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（2）遗传信息的转录（transcription）：系DNA分子上的遗传信息传递到信使RNA（mRNA）的过程。 | [
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转录时，细胞核中DNA分子的双链脱开，以其中一条正义链作为RNA合成的“模板”，在酶的作用下，将不编码的内含子切去，然后将编码的外显子拼接起来，合成信使mRNA，mRNA与模板DNA之间按碱基互补的原则进行碱基配对。 | [
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但A不是与T相配对，而是与U（尿嘧啶）相配，因为RNA分子中不含胸腺嘧啶（T），而是含有尿嘧啶（U）。 | [
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在RNA聚合酶的催化下，合成一条mRNA的单链，其中含有DNA的遗传信息。 | [
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以后mRNA再与DNA“模板”分开，通过核膜进入胞浆。 | [
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（3）遗传信息的翻译（translation）：mRNA以遗传密码的方式控制着特定蛋白质的合成，称作翻译，这个过程是在细胞质的核糖体上进行的。 | [
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各种蛋白质基本上是由20种氨基酸以不同方式和数目组合而成。 | [
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这些氨基酸连接成多肽链，最后形成具有空间结构的蛋白质。 | [
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现在已知道，mRNA分子中每三个相邻的碱基决定多肽链中的一个氨基酸，这三个相邻的碱基（即三联体）称为密码子（codon）。 | [
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由于RNA分子中的碱基是U、A、G、C4种，由于三个相邻的碱基（三联体）代表一个氨基酸的信息，那么就有43</sup>=64种密码子。 | [
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在64种密码子中，有61种属氨基酸的密码，其中AUG是代表起始密码，也是甲硫氨基酸的密码。 | [
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还有3种密码UAA、UAG及UGA不决定任何氨基酸，是“终止密码”，代表蛋白质合成终止的信号。 | [
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二、开胸活检开胸活检是指在切开胸壁组织后，直视下取材。 | [
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近年来随着胸腔镜、纤维支气管镜的大力开展，及细针肺穿刺活检技术的应用，单纯开胸肺活检已较少采用。 | [
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对经上述非创伤或微创伤性检查方法无法确诊者，尤其是罕见肺部疾病的诊断或可能需手术切除病灶者可考虑采用。 | [
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三、抗病毒治疗（一）抗病毒药物的选择性作用位点已知病毒复制过程包括：①病毒吸附（absorption）：与靶细胞接触并吸附至细胞膜（存在病毒的特殊受体）。 | [
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②穿入（penetration）细胞和脱衣壳（uncoating）：病毒一般通过胞饮、吞噬作用或直接穿入而进入细胞。 | [
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某些有包膜的病毒则经与细胞膜融合穿入。 | [
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③细胞内增殖：病毒增殖是一个极其复杂的过程，其中很多环节都有宿主细胞酶的参与。 | [
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另外，病毒基因组类型众多，有DNA或RNA、单股或双股、环状、线状或分节状，各类病毒的核酸复制常有各自独特的形式。 | [
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④病毒装配、成熟和子代病毒释出：此过程涉及基因组和病毒结构蛋白的装配。 | [
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理论上认为，病毒复制过程中任何一个环节均可作为抗病毒治疗的靶点。 | [
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一种安全、有效的抗病毒药物必须具备以下特性：能到达靶细胞，在细胞内外均有活性，代谢过程稳定和抑制病毒增殖时不损害宿主细胞功能。 | [
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由于病毒具有严格的细胞内寄生特性，复制时依赖宿主细胞的多种功能，做到两全其美十分困难。 | [
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迄今为止，特异、有效的抗病毒药物仍然很少，1999年美国市场上销售的抗病毒药物就只有24种。 | [
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（二）抗病毒药物的种类1.化学制剂（1）核苷类似物：其结构与核酸前体类似，可竞争性抑制核酸合成酶，并可中断核苷酸链的延长而阻止病毒核酸合成。 | [
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嘌呤和嘧啶类核苷都是先在细胞内转化成三磷酸盐而活化。 | [
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由于病毒DNA聚合酶对核苷三磷酸有选择性，病毒激酶参与其磷酸化，故有较高的选择性和安全性。 | [
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（2）非核苷类似物：是一类对HIV-1的反转录酶有高度专一抑制作用的非竞争性抑制剂，易发生耐药，需联合或交替用药。 | [
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（3）硫酸化多糖：如硫酸葡聚糖、硫酸右旋糖酐和肝素等。 | [
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"entity": "硫酸化多糖",
"start_offset": 3,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "硫酸葡聚糖",
"start_offset": 10,
"end_offset": 15,
"label": "dru"
},
{
"id": 2,
"entity": "硫酸右旋糖酐",
"start_offset": 16,
"end_offset": 22,
"label": "dru"
},
{
"id": 3,
"entity": "肝素",
"start_offset": 23,
"end_offset": 25,
"label": "dru"
}
] |
具抑制HIV作用，其机制可能是干扰病毒吸附和抑制反转录酶活性。 | [
{
"id": 0,
"entity": "HIV",
"start_offset": 3,
"end_offset": 6,
"label": "mic"
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{
"id": 1,
"entity": "病毒",
"start_offset": 17,
"end_offset": 19,
"label": "mic"
},
{
"id": 2,
"entity": "反转录酶",
"start_offset": 24,
"end_offset": 28,
"label": "mic"
}
] |
