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此时，患儿仍有持续尿检异常、反复高血压和肾功能不全。 | [
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有国内学者建议参照中华医学会儿科学分会肾脏病学组制定的“小儿肾小球疾病的临床分类、诊断及治疗方案”中关于紫癜性肾炎和狼疮性肾炎的“临床分型”和“根据临床表现参照病理类型制定治疗方案”的内容进行用药，可明显改善预后。 | [
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"entity": "狼疮性肾炎",
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"label": "dis"
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有高血压者可长期用ACEI控制。 | [
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对急性期过后暂时无高血压者需进行长期随访，必要时行24小时血压监测或踏步车试验，以便早期发现和治疗高血压，延缓肾损害。 | [
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"entity": "踏步车试验",
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"entity": "高血压",
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"label": "dis"
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"entity": "肾",
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【预后】由于对HUS认识的提高和透析技术的广泛应用，病死率已降至10%以下。 | [
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远期预后与临床肾脏损害程度及肾脏组织学受损范围有关。 | [
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二、尿液生化检查（一）蛋白质正常健康小儿尿中有微量的蛋白，主要有白蛋白、溶菌酶、糖蛋白和脂蛋白等，其中一半来自血浆，另一半为脱落上皮、腺体分泌物及肾小管分泌的Tamm-Horsfall黏蛋白。 | [
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"entity": "蛋白",
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"entity": "白蛋白",
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"entity": "溶菌酶",
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"id": 6,
"entity": "糖蛋白",
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"entity": "脂蛋白",
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"entity": "血浆",
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"entity": "上皮、腺体分泌物",
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"label": "bod"
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"id": 10,
"entity": "肾小管",
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正常时每天由尿中排泄的蛋白＜150mg。 | [
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1.尿蛋白定性测量临床常用的定性方法有磺基水杨酸法、蛋白试纸法及加热醋酸法。 | [
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（1）磺基水杨酸法：用20%的该试剂2～3滴加入放有尿液的平板上或试管中，在黑色背景下观察，根据其浑浊度判定结果。 | [
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"entity": "试管",
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该方法敏感度高，可检出0.05～0.1g/L的蛋白尿，但在高浓度的尿酸、草酸盐和黏蛋白存在时或当青霉素钾盐≥4万U/ml时可出现假阳性。 | [
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"entity": "青霉素钾盐",
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（2）蛋白试纸法：用四溴酚蓝作蛋白指示剂，当有蛋白存在时，蘸有尿液的试纸在10～60秒钟内由黄色变为绿色，再根据指示剂所标定的标准定度，其检测的最小浓度为0.15～0.3g/L。 | [
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强碱性尿可致假阳性，大剂量青霉素时可出现假阴性。 | [
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从定性可粗略估计尿蛋白。 | [
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表12-12示一般情况下用上述两种方法测定的结果彼此相符，且与尿蛋白浓度一致，但有时这两种方法可有不同的结果。 | [
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蛋白试纸法对白蛋白敏感，而磺基水杨酸则对所有蛋白均敏感，因而，当尿中存在低分子蛋白时，用试纸法可能为阴性。 | [
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因此在多发性骨髓瘤患者尿排出大量免疫球蛋白轻链时，不用磺基水杨酸法，否则可能漏诊。 | [
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表12-1尿蛋白定性判断随尿蛋白浓度关系（3）醋酸加热法：灵敏度为0.15g/L，假阳性和假阴性较前两种方法要少，除本-周蛋白（Bence-Jones蛋白）外，所有蛋白均可在加热变性后沉淀。 | [
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"entity": "蛋白",
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检测免疫球蛋白轻链（本-周蛋白）也可用醋酸加热法，当加热至45～55℃时蛋白沉淀，继续加热至100℃时又溶解。 | [
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如果用磺基水杨酸法得到的阳性结果较试纸法强提示为非白蛋白尿，两者得到相同的结果则尿蛋白主要为白蛋白。 | [
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2.尿蛋白定量测定尿蛋白定性常不能评估疾病的严重性，因为排出同等量的蛋白时可因尿量的不同得出不同的结果，因此需进行尿蛋白定量分析。 | [
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通常采用24小时尿蛋白定量，来判断病情的轻重。 | [
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常用定量检查方法有双缩脲法、Esbach法、磺基水杨酸比浊法及各种染料比色法。 | [
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正常小儿尿蛋白定量：①24小时小于150mg；②＜4mg/（h•m2</sup>）；③尿蛋白/尿肌酐比值＜0.2。 | [
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肾病综合征时，尿蛋白定量：①＞50mg/（kg•d）；②＞40mg/（h•m2</sup>）；③尿蛋白/尿肌酐比值＞2.0。 | [
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蛋白尿的轻重程度分为：轻度＜500mg/24h、中度为500mg～2g/24h、重度为＞2g/24h。 | [
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轻至中度蛋白尿见于直立性蛋白尿、急或慢性肾小球肾炎、泌尿系感染及某些药物中毒。 | [
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重度蛋白尿主要见于肾病综合征。 | [
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3.尿蛋白成分分析尿蛋白按其来源可分为：①肾小球性蛋白尿：由于肾小球毛细管壁通透性增加或其静电屏障作用减弱所致。 | [
