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有出血症状者应止血治疗，呕血者可静脉应用抗酸药物如甲氰米胍（cimetidine）10mg/（kg•d），或奥美拉唑（omeprazole，洛赛克，losec）每次0.3～0.5mg/kg，每日2次。
|
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{
"id": 0,
"entity": "出血症状",
"start_offset": 1,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "止血治疗",
"start_offset": 7,
"end_offset": 11,
"label": "pro"
},
{
"id": 2,
"entity": "呕血",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 3,
"entity": "静脉应用抗酸药物",
"start_offset": 16,
"end_offset": 24,
"label": "pro"
},
{
"id": 4,
"entity": "甲氰米胍",
"start_offset": 25,
"end_offset": 29,
"label": "dru"
},
{
"id": 5,
"entity": "cimetidine",
"start_offset": 30,
"end_offset": 40,
"label": "dru"
},
{
"id": 6,
"entity": "奥美拉唑",
"start_offset": 54,
"end_offset": 58,
"label": "dru"
},
{
"id": 7,
"entity": "omeprazole",
"start_offset": 59,
"end_offset": 69,
"label": "dru"
},
{
"id": 8,
"entity": "洛赛克",
"start_offset": 70,
"end_offset": 73,
"label": "dru"
},
{
"id": 9,
"entity": "losec",
"start_offset": 74,
"end_offset": 79,
"label": "dru"
}
] |
有水肿者可应用氢氯噻嗪、螺内酯或呋塞米等利尿剂。
|
[
{
"id": 0,
"entity": "水肿",
"start_offset": 1,
"end_offset": 3,
"label": "sym"
},
{
"id": 1,
"entity": "氢氯噻嗪",
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},
{
"id": 2,
"entity": "螺内酯",
"start_offset": 12,
"end_offset": 15,
"label": "dru"
},
{
"id": 3,
"entity": "呋塞米",
"start_offset": 16,
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"label": "dru"
},
{
"id": 4,
"entity": "利尿剂",
"start_offset": 20,
"end_offset": 23,
"label": "dru"
}
] |
（二）肾上腺皮质激素肾上腺皮质激素对腹痛疗效好，对控制出血性皮疹、关节肿痛及蛋白尿有一定的效果，但对过敏性紫癜的血尿无效。
|
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"id": 0,
"entity": "肾上腺皮质激素",
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"end_offset": 10,
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{
"id": 1,
"entity": "肾上腺皮质激素",
"start_offset": 10,
"end_offset": 17,
"label": "dru"
},
{
"id": 2,
"entity": "腹痛",
"start_offset": 18,
"end_offset": 20,
"label": "sym"
},
{
"id": 3,
"entity": "出血性皮疹",
"start_offset": 27,
"end_offset": 32,
"label": "sym"
},
{
"id": 4,
"entity": "关节",
"start_offset": 33,
"end_offset": 35,
"label": "bod"
},
{
"id": 5,
"entity": "关节肿痛",
"start_offset": 33,
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"label": "sym"
},
{
"id": 6,
"entity": "蛋白尿",
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"label": "sym"
},
{
"id": 7,
"entity": "过敏性紫癜",
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"end_offset": 55,
"label": "dis"
},
{
"id": 8,
"entity": "血尿",
"start_offset": 56,
"end_offset": 58,
"label": "sym"
}
] |
（三）免疫抑制剂对于Ⅳ～Ⅵ级HSPN，使用皮质激素的同时应给予环磷酰胺（CTX）治疗，可改善预后，具体疗法参见本章第四节。
|
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{
"id": 1,
"entity": "Ⅳ～Ⅵ级HSPN",
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},
{
"id": 2,
"entity": "皮质激素",
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"end_offset": 25,
"label": "dru"
},
{
"id": 3,
"entity": "环磷酰胺",
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"end_offset": 35,
"label": "dru"
},
{
"id": 4,
"entity": "CTX",
"start_offset": 36,
"end_offset": 39,
"label": "dru"
}
] |
（四）抗血小板制剂长期口服双嘧达莫（dipyridamole，潘生丁，persantin）5～8mg/（kg•d），分2～3次口服，对预防和治疗HSPN有一定疗效。
|
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"entity": "抗血小板制剂",
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{
"id": 1,
"entity": "双嘧达莫",
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"label": "dru"
},
{
"id": 2,
"entity": "dipyridamole",
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},
{
"id": 3,
"entity": "潘生丁",
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},
{
"id": 4,
"entity": "persantin",
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},
{
"id": 5,
"entity": "HSPN",
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"end_offset": 76,
"label": "dis"
}
] |
（五）中医中药可选用雷公藤多甙片，适用于I、Ⅱ及Ⅲ级HSPN。
|
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"entity": "中药",
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{
"id": 1,
"entity": "雷公藤多甙片",
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},
{
"id": 2,
"entity": "I、Ⅱ及Ⅲ级HSPN",
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"label": "dis"
}
] |
初始剂量2mg/（kg•d），1个月后改为1.5mg/（kg•d）服用1个月，最后以1mg/（kg•d）维持1～2个月，对HSPN有较好疗效。
|
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{
"id": 0,
"entity": "HSPN",
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"end_offset": 65,
"label": "dis"
}
] |
（六）其他有人报道应用硝苯地平（nifedipine，心痛定）每次0.25～0.5mg/kg，一日3～4次，可减轻HSPN的血管炎病变。
|
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"entity": "硝苯地平",
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"id": 1,
"entity": "nifedipine",
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},
{
"id": 2,
"entity": "心痛定",
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"label": "dru"
},
{
"id": 3,
"entity": "HSPN",
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"label": "dis"
},
{
"id": 4,