（4）取代嘧啶酮类化合物具较强的抗病毒和干扰素诱导活性。 | [
{
"id": 0,
"entity": "取代嘧啶酮类化合物",
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{
"id": 1,
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"end_offset": 19,
"label": "mic"
},
{
"id": 2,
"entity": "干扰素",
"start_offset": 20,
"end_offset": 23,
"label": "dru"
}
] |
但肾毒性大，需进一步进行结构改造。 | [
{
"id": 0,
"entity": "肾",
"start_offset": 1,
"end_offset": 2,
"label": "bod"
}
] |
（5）其他：如金刚烷胺和金刚乙胺，作用于流感病毒M2蛋白而阻断病毒的穿入和脱衣壳。 | [
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{
"id": 1,
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{
"id": 2,
"entity": "流感病毒M2蛋白",
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"label": "mic"
},
{
"id": 3,
"entity": "病毒",
"start_offset": 31,
"end_offset": 33,
"label": "mic"
}
] |
神经氨酸酶抑制剂（zanamivir和oseltamivir）经抑制流感病毒的神经氨酸酶而阻止病毒释出和播散。 | [
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"entity": "神经氨酸酶抑制剂",
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{
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"entity": "神经氨酸酶",
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{
"id": 5,
"entity": "病毒",
"start_offset": 47,
"end_offset": 49,
"label": "mic"
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] |
膦甲酸为DNA聚合酶和反转录酶抑制剂，可抑制疱疹类病毒和HIV-1。 | [
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"id": 0,
"entity": "膦甲酸",
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{
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{
"id": 2,
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"label": "mic"
},
{
"id": 3,
"entity": "HIV-1",
"start_offset": 28,
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}
] |
其他还有作用于HIV的蛋白酶抑制剂。 | [
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{
"id": 1,
"entity": "蛋白酶抑制剂",
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"label": "dru"
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] |
2.生物因子干扰素是最常用的生物因子，已证实长疗程大剂量治疗慢性丙型肝炎和乙型肝炎有效。 | [
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"entity": "干扰素",
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{
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{
"id": 2,
"entity": "乙型肝炎",
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"end_offset": 41,
"label": "dis"
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] |
人工合成或克隆表达的可溶性CD4蛋白（sCD4）可阻断HIV与靶细胞结合而保护正常细胞。 | [
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"id": 0,
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{
"id": 1,
"entity": "sCD4",
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{
"id": 2,
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{
"id": 3,
"entity": "靶细胞",
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"label": "bod"
},
{
"id": 4,
"entity": "细胞",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
}
] |
免疫球蛋白中和病毒，可阻断病毒与细胞结合，如狂犬病时联合应用狂犬病病毒免疫球蛋白和狂犬疫苗可降低病死率。 | [
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"id": 0,
"entity": "免疫球蛋白",
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"end_offset": 5,
"label": "bod"
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{
"id": 1,
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"label": "mic"
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{
"id": 2,
"entity": "病毒",
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"label": "mic"
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{
"id": 3,
"entity": "细胞",
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{
"id": 4,
"entity": "狂犬病",
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"label": "dis"
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{
"id": 5,
"entity": "狂犬病病毒免疫球蛋白",
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},
{
"id": 6,
"entity": "狂犬疫苗",
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"end_offset": 45,
"label": "dru"
}
] |
3.治疗性疫苗（1）HSV治疗性疫苗：用重组表达的HSV-2包膜抗原gD2加佐剂用于生殖道疱疹患者，可使生殖道疱疹的复发率和严重病损明显降低。 | [
{
"id": 0,
"entity": "治疗性疫苗",
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"end_offset": 7,
