text stringlengths 4 4.87k | entities list |
|---|---|
（四）胸腺切除胸腺切除仍然是MG的基本疗法。 | [
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适用于：①全身型MG，药物疗效不佳，宜尽早手术。 | [
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发病3～5年内中年女性患者手术疗效甚佳。 | [
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②伴有胸腺瘤的各型MG患者，疗效虽较差，应尽可能手术切除病灶。 | [
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③儿童眼肌型患者，手术虽有效，是否值得手术仍有争议。 | [
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"entity": "手术",
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手术后继续用泼尼松1年。 | [
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"id": 1,
"entity": "泼尼松",
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（五）血浆交换及血浆净化治疗能迅速清除血浆中AChRab及免疫复合物等，用于抢救危象。 | [
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"entity": "危象",
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（六）丙种球蛋白用大剂量丙种球蛋，0.4g/（kg•d），静脉滴注，连用5天。 | [
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治疗病情严重全身型MG患者，迅速扭转危象，或用于手术前准备，安全有效。 | [
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（七）危象的处理儿科病例危象发生率2.2%，病死率0.8%。 | [
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一旦发生危象，呼吸肌瘫痪气管插管或气管切开，应用人工呼吸器辅助呼吸，同时明确何种危象，进行对症处理。 | [
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"entity": "人工呼吸器",
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"entity": "辅助呼吸",
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"entity": "危象",
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在危象处理过程中保持气道护理的无菌操作、雾化吸入、保持呼吸道通畅、防止肺部感染及肺不张等并发症是抢救成功的关键。 | [
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"entity": "无菌操作",
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"entity": "雾化吸入",
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"entity": "保持呼吸道通畅",
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"entity": "防止肺部感染",
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"entity": "肺不张",
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【预后】本病的预后，一些病例在发病后数月或数年后自行缓解；一些儿童期病例可持续到成人时期；眼肌型在青春前发病者预后较青春后发病者好；少数儿童病例病程迁延，其间可缓解、复发或恶化；多数病例经免疫抑制剂、胸腺切除及胸腺放疗等治疗可能得以治愈。 | [
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"entity": "胸腺放疗",
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第八节流行性腮腺炎流行性腮腺炎（mumps，epidemicparotitis）是由腮腺炎病毒引起的急性呼吸道传染病。 | [
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病毒对腺体和神经组织具有亲和力。 | [
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【病原和流行病学】腮腺炎病毒（mumpsvirus）属副黏病毒。 | [
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病毒只有一个血清型，有6种主要结构蛋白。 | [
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M蛋白在病毒包装中起决定作用。 | [
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病毒体外可在许多原代细胞和细胞系内增殖。 | [
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紫外线、甲醛、乙醚、56℃20分钟均可被灭活。 | [
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4℃存活数天，加病毒保护剂-70℃可长期保存。 | [
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在腮腺肿大前6天到后9天，均可自患者唾液中检出病毒。 | [
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病毒经呼吸道途径传播。 | [
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如有再次患腮腺炎者可能系免疫缺陷患者或为其他病毒感染所致。 | [
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婴儿因有母体被动抗体保护（维持9个月）而很少发病。 | [