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以白蛋白为主，既可含有少量β2</sub>-微球蛋白等小分子量蛋白，又可含有免疫球蛋白等大分子量蛋白。 | [
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蛋白尿以白蛋白为主时称选择性蛋白尿。 | [
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含有大量的高分子量蛋白如IgG、IgA和IgM时为非选择性蛋白尿。 | [
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"label": "bod"
}
] |
②肾小管性蛋白尿：由于近端小管重吸收功能减低所致。 | [
{
"id": 0,
"entity": "肾小管性蛋白尿",
"start_offset": 1,
"end_offset": 8,
"label": "bod"
},
{
"id": 1,
"entity": "小管",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
}
] |
以β2</sub>-微球蛋白、溶菌酶和视黄醇结合蛋白（RBP）等小分子蛋白升高为主。 | [
{
"id": 0,
"entity": "溶菌酶",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 1,
"entity": "视黄醇结合蛋白",
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"end_offset": 26,
"label": "bod"
},
{
"id": 2,
"entity": "RBP",
"start_offset": 27,
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"label": "bod"
},
{
"id": 3,
"entity": "蛋白",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
}
] |
测定尿β2</sub>-微球蛋白/白蛋白比值也有助于肾小管性蛋白尿的判断。 | [
{
"id": 0,
"entity": "肾小管性蛋白尿",
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"label": "bod"
}
] |
正常人尿中β2</sub>-微球蛋白/白蛋白=1∶100，肾小管病变时为1∶7，肾小球病变时该比值为1∶750。 | [
{
"id": 0,
"entity": "尿",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "微球蛋白/白蛋白",
"start_offset": 14,
"end_offset": 22,
"label": "ite"
},
{
"id": 2,
"entity": "肾小管病变",
"start_offset": 29,
"end_offset": 34,
"label": "dis"
},
{
"id": 3,
"entity": "肾小球病变",
"start_offset": 40,
"end_offset": 45,
"label": "dis"
}
] |
③混合性蛋白尿：既有肾小球性蛋白尿，又有肾小管性蛋白尿，称混合性蛋白尿。 | [
{
"id": 0,
"entity": "混合性蛋白尿",
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{
"id": 1,
"entity": "肾小球性蛋白尿",
"start_offset": 10,
"end_offset": 17,
"label": "bod"
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{
"id": 2,
"entity": "肾小管性蛋白尿",
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"label": "bod"
},
{
"id": 3,
"entity": "混合性蛋白尿",
"start_offset": 29,
"end_offset": 35,
"label": "bod"
}
] |
④溢出性蛋白尿：血中低分子量蛋白异常增高（如免疫球蛋白轻链和肌红蛋白），超过肾小管重吸收极限时，大量随尿排出，即为溢出性蛋白尿。 | [
{
"id": 0,
"entity": "溢出性蛋白尿",
"start_offset": 1,
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"label": "bod"
},
{
"id": 1,
"entity": "血",
"start_offset": 8,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "蛋白",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "免疫球蛋白轻链",
"start_offset": 22,
"end_offset": 29,
"label": "bod"
},
{
"id": 4,
"entity": "肌红蛋白",
"start_offset": 30,
"end_offset": 34,
"label": "bod"
},
{
"id": 5,
"entity": "肾小管",
"start_offset": 38,
"end_offset": 41,
"label": "bod"
},
{
"id": 6,
"entity": "尿",
"start_offset": 51,
"end_offset": 52,
"label": "bod"
},
{
"id": 7,
"entity": "溢出性蛋白尿",
"start_offset": 57,
"end_offset": 63,
"label": "bod"
}
] |
常见于多发性骨髓瘤、轻链病、原发性冷球蛋白血症以及肌红蛋白尿等。 | [
{
"id": 0,
"entity": "多发性骨髓瘤",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "轻链病",
"start_offset": 10,
"end_offset": 13,
"label": "dis"
},
{
"id": 2,
"entity": "原发性冷球蛋白血症",
"start_offset": 14,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "肌红蛋白尿",
"start_offset": 25,
"end_offset": 30,
"label": "dis"
}
] |
⑤组织性蛋白尿：由肾小管、输尿管、膀胱和尿道局部组织破坏或分泌产生的蛋白尿，见于泌尿道感染、损伤和肿瘤等。 | [
{
"id": 0,
"entity": "组织性蛋白尿",
"start_offset": 1,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "肾小管",
"start_offset": 9,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "输尿管",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "膀胱",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 4,
"entity": "尿道",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 5,
"entity": "蛋白尿",
"start_offset": 34,
"end_offset": 37,
"label": "bod"
},
{
"id": 6,
"entity": "泌尿道感染",
"start_offset": 40,
"end_offset": 45,
"label": "sym"
},
{
"id": 7,
"entity": "损伤",
"start_offset": 46,
"end_offset": 48,
"label": "sym"
},
{
"id": 8,
"entity": "肿瘤",
"start_offset": 49,
"end_offset": 51,
"label": "dis"
}
] |
对尿蛋白成分可采用：①十二烷基磺酸钠-聚丙烯酰胺凝胶电泳（sodiumdodecylsulfate-polyacrylamidegelelectrophoresis，SDS-PAGE）：可采用盘状电泳或垂直板式电泳，板式电泳敏感度更高，两者都是按分子量大小来区分尿蛋白；②等电聚焦电泳：按蛋白质电荷量（PI值）来分离蛋白；③二维电泳：可区分更多蛋白，但操作复杂，要求较高；④反相高效液相色谱分析：分析速度快，灵敏度高，但仪器价格昂贵；⑤毛细管电泳：分析速度快，准确可靠，上样量小，但成本较高。 | [
{
"id": 0,
"entity": "尿蛋白",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "十二烷基磺酸钠-聚丙烯酰胺凝胶电泳",
"start_offset": 11,
"end_offset": 28,
"label": "pro"
},
{
"id": 2,
"entity": "sodiumdodecylsulfate-polyacrylamidegelelectrophoresis",
"start_offset": 29,
"end_offset": 82,
"label": "pro"