"label": "dru"
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{
"id": 1,
"entity": "HSV治疗性疫苗",
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"label": "dru"
},
{
"id": 2,
"entity": "HSV-2包膜抗原gD2",
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"end_offset": 37,
"label": "mic"
},
{
"id": 3,
"entity": "生殖道疱疹",
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"end_offset": 47,
"label": "dis"
},
{
"id": 4,
"entity": "生殖道疱疹",
"start_offset": 52,
"end_offset": 57,
"label": "dis"
}
] |
（2）HIV治疗性疫苗：用重组HIV包膜抗原gp160加佐剂可使HIV感染者产生特异性抗体和细胞免疫。 | [
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"id": 0,
"entity": "HIV治疗性疫苗",
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{
"id": 1,
"entity": "重组HIV包膜抗原gp160",
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"label": "mic"
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{
"id": 2,
"entity": "HIV感染",
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"label": "dis"
},
{
"id": 3,
"entity": "特异性抗体",
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"label": "bod"
},
{
"id": 4,
"entity": "细胞",
"start_offset": 46,
"end_offset": 48,
"label": "bod"
}
] |
（3）HBV治疗性疫苗：包括重组含preS2疫苗、抗原-抗体复合物型疫苗、核心抗原合成肽疫苗和DNA疫苗，经诱导机体特异性免疫应答而清除体内HBV病毒。 | [
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"id": 0,
"entity": "HBV治疗性疫苗",
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"end_offset": 11,
"label": "dru"
},
{
"id": 1,
"entity": "preS2疫苗",
"start_offset": 17,
"end_offset": 24,
"label": "dru"
},
{
"id": 2,
"entity": "抗原-抗体复合物型疫苗",
"start_offset": 25,
"end_offset": 36,
"label": "dru"
},
{
"id": 3,
"entity": "肽疫苗",
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"label": "dru"
},
{
"id": 4,
"entity": "DNA疫苗",
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},
{
"id": 5,
"entity": "HBV病毒",
"start_offset": 70,
"end_offset": 75,
"label": "mic"
}
] |
（4）核酶：是一类具双重特性的RNA分子，能与靶RNA序列特异结合，并能切割降解靶RNA。 | [
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"id": 0,
"entity": "核酶",
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{
"id": 1,
"entity": "靶RNA",
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},
{
"id": 2,
"entity": "靶RNA",
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"end_offset": 44,
"label": "bod"
}
] |
目前已研究设计针对HIV、肝炎病毒、流感病毒等的核酶，显示其潜在应用价值。 | [
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"id": 0,
"entity": "HIV",
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"end_offset": 12,
"label": "mic"
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{
"id": 1,
"entity": "肝炎病毒",
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"label": "mic"
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{
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"entity": "流感病毒",
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"label": "mic"
},
{
"id": 3,
"entity": "核酶",
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"end_offset": 26,
"label": "dru"
}
] |
（5）反义核苷酸：包括反义寡脱氧核苷酸（asODN）和反义寡核苷酸（asON），主要通过与病毒关键DNA或RNA结合，抑制或阻断其复制与转录；与mRNA结合形成二聚体，致其被核酶降解，阻断蛋白质合成。 | [
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{
"id": 1,
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{
"id": 2,
"entity": "asODN",
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{
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},
{
"id": 4,
"entity": "asON",
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{
"id": 5,
"entity": "病毒",
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"label": "mic"
},
{
"id": 6,
"entity": "核酶",
"start_offset": 87,
"end_offset": 89,
"label": "dru"
}
] |
（6）抗病毒中药：已发现一些中药有抗病毒效应，如大蒜新素在体内外均具抗HCMV活性。 | [
{
"id": 0,
"entity": "抗病毒中药",
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{
"id": 1,
"entity": "中药",
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{
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{
"id": 3,
"entity": "大蒜新素",
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},