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孕妇患病可将病毒经胎盘感染胎儿。 | [
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据估计，在应用疫苗前，妊娠期腮腺炎发病率为0.8/万～10/万。 | [
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【发病机制和病理改变】病毒侵入后先在上呼吸道黏膜上皮细胞内增殖，再播散至引流淋巴结，随后发生病毒血症，病毒随血流传播至腺样组织或其他部位。 | [
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"entity": "腺样组织",
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唾液腺感染最为突出，其他包括内耳、胰腺、心脏、神经系统（脑膜和脑）、关节、肾、肝、性腺和甲状腺。 | [
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"entity": "甲状腺",
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在唾液腺，病毒感染小管上皮细胞，引起腺管周围间质水肿和局部炎症反应。 | [
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淋巴细胞、巨噬细胞浸润和受累细胞脱落使管腔阻塞。 | [
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病毒经感染单核细胞通过脉络丛侵入中枢神经系统，在脉络丛和室管膜细胞内增殖，感染细胞脱落进入脑脊液，进而引起脑膜炎。 | [
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"entity": "脑膜炎",
"start_offset": 53,
"end_offset": 56,
"label": "dis"
}
] |
脑炎时，脑室周围单核细胞浸润，散在噬神经细胞病灶和小神经胶质细胞增生，并见脑室周围脱髓鞘病变。 | [
{
"id": 0,
"entity": "脑炎",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "脑室周围单核细胞",
"start_offset": 4,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "脑室周围单核细胞浸润",
"start_offset": 4,
"end_offset": 14,
"label": "sym"
},
{
"id": 3,
"entity": "噬神经细胞",
"start_offset": 17,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "小神经胶质细胞",
"start_offset": 25,
"end_offset": 32,
"label": "bod"
},
{
"id": 5,
"entity": "散在噬神经细胞病灶和小神经胶质细胞增生",
"start_offset": 15,
"end_offset": 34,
"label": "sym"
},
{
"id": 6,
"entity": "脑室",
"start_offset": 37,
"end_offset": 39,
"label": "bod"
},
{
"id": 7,
"entity": "脑室周围脱髓鞘病变",
"start_offset": 37,
"end_offset": 46,
"label": "sym"
}
] |
睾丸炎时，病毒在细精管增殖，引起组织间质水肿和淋巴细胞浸润。 | [
{
"id": 0,
"entity": "睾丸炎",
"start_offset": 0,
"end_offset": 3,
"label": "dis"
},
{
"id": 1,
"entity": "病毒",
"start_offset": 5,
"end_offset": 7,
"label": "mic"
},
{
"id": 2,
"entity": "细精管",
"start_offset": 8,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "组织间质",
"start_offset": 16,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "淋巴细胞",
"start_offset": 23,
"end_offset": 27,
"label": "bod"
},
{
"id": 5,
"entity": "组织间质水肿和淋巴细胞浸润",
"start_offset": 16,
"end_offset": 29,
"label": "sym"
}
] |
胰腺受累时，胰导管上皮细胞肿胀，坏死脱落，与炎性渗出物等阻塞管腔，致胰液潴留，大量淀粉酶反流入血。 | [
{
"id": 0,
"entity": "胰腺",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "胰腺受累",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 2,
"entity": "胰导管上皮细胞",
"start_offset": 6,
"end_offset": 13,
"label": "bod"
},
{
"id": 3,
"entity": "管腔",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "胰导管上皮细胞肿胀，坏死脱落，与炎性渗出物等阻塞管腔",
"start_offset": 6,
"end_offset": 32,
"label": "sym"
},
{
"id": 5,
"entity": "胰液潴留",
"start_offset": 34,
"end_offset": 38,
"label": "sym"
},
{
"id": 6,
"entity": "血",
"start_offset": 47,
"end_offset": 48,
"label": "bod"
},
{
"id": 7,
"entity": "大量淀粉酶反流入血",
"start_offset": 39,
"end_offset": 48,
"label": "sym"
}
] |
【临床表现】潜伏期为12～25天，一般为16～18天，约30%～40%患者为隐性感染。 | [
{
"id": 0,
"entity": "隐性感染",
"start_offset": 38,
"end_offset": 42,
"label": "sym"
}
] |
临床上以腮腺炎最为常见，其他表现可在腮腺炎前、同时或后发生，也可发生在无腮腺炎时。 | [
