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初起时呈小点状和小片状，渐融合成大片，不易擦去，若强行擦拭后局部潮红，可有溢血。 | [
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患儿一般情况良好，无痛，不影响吃奶，偶有个别因累及消化道、呼吸道而出现呕吐、声嘶或呼吸困难鹅口疮的治疗，主要是用碱性药物及制霉菌素。 | [
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"entity": "偶有个别因累及消化道、呼吸道而出现呕吐、声嘶或呼吸困难",
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局部治疗，因为口腔的碱性环境可抑制白色念珠菌的生长繁殖。 | [
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一般用2%碳酸氢钠清洗口腔后，局部涂抹2%甲紫或冰硼散，每日1～2次，数日后便可痊愈。 | [
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若病变广泛者可用制霉菌素10万单位，加水1～2ml涂患处，每日3～4次。 | [
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第二节生理性贫血刚出生的正常足月新生儿红细胞计数可高达5×1012</sup>～7×1012</sup>/L，血红蛋白可达190～220g/L。 | [
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在无任何病理因素存在的情况下，出生后1周内红细胞计数与血红蛋白均逐渐下降，直至8周后方停止。 | [
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出生后2月～3月时，红细胞计数与血红蛋白含量降至最低点，前者可低至3×1012</sup>/L，后者可降至90g/L，呈现轻度贫血的表现。 | [
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由于这种轻度贫血的过程是生理性的，故称生理性贫血（physiologicalanemia）。 | [
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目前认为，这种贫血是胎儿出生后子宫外生命的生理性适应过程。 | [
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（一）可能的发生机制①红细胞生成停止：婴儿出生后自主呼吸的建立，动脉血氧饱和度上升至95%时，红细胞生成作用迅速停止；②红细胞生成素（EPO）水平较低：可能是由于新生儿期EPO的产生部位在肝脏而非肾脏所致，因为肝脏EPO的释放对组织低氧相对不敏感，且EPO的半衰期缩短；③血液稀释：生后头3个月，体重迅速增加，血容量也相应增加，导致血液稀释而使红细胞计数和血红蛋白含量下降。 | [
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（二）生理性贫血时机体的生理性适应过程当血红蛋白降至110g/L以下时，为了满足机体供氧需要，新生儿期血清2，3-二磷酸甘油醛（2，3-diphosphoglycocerate，2，3-DPG）增加，有利于正常成人型血红蛋白（HbA）中氧的释放，减少组织低氧的程度。 | [
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随着婴儿肾脏的不断成熟，肾脏分泌EPO的能力逐渐增加，红细胞生成作用也随之增加。 | [
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如无喂养不当以及其他病理因素存在的情况下，血红蛋白含量将于生后5～6个月恢复至110g/L以上。 | [
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（三）未成熟儿的生理性贫血早产儿也可发生生理性贫血，发生因素与足月儿相同，但这些因素的作用更加明显，血红蛋白下降更快、更严重。 | [
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血红蛋白最低可降至70～90g/L，通常发生于出生后3周～6周龄。 | [
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与足月儿不同，未成熟儿EPO产生的代偿能力较差，致血红蛋白浓度的下降更加明显。 | [
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由于早产儿输入了含有HbA的成人血后，其氧离曲线向右漂移，有利于氧在组织中的释放。 | [
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因此，对早产儿贫血的定义以及需不需要输血，不仅应根据Hb水平，而且还要根据氧需要和婴儿循环中Hb释放氧的能力来决定。 | [
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（四）可加重生理性贫血的因素1.生理性贫血的程度可因生后早期出现严重贫血的各种溶血过程增加而加重。 | [
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2.伴有EPO水平下降的情况如网织红细胞计数降低的低再生性（hyporegenerative）贫血、宫内输血的胎儿、一些伴有先天性支气管肺发育不良的婴儿等，均可以因EPO产生缺陷而发生贫血，因此，有必要对这些病人进行EPO治疗试验。 | [
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3.营养饮食因素如缺铁、叶酸缺乏等。 | [
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但在生后3个月内，如无明显失血，不会发生缺铁性贫血。 | [
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对于出生时铁贮备足够的小婴儿来说，在体重未达到2倍于出生体重前，不会因食物中铁缺乏而致贫血。 | [
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（五）治疗由于生理性贫血是正常发育过程中的一种表现，因此通常不需要治疗。 | [
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喂养良好、生长正常的早产婴儿如无明显医源性失血时极少需要输血。 | [
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健康早产婴儿即使Hb水平低至65g/L时通常也能很好地耐受，未必一定需要输血。 | [
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血细胞比容的监测是输红细胞的最佳观测指标。 | [
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红细胞输注似并不影响呼吸暂停（apneicspells）和心率缓慢的发作。 | [
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国外报道，严重贫血的未成熟儿可用重组人EPO250IU/kg，每周3次，皮下注射或（和）铁剂如蔗糖铁6mg/kg，每周一次静脉注射，或硫酸亚铁6mg/（kg•24h），分3次口服治疗6周，经上述治疗者需要输血的次数明显减少，但应用EPO治疗的费用远比输血要高。 | [
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"end_offset": 71,
"label": "dru"
},
{
"id": 7,
"entity": "输血",
"start_offset": 102,
"end_offset": 104,
"label": "pro"
},
{
"id": 8,
"entity": "EPO治疗",
"start_offset": 115,
"end_offset": 120,
"label": "pro"
},
{
"id": 9,
"entity": "输血",
"start_offset": 125,
"end_offset": 127,
"label": "pro"
}
] |
二、新生儿的体格生长体格生长的常用指标新生儿的生长主要反映在体格方面，其衡量指标包括体重、身长、头围、胸围等指标。 | [
