text
stringlengths 4
4.87k
| entities
list |
|---|---|
痰液涂片和培养可以发现菌丝。
|
[
{
"id": 0,
"entity": "痰液涂片",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "痰液涂片和培养可以发现菌丝",
"start_offset": 0,
"end_offset": 13,
"label": "sym"
}
] |
血IgE明显升高。
|
[
{
"id": 0,
"entity": "血IgE",
"start_offset": 0,
"end_offset": 4,
"label": "ite"
},
{
"id": 1,
"entity": "血IgE明显升高",
"start_offset": 0,
"end_offset": 8,
"label": "sym"
}
] |
对曲霉菌抗原速发型或迟发型皮肤超敏反应。
|
[
{
"id": 0,
"entity": "曲霉菌抗原速发型或迟发型",
"start_offset": 1,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "皮肤",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "皮肤超敏反应",
"start_offset": 13,
"end_offset": 19,
"label": "sym"
}
] |
3.侵袭性肺部曲霉菌病即在肺组织发现曲霉菌菌丝或孢子，为侵袭性肺部曲霉菌病。
|
[
{
"id": 0,
"entity": "侵袭性肺部曲霉菌病",
"start_offset": 2,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "肺组织",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "曲霉菌",
"start_offset": 18,
"end_offset": 21,
"label": "mic"
},
{
"id": 3,
"entity": "侵袭性肺部曲霉菌病",
"start_offset": 28,
"end_offset": 37,
"label": "dis"
}
] |
免疫功能受损越严重，越易发生急性肺部曲霉菌病。
|
[
{
"id": 0,
"entity": "肺部曲霉菌病",
"start_offset": 16,
"end_offset": 22,
"label": "dis"
}
] |
影像学表现早期可为多发或单发小炎性结节，急性肺部曲霉菌病可为双肺弥漫性团块影、云絮影，也可为斑片影。
|
[
{
"id": 0,
"entity": "多发或单发小炎性结节",
"start_offset": 9,
"end_offset": 19,
"label": "sym"
},
{
"id": 1,
"entity": "急性肺部曲霉菌病",
"start_offset": 20,
"end_offset": 28,
"label": "dis"
},
{
"id": 2,
"entity": "双肺弥漫性团块影、云絮影，也可为斑片影",
"start_offset": 30,
"end_offset": 49,
"label": "sym"
}
] |
慢性肺部曲霉菌病多为上叶实变伴胸膜肥厚，实变区内有空洞（故又称慢性坏死性肺曲霉菌病）。
|
[
{
"id": 0,
"entity": "慢性肺部曲霉菌病",
"start_offset": 0,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "上叶实变伴胸膜肥厚",
"start_offset": 10,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "实变区内有空洞",
"start_offset": 20,
"end_offset": 27,
"label": "sym"
},
{
"id": 3,
"entity": "慢性坏死性肺曲霉菌病",
"start_offset": 31,
"end_offset": 41,
"label": "dis"
}
] |
文献还报道慢性肺曲霉菌病的空洞内可见高密度阴影（似曲霉菌球），偶尔在高密度阴影内还可见到许多类似钙化的点状阴影，此征仅见于曲霉菌感染，而在其他真菌感染时不出现。
|
[
{
"id": 0,
"entity": "慢性肺曲霉菌病",
"start_offset": 5,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "空洞内可见高密度阴影",
"start_offset": 13,
"end_offset": 23,
"label": "sym"
},
{
"id": 2,
"entity": "曲霉菌球",
"start_offset": 25,
"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "高密度阴影内还可见到许多类似钙化的点状阴影",
"start_offset": 34,
"end_offset": 55,
"label": "sym"
},
{
"id": 4,
"entity": "曲霉菌感染",
"start_offset": 61,
"end_offset": 66,
"label": "dis"
},
{
"id": 5,
"entity": "真菌感染",
"start_offset": 71,
"end_offset": 75,
"label": "dis"
}
] |
“晕轮征”对于侵袭性肺曲霉菌病有一定的诊断意义。
|
[
{
"id": 0,
"entity": "晕轮征",
"start_offset": 1,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "侵袭性肺曲霉菌病",
"start_offset": 7,
"end_offset": 15,
"label": "dis"
}
] |
急性侵袭性肺曲霉菌病可恶化为播散性曲霉菌病。
|
[
{
"id": 0,
"entity": "急性侵袭性肺曲霉菌病",
"start_offset": 0,
"end_offset": 10,
"label": "dis"
},
{
"id": 1,
"entity": "播散性曲霉菌病",
"start_offset": 14,
"end_offset": 21,
"label": "dis"
}
] |
慢性肺曲霉菌病进展缓慢，最后波及整个肺或胸腔、纵隔、胸壁等。
|
[
{
"id": 0,
"entity": "慢性肺曲霉菌病",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "肺",
"start_offset": 18,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "胸腔",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 3,
"entity": "纵隔",
"start_offset": 23,
"end_offset": 25,
"label": "bod"
},
{
"id": 4,
"entity": "胸壁",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
}
] |
也可转化为急性曲霉菌肺炎。
|
[
{
"id": 0,
"entity": "急性曲霉菌肺炎",
"start_offset": 5,
"end_offset": 12,
"label": "dis"
}
] |
菌丝易侵犯血管，随血流播散到全身各脏器，引起播散性曲霉菌病。
|
[
{
"id": 0,
"entity": "血流",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "全身各脏器",
"start_offset": 14,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "播散性曲霉菌病",
"start_offset": 22,
"end_offset": 29,
"label": "dis"
}
] |
【实验室检查】1.直接镜检痰液、尿等标本，加一滴10%～20%氢氧化钾溶液，镜下见分隔菌丝、分生孢子，有时可见分生孢子梗、顶囊和小梗。
|
[
{
"id": 0,
"entity": "直接镜检",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "痰液",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "尿",
"start_offset": 16,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "镜下见分隔菌丝、分生孢子",
"start_offset": 38,
"end_offset": 50,
"label": "sym"
},
{
"id": 4,
"entity": "有时可见分生孢子梗、顶囊和小梗",
"start_offset": 51,
"end_offset": 66,
"label": "sym"
}
] |
2.培养标本接种于培养基上，48小时后即有菌丝和分生孢子头出现。
|
[
{
"id": 0,
"entity": "培养",
"start_offset": 2,
"end_offset": 4,
"label": "pro"
}
] |
血液、心包液、脑脊液无菌，只要1次培养阳性，即有重要的诊断意义。
|
[
{
"id": 0,
"entity": "血液",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "心包液",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 2,
"entity": "脑脊液无菌",
"start_offset": 7,
"end_offset": 12,
"label": "bod"
},
{
"id": 3,
"entity": "1次培养阳性",
"start_offset": 15,
"end_offset": 21,
"label": "sym"
}
] |
肺内咯出物活检组织或手术切除组织，做病理检查发现曲霉菌，有肯定意义。
|
[
{
"id": 0,
"entity": "肺内咯出物活检组织",
"start_offset": 0,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "手术切除组织",
"start_offset": 10,
"end_offset": 16,
"label": "pro"
},
{
"id": 2,
"entity": "病理检查发现曲霉菌",
"start_offset": 18,
"end_offset": 27,
"label": "sym"
}
] |
2次以上痰液或支气管-肺泡灌洗液（BALF）培养有曲霉菌生长，除外其他病原体感染，结合抗曲霉菌治疗有效，可作出临床诊断。
|
[
{
"id": 0,
