缓慢，月经紊乱，闭经及月经过少等。 | [
{
"id": 0,
"entity": "青春期性发育缓慢，月经紊乱，闭经及月经过少",
"start_offset": 6,
"end_offset": 27,
"label": "sym"
}
] |
【实验室检查】主要测定血清FT3</sub>、FT4</sub>及超敏感TSH浓度。 | [
{
"id": 0,
"entity": "血清FT3",
"start_offset": 11,
"end_offset": 16,
"label": "ite"
},
{
"id": 1,
"entity": "FT4",
"start_offset": 23,
"end_offset": 26,
"label": "ite"
},
{
"id": 2,
"entity": "超敏感TSH浓度",
"start_offset": 33,
"end_offset": 41,
"label": "ite"
}
] |
患者FT4</sub>、FT3</sub>浓度都升高。 | [
{
"id": 0,
"entity": "FT4",
"start_offset": 2,
"end_offset": 5,
"label": "ite"
},
{
"id": 1,
"entity": "FT3",
"start_offset": 12,
"end_offset": 15,
"label": "ite"
}
] |
甲亢疾病初期，临床症状轻微时，常先出现FT3</sub>升高，以后再出现FT4</sub>增高，并出现典型临床症状。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
}
] |
甲亢复发早期亦常见FT3</sub>先升高，后再出现FT4</sub>升高的情况。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
}
] |
甲亢治疗中症状尚未完全控制时，亦可只见FT3</sub>升高。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
}
] |
认识T3</sub>型甲亢，对甲亢早期诊断和甲亢的复发监测具有重要意义。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 15,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "甲亢",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
}
] |
甲亢时TSH降低，TSH水平受抑制而低于正常。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "TSH降低，TSH水平受抑制而低于正常",
"start_offset": 3,
"end_offset": 22,
"label": "sym"
}
] |
在多数新近被诊断为Graves病的患者中，可测出TSH受体刺激抗体（TRSAb），这种抗体的消失预告本病的缓解。 | [
{
"id": 0,
"entity": "Graves病",
"start_offset": 9,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "TSH受体刺激抗体",
"start_offset": 24,
"end_offset": 33,
"label": "bod"
},
{
"id": 2,
"entity": "TRSAb",
"start_offset": 34,
"end_offset": 39,
"label": "bod"
},
{
"id": 3,
"entity": "抗体",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
}
] |
测定抗甲状腺球蛋白抗体（TGAb）及抗甲状腺微粒体抗体（TMAb）以便明确是否为桥本病引致甲亢。 | [
{
"id": 0,
"entity": "抗甲状腺球蛋白抗体",
"start_offset": 2,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "TGAb",
"start_offset": 12,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "抗甲状腺微粒体抗体",
"start_offset": 18,
"end_offset": 27,
"label": "bod"
},
{
"id": 3,
"entity": "TMAb",
"start_offset": 28,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "桥本病",
"start_offset": 40,
"end_offset": 43,
"label": "dis"
},
{
"id": 5,
"entity": "甲亢",
"start_offset": 45,
"end_offset": 47,
"label": "dis"
}
] |
甲状腺B超可以显示甲状腺大小，显示结节及囊肿等，必要时进行甲状腺同位素扫描。 | [
{
"id": 0,
"entity": "甲状腺B超",
"start_offset": 0,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "甲状腺",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "结节",
"start_offset": 17,
"end_offset": 19,
"label": "sym"
},
{
"id": 3,
"entity": "囊肿",
"start_offset": 20,
"end_offset": 22,