{
"id": 4,
"entity": "HCMV",
"start_offset": 35,
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"label": "mic"
}
] |
有报道中药XQ9302治疗晚期艾滋病可缓解症状和增加CD4细胞。 | [
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"id": 0,
"entity": "中药XQ9302",
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},
{
"id": 1,
"entity": "晚期艾滋病",
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"end_offset": 18,
"label": "dis"
}
] |
中药是中国乃至世界医学的宝库，应积极开发利用。 | [
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"entity": "中药",
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] |
（三）合理使用抗病毒药物的原则和有关问题1.正确诊断病毒性疾病由于每种药物的设计都是特异性抑制某种病毒的复制，故在使用药物之前，应确诊感染的病毒，方法详见本章第一节。 | [
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{
"id": 1,
"entity": "病毒性疾病",
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"label": "dis"
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{
"id": 2,
"entity": "病毒",
"start_offset": 49,
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"label": "mic"
},
{
"id": 3,
"entity": "感染",
"start_offset": 67,
"end_offset": 69,
"label": "sym"
},
{
"id": 4,
"entity": "病毒",
"start_offset": 70,
"end_offset": 72,
"label": "mic"
}
] |
2.合理选用抗病毒药物首先要掌握所选药物的作用机制和其敏感病毒谱。 | [
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"id": 0,
"entity": "抗病毒药物",
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},
{
"id": 1,
"entity": "病毒",
"start_offset": 29,
"end_offset": 31,
"label": "mic"
}
] |
由于已用于临床的抗病毒药物都具不同程度的毒副作用，故而即使正确诊断出病毒性疾病，亦应根据病情和患者的基本状况，权衡利弊后合理选用药物。 | [
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"id": 0,
"entity": "病毒",
"start_offset": 9,
"end_offset": 11,
"label": "mic"
},
{
"id": 1,
"entity": "病毒性疾病",
"start_offset": 34,
"end_offset": 39,
"label": "dis"
}
] |
（1）轻症不必给予毒副作用大的药物：例如，婴儿无黄疸型HCMV肝炎肝损害较轻，一般给予护肝等对症治疗都能恢复，预后佳。 | [
{
"id": 0,
"entity": "黄疸型HCMV肝炎",
"start_offset": 24,
"end_offset": 33,
"label": "dis"
},
{
"id": 1,
"entity": "肝",
"start_offset": 33,
"end_offset": 34,
"label": "bod"
},
{
"id": 2,
"entity": "肝损害",
"start_offset": 33,
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"label": "sym"
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{
"id": 3,
"entity": "护肝",
"start_offset": 43,
"end_offset": 45,
"label": "pro"
},
{
"id": 4,
"entity": "对症治疗",
"start_offset": 46,
"end_offset": 50,
"label": "pro"
}
] |
对这类患者就不必选用具有骨髓毒性的更昔洛韦治疗，以免造成不必要的医源性损伤。 | [
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"id": 0,
"entity": "骨髓",
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{
"id": 1,
"entity": "更昔洛韦",
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"label": "dru"
},
{
"id": 2,
"entity": "医源性损伤",
"start_offset": 32,
"end_offset": 37,
"label": "dis"
}
] |
实际上，核苷类似物是病毒增殖的抑制剂，停药后抑制效应常随之消失，很难根除慢性感染的细胞内病毒。 | [
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"entity": "核苷类似物",
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{
"id": 1,
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"entity": "慢性感染",
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{
"id": 3,
"entity": "细胞",
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"label": "bod"
},
{
"id": 4,
"entity": "病毒",
"start_offset": 44,
"end_offset": 46,
"label": "mic"
}
] |
例如，应用更昔洛韦时不宜同时使用其他骨髓毒性药物，包括AZT。 | [
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"id": 0,
"entity": "更昔洛韦",
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},
{
"id": 2,
"entity": "AZT",
"start_offset": 27,
"end_offset": 30,
"label": "dru"
}
] |
此外，患者已有相应功能障碍如肾功能不全时，不宜使用肾毒性抗病毒药物或应减量使用。 | [
{
"id": 0,
"entity": "肾功能不全",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
}
] |
（3）严格按照适应证用药：例如拉米呋定只对复制状态的HBV有抑制作用，即对慢性乙型肝炎、血清HBVDNA和HBeAg阳性患者有一定疗效。 | [
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"id": 0,
"entity": "拉米呋定",
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"label": "dru"
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{
"id": 1,
"entity": "HBV",
"start_offset": 26,
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"label": "mic"