{
"id": 0,
"entity": "腮腺炎",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "腮腺炎",
"start_offset": 18,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "腮腺炎",
"start_offset": 36,
"end_offset": 39,
"label": "dis"
}
] |
在5岁以下，可能仅引起上呼吸道感染，而无腮腺炎。 | [
{
"id": 0,
"entity": "上呼吸道感染",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "腮腺炎",
"start_offset": 20,
"end_offset": 23,
"label": "dis"
}
] |
（一）腮腺炎典型病例先有发热、头痛、厌食和不适。 | [
{
"id": 0,
"entity": "腮腺炎",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "发热",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
},
{
"id": 2,
"entity": "头痛",
"start_offset": 15,
"end_offset": 17,
"label": "sym"
},
{
"id": 3,
"entity": "厌食",
"start_offset": 18,
"end_offset": 20,
"label": "sym"
}
] |
在24小时内，患者诉有“耳痛”，咀嚼时加剧。 | [
{
"id": 0,
"entity": "耳痛",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
}
] |
次日腮腺逐渐肿大，于1～3天内达高峰。 | [
{
"id": 0,
"entity": "腮腺",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "腮腺逐渐肿大",
"start_offset": 2,
"end_offset": 8,
"label": "sym"
}
] |
腮腺以耳垂为中心呈马鞍形肿大，触之有轻度压痛，腮腺急骤肿胀时疼痛比较严重，持续4～5天后逐渐缩小，整个过程为6～10天。 | [
{
"id": 0,
"entity": "腮腺",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "耳垂",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 2,
"entity": "腮腺以耳垂为中心呈马鞍形肿大，触之有轻度压痛",
"start_offset": 0,
"end_offset": 22,
"label": "sym"
},
{
"id": 3,
"entity": "腮腺",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 4,
"entity": "腮腺急骤肿胀",
"start_offset": 23,
"end_offset": 29,
"label": "sym"
}
] |
通常一侧腮腺先肿大，数日内对侧肿大，约25%患者只有单侧肿大。 | [
{
"id": 0,
"entity": "腮腺",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "一侧腮腺先肿大，数日内对侧肿大",
"start_offset": 2,
"end_offset": 17,
"label": "sym"
}
] |
其他唾液腺如颌下腺或舌下腺可同时肿大，或单独肿大。 | [
{
"id": 0,
"entity": "唾液腺",
"start_offset": 2,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "颌下腺",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "舌下腺",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 3,
"entity": "肿大",
"start_offset": 16,
"end_offset": 18,
"label": "sym"
},
{
"id": 4,
"entity": "肿大",
"start_offset": 22,
"end_offset": 24,
"label": "sym"
}
] |
（二）脑膜脑炎较常见。 | [
{
"id": 0,
"entity": "脑膜脑炎",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
}
] |
常发生在腮腺炎后3～10天，也可在腮腺受累前。 | [
{
"id": 0,
"entity": "腮腺炎",
"start_offset": 4,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "腮腺",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
}
] |
脑脊液呈无菌性脑膜炎改变。 | [
{
"id": 0,
"entity": "脑脊液",
"start_offset": 0,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "无菌性脑膜炎",
"start_offset": 4,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "脑脊液呈无菌性脑膜炎改变",
"start_offset": 0,
"end_offset": 12,
"label": "sym"
}
] |
（三）睾丸炎、附睾炎10岁后男性患者约有20%～35%发生，多为单侧。 | [
{
"id": 0,
"entity": "睾丸炎",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "附睾炎",
"start_offset": 7,
"end_offset": 10,
"label": "dis"
}
] |
约半数病例以后睾丸发生萎缩。 | [
{
"id": 0,
"entity": "睾丸",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "睾丸发生萎缩",
"start_offset": 7,
"end_offset": 13,
"label": "sym"
}
] |
因常为单侧受累，很少影响生育。 | [
{
"id": 0,
"entity": "单侧受累",
"start_offset": 3,
"end_offset": 7,