"entity": "痰液或支气管-肺泡灌洗液（BALF）培养有曲霉菌生长",
"start_offset": 4,
"end_offset": 30,
"label": "sym"
},
{
"id": 1,
"entity": "抗曲霉菌治疗",
"start_offset": 43,
"end_offset": 49,
"label": "pro"
}
] |
3.血清学检查（1）血清半乳糖甘露聚糖（GM）抗原检测：半乳糖甘露聚糖仅存在于曲霉细胞壁中，曲霉发生侵袭性感染时，可从细胞壁释放进入血液，在血清中可检测出，简称GM实验。
|
[
{
"id": 0,
"entity": "血清学检查",
"start_offset": 2,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "血清半乳糖甘露聚糖（GM）抗原检测",
"start_offset": 10,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "曲霉细胞壁",
"start_offset": 39,
"end_offset": 44,
"label": "mic"
},
{
"id": 3,
"entity": "曲霉",
"start_offset": 46,
"end_offset": 48,
"label": "mic"
},
{
"id": 4,
"entity": "血液",
"start_offset": 66,
"end_offset": 68,
"label": "bod"
},
{
"id": 5,
"entity": "血清",
"start_offset": 70,
"end_offset": 72,
"label": "bod"
},
{
"id": 6,
"entity": "GM实验",
"start_offset": 80,
"end_offset": 84,
"label": "pro"
}
] |
GM实验阳性提示侵袭性曲霉感染。
|
[
{
"id": 0,
"entity": "GM实验阳性",
"start_offset": 0,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "侵袭性曲霉感染",
"start_offset": 8,
"end_offset": 15,
"label": "dis"
}
] |
半乳糖甘露聚糖最早可在发病前5～8天从血液中检出。
|
[
{
"id": 0,
"entity": "半乳糖甘露聚糖",
"start_offset": 0,
"end_offset": 7,
"label": "bod"
}
] |
假阳性率较高的人群为新生儿、自身抗体阳性、菌血症患者、使用半合成青霉素及异体骨髓抑制患者。
|
[
{
"id": 0,
"entity": "菌血症",
"start_offset": 21,
"end_offset": 24,
"label": "dis"
},
{
"id": 1,
"entity": "半合成青霉素",
"start_offset": 29,
"end_offset": 35,
"label": "dru"
},
{
"id": 2,
"entity": "异体骨髓抑制",
"start_offset": 36,
"end_offset": 42,
"label": "dru"
}
] |
慢性肉芽病患儿发生慢性肺曲霉病时，GM检测呈阴性。
|
[
{
"id": 0,
"entity": "慢性肉芽病",
"start_offset": 0,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "慢性肺曲霉病",
"start_offset": 9,
"end_offset": 15,
"label": "dis"
},
{
"id": 2,
"entity": "GM检测呈阴性",
"start_offset": 17,
"end_offset": 24,
"label": "sym"
}
] |
（2）血清（1-3）-β-D-葡聚糖抗原检测：（1-3）-β-D-葡聚糖为真菌细胞壁成分，国内采用Fungitec-G法（中华鲎实验），简称G试验。
|
[
{
"id": 0,
"entity": "血清（1-3）-β-D-葡聚糖抗原检测",
"start_offset": 3,
"end_offset": 22,
"label": "pro"
},
{
"id": 1,
"entity": "Fungitec-G法",
"start_offset": 49,
"end_offset": 60,
"label": "pro"
},
{
"id": 2,
"entity": "中华鲎实验",
"start_offset": 61,
"end_offset": 66,
"label": "pro"
},
{
"id": 3,
"entity": "G试验",
"start_offset": 70,
"end_offset": 73,
"label": "pro"
}
] |
阳性提示侵袭性真菌感染。
|
[
{
"id": 0,
"entity": "阳性",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "侵袭性真菌感染",
"start_offset": 4,
"end_offset": 11,
"label": "dis"
}
] |
【诊断】1.侵袭性肺曲霉病现行的诊断模式为基于宿主因素、临床特征、微生物学及病理组织学检查三种核心因素的综合诊断，诊断分级为确诊（proven）、临床诊断（probable）、拟诊（possible）（详见概况部分）。
|
[
{
"id": 0,
"entity": "侵袭性肺曲霉病",
"start_offset": 6,
"end_offset": 13,
"label": "dis"
}
] |
肺组织活检发现曲霉菌丝，可以确诊。
|
[
{
"id": 0,
"entity": "肺组织活检发现曲霉菌丝",
"start_offset": 0,
"end_offset": 11,
"label": "sym"
}
] |
气管内吸引物或合格痰标本直接镜检发现菌丝，且培养连续2次分离到同种真菌；BALF经直接镜检发现菌丝，真菌培养阳性；血清GM连续2次阳性，可临床诊断为侵袭性肺曲霉病。
|
[
{
"id": 0,
"entity": "气管内吸引物或合格痰标本直接镜检发现菌丝",
"start_offset": 0,
"end_offset": 20,
"label": "sym"
},
{
"id": 1,
"entity": "培养连续2次分离到同种真菌",
"start_offset": 22,
"end_offset": 35,
"label": "sym"
},
{
"id": 2,
"entity": "BALF经直接镜检发现菌丝，真菌培养阳性",
"start_offset": 36,
"end_offset": 56,
"label": "sym"
},
{
"id": 3,
"entity": "血清GM连续2次阳性",
"start_offset": 57,
"end_offset": 67,
"label": "sym"
},
{
"id": 4,
"entity": "侵袭性肺曲霉病",
"start_offset": 74,
"end_offset": 81,
"label": "dis"
}
] |
2.ABPA目前依据Rosenberg-Patterson诊断标准，主要标准：①哮喘；②肺部影像学检查肺部浸润影；③曲霉菌抗原皮内试验快速反应阳性；④周围血嗜酸性粒细胞增多；⑤血清沉淀抗体IgG阳性；⑥血清总IgE升高（＞1000U/L）；⑦中央型支扩；⑧血清曲霉菌特异性IgG和IgE抗体两倍以上增高。
|
[
{
"id": 0,
"entity": "ABPA",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "哮喘",
"start_offset": 40,
"end_offset": 42,
"label": "sym"
},
{
"id": 2,
"entity": "肺部影像学检查",
"start_offset": 44,
"end_offset": 51,
"label": "pro"
},
{
"id": 3,
"entity": "肺部浸润影",
"start_offset": 51,
"end_offset": 56,
"label": "sym"
},
{
"id": 4,
"entity": "曲霉菌抗原皮内试验快速反应阳性",
"start_offset": 58,
"end_offset": 73,
"label": "sym"
},
{
"id": 5,
"entity": "周围血嗜酸性粒细胞增多",
"start_offset": 75,
"end_offset": 86,
"label": "sym"
},
{
"id": 6,
"entity": "血清沉淀抗体IgG阳性",
"start_offset": 88,
"end_offset": 99,
"label": "sym"
},
{
"id": 7,
"entity": "血清总IgE升高（＞1000U/L）",
"start_offset": 101,
"end_offset": 119,
"label": "sym"
},
{
"id": 8,
"entity": "中央型支扩",
"start_offset": 121,
"end_offset": 126,
"label": "sym"
},
{
"id": 9,
"entity": "血清曲霉菌特异性IgG和IgE抗体两倍以上增高",
"start_offset": 128,
"end_offset": 151,
"label": "sym"
}
] |
次要条件：①痰找到曲霉菌；②咳棕黑色黏液栓；③曲霉菌抗原迟发型皮试阳性。
|
[
{
"id": 0,
"entity": "痰找到曲霉菌",
"start_offset": 6,
"end_offset": 12,
"label": "sym"
},
{
"id": 1,
"entity": "咳棕黑色黏液栓",
"start_offset": 14,
"end_offset": 21,
"label": "sym"
},
{
"id": 2,
"entity": "曲霉菌抗原迟发型皮试阳性",
"start_offset": 23,
"end_offset": 35,
"label": "sym"
}
] |
根据患者是否出现中央型支气管扩张可将ABPA分为2个亚型，即ABPA-S（血清阳性型）和ABPA-CB（中央支气管扩张型）。
|
[
{
"id": 0,
"entity": "出现中央型支气管扩张",
"start_offset": 6,
"end_offset": 16,
"label": "sym"
},
{
"id": 1,
"entity": "ABPA",
"start_offset": 18,
"end_offset": 22,
"label": "dis"
},
{
"id": 2,
"entity": "ABPA-S",
"start_offset": 30,
"end_offset": 36,
"label": "dis"
},
{
"id": 3,
"entity": "ABPA-CB",
"start_offset": 44,