{
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"entity": "体重",
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{
"id": 1,
"entity": "身长",
"start_offset": 45,
"end_offset": 47,
"label": "ite"
},
{
"id": 2,
"entity": "头围",
"start_offset": 48,
"end_offset": 50,
"label": "ite"
},
{
"id": 3,
"entity": "胸围",
"start_offset": 51,
"end_offset": 53,
"label": "ite"
}
] |
1.体重体重是机体各部重量的总和，这是体格生长的重要指标之一。 | [
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{
"id": 1,
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我国城市婴儿出生体重男婴为（3.32±0.39）kg，女婴为（3.21±0.36）kg（2005年9市城区正常男童和女童体格发育指标）。 | [
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"id": 0,
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] |
出生后体重曲线本应是胎儿曲线的延续，但因初生数天内，新生儿摄入不足，胎粪及水分等的丢失，致使体重有下降趋势，大都在出生后3～4日降至最低点，可达出生体重的6%～9%生理性体重下降”。 | [
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"id": 0,
"entity": "体重",
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{
"id": 1,
"entity": "摄入不足",
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"label": "sym"
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{
"id": 2,
"entity": "胎粪及水分等的丢失",
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{
"id": 3,
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{
"id": 4,
"entity": "体重有下降趋势，大都在出生后3～4日降至最低点，可达出生体重的6%～9%",
"start_offset": 46,
"end_offset": 82,
"label": "sym"
},
{
"id": 5,
"entity": "生理性体重下降",
"start_offset": 82,
"end_offset": 89,
"label": "sym"
}
] |
然而需要注意的是，一旦新生儿体重丢失超过出生体重的10%，或10天仍未恢复至出生时的体重，则应考虑为病理性或喂养不足所致。 | [
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{
"id": 2,
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] |
一般来说，在7～10天，新生儿恢复到出生时体重，早产儿体重恢复较迟。 | [
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"entity": "体重",
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{
"id": 1,
"entity": "体重",
"start_offset": 27,
"end_offset": 29,
"label": "ite"
}
] |
以后新生儿体重就不断增加，年龄越小，体重的增加约25～30g体重要求用婴儿磅秤或特别的杠杆秤。 | [
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{
"id": 1,
"entity": "体重",
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{
"id": 2,
"entity": "年龄越小，体重的增加约25～30g",
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"label": "sym"
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{
"id": 3,
"entity": "体重",
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{
"id": 4,
"entity": "婴儿磅秤",
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"label": "equ"
},
{
"id": 5,
"entity": "杠杆秤",
"start_offset": 43,
"end_offset": 46,
"label": "equ"
}
] |
称体重时应卧位，迅速调整游锤至杠杆正中水平，所示读数记录以kg为单位，至小数点后两位。 | [
{
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"entity": "体重",
"start_offset": 1,
"end_offset": 3,
"label": "ite"
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{
"id": 1,
"entity": "游锤",
"start_offset": 12,
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"label": "equ"
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{
"id": 2,
"entity": "杠杆",
"start_offset": 15,
"end_offset": 17,
"label": "equ"
}
] |
2.身长身长代表着头、脊柱、下肢长度的总和。 | [
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"entity": "身长",
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{
"id": 1,
"entity": "身长",
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"label": "ite"
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{
"id": 2,
"entity": "头",
"start_offset": 9,
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"label": "bod"
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"id": 3,
"entity": "脊柱",
"start_offset": 11,
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"label": "bod"
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{
"id": 4,
"entity": "下肢",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
}
] |
身长在出生时平均约50cm。 | [
{
"id": 0,
"entity": "身长",
"start_offset": 0,
"end_offset": 2,
"label": "ite"
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] |
新生儿测量身长用标准的量床或携带式量板。 | [