},
{
"id": 3,
"entity": "SDS-PAGE",
"start_offset": 83,
"end_offset": 91,
"label": "pro"
},
{
"id": 4,
"entity": "盘状电泳",
"start_offset": 96,
"end_offset": 100,
"label": "pro"
},
{
"id": 5,
"entity": "垂直板式电泳",
"start_offset": 101,
"end_offset": 107,
"label": "pro"
},
{
"id": 6,
"entity": "板式电泳",
"start_offset": 108,
"end_offset": 112,
"label": "pro"
},
{
"id": 7,
"entity": "等电聚焦电泳",
"start_offset": 136,
"end_offset": 142,
"label": "pro"
},
{
"id": 8,
"entity": "蛋白质电荷量",
"start_offset": 144,
"end_offset": 150,
"label": "ite"
},
{
"id": 9,
"entity": "PI值",
"start_offset": 151,
"end_offset": 154,
"label": "ite"
},
{
"id": 10,
"entity": "蛋白",
"start_offset": 158,
"end_offset": 160,
"label": "bod"
},
{
"id": 11,
"entity": "二维电泳",
"start_offset": 162,
"end_offset": 166,
"label": "pro"
},
{
"id": 12,
"entity": "蛋白",
"start_offset": 172,
"end_offset": 174,
"label": "bod"
},
{
"id": 13,
"entity": "反相高效液相色谱分析",
"start_offset": 187,
"end_offset": 197,
"label": "pro"
},
{
"id": 14,
"entity": "毛细管电泳",
"start_offset": 218,
"end_offset": 223,
"label": "pro"
}
] |
尿蛋白可按分子量分为三类。 | [
{
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"entity": "尿蛋白",
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"end_offset": 3,
"label": "bod"
}
] |
其一是高分子量蛋白，分子量＞9万，主要为免疫球蛋白和Tamn-Horsfall蛋白；其二是中分子量蛋白，分子量在4万～9万间，主要为白蛋白；其三是低分子量蛋白，分子量＜4万，主要由溶菌酶、β2</sub>-微球蛋白、α1</sub>-微球蛋白、免疫球蛋白Fc片段和自由轻链等组成。 | [
{
"id": 0,
"entity": "高分子量蛋白",
"start_offset": 3,
"end_offset": 9,
"label": "bod"
},
{
"id": 1,
"entity": "免疫球蛋白",
"start_offset": 20,
"end_offset": 25,
"label": "bod"
},
{
"id": 2,
"entity": "Tamn-Horsfall蛋白",
"start_offset": 26,
"end_offset": 41,
"label": "bod"
},
{
"id": 3,
"entity": "中分子量蛋白",
"start_offset": 45,
"end_offset": 51,
"label": "bod"
},
{
"id": 4,
"entity": "白蛋白",
"start_offset": 66,
"end_offset": 69,
"label": "bod"
},
{
"id": 5,
"entity": "低分子量蛋白",
"start_offset": 73,
"end_offset": 79,
"label": "bod"
},
{
"id": 6,
"entity": "溶菌酶",
"start_offset": 90,
"end_offset": 93,
"label": "bod"
},
{
"id": 7,
"entity": "微球蛋白",
"start_offset": 103,
"end_offset": 107,
"label": "bod"
},
{
"id": 8,
"entity": "微球蛋白",
"start_offset": 117,
"end_offset": 121,
"label": "bod"
},
{
"id": 9,
"entity": "免疫球蛋白Fc片段",
"start_offset": 122,
"end_offset": 131,
"label": "bod"
},
{
"id": 10,
"entity": "自由轻链",
"start_offset": 132,
"end_offset": 136,
"label": "bod"
}
] |
此外，也可采用蛋白尿选择性指数的测定来区别尿中排出大分子蛋白质的多少。 | [
{
"id": 0,
"entity": "蛋白尿选择性指数",
"start_offset": 7,
"end_offset": 15,
"label": "ite"
},
{
"id": 1,
"entity": "尿",
"start_offset": 21,
"end_offset": 22,
"label": "bod"
},
{
"id": 2,
"entity": "大分子蛋白质",
"start_offset": 25,
"end_offset": 31,
"label": "bod"
}
] |
选择性蛋白尿指数（selectiveproteinuriaindex，SpI）的计算如下：当尿中排出大分子IgG量少时为选择性好，排出大量IgG时为选择性差。 | [
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"id": 0,
"entity": "选择性蛋白尿指数",
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{
"id": 1,
"entity": "尿",
"start_offset": 46,
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"label": "bod"
},
{
"id": 2,
"entity": "IgG",
"start_offset": 53,
"end_offset": 56,
"label": "bod"
},
{
"id": 3,
"entity": "IgG",
"start_offset": 69,
"end_offset": 72,
"label": "bod"
}
] |
SpI＞0.2为选择性差，见于膜性肾病和膜增殖性肾小球肾炎；SpI0.1～0.2为选择性一般；SpI＜0.1为选择性好，见于微小病变性肾病。 | [
{
"id": 0,
"entity": "膜性肾病",
"start_offset": 15,
"end_offset": 19,
"label": "dis"
},
{
"id": 1,
"entity": "膜增殖性肾小球肾炎",
"start_offset": 20,
"end_offset": 29,
"label": "dis"
},
{
"id": 2,
"entity": "微小病变性肾病",
"start_offset": 62,
"end_offset": 69,
"label": "dis"
}
] |
（二）糖近端肾小管可将滤过的葡萄糖完全回吸收，正常小儿尿糖极微，定量约0.56～5.0mmol/24h，浓度＜2.8mmol/L，定性为阴性。 | [
{
"id": 0,
"entity": "糖",
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"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "近端肾小管",
"start_offset": 4,
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"label": "bod"
},
{
"id": 2,
"entity": "葡萄糖",
"start_offset": 14,
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"label": "bod"
},
{
"id": 3,
"entity": "尿糖",
"start_offset": 27,
"end_offset": 29,
"label": "ite"
}
] |
儿童肾糖阈为8.88mmol/L（160mg/dl）。 | [
{
"id": 0,
"entity": "肾糖",
"start_offset": 2,
"end_offset": 4,
"label": "ite"
}
] |
如血糖超过肾糖阈及肾糖阈降低时，均可出现尿糖。 | [
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"id": 0,
"entity": "血糖",
"start_offset": 1,
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"label": "ite"
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{
"id": 1,