"label": "sym"
}
] |
（四）胰腺炎为严重的少见表现。 | [
{
"id": 0,
"entity": "胰腺炎",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
}
] |
轻型或亚临床型感染远较已诊断者多。 | [
{
"id": 0,
"entity": "轻型或亚临床型感染",
"start_offset": 0,
"end_offset": 9,
"label": "sym"
}
] |
（五）其他女性患者可有卵巢炎。 | [
{
"id": 0,
"entity": "卵巢炎",
"start_offset": 11,
"end_offset": 14,
"label": "dis"
}
] |
（六）宫内感染孕早期患腮腺炎时，胎儿病死率增高，有报告腮腺病毒与胎儿、新生儿原发性心内膜纤维弹力组织增生症有关，但有人持反对意见。 | [
{
"id": 0,
"entity": "宫内感染",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "腮腺炎",
"start_offset": 11,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "腮腺病毒",
"start_offset": 27,
"end_offset": 31,
"label": "mic"
},
{
"id": 3,
"entity": "胎儿、新生儿原发性心内膜纤维弹力组织增生症",
"start_offset": 32,
"end_offset": 53,
"label": "dis"
}
] |
对腮腺病毒致畸作用尚有争议。 | [
{
"id": 0,
"entity": "腮腺病毒",
"start_offset": 1,
"end_offset": 5,
"label": "mic"
},
{
"id": 1,
"entity": "畸",
"start_offset": 6,
"end_offset": 7,
"label": "dis"
}
] |
【诊断】根据流行病学资料、接触史和典型腮腺炎表现易确定诊断，缺乏腮腺炎表现或接种过疫苗的患儿需进行病原学诊断，方法包括：（一）病毒分离收集急性期唾液标本和脑膜脑炎发生后5天内脑脊液接种敏感细胞，病变细胞可见胞质内嗜酸性包涵体，形成多核巨细胞。 | [
{
"id": 0,
"entity": "腮腺炎",
"start_offset": 19,
"end_offset": 22,
"label": "dis"
},
{
"id": 1,
"entity": "腮腺炎",
"start_offset": 32,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "疫苗",
"start_offset": 41,
"end_offset": 43,
"label": "dru"
},
{
"id": 3,
"entity": "病毒分离",
"start_offset": 63,
"end_offset": 67,
"label": "pro"
},
{
"id": 4,
"entity": "唾液",
"start_offset": 72,
"end_offset": 74,
"label": "bod"
},
{
"id": 5,
"entity": "脑膜脑炎",
"start_offset": 77,
"end_offset": 81,
"label": "dis"
},
{
"id": 6,
"entity": "脑脊液",
"start_offset": 87,
"end_offset": 90,
"label": "bod"
},
{
"id": 7,
"entity": "胞质",
"start_offset": 103,
"end_offset": 105,
"label": "bod"
}
] |
用特异性抗血清可早期快速检出培养物中病毒（免疫荧光法）。 | [
{
"id": 0,
"entity": "血清",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "病毒",
"start_offset": 18,
"end_offset": 20,
"label": "mic"
},
{
"id": 2,
"entity": "免疫荧光法",
"start_offset": 21,
"end_offset": 26,
"label": "pro"
}
] |
（二）特异性抗体检测用补体结合试验、血凝抑制试验或ELISA法检测双份血清，特异IgG≥4倍增高可建立诊断，但因腮腺炎病毒与副流感病毒间存在交叉抗体反应，故此法并不理想。 | [
{
"id": 0,
"entity": "特异性抗体检测",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "血凝抑制试验",
"start_offset": 18,
"end_offset": 24,
"label": "pro"
},
{
"id": 2,
"entity": "ELISA法",
"start_offset": 25,
"end_offset": 31,
"label": "pro"
},
{
"id": 3,
"entity": "血清",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
},
{
"id": 4,
"entity": "特异IgG",
"start_offset": 38,
"end_offset": 43,
"label": "ite"
},
{
"id": 5,
"entity": "腮腺炎病毒",
"start_offset": 56,
"end_offset": 61,
"label": "mic"
},
{
"id": 6,
"entity": "副流感病毒",
"start_offset": 62,
"end_offset": 67,
"label": "mic"
}
] |
特异性IgM阳性提示近期感染（IgM在疾病早期出现，持续60天）。 | [
{
"id": 0,
"entity": "特异性IgM阳性",
"start_offset": 0,
"end_offset": 8,
"label": "sym"
},
{
"id": 1,
"entity": "感染",
"start_offset": 12,
"end_offset": 14,
"label": "sym"
}
] |
【鉴别诊断】（一）急性淋巴结炎耳前、颈浅上和下颌角淋巴结发炎肿大伴有周围组织水肿时，易于腮腺炎混淆。 | [
{
"id": 0,
"entity": "急性淋巴结炎",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
},
{
"id": 1,
"entity": "耳前、颈浅上和下颌角淋巴结",
"start_offset": 15,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "耳前、颈浅上和下颌角淋巴结发炎肿大伴有周围组织水肿",