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{
"id": 2,
"entity": "慢性乙型肝炎",
"start_offset": 37,
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"label": "dis"
},
{
"id": 3,
"entity": "血清HBVDNA",
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},
{
"id": 4,
"entity": "HBeAg阳性",
"start_offset": 53,
"end_offset": 60,
"label": "dis"
}
] |
而对慢性HBV感染非复制期（HBVDNA和HBeAg阴性）病毒无明显作用，对失代偿肝硬化者疗效差。 | [
{
"id": 0,
"entity": "慢性HBV感染",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
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{
"id": 1,
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"label": "dis"
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{
"id": 2,
"entity": "病毒",
"start_offset": 29,
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},
{
"id": 3,
"entity": "失代偿肝硬化",
"start_offset": 38,
"end_offset": 44,
"label": "dis"
}
] |
3.严密监测和及时处理毒副作用首先要求了解和熟悉各种药物可能发生的毒副作用；其次在用药前应了解患者相应器官功能如肝、肾功能等；再次，在用药期间需严密监测，如出现严重毒副作用时，一般宜停用药物。 | [
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"entity": "肝",
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"label": "bod"
},
{
"id": 1,
"entity": "肾",
"start_offset": 58,
"end_offset": 59,
"label": "bod"
}
] |
毒副作用发生时要及时处理，如α干扰素易致粒细胞减少，及时加服或加大复方阿胶浆用量，可有效提高粒细胞水平而不必中止治疗。 | [
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"id": 0,
"entity": "α干扰素",
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{
"id": 1,
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{
"id": 2,
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{
"id": 4,
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这种状况多与临床医生未能了解药物的抗病毒机制和适应证有关，例如，阿昔洛韦投放市场后，有医生将其用于治疗感冒、肺炎等呼吸道感染；更昔洛韦问世后，又如法炮制，当成广谱抗病毒药使用。 | [
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"id": 0,
"entity": "病毒",
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{
"id": 1,
"entity": "阿昔洛韦",
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{
"id": 6,
"entity": "病毒",
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] |
事实上，这2种药物均依赖疱疹类病毒胸苷激酶的磷酸化作用而活化，故只对这些病毒起作用，而对引起呼吸道感染的常见病毒如流感病毒、鼻病毒、腺病毒等无抑制效应。 | [
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"id": 0,
"entity": "疱疹类病毒",
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"end_offset": 17,
"label": "mic"
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{
"id": 1,
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{
"id": 2,
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"id": 4,
"entity": "流感病毒",
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{
"id": 5,
"entity": "鼻病毒",
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{
"id": 6,
"entity": "腺病毒",
"start_offset": 66,
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"label": "mic"
}
] |
再如干扰素理论上有广谱抗病毒作用，但实际上并非如此。 | [
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实践证明，干扰素对HCMV感染无效，但临床上就有医生对HCMV感染患儿长期使用干扰素。 | [
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] |
滥用抗病毒药物对病儿百害而无一利，不仅造成浪费、对患儿产生医源性损害，还会诱生耐药毒株。 | [
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] |
有些药物可致基因突变，有潜在致癌的危险。 | [
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{
"id": 1,
"entity": "癌",
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5.正确评估抗病毒药物的疗效对抗病毒药物疗效的评估应包括两个方面：一方面是临床疗效评估，另一方面是病毒学评估。 | [
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"entity": "抗病毒药物",
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{
"id": 1,
"entity": "病毒",
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而后者尤为重要，是抗病毒效应最为可靠的评价指标。 | [
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其方法有：①病毒分离或空斑试验计算病毒含量；②病毒基因定性和定量分析；③病毒抗原定性和半定量分析。 | [
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"id": 1,
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{
"id": 2,
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{
"id": 3,
"entity": "病毒基因定性和定量分析",
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"id": 4,
"entity": "病毒抗原定性和半定量分析",
"start_offset": 36,
"end_offset": 48,