"entity": "血管炎病变",
"start_offset": 62,
"end_offset": 67,
"label": "dis"
}
] |
对肾衰竭病人可作透析及肾移植。
|
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"entity": "肾衰竭",
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{
"id": 1,
"entity": "透析",
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{
"id": 2,
"entity": "肾移植",
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"label": "pro"
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] |
【预后】一般认为本患儿童预后较成人佳，大部分能完全恢复或仅有轻微尿异常，预后与临床及病理类型相关。
|
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"entity": "轻微尿异常",
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] |
但Coup近年对儿童HSPN进行多中心研究后，认为遗留持续肾病或肾炎状态的患儿较多，而且15%在10年后，20%在20年后进展到终末肾衰竭，应引起重视。
|
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"id": 0,
"entity": "HSPN",
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"label": "dis"
},
{
"id": 1,
"entity": "肾病",
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"end_offset": 31,
"label": "dis"
},
{
"id": 2,
"entity": "肾炎",
"start_offset": 32,
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"label": "dis"
},
{
"id": 3,
"entity": "终末肾衰竭",
"start_offset": 64,
"end_offset": 69,
"label": "dis"
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] |
第二节慢性胃炎慢性胃炎（chronicgastritis）是指各种原因持续反复作用于胃黏膜所引起的慢性炎症。
|
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"entity": "慢性胃炎",
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{
"id": 2,
"entity": "chronicgastritis",
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"label": "dis"
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{
"id": 3,
"entity": "胃黏膜",
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},
{
"id": 4,
"entity": "慢性炎症",
"start_offset": 49,
"end_offset": 53,
"label": "dis"
}
] |
慢性胃炎发病原因尚未明了，各种饮食、药物、微生物类、毒素以及胆汁反流，均可能与慢性胃炎的发病有关。
|
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"entity": "微生物类",
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"entity": "胆汁",
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},
{
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"entity": "慢性胃炎",
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"label": "dis"
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] |
【病因及发病机制】（一）幽门螺杆菌自从1983年澳大利亚学者Warren和Marshall首次从慢性胃炎患者的胃黏液中分离出幽门螺杆菌以来，大量的研究表明，幽门螺杆菌与慢性胃炎密切相关。
|
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{
"id": 2,
"entity": "胃黏液",
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{
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"entity": "幽门螺杆菌",
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"entity": "慢性胃炎",
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"label": "dis"
}
] |
在儿童中原发性胃炎幽门螺杆菌感染率高达40%，慢性活动性胃炎高达90%以上，而正常胃黏膜几乎很难检出幽门螺杆菌。
|
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"entity": "慢性活动性胃炎",
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"label": "dis"
},
{
"id": 3,
"entity": "胃黏膜",
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{
"id": 4,
"entity": "幽门螺杆菌",
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"label": "mic"
}
] |
（二）化学性药物小儿时期经常感冒和发热，反复使用非甾体类药物如阿司匹林和吲哚美辛等，使胃黏膜内源性保护物质前列腺素E2</sub>减少，胃黏膜屏障功能降低，而致胃黏膜损伤。
|
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{
"id": 1,
"entity": "感冒",
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},
{
"id": 2,
"entity": "发热",
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},
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"entity": "非甾体类药物",
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{
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"entity": "阿司匹林",
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},
{
"id": 5,
"entity": "吲哚美辛",
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},
{
"id": 6,
"entity": "胃黏膜屏障功能降低",
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},
{
"id": 7,
"entity": "胃黏膜损伤",
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"label": "dis"
}
] |
（三）不合理的饮食习惯食物过冷、过热、过酸、过辣、过咸，或经常暴饮暴食、饮食无规律等均可引起胃黏膜慢性炎症，食物中缺乏蛋白质及B族维生素也使慢性胃炎的易患性增加。
|
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"entity": "蛋白质",
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{
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"entity": "B族维生素",
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{
"id": 3,
"entity": "慢性胃炎",
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] |
（四）细菌、病毒和（或）其毒素鼻腔、口咽部的慢性感染病灶，如扁桃腺炎、鼻旁窦炎等细菌或其毒素吞入胃内，长期慢性刺激可引起慢性胃黏膜炎症。
|
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"entity": "细菌",
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"entity": "胃黏膜炎症",
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] |
（五）十二指肠液反流幽门括约肌功能失调时，使十二指肠液反流入胃增加。
|
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{
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},
{
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"entity": "十二指肠液反流入胃增加",
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] |
十二指肠液中含有胆汁、肠液和胰液。
|