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"id": 0,
"entity": "身长",
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"end_offset": 7,
"label": "ite"
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] |
坐高：是由头顶到坐骨结节的长度。 | [
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"entity": "坐高",
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{
"id": 1,
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"label": "bod"
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{
"id": 2,
"entity": "坐骨结节",
"start_offset": 8,
"end_offset": 12,
"label": "bod"
}
] |
测量时取仰卧位，测量从头顶至臀部的距离，读刻度至0.1cm。 | [
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"id": 0,
"entity": "头顶",
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"label": "bod"
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{
"id": 1,
"entity": "臀部",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
}
] |
新生儿坐高约占身长的66%。 | [
{
"id": 0,
"entity": "坐高",
"start_offset": 3,
"end_offset": 5,
"label": "ite"
}
] |
上部量和下部量：人体的全部长度以耻骨联合上缘为界可分为上、下两部分，上部分即从头顶至耻骨联合上缘的长度称为上部量；下部分即从耻骨联合上缘至足底的长度为下部量。 | [
{
"id": 0,
"entity": "上部量",
"start_offset": 0,
"end_offset": 3,
"label": "ite"
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{
"id": 1,
"entity": "下部量",
"start_offset": 4,
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{
"id": 2,
"entity": "耻骨",
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"label": "bod"
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{
"id": 3,
"entity": "头顶",
"start_offset": 39,
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"label": "bod"
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{
"id": 4,
"entity": "耻骨",
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"label": "bod"
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{
"id": 5,
"entity": "上部量",
"start_offset": 53,
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"label": "ite"
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{
"id": 6,
"entity": "耻骨联合上缘",
"start_offset": 62,
"end_offset": 68,
"label": "bod"
},
{
"id": 7,
"entity": "足底",
"start_offset": 69,
"end_offset": 71,
"label": "bod"
},
{
"id": 8,
"entity": "下部量",
"start_offset": 75,
"end_offset": 78,
"label": "ite"
}
] |
上部量主要表示脊柱的生长，下部代表下肢长骨的生长。 | [
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"id": 0,
"entity": "上部量",
"start_offset": 0,
"end_offset": 3,
"label": "ite"
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{
"id": 1,
"entity": "脊柱",
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{
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"entity": "下部代表",
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{
"id": 3,
"entity": "下肢长骨",
"start_offset": 17,
"end_offset": 21,
"label": "bod"
}
] |
出生时上部量约为身长的60%（30cm），下部量为40%（19.5cm），故身长的中点位于脐上，外表显示下肢短头围头围是指眉弓上方最突出处经枕后结节绕头一周的长度。 | [
{
"id": 0,
"entity": "上部量",
"start_offset": 3,
"end_offset": 6,
"label": "ite"
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{
"id": 1,
"entity": "身长",
"start_offset": 8,
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"label": "ite"
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{
"id": 2,
"entity": "下部量",
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{
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"start_offset": 38,
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{
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"entity": "脐上",
"start_offset": 45,
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{
"id": 5,
"entity": "下肢",
"start_offset": 52,
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{
"id": 6,
"entity": "下肢短",
"start_offset": 52,
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"label": "sym"
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{
"id": 7,
"entity": "头围",
"start_offset": 55,
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"label": "ite"
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{
"id": 8,