"label": "sym"
},
{
"id": 4,
"entity": "甲状腺同位素扫描",
"start_offset": 29,
"end_offset": 37,
"label": "pro"
}
] |
【诊断及鉴别诊断】甲亢典型者根据临床症状、实验室检查发现总T3</sub>和FT3</sub>增高而TSH水平低下可确立诊断，TRSAb的存在可确定弥漫性毒性甲状腺肿的原因。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "TRSAb",
"start_offset": 63,
"end_offset": 68,
"label": "bod"
},
{
"id": 2,
"entity": "弥漫性毒性甲状腺肿",
"start_offset": 74,
"end_offset": 83,
"label": "dis"
}
] |
淋巴细胞性甲状腺炎（桥本病）在病程早期可呈现甲亢症状，但多数是一过性的，经随访可区别，检测TGAb和TPOAb有助于与弥漫性毒性甲状腺肿鉴别，但无法区别两者同时并存的患儿。 | [
{
"id": 0,
"entity": "淋巴细胞性甲状腺炎",
"start_offset": 0,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "桥本病",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "甲亢",
"start_offset": 22,
"end_offset": 24,
"label": "dis"
},
{
"id": 3,
"entity": "TGAb",
"start_offset": 45,
"end_offset": 49,
"label": "bod"
},
{
"id": 4,
"entity": "TPOAb",
"start_offset": 50,
"end_offset": 55,
"label": "bod"
},
{
"id": 5,
"entity": "弥漫性毒性甲状腺肿",
"start_offset": 59,
"end_offset": 68,
"label": "dis"
}
] |
当甲状腺可触及结节或血清T3</sub>值极度增高时，应进行甲状腺B超和（或）同位素扫描检查，以正确诊断结节性甲状腺肿和鉴别癌肿；对甲状腺轻度肿大和甲亢症状轻微的患儿应考虑亚急性甲状腺炎（病毒感染所致）的可能性，必要时可以考虑同位素扫描检查和细针穿刺细胞学检查。 | [
{
"id": 0,
"entity": "甲状腺可触及结节",
"start_offset": 1,
"end_offset": 9,
"label": "sym"
},
{
"id": 1,
"entity": "甲状腺B超",
"start_offset": 30,
"end_offset": 35,
"label": "pro"
},
{
"id": 2,
"entity": "同位素扫描检查",
"start_offset": 39,
"end_offset": 46,
"label": "pro"
},
{
"id": 3,
"entity": "结节性甲状腺肿",
"start_offset": 52,
"end_offset": 59,
"label": "dis"
},
{
"id": 4,
"entity": "癌肿",
"start_offset": 62,
"end_offset": 64,
"label": "dis"
},
{
"id": 5,
"entity": "甲状腺轻度肿大",
"start_offset": 66,
"end_offset": 73,
"label": "sym"
},
{
"id": 6,
"entity": "甲亢症状轻微",
"start_offset": 74,
"end_offset": 80,
"label": "sym"
},
{
"id": 7,
"entity": "亚急性甲状腺炎",
"start_offset": 86,
"end_offset": 93,
"label": "dis"
},
{
"id": 8,
"entity": "病毒感染",
"start_offset": 94,
"end_offset": 98,
"label": "sym"
},
{
"id": 9,
"entity": "同位素扫描检查",
"start_offset": 113,
"end_offset": 120,
"label": "pro"
},
{
"id": 10,
"entity": "细针穿刺细胞学检查",
"start_offset": 121,
"end_offset": 130,
"label": "pro"
}
] |
极少数是由于TSH受体基因激活性突变引起。 | [
{
"id": 0,
"entity": "TSH受体基因激活性突变",
"start_offset": 6,
"end_offset": 18,
"label": "sym"
}
] |
多数新生儿甲亢在出生时即有症状，表现为突眼、甲状腺肿大、烦躁、多动、心动过速、呼吸急促，严重可出现心力衰竭，血T3</sub>、T4</sub>升高，TSH下降。 | [
{
"id": 0,
"entity": "新生儿甲亢",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
}
] |
这些症状经6～12周后，随体内甲状腺刺激免疫球蛋白水平下降而缓解。 | [
{
"id": 0,
"entity": "随体内甲状腺刺激免疫球蛋白水平下降而缓解",
"start_offset": 12,
"end_offset": 32,
"label": "sym"
}
] |
单纯性甲状腺肿多发生在青春期，心率正常，大便次数正常，血FT3</sub>、FT4</sub>正常。 | [
{
"id": 0,