"end_offset": 51,
"label": "dis"
}
] |
【治疗】1.侵袭性曲霉菌两性霉素B是传统治疗的首选药物，静脉应用，同时雾化给药。
|
[
{
"id": 0,
"entity": "侵袭性曲霉菌",
"start_offset": 6,
"end_offset": 12,
"label": "mic"
},
{
"id": 1,
"entity": "两性霉素B",
"start_offset": 12,
"end_offset": 17,
"label": "dru"
},
{
"id": 2,
"entity": "静脉应用",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
},
{
"id": 3,
"entity": "雾化给药",
"start_offset": 35,
"end_offset": 39,
"label": "pro"
}
] |
目前认为病情较重的可首选伏立康唑。
|
[
{
"id": 0,
"entity": "伏立康唑",
"start_offset": 12,
"end_offset": 16,
"label": "dru"
}
] |
伊曲康唑用于轻-中患者。
|
[
{
"id": 0,
"entity": "伊曲康唑",
"start_offset": 0,
"end_offset": 4,
"label": "dru"
}
] |
卡泊芬净用于其他药物治疗无效或不能耐受其他药物者。
|
[
{
"id": 0,
"entity": "卡泊芬净",
"start_offset": 0,
"end_offset": 4,
"label": "dru"
}
] |
氟胞嘧啶对少数曲霉有一定的抗菌活性，常和两性霉素B或咪唑类联合应用。
|
[
{
"id": 0,
"entity": "氟胞嘧啶",
"start_offset": 0,
"end_offset": 4,
"label": "dru"
},
{
"id": 1,
"entity": "两性霉素B",
"start_offset": 20,
"end_offset": 25,
"label": "dru"
},
{
"id": 2,
"entity": "咪唑类",
"start_offset": 26,
"end_offset": 29,
"label": "dru"
}
] |
氟康唑对曲霉菌无效。
|
[
{
"id": 0,
"entity": "氟康唑",
"start_offset": 0,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "曲霉菌",
"start_offset": 4,
"end_offset": 7,
"label": "mic"
}
] |
药物治疗后仍迁延不愈、合并大咯血、病变局限能耐受手术时可考虑外科手术切除病变。
|
[
{
"id": 0,
"entity": "药物治疗后仍迁延不愈",
"start_offset": 0,
"end_offset": 10,
"label": "sym"
},
{
"id": 1,
"entity": "合并大咯血",
"start_offset": 11,
"end_offset": 16,
"label": "sym"
},
{
"id": 2,
"entity": "病变局限",
"start_offset": 17,
"end_offset": 21,
"label": "sym"
},
{
"id": 3,
"entity": "外科手术",
"start_offset": 30,
"end_offset": 34,
"label": "pro"
}
] |
2.ABPA治疗皮质类固醇类激素目前依然是治疗的金标准，常规剂量，依据临床反应调整，可使大部分患者症状减轻、肺部阴影消退、延缓肺功能减退和肺纤维化等毁损肺的发生。
|
[
{
"id": 0,
"entity": "ABPA",
"start_offset": 2,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "皮质类固醇类激素",
"start_offset": 8,
"end_offset": 16,
"label": "dru"
},
{
"id": 2,
"entity": "肺部阴影消退",
"start_offset": 54,
"end_offset": 60,
"label": "sym"
},
{
"id": 3,
"entity": "延缓肺功能减退",
"start_offset": 61,
"end_offset": 68,
"label": "sym"
},
{
"id": 4,
"entity": "肺纤维化",
"start_offset": 69,
"end_offset": 73,
"label": "sym"
},
{
"id": 5,
"entity": "肺",
"start_offset": 76,
"end_offset": 77,
"label": "bod"
}
] |
抗真菌治疗激素依赖性ABPA患者，可使部分患者有效。
|
[
{
"id": 0,
"entity": "抗真菌治疗激素",
"start_offset": 0,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "依赖性ABPA",
"start_offset": 7,
"end_offset": 14,
"label": "dis"
}
] |
三、肾小管功能检查肾小管功能较为复杂，包括排泌、重吸收、浓缩稀释、酸化尿液以及离子转移等多方面。
|
[
{
"id": 0,
"entity": "肾小管功能检查",
"start_offset": 2,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "肾小管",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "尿液",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
}
] |
（一）酚红排泄试验静脉注射0.6%酚红1ml后，94%由肾小管分泌排出，仅6%经肾小球滤过，故根据其排出的时间及量可判断近端肾小管细胞的分泌功能及肾血流量。
|
[
{
"id": 0,
"entity": "酚红排泄试验",
"start_offset": 3,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "静脉注射",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "酚红",
"start_offset": 17,
"end_offset": 19,
"label": "dru"
},
{
"id": 3,
"entity": "肾小管",
"start_offset": 28,
"end_offset": 31,
"label": "bod"
},
{
"id": 4,
"entity": "肾小球",
"start_offset": 40,
"end_offset": 43,
"label": "bod"
},
{
"id": 5,
"entity": "肾小管细胞",
"start_offset": 62,
"end_offset": 67,
"label": "bod"
},
{
"id": 6,
"entity": "肾",
"start_offset": 73,
"end_offset": 74,
"label": "bod"
}
] |
方法：注射前20分钟饮水200ml以上并在注射酚红同时排尿弃去。
|
[
{
"id": 0,
"entity": "注射",
"start_offset": 3,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "注射酚红",
"start_offset": 21,
"end_offset": 25,
"label": "pro"
},
{
"id": 2,
"entity": "尿",
"start_offset": 28,
"end_offset": 29,
"label": "bod"
}
] |
注射后15、30、60及120分钟各留尿一次。
|
[
{
"id": 0,
"entity": "注射",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "尿",
"start_offset": 19,
"end_offset": 20,
"label": "bod"
}
] |
15分钟值在12%以下时，说明肾小管功能有明显损害，见于慢性肾小球肾炎及肾血管硬化者。
|
[
{
"id": 0,
"entity": "肾小管",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 1,
"entity": "慢性肾小球肾炎",
"start_offset": 28,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "肾血管硬化",
"start_offset": 36,
"end_offset": 41,
"label": "dis"
}
] |
（二）肾小管回吸收功能测定1.肾小管葡萄糖最大吸收量（TmG</sub>）测定TmG</sub>（tubularmaximalglucosereabsorptioncapacity）是测定近端肾小管最大重吸收能力的一种功能试验。
|
[
{
"id": 0,
"entity": "肾小管",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "TmG",
"start_offset": 27,
"end_offset": 30,
"label": "ite"
},
{
"id": 2,
"entity": "TmG",
"start_offset": 39,
"end_offset": 42,
"label": "pro"
},
{
"id": 3,
"entity": "tubularmaximalglucosereabsorptioncapacity",
"start_offset": 49,
"end_offset": 90,
"label": "ite"
},
{
"id": 4,
"entity": "肾小管",
"start_offset": 96,
"end_offset": 99,
"label": "bod"
}
] |
采用单位时间内肾小球滤过的葡萄糖量减去单位时间内尿中出现的葡萄糖量，即可计算出TmG</sub>值。
|
[
{
"id": 0,
"entity": "肾小球",
"start_offset": 7,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "葡萄",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "尿",
"start_offset": 24,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "葡萄糖",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "TmG",