"entity": "头围",
"start_offset": 57,
"end_offset": 59,
"label": "ite"
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{
"id": 9,
"entity": "眉弓上方",
"start_offset": 61,
"end_offset": 65,
"label": "bod"
},
{
"id": 10,
"entity": "枕后结节",
"start_offset": 70,
"end_offset": 74,
"label": "bod"
}
] |
新生儿头围平均为34cm，测量头围可知颅骨及脑的生长发育情况，读数至0.1cm。 | [
{
"id": 0,
"entity": "头围",
"start_offset": 3,
"end_offset": 5,
"label": "ite"
},
{
"id": 1,
"entity": "头围",
"start_offset": 15,
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"label": "ite"
},
{
"id": 2,
"entity": "颅骨",
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"label": "bod"
},
{
"id": 3,
"entity": "脑",
"start_offset": 22,
"end_offset": 23,
"label": "bod"
}
] |
前囟及骨缝的变化也是颅骨生长的指标。 | [
{
"id": 0,
"entity": "前囟",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "骨缝",
"start_offset": 3,
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"label": "bod"
},
{
"id": 2,
"entity": "颅骨",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
}
] |
前囟由两额骨与两顶骨相交接的骨缝的构成，出生时斜径约2.5cm。 | [
{
"id": 0,
"entity": "前囟",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "额骨",
"start_offset": 4,
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{
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"entity": "顶骨",
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{
"id": 3,
"entity": "骨缝",
"start_offset": 14,
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"label": "bod"
}
] |
如有先天性佝偻病，前囟可增大，骨缝前面可延至额部后囟门由两顶骨与两枕骨的骨缝构成，呈三角形，在出生时或出生后2～3个月闭合。 | [
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"id": 0,
"entity": "先天性佝偻病",
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"end_offset": 8,
"label": "dis"
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{
"id": 1,
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{
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{
"id": 5,
"entity": "后囟门",
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"id": 6,
"entity": "顶骨",
"start_offset": 29,
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"label": "bod"
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{
"id": 7,
"entity": "枕骨",
"start_offset": 33,
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"label": "bod"
},
{
"id": 8,
"entity": "骨缝",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
}
] |
如果出生时摸不到前囟门，要区别是否为颅骨畸形。 | [
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"entity": "囟门",
"start_offset": 9,
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{
"id": 1,
"entity": "颅骨畸形",
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"label": "dis"
}
] |
前囟饱满颅内压增加，囟门凹陷严重脱水及营养不良。 | [
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"id": 0,
"entity": "前囟",
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"label": "bod"
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{
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"entity": "前囟饱满",
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{
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{
"id": 6,
"entity": "营养不良",
"start_offset": 19,
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"label": "sym"
}
] |
4.胸围胸围是指胸前乳头下缘向后绕经后背的两肩胛骨下角下缘，取平静呼、吸气时的中间读数至0.1cm。 | [
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"entity": "胸围",
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"label": "ite"
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{
"id": 1,
"entity": "胸围",
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{
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{
"id": 3,
"entity": "肩胛骨下角下缘",
"start_offset": 22,
"end_offset": 29,
"label": "bod"
}
] |
新生儿出生时胸廓呈圆筒状，胸围小于头围约1～2cm。 | [
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"id": 0,
"entity": "胸廓",
"start_offset": 6,
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{
"id": 2,
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] |
第二节维生素A缺乏症维生素A族的原形化合物是全反式视黄醇，天然维生素A只存在于动物体内，并分两种类型：维生素A<sub>1<sub>（视黄醇）和维生素A<sub>2<sub>（3-脱氢视黄醇）。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