"label": "pro"
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病毒特异性IgM抗体不宜作为观察指标，因为特异性IgM水平除与病毒增殖状况有关外，还受机体免疫反应强弱和抗体降解速率等因素的影响，而与病毒量无明显关系。 | [
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{
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{
"id": 3,
"entity": "病毒",
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] |
第十一节神经源性膀胱神经源性膀胱（neurogenicbladder）是由于中枢或周围神经部分或完全性损害造成的膀胱、尿道贮尿或/和排尿功能障碍，也可将其称之为下尿路功能障碍。 | [
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{
"id": 1,
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{
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{
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{
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"entity": "周围神经",
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{
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"entity": "膀胱",
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{
"id": 6,
"entity": "尿道",
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"label": "bod"
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{
"id": 7,
"entity": "排尿功能障碍",
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"label": "dis"
},
{
"id": 8,
"entity": "尿路功能障碍",
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"end_offset": 87,
"label": "dis"
}
] |
在小儿泌尿外科，至少有25%的临床问题是由于先天性神经损害影响到下尿路功能造成的。 | [
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其原因主要为脊髓发育不良，包括脊髓脊膜膨出、脊髓栓系、脊髓纵裂及腰骶椎发育不良等；其他原因包括外伤、肿瘤、经骶尾部或盆腔的手术、神经系统炎症和VATER综合征等。 | [
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{
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"entity": "肿瘤",
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{
"id": 6,
"entity": "骶尾部",
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{
"id": 7,
"entity": "盆腔",
"start_offset": 58,
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"label": "bod"
},
{
"id": 8,
"entity": "神经系统炎症",
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"label": "dis"
},
{
"id": 9,
"entity": "VATER综合征",
"start_offset": 71,
"end_offset": 79,
"label": "dis"
}
] |
临床上常可能仅注重对神经系统病变或原发病的治疗而忽视了神经源性膀胱所造成的影响，尤其在膀胱充盈期压力长期增高，引起膀胱输尿管反流可危害到患儿的肾功能，甚至导致肾衰竭。 | [
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{
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{
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"entity": "甚至导致肾衰竭",
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"label": "sym"
}
] |
【分类】在泌尿外科疾病中，神经源性膀胱是分类方法最多，也是最复杂和概念最混淆的一种疾病，迄今为止还没有一种分类能将神经源性膀胱的解剖、生理、病理和症状特点结合统一。 | [
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{
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"entity": "神经源性膀胱",
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"label": "dis"
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] |
另外，根据尿流动力学进行分类也越来越受到关注和应用，它在评价膀胱逼尿肌和尿道括约肌情况的同时可综合考虑其相互关系，将膀胱和尿道分为正常、亢进及无反射三类的同时又分为膀胱逼尿肌与尿道括约肌协调、不协调两种情况。 | [
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{
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{
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{
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{
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{
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{
"id": 9,
"entity": "不协调",
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"label": "dis"
}
] |
【诊断】小儿神经源性膀胱的病因主要为先天性的，故大多可于生后早期发现，而如外伤等获得性者也可通过病史得出结论。 | [
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虽然尿流动力学检查十分重要，但常常由于患儿无法合作或在麻醉下进行以至无法获得完全而真实的评价，因此常需要通过详细的病史询问和体格检查、完善的实验室检查和影像学检查以及一些必要的特殊检查来弥补上述不足。 | [
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（一）病史及体格检查脊髓脊膜膨出等先天性脊髓发育不良和椎管发育不全常导致患儿生后出现排尿（排便）异常，脊柱表面皮肤病变，下肢、足畸形和步态异常等情况，在新生儿或婴幼儿往往多因后两种情况而就诊；在大年龄患儿，通常在可控制大小便和行走的阶段出现异常而被家长发现。 | [
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{
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{
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"entity": "下肢、足畸形和步态异常等情况",
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"label": "sym"