"entity": "肾糖",
"start_offset": 5,
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"label": "ite"
},
{
"id": 2,
"entity": "肾糖",
"start_offset": 9,
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"label": "ite"
},
{
"id": 3,
"entity": "尿糖",
"start_offset": 20,
"end_offset": 22,
"label": "ite"
}
] |
肾性糖尿为肾糖阈降低的肾小管疾病，此种疾病血糖及糖耐量正常而表现为尿糖阳性，可见于各种药物性肾损害、先天性肾性糖尿病、严重感染、胱氨酸尿症、Fanconi综合征、Wilson病以及部分糖原累积症Ⅰ型患儿。 | [
{
"id": 0,
"entity": "肾性糖尿",
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"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "肾糖",
"start_offset": 5,
"end_offset": 7,
"label": "ite"
},
{
"id": 2,
"entity": "肾小管疾病",
"start_offset": 11,
"end_offset": 16,
"label": "dis"
},
{
"id": 3,
"entity": "血糖",
"start_offset": 21,
"end_offset": 23,
"label": "ite"
},
{
"id": 4,
"entity": "糖耐量",
"start_offset": 24,
"end_offset": 27,
"label": "ite"
},
{
"id": 5,
"entity": "尿糖",
"start_offset": 33,
"end_offset": 35,
"label": "ite"
},
{
"id": 6,
"entity": "药物性肾损害",
"start_offset": 43,
"end_offset": 49,
"label": "dis"
},
{
"id": 7,
"entity": "先天性肾性糖尿病",
"start_offset": 50,
"end_offset": 58,
"label": "dis"
},
{
"id": 8,
"entity": "严重感染",
"start_offset": 59,
"end_offset": 63,
"label": "dis"
},
{
"id": 9,
"entity": "胱氨酸尿症",
"start_offset": 64,
"end_offset": 69,
"label": "dis"
},
{
"id": 10,
"entity": "Fanconi综合征",
"start_offset": 70,
"end_offset": 80,
"label": "dis"
},
{
"id": 11,
"entity": "Wilson病",
"start_offset": 81,
"end_offset": 88,
"label": "dis"
},
{
"id": 12,
"entity": "糖原累积症",
"start_offset": 92,
"end_offset": 97,
"label": "dis"
}
] |
20%的足月儿及未成熟儿在生后第1周可出现一过性糖尿，为肾单位发育不成熟所致。 | [
{
"id": 0,
"entity": "一过性糖尿",
"start_offset": 21,
"end_offset": 26,
"label": "sym"
},
{
"id": 1,
"entity": "肾单位",
"start_offset": 28,
"end_offset": 31,
"label": "bod"
}
] |
（三）氨基酸血及尿中常见的氨基酸约有17种左右，大多经肾小球滤过后由近端肾小管上皮细胞主动回吸收，其回吸收率为92%（组氨酸）到99.8%（缬氨酸）不等。 | [
{
"id": 0,
"entity": "氨基酸",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "血",
"start_offset": 6,
"end_offset": 7,
"label": "bod"
},
{
"id": 2,
"entity": "尿",
"start_offset": 8,
"end_offset": 9,
"label": "bod"
},
{
"id": 3,
"entity": "氨基酸",
"start_offset": 13,
"end_offset": 16,
"label": "bod"
},
{
"id": 4,
"entity": "肾小球",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 5,
"entity": "组氨酸",
"start_offset": 59,
"end_offset": 62,
"label": "bod"
},
{
"id": 6,
"entity": "缬氨酸",
"start_offset": 70,
"end_offset": 73,
"label": "bod"
}
] |
氨基酸尿可分为全氨基酸尿或一组氨基酸尿。 | [
{
"id": 0,
"entity": "氨基酸尿",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "全氨基酸尿",
"start_offset": 7,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "一组氨基酸尿",
"start_offset": 13,
"end_offset": 19,
"label": "sym"
}
] |
前者为滤过的所有氨基酸回吸收率降低，见于Lowe综合征及Fanconi综合征。 | [
{
"id": 0,
"entity": "滤过的所有氨基酸回吸收率降低",
"start_offset": 3,
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"label": "sym"
},
{
"id": 1,
"entity": "Lowe综合征",
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},
{
"id": 2,
"entity": "Fanconi综合征",
"start_offset": 28,
"end_offset": 38,
"label": "dis"
}
] |
一组氨基酸尿可见于胱氨酸尿症（cystinuria），主要为二碱基氨基酸（精氨酸、赖氨酸、鸟氨酸及胱氨酸）在尿中排出增加。 | [
{
"id": 0,
"entity": "一组氨基酸尿",
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"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "胱氨酸尿症",
"start_offset": 9,
"end_offset": 14,
"label": "dis"
},
{
"id": 2,
"entity": "cystinuria",
"start_offset": 15,
"end_offset": 25,
"label": "dis"
},
{
"id": 3,
"entity": "二碱基氨基酸（精氨酸、赖氨酸、鸟氨酸及胱氨酸）在尿中排出增加",
"start_offset": 30,
"end_offset": 60,
"label": "sym"
}
] |
单氨基酸尿如苯丙酮尿症。 | [
{
"id": 0,
"entity": "单氨基酸尿",
"start_offset": 0,
"end_offset": 5,
"label": "sym"
},
{
"id": 1,
"entity": "苯丙酮尿症",
"start_offset": 6,
"end_offset": 11,
"label": "dis"
}
] |
其他氨基酸尿尚可见继发于药物及重金属中毒、肾病和维生素D缺乏性佝偻病等。 | [
{
"id": 0,
"entity": "氨基酸尿",
"start_offset": 2,
"end_offset": 6,
"label": "sym"
},
{
"id": 1,
"entity": "重金属中毒",
"start_offset": 15,
"end_offset": 20,
"label": "dis"
},
{
"id": 2,
"entity": "肾病",
"start_offset": 21,
"end_offset": 23,
"label": "dis"
},
{
"id": 3,
"entity": "维生素D缺乏性佝偻病",
"start_offset": 24,
"end_offset": 34,
"label": "dis"
}
] |
常用过筛或半定量法测定尿中游离氨基酸，更精确的方法是用氨基酸分析仪测定。 | [
{
"id": 0,
"entity": "过筛或半定量法",
"start_offset": 2,
"end_offset": 9,
"label": "pro"
},
{
"id": 1,
"entity": "氨基酸",
"start_offset": 15,
"end_offset": 18,
"label": "bod"
},
{
"id": 2,
"entity": "氨基酸分析仪测定",
"start_offset": 27,
"end_offset": 35,
"label": "pro"
}
] |