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"entity": "肠液",
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},
{
"id": 3,
"entity": "胰液",
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] |
【临床表现】小儿慢性胃炎的症状无特异性，多数有不同程度的消化不良症状，临床表现的轻重与胃黏膜的病变程度并非一致，且病程迁延。
|
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{
"id": 1,
"entity": "不同程度的消化不良症状",
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},
{
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"entity": "胃黏膜",
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}
] |
主要表现是反复腹痛，无明显规律性，通常在进食后加重。
|
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] |
疼痛部位不确切，多在脐周。
|
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] |
体征多不明显，压痛部位可在中上腹或脐周，范围较广泛。
|
[
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"id": 0,
"entity": "压痛部位可在中上腹或脐周",
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}
] |
【实验室检查】（一）胃酸测定浅表性胃炎胃酸正常或偏低，萎缩性胃炎则明显降低，甚至缺酸。
|
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{
"id": 2,
"entity": "胃酸正常或偏低",
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},
{
"id": 3,
"entity": "萎缩性胃炎",
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"label": "dis"
}
] |
（二）幽门螺杆菌检测包括胃镜下取胃黏液直接涂片染色，组织切片染色找幽门螺杆菌，幽门螺杆菌培养，尿素酶检测。
|
[
{
"id": 0,
"entity": "幽门螺杆菌检测",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "胃镜",
"start_offset": 12,
"end_offset": 14,
"label": "equ"
},
{
"id": 2,
"entity": "胃黏液",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 3,
"entity": "直接涂片染色",
"start_offset": 19,
"end_offset": 25,
"label": "pro"
},
{
"id": 4,
"entity": "组织切片染色",
"start_offset": 26,
"end_offset": 32,
"label": "pro"
},
{
"id": 5,
"entity": "幽门螺杆菌",
"start_offset": 33,
"end_offset": 38,
"label": "mic"
},
{
"id": 6,
"entity": "幽门螺杆菌培养",
"start_offset": 39,
"end_offset": 46,
"label": "pro"
},
{
"id": 7,
"entity": "尿素酶检测",
"start_offset": 47,
"end_offset": 52,
"label": "pro"
}
] |
其次是非侵袭法利用细菌的生物特性，特别是幽门螺杆菌的尿素酶水解尿素的能力而形成的呼气试验（13</sup>C-尿素呼气）检测幽门螺杆菌。
|
[
{
"id": 0,
"entity": "幽门螺杆菌",
"start_offset": 20,
"end_offset": 25,
"label": "mic"
},
{
"id": 1,
"entity": "尿素酶",
"start_offset": 26,
"end_offset": 29,
"label": "bod"
},
{
"id": 2,
"entity": "尿素",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 3,
"entity": "呼气试验",
"start_offset": 40,
"end_offset": 44,
"label": "pro"
},
{
"id": 4,
"entity": "幽门螺杆菌",
"start_offset": 62,
"end_offset": 67,
"label": "mic"
}
] |
血清学幽门螺杆菌IgG抗体的测定，因不能提供细菌当前是否存在的依据，故不能用于目前感染的诊断，主要用于筛选或流行病学调查。
|
[
{
"id": 0,
"entity": "幽门螺杆菌IgG抗体的测定",
"start_offset": 3,
"end_offset": 16,
"label": "pro"
},
{
"id": 1,
"entity": "细菌",
"start_offset": 22,
"end_offset": 24,
"label": "mic"
}
] |
以上方法中，以尿素酶法最为简便、快速，常一步完成。
|
[
{
"id": 0,
"entity": "尿素酶法",
"start_offset": 7,
"end_offset": 11,
"label": "pro"
}
] |
13</sup>C-尿素呼气试验，因此法价格昂贵，临床普及受到限制。
|
[
{
"id": 0,
"entity": "尿素呼气试验",
"start_offset": 10,
"end_offset": 16,
"label": "ite"
}
] |
（三）其他检查在A型萎缩性胃炎（胃体胃炎）血清中可出现壁细胞抗体、胃泌素抗体和内因子抗体等。
|
[
{
"id": 0,
"entity": "A型萎缩性胃炎",
"start_offset": 8,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "胃体胃炎",
"start_offset": 16,
"end_offset": 20,
"label": "dis"
},
{
"id": 2,
"entity": "血清中可出现壁细胞抗体、胃泌素抗体和内因子抗体",
"start_offset": 21,
"end_offset": 44,
"label": "sym"
}
] |
多数萎缩性胃炎的血、尿胃蛋白酶原分泌减少，而浅表性胃炎多属正常。
|
[
{
"id": 0,
"entity": "多数萎缩性胃炎的血、尿胃蛋白酶原分泌减少",
"start_offset": 0,
"end_offset": 20,
"label": "sym"
},
{
"id": 1,
"entity": "浅表性胃炎",
"start_offset": 22,
"end_offset": 27,
"label": "dis"
}
] |
恶性贫血时血清维生素B12</sub>水平明显减少。
|
[
{
"id": 0,
"entity": "恶性贫血",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
}
] |
【X线钡餐检查】X线钡餐检查对慢性胃炎的诊断无多大帮助。
|
[
{
"id": 0,
"entity": "X线钡餐检查",
"start_offset": 1,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "X线钡餐检查",
"start_offset": 8,
"end_offset": 14,
"label": "pro"
},
{
"id": 2,
"entity": "慢性胃炎",
"start_offset": 15,
"end_offset": 19,
"label": "dis"
}
] |
依据国外资料，胃镜确诊为慢性胃炎者X线检查显示有胃黏膜炎症者仅20%～25%。
|
[
{
"id": 0,
"entity": "慢性胃炎",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "X线检查",
"start_offset": 17,
"end_offset": 21,
"label": "ite"
},
{
"id": 2,
"entity": "胃黏膜炎症",
"start_offset": 24,
"end_offset": 29,
"label": "dis"
}
] |
【胃镜检查】胃镜检查是慢性胃炎最主要的诊断方法，并可取黏膜活体组织做病理学检查。
|
[
{
"id": 0,
"entity": "胃镜检查",
"start_offset": 1,
"end_offset": 5,
"label": "equ"
},
{
"id": 1,
"entity": "胃镜检查",
"start_offset": 6,
"end_offset": 10,
"label": "pro"
},
{
"id": 2,
"entity": "慢性胃炎",
"start_offset": 11,
"end_offset": 15,
"label": "pro"
},
{
"id": 3,
"entity": "黏膜活体组织",
"start_offset": 27,
"end_offset": 33,
"label": "ite"
}
] |
慢性胃炎在胃镜下表现为充血、水肿，反光增强，胃小凹明显，黏膜质脆易出血；黏液增多，微小结节形成，局限或大片状伴有新鲜或陈旧性出血点及糜烂。
|
[
{
"id": 0,
"entity": "慢性胃炎",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "充血",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
{
"id": 2,
"entity": "水肿",
"start_offset": 14,
"end_offset": 16,
"label": "sym"
},
{
"id": 3,
"entity": "反光增强",
"start_offset": 17,
"end_offset": 21,
"label": "sym"
},
{
"id": 4,
"entity": "胃小凹明显",
"start_offset": 22,