"entity": "单纯性甲状腺肿",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
}
] |
【治疗】小儿甲亢的治疗不同于成人，在口服药、手术切除及同位素碘治疗三者中，首选为口服药，一般需口服治疗2～3年；桥本病导致者可缩短些。 | [
{
"id": 0,
"entity": "小儿甲亢",
"start_offset": 4,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "口服药",
"start_offset": 18,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "手术切除",
"start_offset": 22,
"end_offset": 26,
"label": "pro"
},
{
"id": 3,
"entity": "同位素碘治疗",
"start_offset": 27,
"end_offset": 33,
"label": "pro"
},
{
"id": 4,
"entity": "口服药",
"start_offset": 40,
"end_offset": 43,
"label": "pro"
},
{
"id": 5,
"entity": "口服治疗",
"start_offset": 47,
"end_offset": 51,
"label": "pro"
},
{
"id": 6,
"entity": "桥本病",
"start_offset": 56,
"end_offset": 59,
"label": "dis"
}
] |
疗法的选择应根据患儿年龄、病程、甲亢类型、甲状腺大小、药物反应、有无桥本病以及家长能否坚持治疗等。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 16,
"end_offset": 18,
"label": "dis"
},
{
"id": 1,
"entity": "甲状腺",
"start_offset": 21,
"end_offset": 24,
"label": "bod"
},
{
"id": 2,
"entity": "桥本病",
"start_offset": 34,
"end_offset": 37,
"label": "dis"
}
] |
仅在药物治疗无效时才考虑手术或用同位素碘疗法。 | [
{
"id": 0,
"entity": "手术",
"start_offset": 12,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "同位素碘疗法",
"start_offset": 16,
"end_offset": 22,
"label": "pro"
}
] |
2.甲巯咪唑（又称他巴唑）本药能阻抑碘与酪氨酸结合，抑制甲状腺激素的合成，口服后奏效快而作用时间较长（半衰期为6～8小时），可按每日0.3～0.5mg/kg，分2次口服。 | [
{
"id": 0,
"entity": "甲巯咪唑",
"start_offset": 2,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "他巴唑",
"start_offset": 9,
"end_offset": 12,
"label": "dru"
},
{
"id": 2,
"entity": "酪氨酸",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
},
{
"id": 3,
"entity": "甲状腺激素",
"start_offset": 28,
"end_offset": 33,
"label": "bod"
}
] |
用药1～3个月后病情基本得到控制，心率降到80～90次/分，血T3</sub>、T4</sub>亦降到正常时可减量1/3～1/2，如仍稳定，逐步减至维持量，一般用药2～3年为宜。 | [
{
"id": 0,
"entity": "心率",
"start_offset": 17,
"end_offset": 19,
"label": "ite"
},
{
"id": 1,
"entity": "血T3",
"start_offset": 30,
"end_offset": 33,
"label": "ite"
},
{
"id": 2,
"entity": "T4",
"start_offset": 40,
"end_offset": 42,
"label": "ite"
}
] |
少数小儿用药后可能发生暂时性白细胞减少症或皮疹，停药即消失，严重者可发生粒细胞减少、肝损害、肾小球肾炎及脉管炎等，虽属罕见，在使用中仍须仔细观察。 | [
{
"id": 0,
"entity": "暂时性白细胞减少症",
"start_offset": 11,
"end_offset": 20,
"label": "dis"
},
{
"id": 1,
"entity": "皮疹",
"start_offset": 21,
"end_offset": 23,
"label": "dis"
},
{
"id": 2,
"entity": "严重者可发生粒细胞减少、肝损害、肾小球肾炎及脉管炎",
"start_offset": 30,
"end_offset": 55,
"label": "sym"
}
] |
粒细胞缺乏症多发生在服药开始几周或几个月，常伴有发热，故在治疗最初期间，应经常复查血常规，一旦白细胞低于4×109</sup>/L，应减少或停服抗甲状腺药物，并给予升白细胞药物（如鲨肝醇、利血生及MG-CSF等）治疗。 | [
{
"id": 0,
"entity": "粒细胞缺乏症",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "发热",
"start_offset": 24,
"end_offset": 26,
"label": "dis"