（四）酮体包括丙酮、乙酰乙酸和β-羟丁酸，现通用化学试带法检查，其显色反应的原理是亚硝基铁氰化钠与酮体产生紫红色化合物。 | [
{
"id": 0,
"entity": "酮体",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "丙酮",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "乙酰乙酸",
"start_offset": 10,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "β-羟丁酸",
"start_offset": 15,
"end_offset": 20,
"label": "bod"
},
{
"id": 4,
"entity": "化学试带法检查",
"start_offset": 24,
"end_offset": 31,
"label": "equ"
},
{
"id": 5,
"entity": "酮体",
"start_offset": 49,
"end_offset": 51,
"label": "bod"
}
] |
灵敏度高，缺点是不能检测β-羟丁酸。 | [
{
"id": 0,
"entity": "β-羟丁酸",
"start_offset": 12,
"end_offset": 17,
"label": "bod"
}
] |
正常小儿为阴性，糖尿病酮症酸中毒以及重症感染时可出现阳性。 | [
{
"id": 0,
"entity": "糖尿病酮症酸中毒",
"start_offset": 8,
"end_offset": 16,
"label": "dis"
},
{
"id": 1,
"entity": "重症感染",
"start_offset": 18,
"end_offset": 22,
"label": "dis"
}
] |
（五）电解质电解质测定对了解某些疾病的病情变化有很大意义。 | [
{
"id": 0,
"entity": "电解质",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "电解质测定",
"start_offset": 6,
"end_offset": 11,
"label": "pro"
}
] |
正常人尿钠的排泄通常反映饮食钠摄入情况，因此尿钠浓度波动范围较大。 | [
{
"id": 0,
"entity": "尿钠",
"start_offset": 3,
"end_offset": 5,
"label": "ite"
}
] |
在限制钠摄入情况下，血钠可降低或维持正常，当尿钠＜10mmol/L，常见于严重腹泻脱水、心力衰竭及肾病水肿期。 | [
{
"id": 0,
"entity": "血钠",
"start_offset": 10,
"end_offset": 12,
"label": "ite"
},
{
"id": 1,
"entity": "尿钠",
"start_offset": 22,
"end_offset": 24,
"label": "ite"
},
{
"id": 2,
"entity": "腹泻脱水",
"start_offset": 39,
"end_offset": 43,
"label": "dis"
},
{
"id": 3,
"entity": "心力衰竭",
"start_offset": 44,
"end_offset": 48,
"label": "dis"
},
{
"id": 4,
"entity": "肾病水肿",
"start_offset": 49,
"end_offset": 53,
"label": "dis"
}
] |
如尿钠＞20mmol/L，则可能是抗利尿激素不适当分泌综合征（SIADH）、水中毒、慢性肾炎以及急性肾衰竭等；如尿钠＞40mmol/L，则应考虑有无肾小管坏死。 | [
{
"id": 0,
"entity": "尿钠",
"start_offset": 1,
"end_offset": 3,
"label": "ite"
},
{
"id": 1,
"entity": "抗利尿激素不适当分泌综合征",
"start_offset": 17,
"end_offset": 30,
"label": "dis"
},
{
"id": 2,
"entity": "SIADH",
"start_offset": 31,
"end_offset": 36,
"label": "dis"
},
{
"id": 3,
"entity": "水中毒",
"start_offset": 38,
"end_offset": 41,
"label": "dis"
},
{
"id": 4,
"entity": "慢性肾炎",
"start_offset": 42,
"end_offset": 46,
"label": "dis"
},
{
"id": 5,
"entity": "急性肾衰竭",
"start_offset": 48,
"end_offset": 53,
"label": "dis"
},
{
"id": 6,
"entity": "尿钠",
"start_offset": 56,
"end_offset": 58,
"label": "ite"
},
{
"id": 7,
"entity": "肾小管坏死",
"start_offset": 74,
"end_offset": 79,
"label": "dis"
}
] |
肾脏保钾能力小于保钠能力，即使限制钾的摄入，尿钾仍可＞10mmol/L。 | [
{
"id": 0,
"entity": "肾脏",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "尿钾",
"start_offset": 22,
"end_offset": 24,
"label": "ite"
}
] |
尿钾增高见于应用排钾利尿剂和肾上腺皮质激素等药物，也见于原发性醛固酮增多症、库欣综合征、Batter综合征以及肾小管酸中毒等疾病。 | [
{
"id": 0,
"entity": "尿钾增高",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "排钾利尿剂",
"start_offset": 8,
"end_offset": 13,
"label": "dru"
},
{
"id": 2,
"entity": "肾上腺皮质激素",
"start_offset": 14,
"end_offset": 21,
"label": "dru"
},
{
"id": 3,
"entity": "原发性醛固酮增多症",
"start_offset": 28,
"end_offset": 37,
"label": "dis"
},
{
"id": 4,
"entity": "库欣综合征",
"start_offset": 38,
"end_offset": 43,
"label": "dis"
},
{
"id": 5,
"entity": "Batter综合征",
"start_offset": 44,
"end_offset": 53,
"label": "dis"
},
{
"id": 6,
"entity": "肾小管酸中毒",
"start_offset": 55,
"end_offset": 61,
"label": "dis"
}
] |
在正常饮食下（钙摄入量约500mg/d），尿钙应＜4mg/（kg•d），尿Ca/Cr＜0.21，（一般24小时尿钙＜2mg/kg，随意尿Ca/Cr＜0.12）；尿钙＞4mg/（kg•d），见于特发性高钙尿症和肾小管酸中毒等疾病。 | [
{
"id": 0,
"entity": "尿钙",
"start_offset": 21,
"end_offset": 23,
"label": "ite"
},
{
"id": 1,
"entity": "尿Ca/Cr",
"start_offset": 36,
"end_offset": 42,
"label": "ite"
},
{
"id": 2,
"entity": "尿钙",
"start_offset": 55,
"end_offset": 57,
"label": "ite"
},
{
"id": 3,
"entity": "尿Ca/Cr",
"start_offset": 67,
"end_offset": 73,
"label": "ite"
},
{
"id": 4,
"entity": "尿钙",
"start_offset": 80,
"end_offset": 82,
"label": "ite"
},
{
"id": 5,
"entity": "特发性高钙尿症",
"start_offset": 96,
"end_offset": 103,
"label": "dis"
},
{
"id": 6,
"entity": "肾小管酸中毒",
"start_offset": 104,
"end_offset": 110,
"label": "dis"
}
] |
尿磷的排泄与肾小管功能以及血浆中甲状旁腺激素（PTH）水平密切相关。 | [
{
"id": 0,
"entity": "尿磷",
"start_offset": 0,
"end_offset": 2,
"label": "ite"
},
{
"id": 1,
"entity": "肾小管",
"start_offset": 6,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "血浆",
"start_offset": 13,
"end_offset": 15,
"label": "bod"
},
{
"id": 3,
"entity": "甲状旁腺激素",
"start_offset": 16,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "PTH",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