"end_offset": 27,
"label": "sym"
},
{
"id": 5,
"entity": "黏膜质脆易出血",
"start_offset": 28,
"end_offset": 35,
"label": "sym"
},
{
"id": 6,
"entity": "黏液增多",
"start_offset": 36,
"end_offset": 40,
"label": "sym"
},
{
"id": 7,
"entity": "微小结节形成",
"start_offset": 41,
"end_offset": 47,
"label": "sym"
},
{
"id": 8,
"entity": "局限或大片状伴有新鲜",
"start_offset": 48,
"end_offset": 58,
"label": "sym"
},
{
"id": 9,
"entity": "陈旧性出血点及糜烂",
"start_offset": 59,
"end_offset": 68,
"label": "sym"
}
] |
当胃黏膜有萎缩改变时，黏膜失去正常的橘红色，色泽呈灰色，皱襞变细，黏膜变薄，黏膜下血管显露。
|
[
{
"id": 0,
"entity": "胃黏膜",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "黏膜失去正常的橘红色",
"start_offset": 11,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "色泽呈灰色",
"start_offset": 22,
"end_offset": 27,
"label": "sym"
},
{
"id": 3,
"entity": "皱襞变细",
"start_offset": 28,
"end_offset": 32,
"label": "sym"
},
{
"id": 4,
"entity": "黏膜变薄",
"start_offset": 33,
"end_offset": 37,
"label": "sym"
},
{
"id": 5,
"entity": "黏膜下血管显露",
"start_offset": 38,
"end_offset": 45,
"label": "sym"
}
] |
病理组织学改变，上皮细胞变性，小凹上皮细胞增生，固有膜炎症细胞浸润，腺体萎缩，炎症细胞主要是淋巴细胞及浆细胞。
|
[
{
"id": 0,
"entity": "小凹上皮细胞增生",
"start_offset": 15,
"end_offset": 23,
"label": "sym"
},
{
"id": 1,
"entity": "膜炎症细胞浸润",
"start_offset": 26,
"end_offset": 33,
"label": "sym"
},
{
"id": 2,
"entity": "腺体萎缩",
"start_offset": 34,
"end_offset": 38,
"label": "sym"
},
{
"id": 3,
"entity": "淋巴细胞",
"start_offset": 46,
"end_offset": 50,
"label": "bod"
},
{
"id": 4,
"entity": "浆细胞",
"start_offset": 51,
"end_offset": 54,
"label": "bod"
}
] |
【诊断与鉴别诊断】慢性胃炎无特殊性表现，单凭临床症状诊断较为困难，对反复腹痛与消化不良症状的患儿确诊主要依靠胃镜检查与病理组织活体检查。
|
[
{
"id": 0,
"entity": "慢性胃炎",
"start_offset": 9,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "反复腹痛",
"start_offset": 34,
"end_offset": 38,
"label": "sym"
},
{
"id": 2,
"entity": "消化不良",
"start_offset": 39,
"end_offset": 43,
"label": "sym"
},
{
"id": 3,
"entity": "胃镜检查",
"start_offset": 54,
"end_offset": 58,
"label": "pro"
},
{
"id": 4,
"entity": "病理组织活体检查",
"start_offset": 59,
"end_offset": 67,
"label": "pro"
}
] |
根据炎症程度分为轻度（炎症浸润仅限于黏液的浅表1/3）、中度（炎症累及黏膜的浅层1/3～2/3）及重度（炎症超过黏膜浅层2/3以上）；若固有层内有中性粒细胞浸润则说明“活动性”。
|
[
{
"id": 0,
"entity": "中性粒细胞浸润",
"start_offset": 73,
"end_offset": 80,
"label": "bod"
}
] |
此外，常规在胃窦大弯或后壁距幽门5cm内取组织切片染色，快速尿素酶试验或细菌培养，或13</sup>C-尿素呼气试验检查幽门螺杆菌，如阳性则诊断为“幽门螺杆菌相关性胃炎”。
|
[
{
"id": 0,
"entity": "胃窦大弯或后壁距幽门5cm",
"start_offset": 6,
"end_offset": 19,
"label": "bod"
},
{
"id": 1,
"entity": "切片染色",
"start_offset": 23,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "快速尿素酶试验",
"start_offset": 28,
"end_offset": 35,
"label": "pro"
},
{
"id": 3,
"entity": "幽门螺杆菌",
"start_offset": 60,
"end_offset": 65,
"label": "ite"
},
{
"id": 4,
"entity": "幽门螺杆菌相关性胃炎",
"start_offset": 74,
"end_offset": 84,
"label": "dis"
}
] |
发现幽门口收缩不良，反流增多，胆汁滞留胃内，病理切片示纤维组织增生，常提示胃炎与胆汁反流有关。
|
[
{
"id": 0,
"entity": "胆汁",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 1,
"entity": "胃",
"start_offset": 19,
"end_offset": 20,
"label": "bod"
},
{
"id": 2,
"entity": "胃炎",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
},
{
"id": 3,
"entity": "胆汁",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
}
] |
【预防】早期去除各种诱发或加重胃炎的原因，避免精神过度紧张、疲劳与各种刺激性饮食，注意气候变化，防止受凉，积极治疗口腔及鼻咽部慢性感染灶，少用对胃黏膜有刺激的药物。
|
[
{
"id": 0,
"entity": "胃炎",
"start_offset": 15,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "口腔",
"start_offset": 57,
"end_offset": 59,
"label": "bod"
},
{
"id": 2,
"entity": "鼻咽部",
"start_offset": 60,
"end_offset": 63,
"label": "bod"
},
{
"id": 3,
"entity": "胃黏膜",
"start_offset": 72,
"end_offset": 75,
"label": "bod"
}
] |
2.根除幽门螺杆菌对幽门螺杆菌引起的胃炎，尤为活动性胃炎，应给予抗幽门螺杆菌治疗。
|
[
{
"id": 0,
"entity": "幽门螺杆菌",
"start_offset": 4,
"end_offset": 9,
"label": "mic"
},
{
"id": 1,
"entity": "幽门螺杆菌",
"start_offset": 10,
"end_offset": 15,
"label": "mic"
},
{
"id": 2,
"entity": "胃炎",
"start_offset": 18,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "胃炎",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
},
{
"id": 4,
"entity": "抗幽门螺杆菌治疗",
"start_offset": 32,
"end_offset": 40,
"label": "pro"
}
] |
4.高酸或胃炎活动期者，可给予H2</sub>受体阻滞剂：西咪替丁、雷尼替丁和法莫替丁。
|
[
{
"id": 0,
"entity": "胃炎",
"start_offset": 5,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "西咪替丁",
"start_offset": 29,
"end_offset": 33,
"label": "dru"
},
{
"id": 2,
"entity": "雷尼替丁",
"start_offset": 34,
"end_offset": 38,
"label": "dru"
},
{
"id": 3,
"entity": "法莫替丁",
"start_offset": 39,
"end_offset": 43,
"label": "dru"
}
] |
5.有胆汁反流者，给予胃达喜、熊去氧胆酸与胆汁酸结合及促进胆汁排空的药。
|
[
{
"id": 0,
"entity": "胆汁反流",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "胃达喜",
"start_offset": 11,
"end_offset": 14,
"label": "dru"
}
] |
第二节非国家规划疫苗接种一、肺炎链球菌和流感嗜血杆菌疫苗肺炎链球菌和流感嗜血杆菌是严重危害儿童健康的主要致病菌，能引起化脓性脑膜炎、肺炎、败血症和急性中耳炎等感染性疾病。
|
[
{
"id": 0,
"entity": "疫苗",
"start_offset": 8,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "接种",
"start_offset": 10,
"end_offset": 12,
"label": "pro"
},
{
"id": 2,
"entity": "肺炎链球菌",
"start_offset": 14,
"end_offset": 19,
"label": "mic"