}
] |
脊柱尤其是骶尾部的体格检查可了解患儿有无脊柱裂等椎骨发育异常；神经系统的检查如马鞍区感觉减退或消失，肛门括约肌反射和球海绵体肌反射亢进、减退或消失等都有助于对患儿神经损害的程度和定位进行评价。 | [
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{
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"entity": "肛门括约肌反射和球海绵体肌反射亢进、减退或消失",
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] |
病史和体格检查除可对患儿的情况提供一个概括外，还具有以下的作用：①对可能与大小便功能有关的病史作出鉴别，如遗尿史及患儿的排尿类型等；②对神经系统损害进行定位以便证实、解释尿流动力学检查结果；③了解患儿的预后可能，为治疗方案提供参考。 | [
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{
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] |
（二）实验室检查神经源性膀胱最常见的并发症为尿路感染，但症状多不典型，如合并膀胱输尿管反流则可能加速肾脏的损害；在新生儿或婴幼儿可能导致水电解质紊乱、酸碱平衡失调以及肾衰竭等威胁患儿生命。 | [
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{
"id": 2,
"entity": "合并膀胱输尿管反流则可能加速肾脏的损害",
"start_offset": 36,
"end_offset": 55,
"label": "sym"
},
{
"id": 3,
"entity": "在新生儿或婴幼儿可能导致水电解质紊乱、酸碱平衡失调以及肾衰竭等威胁患儿生命",
"start_offset": 56,
"end_offset": 93,
"label": "sym"
}
] |
（三）影像学检查X线脊柱平片检查可发现脊柱畸形（如椎体畸形）和脊柱裂。 | [
{
"id": 0,
"entity": "影像学检查",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "X线脊柱平片",
"start_offset": 8,
"end_offset": 14,
"label": "pro"
},
{
"id": 2,
"entity": "脊柱畸形（如椎体畸形）和脊柱裂",
"start_offset": 19,
"end_offset": 34,
"label": "sym"
}
] |
排尿性膀胱尿道造影多可发现典型的“圣诞树”样膀胱，可了解充盈期膀胱的形态和容量，是否存在膀胱输尿管反流及反流的程度；在排尿时观察尿道和膀胱颈部开放的情况，对是否存在逼尿肌和括约肌不协调具有一定的诊断意义，并可排除后尿道瓣膜等先天性下尿路梗阻性疾病。 | [
{
"id": 0,
"entity": "排尿性膀胱尿道造影",
"start_offset": 0,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "发现典型的“圣诞树”样膀胱",
"start_offset": 11,
"end_offset": 24,
"label": "sym"
},
{
"id": 2,
"entity": "存在膀胱输尿管反流及反流的程度",
"start_offset": 42,
"end_offset": 57,
"label": "sym"
},
{
"id": 3,
"entity": "排尿时观察尿道和膀胱颈部开放的情况",
"start_offset": 59,
"end_offset": 76,
"label": "ite"
},
{
"id": 4,
"entity": "逼尿肌和括约肌不协调",
"start_offset": 82,
"end_offset": 92,
"label": "sym"
},
{
"id": 5,
"entity": "后尿道瓣膜",
"start_offset": 106,
"end_offset": 111,
"label": "dis"
},
{
"id": 6,
"entity": "先天性下尿路梗阻性疾病",
"start_offset": 112,
"end_offset": 123,
"label": "dis"
}
] |
B超因其无创伤性，多用于了解上尿路情况以及患儿的长期随访。 | [
{
"id": 0,
"entity": "B超",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
}
] |
（四）尿流动力学检查包括膀胱测压、外括约肌肌电测定、尿道压力测定和尿流率测定等。 | [
{
"id": 0,
"entity": "尿流动力学检查",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "膀胱测压",
"start_offset": 12,
"end_offset": 16,
"label": "ite"
},
{
"id": 2,
"entity": "外括约肌肌电测定",
"start_offset": 17,
"end_offset": 25,
"label": "ite"
},
{
"id": 3,
"entity": "尿道压力测定",
"start_offset": 26,
"end_offset": 32,
"label": "ite"
},
{
"id": 4,
"entity": "尿流率测定",
"start_offset": 33,
"end_offset": 38,
"label": "ite"
}
] |
在检查方法上有常规尿流动力学检查、影像尿流动力学检查以及动态尿流动力学检查等。 | [
{
"id": 0,
"entity": "常规尿流动力学检查",
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},
{
"id": 1,
"entity": "影像尿流动力学检查",
"start_offset": 17,
"end_offset": 26,
"label": "pro"
},
{
"id": 2,
"entity": "动态尿流动力学检查",
"start_offset": 28,
"end_offset": 37,
"label": "ite"
}
] |
除尿流率测定外，作为一种非自然的膀胱尿道功能的刺激性检查，尿流动力学检查有一定的局限性，但其某些客观的发现，如膀胱存在无抑制性收缩以及括约肌有去神经支配的肌电图表现等情况，仍可为临床提供重要的诊断资料，并且它对于神经源性膀胱的分类及治疗有一定的指导意义。 | [
{
"id": 0,
"entity": "尿流率测定",
"start_offset": 1,
"end_offset": 6,
"label": "ite"
},
{
"id": 1,
"entity": "非自然的膀胱尿道功能的刺激性检查",
"start_offset": 12,
"end_offset": 28,
"label": "pro"
},
{
"id": 2,
"entity": "尿流动力学检查",
"start_offset": 29,
"end_offset": 36,
"label": "pro"
},
{
"id": 3,
"entity": "膀胱存在无抑制性收缩以及括约肌有去神经支配的肌电图表现等情况",
"start_offset": 55,
"end_offset": 85,
"label": "sym"
},
{
"id": 4,
"entity": "神经源性膀胱",
"start_offset": 106,
"end_offset": 112,
"label": "dis"
}
] |
对于小儿的尿流动力学检查，还应考虑到其下尿路神经支配的发育程度，以防止得出片面的结论。 | [
{
"id": 0,
"entity": "小儿的尿流动力学检查",
"start_offset": 2,
"end_offset": 12,
"label": "ite"
}
] |
【治疗】正如尚无单一的分类一样，迄今为止对神经源性膀胱的治疗也没有一种简便而单一的方法，常需要进行个体化的综合治疗，即不同患儿的治疗方案因病情可以完全不同，但又存在着一些根本的治疗原则：①保护肾功能；②防止及控制尿路感染；③尽量避免留置导尿和尿流改道；④尽可能实现既能控制失禁又能基本排空膀胱和尿道以改善患儿的生活质量。 | [
{
"id": 0,
"entity": "神经源性膀胱",
"start_offset": 21,
"end_offset": 27,
"label": "dis"
},
{
"id": 1,
"entity": "保护肾功能",