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},
{
"id": 1,
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{
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{
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"entity": "维生素A",
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{
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"entity": "视黄醇",
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{
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"entity": "维生素A",
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{
"id": 6,
"entity": "3-脱氢视黄醇",
"start_offset": 88,
"end_offset": 95,
"label": "dru"
}
] |
【流行病学】维生素A缺乏是导致儿童严重视觉损害和失明的主要原因，同时也是增加儿童严重感染性疾病危险和死亡风险的主要原因之一，维生素A缺乏被世界卫生组织确认为四大营养缺乏病之一。 | [
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"id": 0,
"entity": "维生素A缺乏",
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"label": "dis"
},
{
"id": 1,
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{
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{
"id": 3,
"entity": "维生素A缺乏",
"start_offset": 62,
"end_offset": 68,
"label": "dis"
}
] |
1991年，Quito营养调查表明：2%的1～5岁儿童血清维生素A水平低于10μgdL，18%低于20μgdL。 | [
{
"id": 0,
"entity": "血清",
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}
] |
同期菲律宾调查农村学龄前儿童，29%的儿童血清维生素A低于20μgdL，6%低于1OμgdL。 | [
{
"id": 0,
"entity": "血清",
"start_offset": 21,
"end_offset": 23,
"label": "ite"
}
] |
可见发展中国家维生素A缺乏发病率高于发达国家。 | [
{
"id": 0,
"entity": "维生素A缺乏",
"start_offset": 7,
"end_offset": 13,
"label": "dis"
}
] |
在我国，卫生部委托首都儿科研究所对14个省42个市县8669例0～5岁儿童于1999年12月～2000年3月协作进行维生素A缺乏情况调查，结果显示，＜6个月婴儿为33.4%，2岁以上儿童维生素A缺乏的发生率为0.15%。 | [
{
"id": 0,
"entity": "维生素A缺乏",
"start_offset": 58,
"end_offset": 64,
"label": "dis"
},
{
"id": 1,
"entity": "维生素A缺乏",
"start_offset": 93,
"end_offset": 99,
"label": "dis"
}
] |
亚临床型维生素A缺乏发生率较高，已成为儿童广泛的缺乏症之一而备受关注。 | [
{
"id": 0,
"entity": "临床型维生素A缺乏",
"start_offset": 1,
"end_offset": 10,
"label": "dis"
}
] |
据WHO统计，1995年，全球近2.51亿儿童有亚临床型维生素A缺乏。 | [
{
"id": 0,
"entity": "亚临床型维生素A缺乏",
"start_offset": 24,
"end_offset": 34,
"label": "dis"
}
] |
根据2002年WHO的报道，全球有80万儿童（1.4%）死于维生素A缺乏症，1.8%的消耗性疾病也是由于维生素A缺乏症所造成的。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
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},
{
"id": 1,
"entity": "维生素A缺乏症",
"start_offset": 52,
"end_offset": 59,
"label": "dis"
}
] |
调查显示，接近12的维生素A缺乏症和干眼症发生在非洲、南亚和东南亚地区。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
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"end_offset": 17,
"label": "dis"
},
{
"id": 1,
"entity": "干眼症",
"start_offset": 18,
"end_offset": 21,
"label": "dis"
}
] |
2000年，南非的调查发现，有13的0～4岁儿童患维生素A缺乏症，在同年调查3000名死亡儿童中发现，28%的儿童死于因维生素A缺乏症导致的腹泻，23%死于因维生素A缺乏症导致的麻疹，21%死于因维生素A缺乏症导致的疟疾。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
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"end_offset": 32,
"label": "dis"
},
{
"id": 1,
"entity": "维生素A缺乏症",
"start_offset": 60,
"end_offset": 67,
"label": "dis"
},
{
"id": 2,
"entity": "腹泻",
"start_offset": 70,
"end_offset": 72,
"label": "sym"
},
{
"id": 3,
"entity": "维生素A缺乏症",
"start_offset": 79,
"end_offset": 86,
"label": "dis"
},
{
"id": 4,
"entity": "麻疹",
"start_offset": 89,
"end_offset": 91,
"label": "dis"
},
{
"id": 5,
"entity": "维生素A缺乏症",
"start_offset": 98,
"end_offset": 105,
"label": "dis"
},
{
"id": 6,
"entity": "疟疾",
"start_offset": 108,
"end_offset": 110,
"label": "dis"
}
] |
维生素A缺乏症是该地区极其严重的公共卫生问题。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
"start_offset": 0,
"end_offset": 7,
"label": "dis"
}
] |
2006年，朝鲜光州调查显示，2.4%的儿童患维生素A缺乏症，42.3%患轻度维生素A缺乏症。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
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"end_offset": 30,
"label": "dis"
},
{
"id": 1,
"entity": "轻度维生素A缺乏症",
"start_offset": 37,
"end_offset": 46,
"label": "dis"
}
] |
印度于2007年进行的全国调查显示，每年有52000名儿童因维生素A缺乏症而导致失明。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