},
{
"id": 3,
"entity": "流感嗜血杆菌疫苗",
"start_offset": 20,
"end_offset": 28,
"label": "dru"
},
{
"id": 4,
"entity": "肺炎链球菌",
"start_offset": 28,
"end_offset": 33,
"label": "mic"
},
{
"id": 5,
"entity": "流感嗜血杆菌",
"start_offset": 34,
"end_offset": 40,
"label": "mic"
},
{
"id": 6,
"entity": "致病菌",
"start_offset": 52,
"end_offset": 55,
"label": "mic"
},
{
"id": 7,
"entity": "化脓性脑膜炎",
"start_offset": 59,
"end_offset": 65,
"label": "dis"
},
{
"id": 8,
"entity": "肺炎",
"start_offset": 66,
"end_offset": 68,
"label": "dis"
},
{
"id": 9,
"entity": "败血症",
"start_offset": 69,
"end_offset": 72,
"label": "dis"
},
{
"id": 10,
"entity": "急性中耳炎",
"start_offset": 73,
"end_offset": 78,
"label": "dis"
}
] |
WHO希望将这两种疫苗纳入各国的扩大免疫计划中去。
|
[
{
"id": 0,
"entity": "疫苗",
"start_offset": 9,
"end_offset": 11,
"label": "dru"
}
] |
（一）肺炎链球菌疫苗荚膜多糖是肺炎链球菌的分型依据，也是致病的主要因素。
|
[
{
"id": 0,
"entity": "肺炎链球菌疫苗",
"start_offset": 3,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "肺炎链球菌",
"start_offset": 15,
"end_offset": 20,
"label": "mic"
}
] |
到目前为止，可分型的肺炎链球菌有90种，但经常引起人类感染的只有20余种血清型，国外最重要的肺炎链球菌致病血清型是6B、9V、14、19A、19F和23F等。
|
[
{
"id": 0,
"entity": "肺炎链球菌",
"start_offset": 10,
"end_offset": 15,
"label": "mic"
},
{
"id": 1,
"entity": "肺炎链球菌",
"start_offset": 46,
"end_offset": 51,
"label": "mic"
}
] |
肺炎链球菌多糖疫苗由提纯的细菌荚膜多糖制备，有14价（型）和23价的多糖疫苗两种。
|
[
{
"id": 0,
"entity": "肺炎链球菌多糖疫苗",
"start_offset": 0,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "14价（型）和23价的多糖疫苗",
"start_offset": 23,
"end_offset": 38,
"label": "dru"
}
] |
23价至少覆盖85%～90%在成人和儿童引起侵袭性感染的血清型，有效性为61%～75%。
|
[
{
"id": 0,
"entity": "23价",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "侵袭性感染",
"start_offset": 22,
"end_offset": 27,
"label": "dis"
}
] |
23价多糖疫苗可诱导特异性抗体产生，增强淋巴细胞和吞噬细胞的调理、吞噬和杀菌功能。
|
[
{
"id": 0,
"entity": "23价多糖疫苗",
"start_offset": 0,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "诱导特异性抗体",
"start_offset": 8,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "淋巴细胞",
"start_offset": 20,
"end_offset": 24,
"label": "bod"
},
{
"id": 3,
"entity": "吞噬细胞",
"start_offset": 25,
"end_offset": 29,
"label": "bod"
}
] |
注射后2～3周，80%以上健康年轻人血清中的特异性抗体升高2倍以上，并可维持5～10年。
|
[
{
"id": 0,
"entity": "血清",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
},
{
"id": 1,
"entity": "特异性抗体",
"start_offset": 22,
"end_offset": 27,
"label": "bod"
}
] |
疫苗的安全性较好。
|
[
{
"id": 0,
"entity": "疫苗",
"start_offset": 0,
"end_offset": 2,
"label": "dru"
}
] |
注射后一般出现轻微的局部不良反应（注射部位疼痛和红肿），48小时以内可消失。
|
[
{
"id": 0,
"entity": "注射",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "注射部位疼痛和红肿",
"start_offset": 17,
"end_offset": 26,
"label": "sym"
}
] |
个别出现全身不良反应（发热和肌痛）和局部严重反应（局部硬结）。
|
[
{
"id": 0,
"entity": "发热",
"start_offset": 11,
"end_offset": 13,
"label": "sym"
},
{
"id": 1,
"entity": "肌痛",
"start_offset": 14,
"end_offset": 16,
"label": "sym"
},
{
"id": 2,
"entity": "局部硬结",
"start_offset": 25,
"end_offset": 29,
"label": "sym"
}
] |
全身严重反应（过敏反应）很罕见。
|
[
{
"id": 0,
"entity": "过敏反应",
"start_offset": 7,
"end_offset": 11,
"label": "sym"
}
] |
推荐使用多糖疫苗的对象：①＞2岁儿童和＞65岁老年人；②镰状细胞病；③功能性或解剖性无脾；④肾病综合征或慢性肾衰竭；⑤各种原因的免疫缺陷，包括器官移植和长期全身使用肾上腺皮质类固醇；⑥脑脊液漏；⑦HIV感染。
|
[
{
"id": 0,
"entity": "多糖疫苗",
"start_offset": 4,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "镰状细胞病",
"start_offset": 28,
"end_offset": 33,
"label": "dis"
},
{
"id": 2,
"entity": "功能性或解剖性无脾",
"start_offset": 35,
"end_offset": 44,
"label": "dis"
},
{
"id": 3,
"entity": "肾病综合征",
"start_offset": 46,
"end_offset": 51,
"label": "dis"
},
{
"id": 4,
"entity": "慢性肾衰竭",
"start_offset": 52,
"end_offset": 57,
"label": "dis"
},
{
"id": 5,
"entity": "免疫缺陷",
"start_offset": 64,
"end_offset": 68,
"label": "dis"
},
{
"id": 6,
"entity": "器官移植",
"start_offset": 71,
"end_offset": 75,
"label": "pro"
},
{
"id": 7,
"entity": "肾上腺皮质类固醇",
"start_offset": 82,
"end_offset": 90,
"label": "dru"
},
{
"id": 8,
"entity": "脑脊液漏",
"start_offset": 92,
"end_offset": 96,
"label": "sym"
},
{
"id": 9,
"entity": "HIV感染",
"start_offset": 98,
"end_offset": 103,
"label": "dis"
}
] |
多糖疫苗不足之处：①对＜2岁婴幼儿无免疫原性，因为多糖是非T细胞依赖性半抗原。
|
[
{
"id": 0,
"entity": "多糖疫苗",
"start_offset": 0,
"end_offset": 4,
"label": "dru"
},
{
"id": 1,
"entity": "T细胞",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
}
] |
而＜2岁儿童又是侵袭性感染和黏膜感染的高发年龄组，因为此时从母体获得的抗体已经消失，自身产生的抗体水平很低。
|
[
{
"id": 0,
"entity": "侵袭性感染",
"start_offset": 8,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "黏膜感染",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
}
] |
②对某些患者提供的保护作用是有限的，例如免疫缺陷和血液恶性肿瘤。
|
[
{
"id": 0,
"entity": "免疫缺陷",
"start_offset": 20,
"end_offset": 24,
"label": "dis"
},
{
"id": 1,
"entity": "血液恶性肿瘤",
"start_offset": 25,
"end_offset": 31,
"label": "dis"
}
] |
③不能降低呼吸道黏膜肺炎链球菌的带菌率。
|
[
{
"id": 0,
"entity": "呼吸道黏膜",
"start_offset": 5,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "肺炎链球菌",
"start_offset": 10,
"end_offset": 15,
"label": "mic"
}
] |
新的为幼小儿童使用的肺炎链球菌结合疫苗已经研制成功，在多糖上加蛋白载体，由非T细胞依赖性抗原变为T细胞依赖性抗原，以增加免疫原性。
|
[
{
"id": 0,