"start_offset": 94,
"end_offset": 99,
"label": "pro"
},
{
"id": 2,
"entity": "防止及控制尿路感染",
"start_offset": 101,
"end_offset": 110,
"label": "pro"
},
{
"id": 3,
"entity": "尽量避免留置导尿和尿流改道",
"start_offset": 112,
"end_offset": 125,
"label": "pro"
},
{
"id": 4,
"entity": "尽可能实现既能控制失禁又能基本排空膀胱和尿道以改善患儿的生活质量",
"start_offset": 127,
"end_offset": 159,
"label": "pro"
}
] |
同时，患儿及其家长对治疗的理解和配合也是治疗成功与否的关键，应对以下情况进行充分的了解，以合理选用治疗方案：①患儿的意识和智力情况；②患儿是否具有治疗所需的能力，如是否能自行进行间歇性清洁导尿或排尿训练等；③患儿和家长对神经源性膀胱及选用治疗方案的理解；④患儿及家长的合作程度及其经济能力等。 | [
{
"id": 0,
"entity": "间歇性清洁导尿或排尿训练",
"start_offset": 89,
"end_offset": 101,
"label": "pro"
},
{
"id": 1,
"entity": "神经源性膀胱",
"start_offset": 110,
"end_offset": 116,
"label": "dis"
}
] |
另外，也可将众多的治疗方法分为非手术和手术治疗两类。 | [
{
"id": 0,
"entity": "非手术",
"start_offset": 15,
"end_offset": 18,
"label": "pro"
},
{
"id": 1,
"entity": "手术治疗",
"start_offset": 19,
"end_offset": 23,
"label": "pro"
}
] |
（一）非手术治疗1.导尿术以导尿管引流尿液，是一种有长久历史的治疗手段，具有操作简便、效果好及经济等优点，至今仍被普遍应用。 | [
{
"id": 0,
"entity": "非手术治疗",
"start_offset": 3,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "导尿术",
"start_offset": 10,
"end_offset": 13,
"label": "pro"
},
{
"id": 2,
"entity": "导尿管",
"start_offset": 14,
"end_offset": 17,
"label": "equ"
}
] |
主要包括留置导尿、无菌性间歇性导尿和间歇性清洁导尿（clearintermittentcatheterization，CIC）。 | [
{
"id": 0,
"entity": "留置导尿",
"start_offset": 4,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "无菌性间歇性导尿",
"start_offset": 9,
"end_offset": 17,
"label": "pro"
},
{
"id": 2,
"entity": "间歇性清洁导尿",
"start_offset": 18,
"end_offset": 25,
"label": "pro"
},
{
"id": 3,
"entity": "clearintermittentcatheterization",
"start_offset": 26,
"end_offset": 58,
"label": "pro"
},
{
"id": 4,
"entity": "CIC",
"start_offset": 59,
"end_offset": 62,
"label": "pro"
}
] |
由于传统的留置导尿法常易引起尿路感染，故多数情况下，主张首选间歇性清洁导尿。 | [
{
"id": 0,
"entity": "留置导尿法",
"start_offset": 5,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "尿路感染",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
},
{
"id": 2,
"entity": "间歇性清洁导尿",
"start_offset": 30,
"end_offset": 37,
"label": "pro"
}
] |
（1）间歇性清洁导尿和无菌性间歇性导尿：对于任何不能自行排空膀胱的患儿均可考虑，其适应证为：①暂时性或永久性尿潴留；②逼尿肌反射亢进及膀胱逼尿肌、尿道外括约肌不协调；③有手术禁忌的膀胱出口梗阻者。 | [
{
"id": 0,
"entity": "间歇性清洁导尿",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "无菌性间歇性导尿",
"start_offset": 11,
"end_offset": 19,
"label": "pro"
},
{
"id": 2,
"entity": "暂时性或永久性尿潴留",
"start_offset": 47,
"end_offset": 57,
"label": "sym"
},
{
"id": 3,
"entity": "逼尿肌反射亢进及膀胱逼尿肌、尿道外括约肌不协调",
"start_offset": 59,
"end_offset": 82,
"label": "sym"
},
{
"id": 4,
"entity": "有手术禁忌的膀胱出口梗阻者",
"start_offset": 84,
"end_offset": 97,
"label": "sym"
}
] |
尿道畸形、严重尿道炎和尿道周围脓肿则为其禁忌证。 | [
{
"id": 0,
"entity": "尿道畸形",
"start_offset": 0,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "严重尿道炎",
"start_offset": 5,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "尿道周围脓肿",
"start_offset": 11,
"end_offset": 17,
"label": "dis"
}
] |
有实验证明正常的膀胱具有抗感染能力，膀胱黏膜的完整和膀胱自身的排空是机体的一种防御机制，因此，即使因导尿管或导尿过程中可能使细菌进入膀胱，也完全可以依赖这一机制以及间歇性导尿（如同形成正常的排尿周期）加以消灭或清除，从而最大程度地避免尿路感染。 | [
{
"id": 0,
"entity": "膀胱",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "膀胱黏膜",
"start_offset": 18,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "膀胱",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "导尿管",
"start_offset": 50,
"end_offset": 53,
"label": "equ"
},
{
"id": 4,
"entity": "导尿",
"start_offset": 54,
"end_offset": 56,
"label": "pro"
},
{
"id": 5,
"entity": "细菌",
"start_offset": 62,
"end_offset": 64,
"label": "mic"
},
{
"id": 6,
"entity": "间歇性导尿",
"start_offset": 82,
"end_offset": 87,
"label": "pro"
},
{
"id": 7,
"entity": "尿路感染",
"start_offset": 117,
"end_offset": 121,
"label": "dis"
}
] |
尽管无菌性间歇性导尿略优于间歇性清洁导尿，但相对而言后者更为简单方便，尤其适于需长期在家导尿又无法达到无菌要求的患儿。 | [
{
"id": 0,
"entity": "无菌性间歇性导尿",
"start_offset": 2,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "间歇性清洁导尿",
"start_offset": 13,
"end_offset": 20,
"label": "pro"
}
] |
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