},
{
"id": 2,
"entity": "血常规",
"start_offset": 41,
"end_offset": 44,
"label": "pro"
},
{
"id": 3,
"entity": "白细胞",
"start_offset": 47,
"end_offset": 50,
"label": "ite"
},
{
"id": 4,
"entity": "抗甲状腺药物",
"start_offset": 72,
"end_offset": 78,
"label": "dru"
},
{
"id": 5,
"entity": "升白细胞药物",
"start_offset": 82,
"end_offset": 88,
"label": "dru"
},
{
"id": 6,
"entity": "鲨肝醇",
"start_offset": 90,
"end_offset": 93,
"label": "dru"
},
{
"id": 7,
"entity": "利血生",
"start_offset": 94,
"end_offset": 97,
"label": "dru"
},
{
"id": 8,
"entity": "MG-CSF",
"start_offset": 98,
"end_offset": 104,
"label": "dru"
}
] |
皮疹一般经抗过敏药治疗可好转，严重的皮疹可试用糖皮质激素。 | [
{
"id": 0,
"entity": "皮疹",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "抗过敏药",
"start_offset": 5,
"end_offset": 9,
"label": "dru"
},
{
"id": 2,
"entity": "皮疹",
"start_offset": 18,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "糖皮质激素",
"start_offset": 23,
"end_offset": 28,
"label": "dru"
}
] |
3.丙基硫氧嘧啶（PTU）除抑制甲状腺激素的合成外，同时还减少在外周组织的T4</sub>转化成T3</sub>，毒性与甲巯咪唑类相同，初始剂量为每日4～6mg/kg，因其半衰期较甲巯咪唑短，故需分3次服用。 | [
{
"id": 0,
"entity": "丙基硫氧嘧啶",
"start_offset": 2,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "PTU",
"start_offset": 9,
"end_offset": 12,
"label": "dru"
},
{
"id": 2,
"entity": "甲状腺激素",
"start_offset": 16,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "外周组织",
"start_offset": 32,
"end_offset": 36,
"label": "bod"
},
{
"id": 4,
"entity": "T4",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "T3",
"start_offset": 48,
"end_offset": 50,
"label": "bod"
},
{
"id": 6,
"entity": "甲巯咪唑类",
"start_offset": 60,
"end_offset": 65,
"label": "dru"
},
{
"id": 7,
"entity": "甲巯咪唑",
"start_offset": 90,
"end_offset": 94,
"label": "dru"
}
] |
PTU被吸收后大多在血循环中与蛋白质结合，极少通过胎盘，不致损伤胎儿。 | [
{
"id": 0,
"entity": "PTU",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "血循环",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "蛋白质",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 3,
"entity": "胎盘",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
}
] |
13岁以上的病人、男孩以及甲状腺肿较小和甲状腺激素水平轻度升高者，症状可能较早缓解。 | [
{
"id": 0,
"entity": "甲状腺肿较小",
"start_offset": 13,
"end_offset": 19,
"label": "sym"
},
{
"id": 1,
"entity": "甲状腺激素水平轻度升高",
"start_offset": 20,
"end_offset": 31,
"label": "sym"
}
] |
5.治疗过程中若出现甲低、甲状腺肿大或者突眼更明显者，应加服甲状腺素，并酌情减少甲巯咪唑用量。 | [
{
"id": 0,
"entity": "甲低、甲状腺肿大或者突眼更明显",
"start_offset": 10,
"end_offset": 25,
"label": "sym"
},
{
"id": 1,
"entity": "甲状腺素",
"start_offset": 30,
"end_offset": 34,
"label": "dru"
},
{
"id": 2,
"entity": "甲巯咪唑",
"start_offset": 40,
"end_offset": 44,
"label": "dru"
}
] |
6.对有药物过敏、粒细胞减少、甲状腺肿瘤、甲状腺明显肿大且服药后缩小不明显、服药后复发不愈者等，则有甲状腺手术切除治疗适应证。 | [