"entity": "肺炎链球菌结合疫苗",
"start_offset": 10,
"end_offset": 19,
"label": "dru"
},
{
"id": 1,
"entity": "T细胞",
"start_offset": 38,
"end_offset": 41,
"label": "bod"
},
{
"id": 2,
"entity": "T细胞",
"start_offset": 48,
"end_offset": 51,
"label": "bod"
}
] |
目前主要开发出5种结合疫苗，在多糖上分别加白喉类毒素（Pnc-D）、破伤风类毒素（Pnc-T）、CRM197蛋白（Pnc-CRM）、脑膜炎球菌外膜蛋白复合物（Pnc-OMPC）和既有白喉类毒素又有破伤风类毒素混合物（Pnc-TD）。
|
[
{
"id": 0,
"entity": "结合疫苗",
"start_offset": 9,
"end_offset": 13,
"label": "dru"
},
{
"id": 1,
"entity": "白喉类毒素",
"start_offset": 21,
"end_offset": 26,
"label": "mic"
},
{
"id": 2,
"entity": "Pnc-D",
"start_offset": 27,
"end_offset": 32,
"label": "mic"
},
{
"id": 3,
"entity": "破伤风类毒素",
"start_offset": 34,
"end_offset": 40,
"label": "mic"
},
{
"id": 4,
"entity": "Pnc-T",
"start_offset": 41,
"end_offset": 46,
"label": "mic"
},
{
"id": 5,
"entity": "CRM197蛋白",
"start_offset": 48,
"end_offset": 56,
"label": "mic"
},
{
"id": 6,
"entity": "Pnc-CRM",
"start_offset": 57,
"end_offset": 64,
"label": "mic"
},
{
"id": 7,
"entity": "脑膜炎球菌外膜蛋白复合物",
"start_offset": 66,
"end_offset": 78,
"label": "mic"
},
{
"id": 8,
"entity": "Pnc-OMPC",
"start_offset": 79,
"end_offset": 87,
"label": "mic"
},
{
"id": 9,
"entity": "白喉类毒素",
"start_offset": 91,
"end_offset": 96,
"label": "mic"
},
{
"id": 10,
"entity": "破伤风类毒素",
"start_offset": 98,
"end_offset": 104,
"label": "mic"
},
{
"id": 11,
"entity": "Pnc-TD",
"start_offset": 108,
"end_offset": 114,
"label": "mic"
}
] |
结合疫苗不仅能够诱导产生足够的特异性抗体，还能诱导免疫回忆反应。
|
[
{
"id": 0,
"entity": "结合疫苗",
"start_offset": 0,
"end_offset": 4,
"label": "dru"
},
{
"id": 1,
"entity": "特异性抗体",
"start_offset": 15,
"end_offset": 20,
"label": "bod"
}
] |
因此可以抗侵袭性感染（肺炎、脑膜炎和败血症等）和急性中耳炎，还能降低肺炎链球菌在鼻咽部的带菌率。
|
[
{
"id": 0,
"entity": "侵袭性感染",
"start_offset": 5,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "肺炎",
"start_offset": 11,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "脑膜炎",
"start_offset": 14,
"end_offset": 17,
"label": "dis"
},
{
"id": 3,
"entity": "败血症",
"start_offset": 18,
"end_offset": 21,
"label": "dis"
},
{
"id": 4,
"entity": "急性中耳炎",
"start_offset": 24,
"end_offset": 29,
"label": "dis"
},
{
"id": 5,
"entity": "肺炎链球菌",
"start_offset": 34,
"end_offset": 39,
"label": "mic"
},
{
"id": 6,
"entity": "鼻咽部",
"start_offset": 40,
"end_offset": 43,
"label": "bod"
}
] |
以此为依据推出一种7价的结合疫苗。
|
[
{
"id": 0,
"entity": "7价的结合疫苗",
"start_offset": 9,
"end_offset": 16,
"label": "dru"
}
] |
临床研究表明可覆盖86%的菌血症，83%的脑膜炎，65%急性中耳炎。
|
[
{
"id": 0,
"entity": "菌血症",
"start_offset": 13,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "脑膜炎",
"start_offset": 21,
"end_offset": 24,
"label": "dis"
}
] |
另有9价和11价结合疫苗可覆盖高达92%的侵袭性感染。
|
[
{
"id": 0,
"entity": "9价和11价结合疫苗",
"start_offset": 2,
"end_offset": 12,
"label": "dru"
},
{
"id": 1,
"entity": "侵袭性感染",
"start_offset": 21,
"end_offset": 26,
"label": "dis"
}
] |
注射1个月后健康成人血清中特异性抗体2～10倍升高，而在多糖疫苗组中只有2～6倍升高。
|
[
{
"id": 0,
"entity": "血清",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "特异性抗体",
"start_offset": 13,
"end_offset": 18,
"label": "bod"
}
] |
WHO推荐这种结合疫苗到儿童计划免疫中。
|
[
{
"id": 0,
"entity": "结合疫苗",
"start_offset": 7,
"end_offset": 11,
"label": "dru"
}
] |
目前，PCV9、PCV10、PCV11、PCV13疫苗陆续被研制成功，且增加了1、3、5、6A、7F、19A等常见和有增多趋势的IPD血清型。
|
[
{
"id": 0,
"entity": "PCV9",
"start_offset": 3,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "PCV11",
"start_offset": 14,
"end_offset": 19,
"label": "dru"
},
{
"id": 2,
"entity": "PCV13",
"start_offset": 20,
"end_offset": 25,
"label": "dru"
}
] |
（二）流感嗜血杆菌疫苗流感嗜血杆菌（haemophilusinfluenzae，Hi）分为有荚膜和无荚膜两种。
|
[
{
"id": 0,
"entity": "流感嗜血杆菌疫苗",
"start_offset": 3,
"end_offset": 11,
"label": "dru"
},
{
"id": 1,
"entity": "流感嗜血杆菌",
"start_offset": 11,
"end_offset": 17,
"label": "dru"
},
{
"id": 2,
"entity": "haemophilusinfluenzae",
"start_offset": 18,
"end_offset": 39,
"label": "dru"
},
{
"id": 3,
"entity": "Hi",
"start_offset": 40,
"end_offset": 42,
"label": "dru"
}
] |
所有流感嗜血杆菌都可引起侵袭性感染，但b型是引起5岁以下儿童严重感染和死亡的最常见病原菌之一。
|
[
{
"id": 0,
"entity": "流感嗜血杆菌",
"start_offset": 2,
"end_offset": 8,
"label": "mic"
},
{
"id": 1,
"entity": "侵袭性感染",
"start_offset": 12,
"end_offset": 17,
"label": "dis"
}
] |
目前有4种结合疫苗登记注册，在磷酸多核糖核醇（PRP）上分别加白喉类毒素（PRP-D）、破伤风类毒素（PRPT）、CRM197蛋白（PRP-CRM或HbOC）、脑膜炎球菌外膜蛋白复合物（PRP-OMP）。
|
[
{
"id": 0,
"entity": "结合疫苗",
"start_offset": 5,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "白喉类毒素",
"start_offset": 31,
"end_offset": 36,
"label": "mic"
},
{
"id": 2,
"entity": "PRP-D",
"start_offset": 37,
"end_offset": 42,
"label": "mic"
},
{
"id": 3,
"entity": "破伤风类毒素",
"start_offset": 44,
"end_offset": 50,
"label": "mic"
},
{
"id": 4,
"entity": "PRPT",
"start_offset": 51,
"end_offset": 55,
"label": "mic"
},
{
"id": 5,
"entity": "CRM197蛋白",
"start_offset": 57,
"end_offset": 65,
"label": "mic"
},
{
"id": 6,
"entity": "PRP-CRM",
"start_offset": 66,
"end_offset": 73,
"label": "mic"
},
{
"id": 7,
"entity": "HbOC",
"start_offset": 74,
"end_offset": 78,
"label": "mic"
},
{
"id": 8,
"entity": "脑膜炎球菌",