"start_offset": 15,
"end_offset": 40,
"label": "sym"
},
{
"id": 3,
"entity": "腮腺炎",
"start_offset": 44,
"end_offset": 47,
"label": "dis"
}
] |
而颌下和颏下淋巴结炎时，又易与颌下和舌下腺炎混淆。 | [
{
"id": 0,
"entity": "颌下和颏下淋巴结炎",
"start_offset": 1,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "颌下和舌下腺炎",
"start_offset": 15,
"end_offset": 22,
"label": "dis"
}
] |
这些淋巴结炎局部疼痛较重，且常有头面部或口咽部感染病灶，周围血象中白细胞总数和中性粒细胞均增高。 | [
{
"id": 0,
"entity": "淋巴结炎",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "头面部",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "口咽部",
"start_offset": 20,
"end_offset": 23,
"label": "bod"
},
{
"id": 3,
"entity": "白细胞总数",
"start_offset": 33,
"end_offset": 38,
"label": "ite"
},
{
"id": 4,
"entity": "中性粒细胞",
"start_offset": 39,
"end_offset": 44,
"label": "ite"
}
] |
（二）急性化脓性腮腺炎病原多为金黄色葡萄球菌。 | [
{
"id": 0,
"entity": "急性化脓性腮腺炎",
"start_offset": 3,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "金黄色葡萄球菌",
"start_offset": 15,
"end_offset": 22,
"label": "mic"
}
] |
外周血白细胞总数和中性粒细胞增高。 | [
{
"id": 0,
"entity": "外周血白细胞总数",
"start_offset": 0,
"end_offset": 8,
"label": "ite"
},
{
"id": 1,
"entity": "中性粒细胞",
"start_offset": 9,
"end_offset": 14,
"label": "ite"
},
{
"id": 2,
"entity": "外周血白细胞总数和中性粒细胞增高",
"start_offset": 0,
"end_offset": 16,
"label": "sym"
}
] |
（三）复发性腮腺炎病因不明，可因感染和药物过敏所致，腮腺反复肿大，有些患者作腮腺管X线造影可见结石。 | [
{
"id": 0,
"entity": "复发性腮腺炎",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "腮腺",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "腮腺反复肿大",
"start_offset": 26,
"end_offset": 32,
"label": "sym"
},
{
"id": 3,
"entity": "腮腺管X线造影",
"start_offset": 38,
"end_offset": 45,
"label": "pro"
},
{
"id": 4,
"entity": "结石",
"start_offset": 47,
"end_offset": 49,
"label": "sym"
}
] |
（四）其他病毒所致腮腺炎柯萨基病毒和副流感病毒可致腮腺炎，需借助病原学检查鉴别。 | [
{
"id": 0,
"entity": "病毒",
"start_offset": 5,
"end_offset": 7,
"label": "mic"
},
{
"id": 1,
"entity": "腮腺炎",
"start_offset": 9,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "柯萨基病毒",
"start_offset": 12,
"end_offset": 17,
"label": "mic"
},
{
"id": 3,
"entity": "副流感病毒",
"start_offset": 18,
"end_offset": 23,
"label": "mic"
},
{
"id": 4,
"entity": "腮腺炎",
"start_offset": 25,
"end_offset": 28,
"label": "dis"
}
] |
【预防】一般预防应隔离患者至腮腺肿胀完全消退为止。 | [
{
"id": 0,
"entity": "隔离患者",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "腮腺",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "腮腺肿胀",
"start_offset": 14,
"end_offset": 18,
"label": "sym"
}
] |
孕早期易感孕妇应避免接触患者，以免造成胎儿感染。 | [
{
"id": 0,
"entity": "感染",
"start_offset": 21,
"end_offset": 23,
"label": "sym"
}
] |
腮腺炎减毒活疫苗（JerylLynn株）接种后产生亚临床感染，诱生的抗体可维持至少20年。 | [
{
"id": 0,
"entity": "腮腺炎减毒活疫苗",
"start_offset": 0,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "JerylLynn株",
"start_offset": 9,
"end_offset": 19,
"label": "dru"
},
{
"id": 2,
"entity": "亚临床感染",
"start_offset": 25,
"end_offset": 30,
"label": "sym"
},
{
"id": 3,
"entity": "抗体",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
}
] |
应用麻疹-腮腺炎-风疹（MMR）三联疫苗抗体阳转率可达95%以上，推荐对大于12月龄小儿、青春期和成年无自然感染史者普遍接种。 | [
{
"id": 0,
"entity": "麻疹-腮腺炎-风疹（MMR）三联疫苗",
"start_offset": 2,
"end_offset": 20,