"start_offset": 30,
"end_offset": 37,
"label": "dis"
},
{
"id": 1,
"entity": "失明",
"start_offset": 40,
"end_offset": 42,
"label": "sym"
}
] |
2006年，中国疾病控制中心调查显示，我国6岁以下儿童维生素A缺乏症的发生率是12.2%，严重维生素A缺乏症占0.5%，1岁以上儿童发病率最高的西部地区占17.4%。 | [
{
"id": 0,
"entity": "维生素A缺乏症",
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"end_offset": 34,
"label": "dis"
},
{
"id": 1,
"entity": "严重维生素A缺乏症",
"start_offset": 45,
"end_offset": 54,
"label": "dis"
}
] |
【发病机制及病因】（一）摄入不足初生时维生素A在肝脏中的贮存量很少。 | [
{
"id": 0,
"entity": "维生素A",
"start_offset": 19,
"end_offset": 23,
"label": "dru"
},
{
"id": 1,
"entity": "肝脏",
"start_offset": 24,
"end_offset": 26,
"label": "bod"
}
] |
出生后维生素A的主要来源是食物。 | [
{
"id": 0,
"entity": "维生素A",
"start_offset": 3,
"end_offset": 7,
"label": "dru"
}
] |
故婴儿时期，应提倡母乳喂养，人工喂养时，须给含脂肪的牛乳，婴儿如果单靠炼乳、脱脂牛乳、豆浆、米粉等食品喂养，容易发生维生素A缺乏。 | [
{
"id": 0,
"entity": "维生素A缺乏",
"start_offset": 58,
"end_offset": 64,
"label": "sym"
}
] |
早产儿肝脏内维生素A的贮存量更少，且脂肪吸收能力也有限，生长发育的速度又较快，故更容易发生维生素A缺乏症。 | [
{
"id": 0,
"entity": "肝脏",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "维生素A",
"start_offset": 6,
"end_offset": 10,
"label": "dru"
},
{
"id": 2,
"entity": "维生素A缺乏症",
"start_offset": 45,
"end_offset": 52,
"label": "dis"
}
] |
如在疾病状态下，长期静脉补液未补充维生素A；或因饮食受到限制，也将导致维生素A缺乏。 | [
{
"id": 0,
"entity": "维生素A",
"start_offset": 17,
"end_offset": 21,
"label": "dru"
},
{
"id": 1,
"entity": "维生素A",
"start_offset": 35,
"end_offset": 39,
"label": "dru"
},
{
"id": 2,
"entity": "维生素A缺乏",
"start_offset": 35,
"end_offset": 41,
"label": "sym"
}
] |
（二）吸收减少维生素A缺乏可见于多种临床情况，如吸收障碍综合征、慢性腹泻、慢性痢疾、慢性肝炎、胆道梗阻、胆囊纤维化、钩虫病、肠道感染等均可影响维生素A的吸收。 | [
{
"id": 0,
"entity": "维生素A缺乏",
"start_offset": 7,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "吸收障碍综合征",
"start_offset": 24,
"end_offset": 31,
"label": "dis"
},
{
"id": 2,
"entity": "慢性腹泻",
"start_offset": 32,
"end_offset": 36,
"label": "dis"
},
{
"id": 3,
"entity": "慢性痢疾",
"start_offset": 37,
"end_offset": 41,
"label": "dis"
},
{
"id": 4,
"entity": "慢性肝炎",
"start_offset": 42,
"end_offset": 46,
"label": "dis"
},
{
"id": 5,
"entity": "胆道梗阻",
"start_offset": 47,
"end_offset": 51,
"label": "dis"
},
{
"id": 6,
"entity": "胆囊纤维化",
"start_offset": 52,
"end_offset": 57,
"label": "dis"
},
{
"id": 7,
"entity": "钩虫病",
"start_offset": 58,
"end_offset": 61,
"label": "dis"
},
{
"id": 8,
"entity": "肠道感染",
"start_offset": 62,
"end_offset": 66,
"label": "dis"
},
{
"id": 9,
"entity": "维生素A",
"start_offset": 71,
"end_offset": 75,
"label": "dru"
}
] |
（三）锌摄入不足当锌缺乏时，维生素A结合蛋白、前清蛋白、维生素A还原酶都降低，使维生素A不能利用而排出体外，造成维生素A缺乏。 | [
{
"id": 0,
"entity": "锌",
"start_offset": 3,
"end_offset": 4,
"label": "dru"
},
{
"id": 1,
"entity": "锌",
"start_offset": 9,
"end_offset": 10,
"label": "dru"
},
{
"id": 2,
"entity": "锌缺乏",
"start_offset": 9,
"end_offset": 12,
"label": "sym"
},
{
"id": 3,
"entity": "维生素A结合蛋白",
"start_offset": 14,
"end_offset": 22,
"label": "dru"
},
{
"id": 4,
"entity": "前清蛋白",
"start_offset": 23,
"end_offset": 27,
"label": "dru"
},
{
"id": 5,
"entity": "维生素A还原酶",
"start_offset": 28,
"end_offset": 35,
"label": "dru"
},
{
"id": 6,
"entity": "维生素A结合蛋白、前清蛋白、维生素A还原酶都降低",
"start_offset": 14,
"end_offset": 38,
"label": "sym"
},
{
"id": 7,
"entity": "维生素A",
"start_offset": 40,
"end_offset": 44,
"label": "dru"
},
{
"id": 8,
"entity": "维生素A缺乏",
"start_offset": 56,
"end_offset": 62,
"label": "sym"
}
] |
Rahman等证实锌的缺乏限制了维生素A的生物利用率，锌和维生素A的缺乏经常同时存在于营养不良的小儿，同时给予维生素A和锌的补充可以改善维生素A的缺乏。 | [
{
"id": 0,
"entity": "锌",
"start_offset": 9,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "维生素A",
"start_offset": 16,
"end_offset": 20,
"label": "dru"
},
{
"id": 2,
"entity": "锌",
"start_offset": 27,
"end_offset": 28,
"label": "dru"
},
{
"id": 3,
"entity": "维生素A",
"start_offset": 29,
"end_offset": 33,
"label": "dru"
},
{
"id": 4,
"entity": "营养不良",
"start_offset": 43,
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"label": "dis"
},
{
"id": 5,