"start_offset": 39,
"end_offset": 42,
"label": "ite"
}
] |
TmG</sub>=PG</sub>×Cin-UG</sub>×VPG</sub>、UG</sub>分别为血、尿中葡萄糖浓度（mg/dl），V为尿量（ml），Cin为菊粉清除率（ml/min），3～15岁小儿正常参考值为（254±115）mg/（min•1.73m2</sup>）。
|
[
{
"id": 0,
"entity": "TmG",
"start_offset": 0,
"end_offset": 3,
"label": "ite"
},
{
"id": 1,
"entity": "PG",
"start_offset": 10,
"end_offset": 12,
"label": "ite"
},
{
"id": 2,
"entity": "Cin-UG",
"start_offset": 19,
"end_offset": 25,
"label": "ite"
},
{
"id": 3,
"entity": "PG",
"start_offset": 33,
"end_offset": 35,
"label": "ite"
},
{
"id": 4,
"entity": "UG",
"start_offset": 42,
"end_offset": 44,
"label": "ite"
},
{
"id": 5,
"entity": "血、尿中葡萄糖浓度",
"start_offset": 53,
"end_offset": 62,
"label": "ite"
},
{
"id": 6,
"entity": "尿量",
"start_offset": 72,
"end_offset": 74,
"label": "ite"
},
{
"id": 7,
"entity": "菊粉清除率",
"start_offset": 83,
"end_offset": 88,
"label": "ite"
}
] |
在近端肾小管疾病时TmG</sub>降低。
|
[
{
"id": 0,
"entity": "近端肾小管疾病",
"start_offset": 1,
"end_offset": 8,
"label": "dis"
},
{
"id": 1,
"entity": "TmG",
"start_offset": 9,
"end_offset": 12,
"label": "ite"
}
] |
2.尿中低分子量蛋白的测定溶菌酶（lysozyme）、视黄醇结合蛋白（retinol-bindingprotein，RBP）以及尿中κ、λ轻链都属低分子量蛋白，绝大多数在肾近端小管重吸收，如果尿中浓度升高，往往说明肾小管回吸收功能减低。
|
[
{
"id": 0,
"entity": "尿中低分子量蛋白的测定",
"start_offset": 2,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "溶菌酶",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 2,
"entity": "lysozyme",
"start_offset": 17,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "视黄醇结合蛋白",
"start_offset": 27,
"end_offset": 34,
"label": "bod"
},
{
"id": 4,
"entity": "retinol-bindingprotein",
"start_offset": 35,
"end_offset": 57,
"label": "bod"
},
{
"id": 5,
"entity": "RBP",
"start_offset": 58,
"end_offset": 61,
"label": "bod"
},
{
"id": 6,
"entity": "尿",
"start_offset": 64,
"end_offset": 65,
"label": "bod"
},
{
"id": 7,
"entity": "κ、λ轻链",
"start_offset": 66,
"end_offset": 71,
"label": "bod"
},
{
"id": 8,
"entity": "肾近端小管",
"start_offset": 85,
"end_offset": 90,
"label": "bod"
},
{
"id": 9,
"entity": "尿",
"start_offset": 96,
"end_offset": 97,
"label": "bod"
},
{
"id": 10,
"entity": "肾小管",
"start_offset": 107,
"end_offset": 110,
"label": "bod"
}
] |
（三）尿液浓缩与稀释功能检查1.改良莫氏试验（Mosenthaltest）反映远端肾小管功能。
|
[
{
"id": 0,
"entity": "尿液浓缩与稀释功能检查",
"start_offset": 3,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "改良莫氏试验",
"start_offset": 16,
"end_offset": 22,
"label": "pro"
},
{
"id": 2,
"entity": "Mosenthaltest",
"start_offset": 23,
"end_offset": 36,
"label": "pro"
},
{
"id": 3,
"entity": "远端肾小管",
"start_offset": 39,
"end_offset": 44,
"label": "bod"
}
] |
试验前1天晚8时后禁水，试验当天正常饮食，餐间禁水，晨8时排尿弃去，以后每2小时留尿一次至晚8时共6次，自晚8时至次日晨留12小时尿，白天12小时尿量应为全日总量的1/2～3/4，比重应有一次＞1.020，最高与最低尿比重之差应＞0.009。
|
[
{
"id": 0,
"entity": "尿",
"start_offset": 30,
"end_offset": 31,
"label": "bod"
},
{
"id": 1,
"entity": "尿",
"start_offset": 41,
"end_offset": 42,
"label": "bod"
},
{
"id": 2,
"entity": "尿",
"start_offset": 65,
"end_offset": 66,
"label": "bod"
},
{
"id": 3,
"entity": "尿量",
"start_offset": 73,
"end_offset": 75,
"label": "ite"
},
{
"id": 4,
"entity": "尿比重",
"start_offset": 108,
"end_offset": 111,
"label": "ite"
}
] |
浓缩功能障碍见于急、慢性肾功能不全、肾间质损伤及肾小管疾病等。
|
[
{
"id": 0,
"entity": "浓缩功能障碍",
"start_offset": 0,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "急、慢性肾功能不全",
"start_offset": 8,
"end_offset": 17,
"label": "dis"
},
{
"id": 2,
"entity": "肾间质损伤",
"start_offset": 18,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "肾小管疾病",
"start_offset": 24,
"end_offset": 29,
"label": "dis"
}
] |
2.尿渗透压测定检测禁水12小时后的浓缩尿的渗透压，正常应达800mOsm/L以上，较莫氏试验简单，方便。
|
[
{
"id": 0,
"entity": "尿渗透压测定",
"start_offset": 2,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "浓缩尿的渗透压",
"start_offset": 18,
"end_offset": 25,
"label": "ite"
},
{
"id": 2,
"entity": "莫氏试验",
"start_offset": 43,
"end_offset": 47,
"label": "pro"
}
] |
3.自由水清除率（clearanceoffreewater，CH2O</sub>）指单位时间内从血浆中清除到尿中的不含溶质的水量，计算方法：CH2O（ml/min）=V-Uosm×V/Posm，式中V为尿量，Uosm、Posm分别为尿和血的渗透压。
|
[
{
"id": 0,
"entity": "自由水清除率",
"start_offset": 2,
"end_offset": 8,
"label": "ite"
},
{
"id": 1,
"entity": "clearanceoffreewater",
"start_offset": 9,
"end_offset": 29,
"label": "ite"
},
{
"id": 2,
"entity": "CH2O",
"start_offset": 30,
"end_offset": 34,
"label": "ite"
},
{
"id": 3,
"entity": "血浆",
"start_offset": 48,
"end_offset": 50,
"label": "bod"
},
{
"id": 4,
"entity": "尿",
"start_offset": 54,
"end_offset": 55,
"label": "bod"
},
{
"id": 5,
"entity": "CH2O",
"start_offset": 70,
"end_offset": 74,
"label": "ite"
},
{
"id": 6,
"entity": "V-Uosm",
"start_offset": 83,
"end_offset": 89,
"label": "ite"
},
{
"id": 7,
"entity": "V",
"start_offset": 90,
"end_offset": 91,
"label": "ite"
},
{
"id": 8,
"entity": "Posm",
"start_offset": 92,
"end_offset": 96,
"label": "ite"
},
{
"id": 9,
"entity": "V",
"start_offset": 99,
"end_offset": 100,
"label": "ite"
},
{
"id": 10,
"entity": "尿量",
"start_offset": 101,
"end_offset": 103,
"label": "ite"
},
{
"id": 11,
"entity": "Posm",
"start_offset": 109,
"end_offset": 113,
"label": "ite"
},
{
"id": 12,
"entity": "尿和血的渗透压",
"start_offset": 116,
"end_offset": 123,