"start_offset": 80,
"end_offset": 85,
"label": "mic"
}
] |
在欧洲和美国，4种结合疫苗抗侵袭性感染的有效性＞90%。
|
[
{
"id": 0,
"entity": "结合疫苗",
"start_offset": 9,
"end_offset": 13,
"label": "dru"
},
{
"id": 1,
"entity": "侵袭性感染",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
}
] |
美国自从1988使用结合疫苗以来，1993年＜5岁儿童中Hib侵袭性感染的发病率下降了95%以上。
|
[
{
"id": 0,
"entity": "结合疫苗",
"start_offset": 10,
"end_offset": 14,
"label": "dru"
},
{
"id": 1,
"entity": "Hib侵袭性感染",
"start_offset": 28,
"end_offset": 36,
"label": "dis"
}
] |
在冈比亚，Hib结合疫苗抗侵袭性感染有效性与发达国家相同。
|
[
{
"id": 0,
"entity": "Hib结合疫苗",
"start_offset": 5,
"end_offset": 12,
"label": "dru"
},
{
"id": 1,
"entity": "侵袭性感染",
"start_offset": 13,
"end_offset": 18,
"label": "dis"
}
] |
该国儿童脑膜炎发病率由使用疫苗前的每年200/10万人下降到使用疫苗后的21/10万人。
|
[
{
"id": 0,
"entity": "脑膜炎",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "疫苗",
"start_offset": 13,
"end_offset": 15,
"label": "dru"
}
] |
另外从X线诊断学上判断，结合疫苗接种组的肺炎发病率减少＞20%。
|
[
{
"id": 0,
"entity": "X线",
"start_offset": 3,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "疫苗",
"start_offset": 14,
"end_offset": 16,
"label": "dru"
},
{
"id": 2,
"entity": "接种",
"start_offset": 16,
"end_offset": 18,
"label": "pro"
},
{
"id": 3,
"entity": "肺炎",
"start_offset": 20,
"end_offset": 22,
"label": "dis"
}
] |
这种结合疫苗可以降低疫苗接种者的鼻咽部的带菌率，减少病原体在易感小儿中的传播。
|
[
{
"id": 0,
"entity": "鼻咽部",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
}
] |
Hib结合疫苗能与DTP疫苗同时注射，不良反应比单独使用DTP时无明显增加。
|
[
{
"id": 0,
"entity": "Hib结合疫苗",
"start_offset": 0,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "DTP疫苗",
"start_offset": 9,
"end_offset": 14,
"label": "dru"
},
{
"id": 2,
"entity": "注射",
"start_offset": 16,
"end_offset": 18,
"label": "pro"
},
{
"id": 3,
"entity": "DTP",
"start_offset": 28,
"end_offset": 31,
"label": "dru"
}
] |
一般局部反应有发热、皮疹和易激惹等。
|
[
{
"id": 0,
"entity": "发热",
"start_offset": 7,
"end_offset": 9,
"label": "sym"
},
{
"id": 1,
"entity": "皮疹",
"start_offset": 10,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "易激惹",
"start_offset": 13,
"end_offset": 16,
"label": "sym"
}
] |
目前存在的问题：①流感嗜血杆菌在亚洲，包括我国的流行病学资料还很少；②流感嗜血杆菌疫苗接种时间与DPT和MMR（麻疹、腮腺炎、风疹）等同时，需要开发联合疫苗，即一针多苗，国外已有无细胞百、白、破与Hib的联合疫苗；③结合疫苗及联合多种疫苗的价格较贵。
|
[
{
"id": 0,
"entity": "流感嗜血杆菌",
"start_offset": 9,
"end_offset": 15,
"label": "mic"
},
{
"id": 1,
"entity": "流感嗜血杆菌疫苗",
"start_offset": 35,
"end_offset": 43,
"label": "dru"
},
{
"id": 2,
"entity": "麻疹",
"start_offset": 56,
"end_offset": 58,
"label": "dis"
},
{
"id": 3,
"entity": "腮腺炎",
"start_offset": 59,
"end_offset": 62,
"label": "dis"
},
{
"id": 4,
"entity": "风疹",
"start_offset": 63,
"end_offset": 65,
"label": "dis"
},
{
"id": 5,
"entity": "Hib",
"start_offset": 98,
"end_offset": 101,
"label": "dis"
}
] |
第三节儿童慢性粒细胞白血病慢性粒细胞白血病（chronicmyelogenousleukemia，CML）是一种骨髓异常增生性疾病，在儿童中分为成人型慢性粒细胞白血病和幼年型慢性粒细胞白血病（JCML），主要为骨髓多能造血干细胞病变。
|
[
{
"id": 0,
"entity": "儿童慢性粒细胞白血病",
"start_offset": 3,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "慢性粒细胞白血病",
"start_offset": 13,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "chronicmyelogenousleukemia",
"start_offset": 22,
"end_offset": 48,
"label": "dis"
},
{
"id": 3,
"entity": "CML",
"start_offset": 49,
"end_offset": 52,
"label": "dis"
},
{
"id": 4,
"entity": "骨髓异常增生性疾病",
"start_offset": 56,
"end_offset": 65,
"label": "dis"
},
{
"id": 5,
"entity": "成人型慢性粒细胞白血病",
"start_offset": 72,
"end_offset": 83,
"label": "dis"
},
{
"id": 6,
"entity": "幼年型慢性粒细胞白血病",
"start_offset": 84,
"end_offset": 95,
"label": "dis"
},
{
"id": 7,
"entity": "JCML",
"start_offset": 96,
"end_offset": 100,
"label": "dis"
},
{
"id": 8,
"entity": "骨髓多能造血干细胞病变",
"start_offset": 105,
"end_offset": 116,
"label": "sym"
}
] |
与急性白血病比较病变细胞形态相对成熟，发病相对缓慢，尤其是CML自然病程可达数年。
|
[
{
"id": 0,
"entity": "急性白血病",
"start_offset": 1,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "CML",
"start_offset": 29,
"end_offset": 32,
"label": "dis"
}
] |
儿童CML约占白血病总发病数的5%不到，其中JCML则更少。
|
[
{
"id": 0,
"entity": "儿童CML",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "白血病",
"start_offset": 7,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "JCML",
"start_offset": 22,
"end_offset": 26,
"label": "dis"
}
] |
一、慢性粒细胞白血病CML是白血病中最先被认识的一种血细胞疾病，1844年Doune首先描述了它的临床特征，至1870年Neumann提出本病起源于骨髓而不是脾脏，1960年Nowell和Hungerford在费城发现本病的细胞遗传学特征Ph1</sup>染色体。
|
[
{
"id": 0,
"entity": "慢性粒细胞白血病",
"start_offset": 2,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "CML",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "白血病",
"start_offset": 14,
"end_offset": 17,
"label": "dis"
},
{
"id": 3,
"entity": "骨髓",
"start_offset": 74,
"end_offset": 76,
"label": "bod"
},
{
"id": 4,
"entity": "脾脏",
"start_offset": 79,
"end_offset": 81,
"label": "bod"
},
{
"id": 5,
"entity": "染色体",
"start_offset": 128,
"end_offset": 131,
"label": "bod"
}
] |
【流行病学】CML好发于中年人，40～50岁为发病高峰，在儿童中80%病人在4岁后发病，60%在6岁后发病，也有生后3个月即发病的报告。
|
[
{
"id": 0,
"entity": "CML",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
}
] |