"label": "dru"
},
{
"id": 1,
"entity": "抗体",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "接种",
"start_offset": 60,
"end_offset": 62,
"label": "pro"
}
] |
12月龄以内婴儿因存在母传抗体干扰，不宜接种。 | [
{
"id": 0,
"entity": "接种",
"start_offset": 20,
"end_offset": 22,
"label": "pro"
}
] |
孕期、严重发热性疾病、过敏、近期接受过免疫球蛋白和免疫抑制患者不能接种。 | [
{
"id": 0,
"entity": "严重发热性疾病",
"start_offset": 3,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "过敏",
"start_offset": 11,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "免疫球蛋白",
"start_offset": 19,
"end_offset": 24,
"label": "dru"
},
{
"id": 3,
"entity": "接种",
"start_offset": 33,
"end_offset": 35,
"label": "pro"
}
] |
可用中药板蓝根口服口服或注射，或用青黛散调醋局部涂敷。 | [
{
"id": 0,
"entity": "中药板蓝根",
"start_offset": 2,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "口服",
"start_offset": 7,
"end_offset": 9,
"label": "pro"
},
{
"id": 2,
"entity": "注射",
"start_offset": 12,
"end_offset": 14,
"label": "pro"
},
{
"id": 3,
"entity": "青黛散调醋局部涂敷",
"start_offset": 17,
"end_offset": 26,
"label": "pro"
}
] |
发生睾丸炎时，局部冷湿敷，并将阴囊吊起。 | [
{
"id": 0,
"entity": "睾丸炎",
"start_offset": 2,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "局部冷湿敷",
"start_offset": 7,
"end_offset": 12,
"label": "pro"
},
{
"id": 2,
"entity": "阴囊",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
}
] |
发生胰腺炎或脑膜炎时，应作相应处理。 | [
{
"id": 0,
"entity": "胰腺炎",
"start_offset": 2,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "脑膜炎",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
}
] |
第四节曲霉菌病【病原学和发病机制】曲霉菌（aspergillosis）可分为18个群、132个种和18个变种，绝大多数分为非致病菌，对人类致病者有烟曲霉、黄曲霉、黑曲霉、土曲霉、构巢曲霉等，其中以烟曲霉最常见。 | [
{
"id": 0,
"entity": "曲霉菌病",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "曲霉菌",
"start_offset": 17,
"end_offset": 20,
"label": "mic"
},
{
"id": 2,
"entity": "aspergillosis",
"start_offset": 21,
"end_offset": 34,
"label": "mic"
},
{
"id": 3,
"entity": "非致病菌",
"start_offset": 61,
"end_offset": 65,
"label": "mic"
},
{
"id": 4,
"entity": "烟曲霉",
"start_offset": 73,
"end_offset": 76,
"label": "mic"
},
{
"id": 5,
"entity": "黄曲霉",
"start_offset": 77,
"end_offset": 80,
"label": "mic"
},
{
"id": 6,
"entity": "黑曲霉",
"start_offset": 81,
"end_offset": 84,
"label": "mic"
},
{
"id": 7,
"entity": "土曲霉",
"start_offset": 85,
"end_offset": 88,
"label": "mic"
},
{
"id": 8,
"entity": "构巢曲霉",
"start_offset": 89,
"end_offset": 93,
"label": "mic"
},
{
"id": 9,
"entity": "烟曲霉",
"start_offset": 98,
"end_offset": 101,
"label": "mic"
}
] |
在各种曲霉病中，可为单一曲霉菌的感染，也可两种以上曲霉合并感染。 | [
{
"id": 0,
"entity": "曲霉病",
"start_offset": 3,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "曲霉菌",
"start_offset": 12,
"end_offset": 15,
"label": "mic"
},
{
"id": 2,
"entity": "曲霉",
"start_offset": 25,
"end_offset": 27,
"label": "mic"
}
] |
曲霉菌的致病方式有以下几种：（1）原发性侵袭型：机体抵抗力正常，吸入大量的病原体，使机体感染，引起急性肺炎表现。 | [
{
"id": 0,
"entity": "曲霉菌",
"start_offset": 0,
"end_offset": 3,
"label": "mic"
},
{
"id": 1,
"entity": "急性肺炎",
"start_offset": 49,
"end_offset": 53,
"label": "dis"
}
] |
（2）继发性侵袭型：机体患有严重疾病或长期应用大量抗生素、免疫抑制剂，此型较为常见。 | [
{
"id": 0,
"entity": "抗生素",
"start_offset": 25,
"end_offset": 28,
"label": "dru"
},
{
"id": 1,
"entity": "免疫抑制剂",