"label": "ite"
}
] |
当Uosm=Posm时，CH2O</sub>=0，说明肾脏不起浓缩作用。
|
[
{
"id": 0,
"entity": "Uosm",
"start_offset": 1,
"end_offset": 5,
"label": "ite"
},
{
"id": 1,
"entity": "Posm",
"start_offset": 6,
"end_offset": 10,
"label": "ite"
},
{
"id": 2,
"entity": "CH2O",
"start_offset": 12,
"end_offset": 16,
"label": "ite"
},
{
"id": 3,
"entity": "肾脏不起浓缩作用",
"start_offset": 27,
"end_offset": 35,
"label": "sym"
}
] |
CH2O</sub>正值说明机体需排出较多水分以维持正常的血浆渗透压。
|
[
{
"id": 0,
"entity": "CH2O",
"start_offset": 0,
"end_offset": 4,
"label": "ite"
},
{
"id": 1,
"entity": "血浆渗透压",
"start_offset": 29,
"end_offset": 34,
"label": "ite"
}
] |
CH2O</sub>负值越大，表示浓缩功能越强。
|
[
{
"id": 0,
"entity": "CH2O",
"start_offset": 0,
"end_offset": 4,
"label": "ite"
}
] |
浓缩试验时，CH2O可达-0.4～10.7ml/min，稀释试验时CH2O</sub>为1～9ml/min。
|
[
{
"id": 0,
"entity": "浓缩试验",
"start_offset": 0,
"end_offset": 4,
"label": "pro"
},
{
"id": 1,
"entity": "CH2O",
"start_offset": 6,
"end_offset": 10,
"label": "ite"
},
{
"id": 2,
"entity": "稀释试验",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
},
{
"id": 3,
"entity": "CH2O",
"start_offset": 33,
"end_offset": 37,
"label": "ite"
}
] |
（四）尿酸化功能检查近端肾小管和远端肾小管都有分泌H+</sup>、保的功能，这种酸化尿液的功能受损将导致肾小管酸中毒的发生。
|
[
{
"id": 0,
"entity": "尿酸化功能检查",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "近端肾小管",
"start_offset": 10,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "远端肾小管",
"start_offset": 16,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "H+",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
},
{
"id": 4,
"entity": "尿液",
"start_offset": 43,
"end_offset": 45,
"label": "bod"
},
{
"id": 5,
"entity": "肾小管酸中毒",
"start_offset": 53,
"end_offset": 59,
"label": "dis"
}
] |
尿液酸化功能的检查包括尿pH、尿氨、可滴定酸的测定以及酸负荷试验、碱负荷试验和呋塞米试验等，方法详见本篇第四章第一节“肾小管性酸中毒”。
|
[
{
"id": 0,
"entity": "尿液酸化功能的检查",
"start_offset": 0,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "尿pH",
"start_offset": 11,
"end_offset": 14,
"label": "ite"
},
{
"id": 2,
"entity": "尿氨",
"start_offset": 15,
"end_offset": 17,
"label": "ite"
},
{
"id": 3,
"entity": "可滴定酸",
"start_offset": 18,
"end_offset": 22,
"label": "ite"
},
{
"id": 4,
"entity": "酸负荷",
"start_offset": 27,
"end_offset": 30,
"label": "ite"
},
{
"id": 5,
"entity": "碱负荷试验",
"start_offset": 33,
"end_offset": 38,
"label": "pro"
},
{
"id": 6,
"entity": "呋塞米试验",
"start_offset": 39,
"end_offset": 44,
"label": "pro"
},
{
"id": 7,
"entity": "肾小管性酸中毒",
"start_offset": 59,
"end_offset": 66,
"label": "dis"
}
] |
（五）肾脏内分泌功能检查肾脏与内分泌关系主要包括：①产生内分泌激素的能力：如促红细胞生成素（Epo）、肾素、血管紧张素、1，25（OH）2</sub>D3</sub>以及前列腺素；②作为靶器官对外分泌激素的反应能力：如ADH和PTH等可作用于肾脏；③降解部分内分泌激素如胰岛素等。
|
[
{
"id": 0,
"entity": "肾脏内分泌功能检查",
"start_offset": 3,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "肾脏",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "内分泌激素",
"start_offset": 28,
"end_offset": 33,
"label": "bod"
},
{
"id": 3,
"entity": "促红细胞生成素",
"start_offset": 38,
"end_offset": 45,
"label": "bod"
},
{
"id": 4,
"entity": "Epo",
"start_offset": 46,
"end_offset": 49,
"label": "bod"
},
{
"id": 5,
"entity": "肾素",
"start_offset": 51,
"end_offset": 53,
"label": "bod"
},
{
"id": 6,
"entity": "血管紧张素",
"start_offset": 54,
"end_offset": 59,
"label": "bod"
},
{
"id": 7,
"entity": "前列腺素",
"start_offset": 85,
"end_offset": 89,
"label": "bod"
},
{
"id": 8,
"entity": "靶器官",
"start_offset": 93,
"end_offset": 96,
"label": "bod"
},
{
"id": 9,
"entity": "外分泌激素",
"start_offset": 97,
"end_offset": 102,
"label": "bod"
},
{
"id": 10,
"entity": "ADH",
"start_offset": 109,
"end_offset": 112,
"label": "bod"
},
{
"id": 11,
"entity": "PTH",
"start_offset": 113,
"end_offset": 116,
"label": "bod"
},
{
"id": 12,
"entity": "肾脏",
"start_offset": 121,
"end_offset": 123,
"label": "bod"
},
{
"id": 13,
"entity": "内分泌激素",
"start_offset": 129,
"end_offset": 134,
"label": "bod"
},
{
"id": 14,
"entity": "胰岛素",
"start_offset": 135,
"end_offset": 138,
"label": "bod"
}
] |
反映肾脏内分泌功能检测主要是血中Epo浓度、1，25（OH）2</sub>血浆肾素活性测定等方面。
|
[
{
"id": 0,
"entity": "肾脏",
"start_offset": 2,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "血",
"start_offset": 14,
"end_offset": 15,
"label": "ite"
},
{
"id": 2,
"entity": "Epo浓度",
"start_offset": 16,
"end_offset": 21,
"label": "ite"
},
{
"id": 3,
"entity": "血浆肾素",
"start_offset": 37,
"end_offset": 41,
"label": "bod"
}
] |
（六）尿酶检查肾脏受损时血液及肾组织中的某些酶可从尿中排出，现已证实可从尿液中检测出30～50种酶。
|
[
{
"id": 0,
"entity": "尿酶检查",
"start_offset": 3,
"end_offset": 7,
"label": "pro"
},
{
"id": 1,
"entity": "肾脏受损",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
},
{
"id": 2,
"entity": "血液",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "肾组织",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 4,
"entity": "酶",
"start_offset": 22,
"end_offset": 23,
"label": "bod"
},
{
"id": 5,
"entity": "尿",
"start_offset": 25,
"end_offset": 26,
"label": "bod"
},
{
"id": 6,
"entity": "尿液",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 7,
"entity": "酶",
"start_offset": 48,
"end_offset": 49,
"label": "bod"
}
] |
临床上已有十几种尿酶测定应用于肾脏病的诊断和判断预后。
|
[
{
"id": 0,
"entity": "尿酶测定",
"start_offset": 8,
"end_offset": 12,