}
] |
尿磷增多见于Fanconi综合征、原发或者继发性甲状旁腺功能亢进、药物或重金属肾损害、应用大量皮质激素、利尿剂以及痛风、烧伤和各种佝偻病等。 | [
{
"id": 0,
"entity": "尿磷增多",
"start_offset": 0,
"end_offset": 4,
"label": "sym"
},
{
"id": 1,
"entity": "Fanconi综合征",
"start_offset": 6,
"end_offset": 16,
"label": "dis"
},
{
"id": 2,
"entity": "原发或者继发性甲状旁腺功能亢进",
"start_offset": 17,
"end_offset": 32,
"label": "dis"
},
{
"id": 3,
"entity": "药物或重金属肾损害",
"start_offset": 33,
"end_offset": 42,
"label": "dis"
},
{
"id": 4,
"entity": "大量皮质激素",
"start_offset": 45,
"end_offset": 51,
"label": "dru"
},
{
"id": 5,
"entity": "利尿剂",
"start_offset": 52,
"end_offset": 55,
"label": "dru"
},
{
"id": 6,
"entity": "痛风",
"start_offset": 57,
"end_offset": 59,
"label": "dis"
},
{
"id": 7,
"entity": "烧伤",
"start_offset": 60,
"end_offset": 62,
"label": "dis"
},
{
"id": 8,
"entity": "佝偻病",
"start_offset": 65,
"end_offset": 68,
"label": "dis"
}
] |
正常尿磷：婴儿＜6.4mmol/d，儿童＜0.5～0.6mmol/（kg•d）。 | [
{
"id": 0,
"entity": "尿磷",
"start_offset": 2,
"end_offset": 4,
"label": "ite"
}
] |
尿铜增高见于Wilson病。 | [
{
"id": 0,
"entity": "尿铜",
"start_offset": 0,
"end_offset": 2,
"label": "ite"
},
{
"id": 1,
"entity": "Wilson病",
"start_offset": 6,
"end_offset": 13,
"label": "dis"
}
] |
第四节营养性巨幼红细胞性贫血营养性巨幼红细胞性贫血（nutritionalmegaloblasticanemia）又称大细胞性贫血，主要由叶酸或（和）维生素B12</sub>直接或间接缺乏所致，大多因摄入不足而导致直接缺乏引起。 | [
{
"id": 0,
"entity": "营养性巨幼红细胞性贫血",
"start_offset": 3,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "营养性巨幼红细胞性贫血",
"start_offset": 14,
"end_offset": 25,
"label": "dis"
},
{
"id": 2,
"entity": "nutritionalmegaloblasticanemia",
"start_offset": 26,
"end_offset": 56,
"label": "dis"
},
{
"id": 3,
"entity": "大细胞性贫血",
"start_offset": 59,
"end_offset": 65,
"label": "dis"
},
{
"id": 4,
"entity": "叶酸",
"start_offset": 69,
"end_offset": 71,
"label": "dru"
},
{
"id": 5,
"entity": "维生素B12",
"start_offset": 75,
"end_offset": 81,
"label": "dru"
}
] |
其血细胞形态学特点是红细胞体积较大，中性粒细胞核分叶过多，骨髓中巨幼红细胞增生。 | [
{
"id": 0,
"entity": "血细胞",
"start_offset": 1,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "红细胞",
"start_offset": 10,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "中性粒细胞核",
"start_offset": 18,
"end_offset": 24,
"label": "bod"
},
{
"id": 3,
"entity": "骨髓",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
},
{
"id": 4,
"entity": "巨幼红细胞",
"start_offset": 32,
"end_offset": 37,
"label": "bod"
}
] |
【叶酸与维生素B12</sub>的代谢】（一）叶酸的代谢和利用食物中的叶酸（蝶酰谷氨酸）摄入后，与位于小肠黏膜上皮细胞上的叶酸结合蛋白结合而被吸收。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 1,
"end_offset": 3,
"label": "bod"
},
{
"id": 1,
"entity": "维生素B12",
"start_offset": 4,
"end_offset": 10,
"label": "dru"
},
{
"id": 2,
"entity": "叶酸",
"start_offset": 23,
"end_offset": 25,
"label": "dru"
},
{
"id": 3,
"entity": "叶酸",
"start_offset": 35,
"end_offset": 37,
"label": "dru"
},
{
"id": 4,
"entity": "蝶酰谷氨酸",
"start_offset": 38,
"end_offset": 43,
"label": "dru"
},
{
"id": 5,
"entity": "小肠黏膜上皮细胞",
"start_offset": 51,
"end_offset": 59,
"label": "bod"
},
{
"id": 6,
"entity": "叶酸结合蛋白",
"start_offset": 61,
"end_offset": 67,
"label": "bod"
}
] |
蝶酰单谷氨酸较蝶酰多谷氨酸容易吸收。 | [
{
"id": 0,
"entity": "蝶酰单谷氨酸",
"start_offset": 0,
"end_offset": 6,
"label": "dru"
},
{
"id": 1,
"entity": "蝶酰多谷氨酸",
"start_offset": 7,
"end_offset": 13,
"label": "dru"
}
] |
而位于刷状缘的蝶酰谷氨酸羟化酶具有促进蝶酰多谷氨酸向蝶酰单谷氨酸转化，从而有利于叶酸的吸收。 | [
{
"id": 0,
"entity": "刷状缘",
"start_offset": 3,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "蝶酰谷氨酸羟化酶",
"start_offset": 7,
"end_offset": 15,
"label": "bod"
},
{
"id": 2,
"entity": "蝶酰多谷氨酸",
"start_offset": 19,
"end_offset": 25,
"label": "bod"
},
{
"id": 3,
"entity": "蝶酰单谷氨酸",
"start_offset": 26,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "叶酸",
"start_offset": 40,
"end_offset": 42,
"label": "dru"
}
] |
叶酸具有肠肝循环。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 0,
"end_offset": 2,
"label": "dru"
},
{
"id": 1,
"entity": "肠肝",
"start_offset": 4,
"end_offset": 6,
"label": "bod"
}
] |
血浆中大多数叶酸与血清清蛋白结合，叶酸本身并无生物学活性，必须在二氢叶酸还原酶的作用下还原成四氢叶酸，而后被转运入组织细胞内。 | [
{
"id": 0,
"entity": "血浆",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "叶酸",
"start_offset": 6,
"end_offset": 8,
"label": "dru"
},
{
"id": 2,
"entity": "血清清蛋白",
"start_offset": 9,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "叶酸",
"start_offset": 17,
"end_offset": 19,
"label": "dru"
},
{
"id": 4,
"entity": "二氢叶酸还原酶",
"start_offset": 32,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "四氢叶酸",
"start_offset": 46,
"end_offset": 50,
"label": "bod"