"entity": "维生素A",
"start_offset": 55,
"end_offset": 59,
"label": "dru"
},
{
"id": 6,
"entity": "锌",
"start_offset": 60,
"end_offset": 61,
"label": "dru"
},
{
"id": 7,
"entity": "维生素A",
"start_offset": 68,
"end_offset": 72,
"label": "dru"
}
] |
近来有报道指出，铁的不足对维生素A的利用也有影响。 | [
{
"id": 0,
"entity": "铁",
"start_offset": 8,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "维生素A",
"start_offset": 13,
"end_offset": 17,
"label": "dru"
}
] |
（四）消耗增加当小儿患结核、麻疹、水痘、肺炎以及高热时，维生素A的消耗增加，如此时未予及时补充，则造成维生素A的血浆浓度降低。 | [
{
"id": 0,
"entity": "结核",
"start_offset": 11,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "麻疹",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "水痘",
"start_offset": 17,
"end_offset": 19,
"label": "dis"
},
{
"id": 3,
"entity": "肺炎",
"start_offset": 20,
"end_offset": 22,
"label": "dis"
},
{
"id": 4,
"entity": "高热",
"start_offset": 24,
"end_offset": 26,
"label": "dis"
},
{
"id": 5,
"entity": "维生素A",
"start_offset": 28,
"end_offset": 32,
"label": "dru"
},
{
"id": 6,
"entity": "维生素A",
"start_offset": 51,
"end_offset": 55,
"label": "dru"
},
{
"id": 7,
"entity": "维生素A的血浆浓度降低",
"start_offset": 51,
"end_offset": 62,
"label": "sym"
}
] |
（五）利用障碍如小儿患有肝脏、肾脏、甲状腺疾病、胰腺囊性纤维变性及蛋白-能量营养不良时，将导致血浆中视黄醇结合蛋白（RBP）代谢异常，导致维生素A缺乏。 | [
{
"id": 0,
"entity": "肝脏",
"start_offset": 12,
"end_offset": 14,
"label": "bod"
},
{
"id": 1,
"entity": "肾脏",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "甲状腺",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 3,
"entity": "胰腺囊性纤维变性",
"start_offset": 24,
"end_offset": 32,
"label": "dis"
},
{
"id": 4,
"entity": "蛋白-能量营养不良",
"start_offset": 33,
"end_offset": 42,
"label": "dis"
},
{
"id": 5,
"entity": "血浆",
"start_offset": 47,
"end_offset": 49,
"label": "bod"
},
{
"id": 6,
"entity": "视黄醇结合蛋白",
"start_offset": 50,
"end_offset": 57,
"label": "dru"
},
{
"id": 7,
"entity": "RBP",
"start_offset": 58,
"end_offset": 61,
"label": "dru"
},
{
"id": 8,
"entity": "血浆中视黄醇结合蛋白（RBP）代谢异常",
"start_offset": 47,
"end_offset": 66,
"label": "sym"
},
{
"id": 9,
"entity": "维生素A",
"start_offset": 69,
"end_offset": 73,
"label": "dru"
},
{
"id": 10,
"entity": "维生素A缺乏",
"start_offset": 69,
"end_offset": 75,
"label": "sym"
}
] |
【临床表现】由于维生素A和维生素A原缺乏所引起的营养缺乏病，临床上首先出现暗适应能力下降，小婴儿此症状不明显，如不仔细观察，容易被忽视。 | [
{
"id": 0,
"entity": "维生素A",
"start_offset": 8,
"end_offset": 12,
"label": "dru"
},
{
"id": 1,
"entity": "维生素A原",
"start_offset": 13,
"end_offset": 18,
"label": "dru"
},
{
"id": 2,
"entity": "营养缺乏病",
"start_offset": 24,
"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "暗适应能力",
"start_offset": 37,
"end_offset": 42,
"label": "sym"
}
] |
首先由母亲发现，患儿在暗环境下安静，视物不清，行走、定向困难。 | [
{
"id": 0,
"entity": "暗环境下安静",
"start_offset": 11,
"end_offset": 17,
"label": "sym"
},
{
"id": 1,
"entity": "视物不清",
"start_offset": 18,
"end_offset": 22,
"label": "sym"
},
{
"id": 2,
"entity": "行走、定向困难",
"start_offset": 23,
"end_offset": 30,
"label": "sym"
}
] |
数周及数月后出现结膜干燥症，结膜干燥，失去光泽，主要是由于结膜和附近腺体组织增生，分泌减少，继而发生干燥。 | [
{
"id": 0,
"entity": "结膜干燥症",
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"label": "dis"
},
{
"id": 1,
"entity": "结膜干燥",
"start_offset": 14,
"end_offset": 18,
"label": "sym"
},
{
"id": 2,
"entity": "结膜",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
},
{
"id": 3,
"entity": "腺体",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
}
] |
在眼球巩膜近角膜缘外侧，由脱落的角膜上皮形成三角形白色泡沫状斑块称结膜干燥斑（Bitot斑）。 | [
{
"id": 0,
"entity": "眼球巩膜近角膜缘",
"start_offset": 1,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "角膜上皮",
"start_offset": 16,
"end_offset": 20,
"label": "bod"
},
{
"id": 2,
"entity": "结膜干燥斑",
"start_offset": 33,
"end_offset": 38,
"label": "dis"
},
{
"id": 3,
"entity": "Bitot斑",
"start_offset": 39,
"end_offset": 45,
"label": "dis"
}
] |
丘疹坚实而干燥，色暗棕，多为毛囊性，针头大至米粒大，圆锥形。 | [
{
"id": 0,
"entity": "丘疹",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "丘疹坚实而干燥，色暗棕，多为毛囊性，针头大至米粒大，圆锥形",
"start_offset": 0,
"end_offset": 29,
"label": "sym"
}
] |