"label": "ite"
},
{
"id": 1,
"entity": "肾脏病",
"start_offset": 15,
"end_offset": 18,
"label": "dis"
}
] |
但因大多数缺乏特异性且影响因素较多，故常需检查2种以上尿酶并结合临床资料综合判断。
|
[
{
"id": 0,
"entity": "尿酶",
"start_offset": 27,
"end_offset": 29,
"label": "ite"
}
] |
尿酶有以下几类：①水解酶类：如N-乙酰-β-D氨基葡萄糖苷酶（N-acetyl-D-glucosaminidase，NAG）临床上应用较多，为溶酶体酶，不能为肾小球滤过，广泛存在于肾小管和泌尿道上皮细胞中。
|
[
{
"id": 0,
"entity": "尿酶",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "水解酶类",
"start_offset": 9,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "N-乙酰-β-D氨基葡萄糖苷酶",
"start_offset": 15,
"end_offset": 30,
"label": "bod"
},
{
"id": 3,
"entity": "N-acetyl-D-glucosaminidase",
"start_offset": 31,
"end_offset": 57,
"label": "bod"
},
{
"id": 4,
"entity": "NAG",
"start_offset": 58,
"end_offset": 61,
"label": "bod"
},
{
"id": 5,
"entity": "溶酶体酶",
"start_offset": 71,
"end_offset": 75,
"label": "bod"
},
{
"id": 6,
"entity": "肾小球",
"start_offset": 79,
"end_offset": 82,
"label": "bod"
},
{
"id": 7,
"entity": "肾小管",
"start_offset": 90,
"end_offset": 93,
"label": "bod"
},
{
"id": 8,
"entity": "泌尿道上皮细胞",
"start_offset": 94,
"end_offset": 101,
"label": "bod"
}
] |
在急性肾炎、肾衰竭、肾病、狼疮肾和紫癜肾的急性期均较缓解期明显升高。
|
[
{
"id": 0,
"entity": "急性肾炎",
"start_offset": 1,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "肾衰竭",
"start_offset": 6,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "肾病",
"start_offset": 10,
"end_offset": 12,
"label": "dis"
},
{
"id": 3,
"entity": "狼疮肾",
"start_offset": 13,
"end_offset": 16,
"label": "dis"
},
{
"id": 4,
"entity": "紫癜肾",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
}
] |
NAG在尿中活性升高是肾脏损害的标志。
|
[
{
"id": 0,
"entity": "NAG",
"start_offset": 0,
"end_offset": 3,
"label": "ite"
},
{
"id": 1,
"entity": "尿",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 2,
"entity": "肾脏损害",
"start_offset": 11,
"end_offset": 15,
"label": "dis"
}
] |
NAG还可作为一灵敏的指标用于监测氨基甙类抗生素的中毒及肾移植后急性排异反应。
|
[
{
"id": 0,
"entity": "NAG",
"start_offset": 0,
"end_offset": 3,
"label": "ite"
},
{
"id": 1,
"entity": "肾移植",
"start_offset": 28,
"end_offset": 31,
"label": "pro"
},
{
"id": 2,
"entity": "急性排异",
"start_offset": 32,
"end_offset": 36,
"label": "dis"
}
] |
②转换酶类：如γ-谷氨酰转换酶（r-glutamyltransferase，γ-GT）为肾小管细胞刷状缘酶，增高可见于急性肾炎及肾病急性期，肾病合并泌尿系感染者增高尤为明显。
|
[
{
"id": 0,
"entity": "转换酶类",
"start_offset": 1,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "γ-谷氨酰转换酶",
"start_offset": 7,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "r-glutamyltransferase",
"start_offset": 16,
"end_offset": 37,
"label": "bod"
},
{
"id": 3,
"entity": "γ-GT",
"start_offset": 38,
"end_offset": 42,
"label": "bod"
},
{
"id": 4,
"entity": "肾小管细胞刷状缘酶",
"start_offset": 44,
"end_offset": 53,
"label": "bod"
},
{
"id": 5,
"entity": "急性肾炎",
"start_offset": 59,
"end_offset": 63,
"label": "dis"
},
{
"id": 6,
"entity": "肾病",
"start_offset": 64,
"end_offset": 66,
"label": "dis"
},
{
"id": 7,
"entity": "肾病合并泌尿系感染者",
"start_offset": 70,
"end_offset": 80,
"label": "dis"
}
] |
肾小球性血尿、肾小管疾病、肾结石及迁延性肾炎时也可见增高。
|
[
{
"id": 0,
"entity": "肾小球性血尿",
"start_offset": 0,
"end_offset": 6,
"label": "dis"
},
{
"id": 1,
"entity": "肾小管疾病",
"start_offset": 7,
"end_offset": 12,
"label": "dis"
},
{
"id": 2,
"entity": "肾结石",
"start_offset": 13,
"end_offset": 16,
"label": "dis"
},
{
"id": 3,
"entity": "迁延性肾炎",
"start_offset": 17,
"end_offset": 22,
"label": "dis"
}
] |
③肽酶类：如亮氨酸氨基肽酶（leucineaminopeptidase，LAP）也是近端肾小管细胞刷状缘酶，对小管细胞的损伤较敏感。
|
[
{
"id": 0,
"entity": "肽酶类",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "亮氨酸氨基肽酶",
"start_offset": 6,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "leucineaminopeptidase",
"start_offset": 14,
"end_offset": 35,
"label": "bod"
},
{
"id": 3,
"entity": "LAP",
"start_offset": 36,
"end_offset": 39,
"label": "bod"
},
{
"id": 4,
"entity": "近端肾小管细胞刷状缘酶",
"start_offset": 42,
"end_offset": 53,
"label": "bod"
},
{
"id": 5,
"entity": "小管细胞",
"start_offset": 55,
"end_offset": 59,
"label": "bod"
}
] |
其增高的意义与r-GT相似，临床上常两者同时检测。
|
[
{
"id": 0,
"entity": "r-GT",
"start_offset": 7,
"end_offset": 11,
"label": "bod"
}
] |
④氧化还原酶类：如乳酸脱氢酶（lacticdehydrogenase，LDH）及其异构酶，可在急性肾炎及肾病时增高。
|
[
{
"id": 0,
"entity": "氧化还原酶类",
"start_offset": 1,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "乳酸脱氢酶",
"start_offset": 9,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "lacticdehydrogenase",
"start_offset": 15,
"end_offset": 34,
"label": "bod"
},
{
"id": 3,
"entity": "LDH",
"start_offset": 35,
"end_offset": 38,
"label": "bod"
},
{
"id": 4,
"entity": "异构酶",
"start_offset": 41,
"end_offset": 44,
"label": "bod"
},
{
"id": 5,
"entity": "急性肾炎",
"start_offset": 47,
"end_offset": 51,
"label": "dis"
},
{
"id": 6,
"entity": "肾病",
"start_offset": 52,
"end_offset": 54,
"label": "dis"
}
] |
LDH5</sub>增高提示为上泌尿系感染，还可用于肾移植后排异的早期诊断。
|
[
{
"id": 0,
"entity": "LDH5",
"start_offset": 0,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "上泌尿系感染",
"start_offset": 15,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "肾移植",
"start_offset": 26,
"end_offset": 29,
"label": "pro"
}
] |
其他蛋白酶类还有如尿激酶和胰蛋白酶，裂解酶类有透明质酸酶等，但临床应用较少。
|
[
{
"id": 0,
"entity": "蛋白酶类",