},
{
"id": 6,
"entity": "组织细胞",
"start_offset": 57,
"end_offset": 61,
"label": "bod"
}
] |
正常成人的叶酸需要量为每日100μg，怀孕期母亲可增至每日350μg，以千克体重计算，婴幼儿的叶酸需要量比成人为高。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 5,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "叶酸",
"start_offset": 47,
"end_offset": 49,
"label": "dru"
}
] |
（二）维生素B12</sub>的代谢和利用维生素B12</sub>来源于动物性食物中的钴胺素（cobalamin），人类不能合成维生素B12</sub>，但肠道细菌却能合成并能供人体使用。 | [
{
"id": 0,
"entity": "维生素B12",
"start_offset": 3,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "维生素B12",
"start_offset": 21,
"end_offset": 27,
"label": "dru"
},
{
"id": 2,
"entity": "钴胺素",
"start_offset": 43,
"end_offset": 46,
"label": "dru"
},
{
"id": 3,
"entity": "cobalamin",
"start_offset": 47,
"end_offset": 56,
"label": "dru"
},
{
"id": 4,
"entity": "维生素B12",
"start_offset": 64,
"end_offset": 70,
"label": "dru"
},
{
"id": 5,
"entity": "肠道细菌",
"start_offset": 78,
"end_offset": 82,
"label": "mic"
}
] |
食物中的钴胺素在胃酸的作用下释放出来，并立即与R蛋白及内因子结合后通过十二指肠，其中的R蛋白被胰腺蛋白酶水解，残余的维生素B12</sub>内因子复合物在回肠末端借助于一种位于回肠末端黏膜上皮细胞上的钴胺素内因子复合物的特殊受体而吸收。 | [
{
"id": 0,
"entity": "钴胺素",
"start_offset": 4,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "胃酸",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 2,
"entity": "R蛋白",
"start_offset": 23,
"end_offset": 26,
"label": "bod"
},
{
"id": 3,
"entity": "十二指肠",
"start_offset": 35,
"end_offset": 39,
"label": "bod"
},
{
"id": 4,
"entity": "R蛋白",
"start_offset": 43,
"end_offset": 46,
"label": "bod"
},
{
"id": 5,
"entity": "胰腺蛋白酶",
"start_offset": 47,
"end_offset": 52,
"label": "bod"
},
{
"id": 6,
"entity": "维生素B12",
"start_offset": 58,
"end_offset": 64,
"label": "dru"
},
{
"id": 7,
"entity": "回肠末端",
"start_offset": 77,
"end_offset": 81,
"label": "bod"
},
{
"id": 8,
"entity": "回肠末端黏膜上皮细胞",
"start_offset": 88,
"end_offset": 98,
"label": "bod"
},
{
"id": 9,
"entity": "钴胺素",
"start_offset": 100,
"end_offset": 103,
"label": "bod"
},
{
"id": 10,
"entity": "受体",
"start_offset": 112,
"end_offset": 114,
"label": "bod"
}
] |
此外，当给予大剂量维生素B12</sub>时，也可在口腔和小肠黏膜通过梯度弥散机制而吸收。 | [
{
"id": 0,
"entity": "维生素B12",
"start_offset": 9,
"end_offset": 15,
"label": "dru"
},
{
"id": 1,
"entity": "口腔",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "小肠黏膜",
"start_offset": 29,
"end_offset": 33,
"label": "bod"
}
] |
血浆中的维生素B12</sub>与转钴胺素蛋白（transcobalamin，TC）Ⅰ、Ⅱ、Ⅲ结合，其中TCⅡ尤为重要。 | [
{
"id": 0,
"entity": "血浆",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "维生素B12",
"start_offset": 4,
"end_offset": 10,
"label": "dru"
},
{
"id": 2,
"entity": "转钴胺素蛋白（transcobalamin，TC）Ⅰ、Ⅱ、Ⅲ",
"start_offset": 17,
"end_offset": 47,
"label": "bod"
},
{
"id": 3,
"entity": "TCⅡ",
"start_offset": 52,
"end_offset": 55,
"label": "bod"
}
] |
TCⅡ钴胺素通过特殊的受体介导内吞作用进入细胞内，然后钴胺素被转化成甲基钴胺素和腺苷钴胺素，后两者为活性形式，参与转甲基作用和合成DNA。 | [
{
"id": 0,
"entity": "TCⅡ钴胺素",
"start_offset": 0,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "受体",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 2,
"entity": "细胞",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 3,
"entity": "钴胺素",
"start_offset": 27,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "甲基钴胺素",
"start_offset": 34,
"end_offset": 39,
"label": "bod"
},
{
"id": 5,
"entity": "腺苷钴胺素",
"start_offset": 40,
"end_offset": 45,
"label": "bod"
},
{
"id": 6,
"entity": "转甲基",
"start_offset": 57,
"end_offset": 60,
"label": "bod"
},
{
"id": 7,
"entity": "DNA",
"start_offset": 65,
"end_offset": 68,
"label": "bod"
}
] |
【叶酸、维生素B12</sub>缺乏的原因】（一）喂养不当叶酸主要存在于绿叶蔬菜中，其他如酵母、肝、肾等食物中也较多。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 1,
"end_offset": 3,
"label": "dru"
},
{
"id": 1,
"entity": "维生素B12",
"start_offset": 4,
"end_offset": 10,
"label": "dru"
},
{
"id": 2,
"entity": "叶酸",
"start_offset": 29,
"end_offset": 31,
"label": "dru"
},
{
"id": 3,
"entity": "酵母",
"start_offset": 45,
"end_offset": 47,
"label": "mic"
}
] |
而维生素B12</sub>则主要位于动物肝、肌肉和肾中。 | [
{
"id": 0,
"entity": "维生素B12",
"start_offset": 1,
"end_offset": 7,
"label": "dru"
}
] |
当单纯母乳喂养而未及时添加辅食、人工喂养不当及严重偏食的小儿，其饮食中缺乏肉类、动物肝、肾及蔬菜，常常可以引起维生素B12</sub>和叶酸的缺乏。 | [
{
"id": 0,
"entity": "母乳",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "维生素B12",
"start_offset": 55,
"end_offset": 61,
"label": "dru"
},
{
"id": 2,
"entity": "叶酸",
"start_offset": 68,
"end_offset": 70,
"label": "bod"
}
] |
羊奶中所含叶酸甚微，因此，单纯以羊奶喂养者，容易出现叶酸的缺乏。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 5,
"end_offset": 7,
"label": "dru"
},
{
"id": 1,
"entity": "叶酸",