【细胞遗传学及生物学特征】Ph1</sup>是CML的标志性染色体变化，由非随机t（9；22）（q34；q11）形成。
|
[
{
"id": 0,
"entity": "Ph1",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 1,
"entity": "CML",
"start_offset": 23,
"end_offset": 26,
"label": "dis"
},
{
"id": 2,
"entity": "染色体",
"start_offset": 30,
"end_offset": 33,
"label": "bod"
}
] |
在9号染色体断裂点上有c-abl基因，它的变异性可大于100kb。
|
[
{
"id": 0,
"entity": "染色体",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "c-abl基因",
"start_offset": 11,
"end_offset": 18,
"label": "bod"
}
] |
Bcr基因位于22号染色体，是一个变异性很小的5.8kbDNA小片段，易位后22q-和9q+结合部形成bcr/abl融合基因，编码一个特异的210kb蛋白质（P210），它是一种酪氨酸激酶，在肿瘤的发病中起作用。
|
[
{
"id": 0,
"entity": "Bcr基因",
"start_offset": 0,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "染色体",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "5.8kbDNA",
"start_offset": 23,
"end_offset": 31,
"label": "bod"
},
{
"id": 3,
"entity": "bcr/abl融合基因",
"start_offset": 51,
"end_offset": 62,
"label": "bod"
},
{
"id": 4,
"entity": "210kb蛋白质",
"start_offset": 70,
"end_offset": 78,
"label": "bod"
},
{
"id": 5,
"entity": "P210",
"start_offset": 79,
"end_offset": 83,
"label": "bod"
},
{
"id": 6,
"entity": "酪氨酸激酶",
"start_offset": 89,
"end_offset": 94,
"label": "bod"
},
{
"id": 7,
"entity": "肿瘤",
"start_offset": 96,
"end_offset": 98,
"label": "dis"
}
] |
Ph1</sup>染色体在儿童CML中尚有它的特殊情况。
|
[
{
"id": 0,
"entity": "儿童CML",
"start_offset": 13,
"end_offset": 18,
"label": "dis"
}
] |
（一）Ph1</sup>阴性CML约5%～10%有典型CML临床表现的病例Ph1</sup>阴性，可能有以下原因：①其他染色体片段结合于22q，使Ph1</sup>的22q-在细胞遗传学水平不易检测到；②9号染色体有断裂或基因重排，但22q11未断裂，分子生物学技术可检测出CMLPh1</sup>阴性时的这些变化。
|
[
{
"id": 0,
"entity": "Ph1",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "CML",
"start_offset": 14,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "CML",
"start_offset": 27,
"end_offset": 30,
"label": "dis"
},
{
"id": 3,
"entity": "Ph1",
"start_offset": 37,
"end_offset": 40,
"label": "bod"
},
{
"id": 4,
"entity": "染色体",
"start_offset": 60,
"end_offset": 63,
"label": "bod"
},
{
"id": 5,
"entity": "Ph1",
"start_offset": 73,
"end_offset": 76,
"label": "bod"
},
{
"id": 6,
"entity": "染色体",
"start_offset": 104,
"end_offset": 107,
"label": "bod"
},
{
"id": 7,
"entity": "CMLPh1",
"start_offset": 137,
"end_offset": 143,
"label": "bod"
}
] |
（二）Ph1</sup>阳性急性白血病Ph1</sup>染色体并不只存在于CML中，约3%～10%的儿童急性白血病有Ph1</sup>染色体。
|
[
{
"id": 0,
"entity": "Ph1",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "急性白血病",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
},
{
"id": 2,
"entity": "Ph1</sup>染色体",
"start_offset": 19,
"end_offset": 31,
"label": "bod"
},
{
"id": 3,
"entity": "CML",
"start_offset": 37,
"end_offset": 40,
"label": "dis"
},
{
"id": 4,
"entity": "儿童急性白血病",
"start_offset": 50,
"end_offset": 57,
"label": "dis"
},
{
"id": 5,
"entity": "Ph1",
"start_offset": 58,
"end_offset": 61,
"label": "bod"
},
{
"id": 6,
"entity": "染色体",
"start_offset": 67,
"end_offset": 70,
"label": "bod"
}
] |
Ph1</sup>阳性急性白血病可以是CML急变，也可能是原发的急性白血病。
|
[
{
"id": 0,
"entity": "急性白血病",
"start_offset": 11,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "CML",
"start_offset": 19,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "急性白血病",
"start_offset": 32,
"end_offset": 37,
"label": "dis"
}
] |
在临床和血液学检查中区别这两种情况很困难，但细胞遗传学结合分子生物学技术检查可发现Ph1</sup>阳性急性白血病常为非CML特异的非随机的染色体异常t（9；22）（q34；q11），有bcr基因以外的基因重排，并产生190kb蛋白（P190），在治疗缓解后骨髓细胞中的Ph1</sup>染色体和P190即可消失。
|
[
{
"id": 0,
"entity": "临床和血液学检查",
"start_offset": 1,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "Ph1",
"start_offset": 41,
"end_offset": 44,
"label": "bod"
},
{
"id": 2,
"entity": "急性白血病",
"start_offset": 52,
"end_offset": 57,
"label": "dis"
},
{
"id": 3,
"entity": "染色体",
"start_offset": 70,
"end_offset": 73,
"label": "bod"
},
{
"id": 4,
"entity": "bcr基因",
"start_offset": 93,
"end_offset": 98,
"label": "bod"
},
{
"id": 5,
"entity": "190kb蛋白",
"start_offset": 109,
"end_offset": 116,
"label": "bod"
},
{
"id": 6,
"entity": "P190",
"start_offset": 117,
"end_offset": 121,
"label": "bod"
},
{
"id": 7,
"entity": "骨髓细胞",
"start_offset": 129,
"end_offset": 133,
"label": "bod"
},
{
"id": 8,
"entity": "Ph1</sup>染色体",
"start_offset": 135,
"end_offset": 147,
"label": "bod"
},
{
"id": 9,
"entity": "P190",
"start_offset": 148,
"end_offset": 152,
"label": "bod"
}
] |
而CML则相反，有CML特异的非随机染色体异常t（9；22）（q34；q11），无论在疾病的哪一个时期，Ph1</sup>染色体和bcr基因重排所产生的210kb蛋白（P210）始终存在。
|
[
{
"id": 0,
"entity": "CML",
"start_offset": 1,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "CML",
"start_offset": 9,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "染色体",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "Ph1</sup>染色体",
"start_offset": 52,
"end_offset": 64,
"label": "bod"
},
{
"id": 4,
"entity": "bcr基因",
"start_offset": 65,
"end_offset": 70,
"label": "bod"
},
{
"id": 5,
"entity": "210kb蛋白",
"start_offset": 76,
"end_offset": 83,
"label": "bod"
},
{
"id": 6,
"entity": "P210",
"start_offset": 84,
"end_offset": 88,
"label": "bod"
}
] |
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