"start_offset": 2,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "尿激酶",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "胰蛋白酶",
"start_offset": 13,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "透明质酸酶",
"start_offset": 23,
"end_offset": 28,
"label": "bod"
}
] |
第十一节病态窦房结综合征病态窦房结综合征（sicksinussyndrome）由窦房结或心房传导组织的异常所引起。
|
[
{
"id": 0,
"entity": "病态窦房结综合征",
"start_offset": 4,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "病态窦房结综合征",
"start_offset": 12,
"end_offset": 20,
"label": "dis"
},
{
"id": 2,
"entity": "sicksinussyndrome",
"start_offset": 21,
"end_offset": 38,
"label": "dis"
},
{
"id": 3,
"entity": "窦房结",
"start_offset": 40,
"end_offset": 43,
"label": "bod"
},
{
"id": 4,
"entity": "心房传导组织",
"start_offset": 44,
"end_offset": 50,
"label": "bod"
}
] |
可发生在无先天性心脏病的患儿，也有报道在同胞中出现，但最常见于先天性心脏病外科纠治术后，特别是大动脉错位Mustard或Senning手术后。
|
[
{
"id": 0,
"entity": "先天性心脏病",
"start_offset": 5,
"end_offset": 11,
"label": "dis"
},
{
"id": 1,
"entity": "先天性心脏病外科纠治术",
"start_offset": 31,
"end_offset": 42,
"label": "sym"
},
{
"id": 2,
"entity": "大动脉错位Mustard或Senning手术",
"start_offset": 47,
"end_offset": 69,
"label": "sym"
}
] |
其临床表现主要取决于心率。
|
[
{
"id": 0,
"entity": "心率",
"start_offset": 10,
"end_offset": 12,
"label": "ite"
}
] |
三、腹膜透析的基本方式（一）间歇性腹膜透析间歇性腹膜透析（IPD）透析方式运用于急性肾衰PD或慢性PD治疗的最初阶段，一般推荐透析交换8～10次/d（8～10个透析周期），每次透析液30～50m1/kg，最多不能超过2000ml/（m2</sup>•次），由于IPD透析方式腹透液置留腹腔内约30～40min，对中大分子物质清除效果差，因此不作为慢性腹透的常规。
|
[
{
"id": 0,
"entity": "腹膜透析",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 1,
"entity": "间歇性腹膜透析",
"start_offset": 14,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "间歇性腹膜透析",
"start_offset": 21,
"end_offset": 28,
"label": "pro"
},
{
"id": 3,
"entity": "IPD",
"start_offset": 29,
"end_offset": 32,
"label": "pro"
},
{
"id": 4,
"entity": "透析",
"start_offset": 33,
"end_offset": 35,
"label": "pro"
},
{
"id": 5,
"entity": "急性肾衰PD",
"start_offset": 40,
"end_offset": 46,
"label": "dis"
},
{
"id": 6,
"entity": "慢性PD",
"start_offset": 47,
"end_offset": 51,
"label": "dis"
},
{
"id": 7,
"entity": "透析",
"start_offset": 63,
"end_offset": 65,
"label": "pro"
},
{
"id": 8,
"entity": "透析液",
"start_offset": 88,
"end_offset": 91,
"label": "dru"
},
{
"id": 9,
"entity": "IPD透析",
"start_offset": 130,
"end_offset": 135,
"label": "pro"
},
{
"id": 10,
"entity": "腹透液",
"start_offset": 137,
"end_offset": 140,
"label": "dru"
},
{
"id": 11,
"entity": "腹腔",
"start_offset": 142,
"end_offset": 144,
"label": "bod"
},
{
"id": 12,
"entity": "慢性腹透",
"start_offset": 173,
"end_offset": 177,
"label": "pro"
}
] |
（二）连续性非卧床腹膜透析连续性非卧床腹膜透析（continuousambulatorperitonealdialysis，CAPD）是慢性腹膜透析方式中使用最广的一种，其简单易行，费用低，不需特殊透析设备，具有持续性腹膜透析状态，缓慢持续的超滤脱水，生理状态稳定，血压控制满意。
|
[
{
"id": 0,
"entity": "连续性非卧床腹膜透析",
"start_offset": 3,
"end_offset": 13,
"label": "pro"
},
{
"id": 1,
"entity": "continuousambulatorperitonealdialysis",
"start_offset": 24,
"end_offset": 61,
"label": "pro"
},
{
"id": 2,
"entity": "慢性腹膜透析",
"start_offset": 68,
"end_offset": 74,
"label": "pro"
},
{
"id": 3,
"entity": "腹膜透析",
"start_offset": 109,
"end_offset": 113,
"label": "pro"
},
{
"id": 4,
"entity": "脱水",
"start_offset": 123,
"end_offset": 125,
"label": "sym"
},
{
"id": 5,
"entity": "血压",
"start_offset": 133,
"end_offset": 135,
"label": "ite"
}
] |
儿童标准的CAPD，每日4次，每次透析量为50ml/kg或2000ml/m2</sup>，白天交换3次，间隔4～6小时交换一次，夜间交换一次，透析液存留在腹腔中过夜8～10小时。
|
[
{
"id": 0,
"entity": "CAPD",
"start_offset": 5,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "透析",
"start_offset": 17,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "透析液",
"start_offset": 71,
"end_offset": 74,
"label": "dru"
},
{
"id": 3,
"entity": "腹腔",
"start_offset": 77,
"end_offset": 79,
"label": "bod"
}
] |
患儿的CAPD次数并非一成不变，可根据病情及残余肾功能来增加或减少交换次数，当患儿常规透析仍出现高血钾或高分解状态或透析不充分时，可适当增加交换次数。
|
[
{
"id": 0,
"entity": "肾",
"start_offset": 24,
"end_offset": 25,
"label": "bod"
},
{
"id": 1,
"entity": "高血钾或高分解状态或透析不充分",
"start_offset": 48,
"end_offset": 63,
"label": "sym"
}
] |
对于儿童患儿腹膜透析超滤脱水，可根据患儿尿量、水肿以及心功能状态酌情选用1.5%、2.5%及4.25%的葡萄糖透析液，一般情况白天采用1.5%透析液，夜间因腹透液置留腹腔时间过长，导致透析液葡萄糖经腹膜再吸收致使透析液渗透压下降而影响超滤，故应考虑使用2.5%或4.25%葡萄糖透析液。
|
[
{
"id": 0,
"entity": "腹膜透析超滤脱水",
"start_offset": 6,
"end_offset": 14,
"label": "sym"
},
{
"id": 1,
"entity": "尿量",
"start_offset": 20,
"end_offset": 22,
"label": "ite"
},
{
"id": 2,
"entity": "水肿",
"start_offset": 23,
"end_offset": 25,
"label": "sym"
},
{
"id": 3,
"entity": "心",
"start_offset": 27,
"end_offset": 28,
"label": "bod"
},
{
"id": 4,
"entity": "葡萄糖透析液",
"start_offset": 52,
"end_offset": 58,
"label": "dru"
},
{
"id": 5,
"entity": "透析液",
"start_offset": 71,
"end_offset": 74,
"label": "dru"
},
{
"id": 6,
"entity": "腹透液",
"start_offset": 78,
"end_offset": 81,
"label": "dru"
},
{
"id": 7,
"entity": "腹腔",
"start_offset": 83,
"end_offset": 85,
"label": "bod"
},
{
"id": 8,
"entity": "透析液葡萄糖",
"start_offset": 92,
"end_offset": 98,
"label": "dru"
},
{
"id": 9,
"entity": "腹膜",
"start_offset": 99,
"end_offset": 101,
"label": "bod"
},
{
"id": 10,
"entity": "透析液",
"start_offset": 106,
"end_offset": 109,
"label": "dru"
},
{