"start_offset": 26,
"end_offset": 28,
"label": "bod"
}
] |
（三）疾病因素叶酸的主要吸收部位是小肠上段，而维生素B12</sub>的主要吸收部位则位于回肠末端。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 7,
"end_offset": 9,
"label": "dru"
},
{
"id": 1,
"entity": "小肠上段",
"start_offset": 17,
"end_offset": 21,
"label": "bod"
},
{
"id": 2,
"entity": "维生素B12",
"start_offset": 23,
"end_offset": 29,
"label": "dru"
},
{
"id": 3,
"entity": "回肠末端",
"start_offset": 45,
"end_offset": 49,
"label": "bod"
}
] |
因此，任何原因导致小肠病变均可使叶酸和维生素B12</sub>的吸收障碍，从而导致两者的缺乏，如慢性腹泻可严重影响叶酸、维生素B12</sub>的吸收。 | [
{
"id": 0,
"entity": "小肠",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 1,
"entity": "叶酸",
"start_offset": 16,
"end_offset": 18,
"label": "dru"
},
{
"id": 2,
"entity": "维生素B12",
"start_offset": 19,
"end_offset": 25,
"label": "dru"
},
{
"id": 3,
"entity": "慢性腹泻",
"start_offset": 48,
"end_offset": 52,
"label": "dis"
},
{
"id": 4,
"entity": "叶酸",
"start_offset": 57,
"end_offset": 59,
"label": "dru"
},
{
"id": 5,
"entity": "维生素B12",
"start_offset": 60,
"end_offset": 66,
"label": "dru"
}
] |
空肠外科切除可引起叶酸缺乏，而回肠切除则可引起维生素B12</sub>的缺乏。 | [
{
"id": 0,
"entity": "空肠",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "外科切除",
"start_offset": 2,
"end_offset": 6,
"label": "pro"
},
{
"id": 2,
"entity": "叶酸",
"start_offset": 9,
"end_offset": 11,
"label": "dru"
},
{
"id": 3,
"entity": "回肠",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 4,
"entity": "切除",
"start_offset": 17,
"end_offset": 19,
"label": "pro"
},
{
"id": 5,
"entity": "维生素B12",
"start_offset": 23,
"end_offset": 29,
"label": "dru"
}
] |
此外，肝脏病变可影响叶酸的正常代谢，使叶酸的生物转化发生障碍而致病。 | [
{
"id": 0,
"entity": "肝脏病变",
"start_offset": 3,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "叶酸",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "叶酸",
"start_offset": 19,
"end_offset": 21,
"label": "bod"
}
] |
（四）先天性缺陷1.小肠先天性叶酸吸收缺陷是一种常染色体隐性遗传性疾病，可导致叶酸的吸收障碍。 | [
{
"id": 0,
"entity": "小肠先天性叶酸吸收缺陷",
"start_offset": 10,
"end_offset": 21,
"label": "dis"
},
{
"id": 1,
"entity": "常染色体隐性遗传性疾病",
"start_offset": 24,
"end_offset": 35,
"label": "dis"
},
{
"id": 2,
"entity": "叶酸",
"start_offset": 39,
"end_offset": 41,
"label": "dru"
}
] |
2.幼年型恶性贫血该病罕见，属于常染色体隐性遗传。 | [
{
"id": 0,
"entity": "幼年型恶性贫血",
"start_offset": 2,
"end_offset": 9,
"label": "dis"
}
] |
病因为胃壁细胞不能分泌内因子（IF）而使维生素B12</sub>吸收障碍所致。 | [
{
"id": 0,
"entity": "胃壁细胞",
"start_offset": 3,
"end_offset": 7,
"label": "bod"
},
{
"id": 1,
"entity": "内因子",
"start_offset": 11,
"end_offset": 14,
"label": "bod"
},
{
"id": 2,
"entity": "IF",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 3,
"entity": "维生素B12",
"start_offset": 20,
"end_offset": 26,
"label": "dru"
}
] |
3.先天性转钴胺蛋白缺陷转钴胺蛋白Ⅱ（TCⅡ）是维生素B12</sub>的主要转运蛋白，先天性转钴胺蛋白缺陷可以导致维生素B12</sub>转运障碍，从而出现维生素B12</sub>的间接缺陷。 | [
{
"id": 0,
"entity": "先天性转钴胺蛋白缺陷",
"start_offset": 2,
"end_offset": 12,
"label": "dis"
},
{
"id": 1,
"entity": "转钴胺蛋白Ⅱ（TCⅡ）",
"start_offset": 12,
"end_offset": 23,
"label": "bod"
},
{
"id": 2,
"entity": "维生素B12",
"start_offset": 24,
"end_offset": 30,
"label": "dru"
},
{
"id": 3,
"entity": "转运蛋白",
"start_offset": 39,
"end_offset": 43,
"label": "bod"
},
{
"id": 4,
"entity": "先天性转钴胺蛋白缺陷",
"start_offset": 44,
"end_offset": 54,
"label": "dis"
},
{
"id": 5,
"entity": "维生素B12",
"start_offset": 58,
"end_offset": 64,
"label": "dru"
},
{
"id": 6,
"entity": "维生素B12",
"start_offset": 79,
"end_offset": 85,
"label": "dru"
}
] |
该病属于常染色体隐性遗传。 | [
{
"id": 0,
"entity": "常染色体",
"start_offset": 4,
"end_offset": 8,
"label": "bod"
}
] |
【发病机制】叶酸和维生素B12</sub>是脱氧核糖核酸（DNA）合成过程中重要的辅酶，主要起转甲基作用。 | [
{
"id": 0,
"entity": "叶酸",
"start_offset": 6,
"end_offset": 8,
"label": "dru"
},
{
"id": 1,
"entity": "维生素B12",
"start_offset": 9,
"end_offset": 15,
"label": "dru"
},
{
"id": 2,
"entity": "脱氧核糖核酸",
"start_offset": 22,
"end_offset": 28,
"label": "bod"
},
{
"id": 3,
"entity": "DNA",
"start_offset": 29,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "辅酶",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
}
] |
缺乏时，尿嘧啶脱氧核苷酸不能甲基化，从而阻碍了合成DNA的重要原料胸腺嘧啶脱氧核苷酸的合成，进而影响DNA的合成。 | [
{
"id": 0,
"entity": "尿嘧啶脱氧核苷酸",
"start_offset": 4,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "DNA",
"start_offset": 25,
"end_offset": 28,
"label": "bod"
},
{
"id": 2,
"entity": "胸腺嘧啶脱氧核苷酸",
"start_offset": 33,
"end_offset": 42,
"label": "bod"
},
{
"id": 3,
"entity": "DNA",
"start_offset": 50,
"end_offset": 53,
"label": "bod"
}
] |
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