"start_offset": 29,
"end_offset": 34,
"label": "dru"
}
] |
（3）变态反应型：因吸入大量曲霉孢子而引起过敏反应。 | [
{
"id": 0,
"entity": "曲霉孢子",
"start_offset": 14,
"end_offset": 18,
"label": "mic"
},
{
"id": 1,
"entity": "过敏反应",
"start_offset": 21,
"end_offset": 25,
"label": "dis"
}
] |
（4）寄生型：曲霉菌寄生在支气管扩张的空腔内和肺结核的空洞内。 | [
{
"id": 0,
"entity": "曲霉菌",
"start_offset": 7,
"end_offset": 10,
"label": "mic"
},
{
"id": 1,
"entity": "支气管扩张的空腔",
"start_offset": 13,
"end_offset": 21,
"label": "bod"
},
{
"id": 2,
"entity": "肺结核的空洞",
"start_offset": 23,
"end_offset": 29,
"label": "bod"
}
] |
本病为外源性感染，主要是肺部吸入大量的曲霉菌孢子，侵入血流播散至全身各器官。 | [
{
"id": 0,
"entity": "外源性感染",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "肺部",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "曲霉菌孢子",
"start_offset": 19,
"end_offset": 24,
"label": "mic"
},
{
"id": 3,
"entity": "血流",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
}
] |
其次是皮肤创伤性接种。 | [
{
"id": 0,
"entity": "皮肤",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "接种",
"start_offset": 8,
"end_offset": 10,
"label": "pro"
}
] |
主要有渗出性炎症、脓肿、坏死溃疡、和肉芽肿等4种类型。 | [
{
"id": 0,
"entity": "渗出性炎症",
"start_offset": 3,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "脓肿",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 2,
"entity": "坏死溃疡",
"start_offset": 12,
"end_offset": 16,
"label": "dis"
},
{
"id": 3,
"entity": "肉芽肿",
"start_offset": 18,
"end_offset": 21,
"label": "dis"
}
] |
脓肿中常可见到菌丝。 | [
{
"id": 0,
"entity": "脓肿中常可见到菌丝",
"start_offset": 0,
"end_offset": 9,
"label": "sym"
}
] |
HE染色呈蓝色略带红色，PAS染色红色，嗜银染色呈黑色。 | [
{
"id": 0,
"entity": "HE染色呈蓝色略带红色",
"start_offset": 0,
"end_offset": 11,
"label": "sym"
},
{
"id": 1,
"entity": "PAS染色红色",
"start_offset": 12,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "嗜银染色呈黑色",
"start_offset": 20,
"end_offset": 27,
"label": "sym"
}
] |
慢性肺曲霉菌病特点为肺组织损伤显著，但曲霉菌成分仅少量，或菌丝发生变型，故称半侵袭性肺曲霉菌病，应注意仔细反复寻找。 | [
{
"id": 0,
"entity": "慢性肺曲霉菌病",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "肺组织损伤显著",
"start_offset": 10,
"end_offset": 17,
"label": "sym"
},
{
"id": 2,
"entity": "曲霉菌成分仅少量",
"start_offset": 19,
"end_offset": 27,
"label": "sym"
},
{
"id": 3,
"entity": "菌丝发生变型",
"start_offset": 29,
"end_offset": 35,
"label": "sym"
},
{
"id": 4,
"entity": "半侵袭性肺曲霉菌病",
"start_offset": 38,
"end_offset": 47,
"label": "dis"
}
] |
【临床类型】由于机体免疫状态和易感性不同，曲霉菌侵入肺部可以引起下列3种表现：曲霉菌球、过敏性支气管肺曲霉菌病、侵袭性肺部曲霉菌病。 | [
{
"id": 0,
"entity": "曲霉菌",
"start_offset": 21,
"end_offset": 24,
"label": "mic"
},
{
"id": 1,
"entity": "肺部",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "曲霉菌球",
"start_offset": 39,
"end_offset": 43,
"label": "dis"
},
{
"id": 3,
"entity": "过敏性支气管肺曲霉菌病",
"start_offset": 44,
"end_offset": 55,
"label": "dis"
},
{
"id": 4,
"entity": "侵袭性肺部曲霉菌病",
"start_offset": 56,
"end_offset": 65,
"label": "dis"
}
] |
1.曲霉菌球此型多在肺部存在空洞性病变的情况下，真菌在空腔内寄生，形成曲霉球。 | [
{
"id": 0,
"entity": "曲霉菌球",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肺部存在空洞性病变",
"start_offset": 10,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "真菌",
"start_offset": 24,
"end_offset": 26,
"label": "mic"
},
{
"id": 3,
"entity": "曲霉球",
"start_offset": 35,