"id": 11,
"entity": "葡萄糖透析液",
"start_offset": 136,
"end_offset": 142,
"label": "dru"
}
] |
CAPD透析方式对于儿童患者需要其他人的帮助，同时影响学龄儿童正常上学，由于CAPD透析方式液体交换次数多，腹膜炎的发生率相对较高。
|
[
{
"id": 0,
"entity": "CAPD透析",
"start_offset": 38,
"end_offset": 44,
"label": "pro"
},
{
"id": 1,
"entity": "腹膜炎",
"start_offset": 54,
"end_offset": 57,
"label": "dis"
}
] |
（三）持续循环腹膜透析持续循环腹膜透析（CCPD）是近年来随着自动腹膜透析机（APD）而发展起来的一种腹透方法，实际上它与CAPD相似，将CAPD白天3次透析液交换改在夜间利用腹膜透析机自动进行，晨起腹腔放入腹透液，持续到晚上重新循环开始。
|
[
{
"id": 0,
"entity": "持续循环腹膜透析",
"start_offset": 3,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "持续循环腹膜透析",
"start_offset": 11,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "CCPD",
"start_offset": 20,
"end_offset": 24,
"label": "pro"
},
{
"id": 3,
"entity": "自动腹膜透析机",
"start_offset": 31,
"end_offset": 38,
"label": "equ"
},
{
"id": 4,
"entity": "APD",
"start_offset": 39,
"end_offset": 42,
"label": "equ"
},
{
"id": 5,
"entity": "腹透",
"start_offset": 51,
"end_offset": 53,
"label": "pro"
},
{
"id": 6,
"entity": "CAPD",
"start_offset": 61,
"end_offset": 65,
"label": "pro"
},
{
"id": 7,
"entity": "CAPD",
"start_offset": 69,
"end_offset": 73,
"label": "pro"
},
{
"id": 8,
"entity": "透析液",
"start_offset": 77,
"end_offset": 80,
"label": "dru"
},
{
"id": 9,
"entity": "腹膜透析机",
"start_offset": 88,
"end_offset": 93,
"label": "equ"
},
{
"id": 10,
"entity": "腹腔",
"start_offset": 100,
"end_offset": 102,
"label": "bod"
},
{
"id": 11,
"entity": "腹透液",
"start_offset": 104,
"end_offset": 107,
"label": "dru"
}
] |
对于儿童患者选用CCPD方式其优点是：①由于CCPD是由腹膜透析机换液，自动加温，控制液体出入量，减少了人工换液的次数，从而有效降低腹膜炎的发生率。
|
[
{
"id": 0,
"entity": "CCPD",
"start_offset": 8,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "CCPD",
"start_offset": 22,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "腹膜透析机",
"start_offset": 28,
"end_offset": 33,
"label": "equ"
},
{
"id": 3,
"entity": "人工换液",
"start_offset": 52,
"end_offset": 56,
"label": "pro"
},
{
"id": 4,
"entity": "腹膜炎",
"start_offset": 66,
"end_offset": 69,
"label": "dis"
}
] |
复旦大学附属儿科医院近年引进自动腹膜透析技术，患儿采用CCPD长达一年余未有腹膜炎发生。
|
[
{
"id": 0,
"entity": "儿科",
"start_offset": 6,
"end_offset": 8,
"label": "dep"
},
{
"id": 1,
"entity": "自动腹膜透析",
"start_offset": 14,
"end_offset": 20,
"label": "pro"
},
{
"id": 2,
"entity": "CCPD",
"start_offset": 27,
"end_offset": 31,
"label": "pro"
},
{
"id": 3,
"entity": "腹膜炎",
"start_offset": 38,
"end_offset": 41,
"label": "dis"
}
] |
②通过透析机可调整灌入量，适用于体表面积较小的儿童患者。
|
[
{
"id": 0,
"entity": "透析机",
"start_offset": 3,
"end_offset": 6,
"label": "equ"
}
] |
③CCPD每天仅操作一次，最大限度地减少患儿父母对透析的参与，而患儿白天不需透析，可充分地利用白天时间学习。
|
[
{
"id": 0,
"entity": "CCPD",
"start_offset": 1,
"end_offset": 5,
"label": "pro"
},
{
"id": 1,
"entity": "透析",
"start_offset": 25,
"end_offset": 27,
"label": "pro"
},
{
"id": 2,
"entity": "透析",
"start_offset": 38,
"end_offset": 40,
"label": "pro"
}
] |
④透析在夜间进行，白天可提高营养和热量的摄入。
|
[
{
"id": 0,
"entity": "透析",
"start_offset": 1,
"end_offset": 3,
"label": "pro"
}
] |
⑤儿童腹膜表面积与单位体重之比较成年人大，腹膜对葡萄糖再吸收快。
|
[
{
"id": 0,
"entity": "腹膜",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "腹膜",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 2,
"entity": "葡萄糖",
"start_offset": 24,
"end_offset": 27,
"label": "dru"
}
] |
因此对于儿童腹透患者选择透析方式CCPD明显优于CAPD。
|
[
{
"id": 0,
"entity": "腹透",
"start_offset": 6,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "透析",
"start_offset": 12,
"end_offset": 14,
"label": "pro"
},
{
"id": 2,
"entity": "CCPD",
"start_offset": 16,
"end_offset": 20,
"label": "pro"
},
{
"id": 3,
"entity": "CAPD",
"start_offset": 24,
"end_offset": 28,
"label": "pro"
}
] |
（四）夜间间歇性腹膜透析夜间间歇性腹膜透析（nocturnalintermittentperitonealdialysis，NIPD）是在夜间交接，不影明白天的上课和正常的学习以及其他活动。
|
[
{
"id": 0,
"entity": "夜间间歇性腹膜透析",
"start_offset": 3,
"end_offset": 12,
"label": "pro"
},
{
"id": 1,
"entity": "夜间间歇性腹膜透析",
"start_offset": 12,
"end_offset": 21,
"label": "pro"
},
{
"id": 2,
"entity": "nocturnalintermittentperitonealdialysis",
"start_offset": 22,
"end_offset": 61,
"label": "pro"
},
{
"id": 3,
"entity": "NIPD",
"start_offset": 62,
"end_offset": 66,
"label": "pro"
}
] |
第五节心房扑动心房扑动（简称房扑）系由于激动在心房内快速环形运动所产生的一种主动性快速而规则的心律失常。
|
[
{
"id": 0,
"entity": "心房扑动",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "心房扑动",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
},
{
"id": 2,
"entity": "房扑",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 3,
"entity": "心律失常",
"start_offset": 47,
"end_offset": 51,
"label": "sym"
}
] |
较少见，占心律失常的2%左右。
|
[
{
"id": 0,
"entity": "心律失常",
"start_offset": 5,
"end_offset": 9,
"label": "sym"
}
] |
室律规则（房室传导比例固定或完全房室传导阻滞）或不规则（房室传导不固定）。
|
[
{
"id": 0,
"entity": "完全房室传导阻滞",
"start_offset": 14,
"end_offset": 22,
"label": "sym"
}
] |
新生儿房扑通常心脏正常。
|
[
{
"id": 0,
"entity": "房扑",
"start_offset": 3,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "心脏",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
}
] |
房扑不控制易发生心力衰竭。
|
[
{
"id": 0,
"entity": "房扑",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "心力衰竭",
"start_offset": 8,
"end_offset": 12,
"label": "sym"
}
] |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.