{
"id": 0,
"entity": "对有药物过敏、粒细胞减少、甲状腺肿瘤、甲状腺明显肿大且服药后缩小不明显、服药后复发不愈",
"start_offset": 2,
"end_offset": 45,
"label": "sym"
},
{
"id": 1,
"entity": "甲状腺手术切除",
"start_offset": 50,
"end_offset": 57,
"label": "pro"
}
] |
术前应用抗甲状腺药物2～3个月使甲状腺功能正常。 | [
{
"id": 0,
"entity": "抗甲状腺药物",
"start_offset": 4,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "甲状腺",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
}
] |
术前服复方碘溶液1～2周防止术中出血。 | [
{
"id": 0,
"entity": "复方碘溶液",
"start_offset": 3,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "术中出血",
"start_offset": 14,
"end_offset": 18,
"label": "sym"
}
] |
自术前4日至术后7日，口服普萘洛尔1～2mg/kg，每6小时1次。 | [
{
"id": 0,
"entity": "普萘洛尔",
"start_offset": 13,
"end_offset": 17,
"label": "dru"
}
] |
手术后甲低发生率为50%，少数出现暂时性或永久性甲状旁腺功能减低。 | [
{
"id": 0,
"entity": "甲低",
"start_offset": 3,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "少数出现暂时性或永久性甲状旁腺功能减低",
"start_offset": 13,
"end_offset": 32,
"label": "sym"
}
] |
7.近来不少学者推荐甲亢用同位素碘治疗，认为简单、有效、经济且无致癌危险。 | [
{
"id": 0,
"entity": "甲亢",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "同位素碘治疗",
"start_offset": 13,
"end_offset": 19,
"label": "pro"
}
] |
治疗后甲状腺可缩小35%～54%，但远期甲低发生率可高达92%。 | [
{
"id": 0,
"entity": "甲状腺",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "甲低",
"start_offset": 20,
"end_offset": 22,
"label": "dis"
}
] |
8.新生儿甲亢轻者不必用药，症状明显的可用丙基硫氧嘧啶，重症加服普萘洛尔及对症治疗，必要时输液、加用抗生素及皮质激素等。 | [
{
"id": 0,
"entity": "新生儿甲亢",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "丙基硫氧嘧啶",
"start_offset": 21,
"end_offset": 27,
"label": "dru"
},
{
"id": 2,
"entity": "普萘洛尔",
"start_offset": 32,
"end_offset": 36,
"label": "dru"
},
{
"id": 3,
"entity": "输液",
"start_offset": 45,
"end_offset": 47,
"label": "pro"
},
{
"id": 4,
"entity": "抗生素",
"start_offset": 50,
"end_offset": 53,
"label": "dru"
},
{
"id": 5,
"entity": "皮质激素",
"start_offset": 54,
"end_offset": 58,
"label": "dru"
}
] |
二、髓母细胞瘤髓母细胞瘤（medulloblastoma）本病为常见的中枢神经系统肿瘤，属于恶性程度很高的肿瘤，起源于小脑蚓部或第四脑室顶的后髓帆原始胚胎残留组织。 | [
{
"id": 0,
"entity": "髓母细胞瘤",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "髓母细胞瘤",
"start_offset": 7,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "medulloblastoma",
"start_offset": 13,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "中枢神经系统肿瘤",
"start_offset": 35,
"end_offset": 43,
"label": "dis"
},
{
"id": 4,
"entity": "小脑蚓部",
"start_offset": 59,
"end_offset": 63,
"label": "bod"
},
{
"id": 5,
"entity": "第四脑室顶",
"start_offset": 64,
"end_offset": 69,
"label": "bod"
},
{
"id": 6,
"entity": "后髓帆",
"start_offset": 70,
"end_offset": 73,
"label": "bod"
}
] |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.