"end_offset": 38,
"label": "dis"
}
] |
一般为单个出现，偶尔双肺同时出现。 | [
{
"id": 0,
"entity": "双肺",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "双肺同时出现",
"start_offset": 10,
"end_offset": 16,
"label": "sym"
}
] |
典型的X线表现：空洞内有一个新月形气体阴影，由于菌丝不侵袭空洞壁，较小的曲霉球可在空洞内移动，或随体位改变而移动。 | [
{
"id": 0,
"entity": "X线",
"start_offset": 3,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "空洞内有一个新月形气体阴影",
"start_offset": 8,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "较小的曲霉球可在空洞内移动，或随体位改变而移动",
"start_offset": 33,
"end_offset": 56,
"label": "sym"
}
] |
这些空洞也可为过敏性或侵袭性曲霉菌病的演变。 | [
{
"id": 0,
"entity": "过敏性或侵袭性曲霉菌病",
"start_offset": 7,
"end_offset": 18,
"label": "dis"
}
] |
侵袭性曲霉菌病引起肺炎，肺组织坏死，呈真菌性肺脓肿，脓腔形成，进一步形成球体。 | [
{
"id": 0,
"entity": "侵袭性曲霉菌病",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "肺炎",
"start_offset": 9,
"end_offset": 11,
"label": "dis"
},
{
"id": 2,
"entity": "肺组织坏死",
"start_offset": 12,
"end_offset": 17,
"label": "dis"
},
{
"id": 3,
"entity": "真菌性肺脓肿",
"start_offset": 19,
"end_offset": 25,
"label": "dis"
}
] |
此外，过敏性支气管肺曲霉菌病亦可发生脓肿，最后形成曲霉球。 | [
{
"id": 0,
"entity": "过敏性支气管肺曲霉菌病",
"start_offset": 3,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "脓肿",
"start_offset": 18,
"end_offset": 20,
"label": "dis"
},
{
"id": 2,
"entity": "曲霉球",
"start_offset": 25,
"end_offset": 28,
"label": "dis"
}
] |
2.过敏性支气管肺曲霉菌病（ABPA）是曲霉菌引起的过敏性肺疾病。 | [
{
"id": 0,
"entity": "过敏性支气管肺曲霉菌病",
"start_offset": 2,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "ABPA",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "曲霉菌",
"start_offset": 20,
"end_offset": 23,
"label": "mic"
},
{
"id": 3,
"entity": "过敏性肺疾病",
"start_offset": 26,
"end_offset": 32,
"label": "dis"
}
] |
绝大多数发生于哮喘或有过敏性疾病的患者。 | [
{
"id": 0,
"entity": "哮喘",
"start_offset": 7,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "过敏性疾病",
"start_offset": 11,
"end_offset": 16,
"label": "dis"
}
] |
ABPA典型的病理变化是中央气道扩张，常有黏液堵塞，远端气道通常正常。 | [
{
"id": 0,
"entity": "ABPA",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "中央气道扩张，常有黏液堵塞",
"start_offset": 12,
"end_offset": 25,
"label": "sym"
},
{
"id": 2,
"entity": "远端气道通常正常",
"start_offset": 26,
"end_offset": 34,
"label": "sym"
}
] |
曲霉菌的菌丝可与支气管壁紧密相邻，但界限清楚，不侵入管壁和血管，一些病例可形成肉芽肿。 | [
{
"id": 0,
"entity": "曲霉菌",
"start_offset": 0,
"end_offset": 3,
"label": "mic"
},
{
"id": 1,
"entity": "支气管壁",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "管壁",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "血管",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
},
{
"id": 4,
"entity": "肉芽肿",
"start_offset": 39,
"end_offset": 42,
"label": "sym"
}
] |
在临床上，ABPA支气管痉挛是短暂的，后期症状趋于慢性。 | [
{
"id": 0,
"entity": "ABPA支气管痉挛",
"start_offset": 5,
"end_offset": 14,
"label": "dis"
}
] |
外周血和痰液嗜酸性粒细胞升高。 | [
{
"id": 0,
"entity": "血",
"start_offset": 2,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "痰液",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
},
{
"id": 2,
"entity": "嗜酸性粒细胞",
"start_offset": 6,
"end_offset": 12,
"label": "ite"
},
{
"id": 3,
"entity": "外周血和痰液嗜酸性粒细胞升高",
"start_offset": 0,
"end_offset": 14,
"label": "sym"
}
] |
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