丘疹的中央有棘刺状角质栓，触之坚硬，去除后留下坑状凹陷，无炎症，无主观症状，丘疹密集犹似蟾蜍皮，称蟾蜍皮病（phrynoderma）。 | [
{
"id": 0,
"entity": "丘疹",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "丘疹",
"start_offset": 38,
"end_offset": 40,
"label": "dis"
},
{
"id": 2,
"entity": "丘疹密集犹似蟾蜍皮",
"start_offset": 38,
"end_offset": 47,
"label": "sym"
},
{
"id": 3,
"entity": "蟾蜍皮病",
"start_offset": 49,
"end_offset": 53,
"label": "dis"
},
{
"id": 4,
"entity": "phrynoderma",
"start_offset": 54,
"end_offset": 65,
"label": "dis"
}
] |
皮疹发生在面部，可有许多黑头。 | [
{
"id": 0,
"entity": "皮疹",
"start_offset": 0,
"end_offset": 2,
"label": "dis"
},
{
"id": 1,
"entity": "面部",
"start_offset": 5,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "有许多黑头",
"start_offset": 9,
"end_offset": 14,
"label": "sym"
}
] |
患者毛发干燥，缺少光泽，易脱落，呈弥漫稀疏，指甲变脆，表面有纵横沟纹或点状凹陷。 | [
{
"id": 0,
"entity": "毛发干燥，缺少光泽，易脱落，呈弥漫稀疏",
"start_offset": 2,
"end_offset": 21,
"label": "sym"
},
{
"id": 1,
"entity": "指甲",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 2,
"entity": "指甲变脆，表面有纵横沟纹或点状凹陷",
"start_offset": 22,
"end_offset": 39,
"label": "sym"
}
] |
维生素A缺乏对骨骼（特别是长骨）的伸长也有明显影响，使骨变得又短又厚。 | [
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"entity": "使骨变得又短又厚",
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HuW等人通过色层分析法测定维生素A浓度，证明维生素A浓度和体重以及BMI有明显的统计学意义，提示维生素A对儿童的生长发育有明显的影响。 | [
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维生素A缺乏时，对呼吸系统也有不同程度的影响，使气管及支气管的上皮细胞中间层的细胞增殖，变成鳞状、角化，并使上皮细胞的纤毛脱落，失去上皮组织的正常保护功能，容易发生呼吸系统的感染。 | [
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"entity": "细胞",
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{
"id": 8,
"entity": "上皮细胞的纤毛脱落",
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"label": "sym"
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"entity": "上皮组织",
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"entity": "呼吸系统",
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【实验室检查】（一）视觉暗适应功能测定维生素A缺乏症患者的暗适应能力比正常人差，但是其他因素也可引起暗适应能力降低，如视神经萎缩、色素性视网膜炎、睡眠不足等。 | [
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"id": 5,
"entity": "睡眠不足",
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（二）血清维生素A水平测定是评价维生素A营养状况的常用指标，也是最可靠的指标，正常值为300～500μgL，若低于200μgL为缺乏。 | [
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（三）血浆中视黄醇结合蛋白测定（RBP）近来有人认为RBP与人体维生素A水平呈正相关，RBP的含量可反映人体维生素A的营养水平。 | [
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"id": 4,
"entity": "维生素A",
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"label": "dru"
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] |
正常儿童的血浆RBP的含量为23.1mgL。 | [
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"entity": "RBP",
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（四）维生素A的相对剂量反应试验当血清中维生素A浓度在正常范围时，肝脏维生素A已有耗尽的可能，因此采用相对剂量反应（RDR）法间接评价个体体内维生素A的贮存量。 | [
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"entity": "肝脏",
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},
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"id": 4,
"entity": "维生素A",
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"label": "dru"
},
{
"id": 5,
"entity": "维生素A",
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"end_offset": 75,
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] |
口服1000mg维生素A棕榈酸，分别于口服前和口服后5小时测定血清维生素A浓度。 | [
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"entity": "维生素A棕榈酸",
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若服后5小时的血清维生素A浓度增高幅度，即RDR（relativedosereation，RDR）率≥20%，表示肝脏内维生素A的贮存已处于临界状态。 | [
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{
"id": 1,
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"label": "bod"
},
{
"id": 2,
"entity": "维生素A",
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"end_offset": 64,
"label": "dru"
}
] |
用此方法可以进一步确定亚临床状态维生素A缺乏。 | [
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"entity": "亚临床状态维生素A缺乏",
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"end_offset": 22,
"label": "dis"
}
] |
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