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参考文献1.AllahabadiaA，DaykinJ，SheppardMC，etal.Radioiodinetreatmentofhyperthyroidism-prognosticfactorsforoutcome.JClinEndocrinolMetab.2001，86：3611-36112.ArslanogluI，KutluH，IsguvenP，etal.DiagnosticvalueofpituitaryMRIindifferentiationofchildrenwithnormalgrowthhormonesecretion，isolatedgrowthhormonedeficiencyandmultiplepituitaryhormonedeficiency.JPediatrEndocrinolMetab.2001，14：517-5173.CarelJC，EugsterEA，RogolA，etal.ConsensusStatementontheuseofgonadotropin-releasinghormoneanalogsinchildren.Pediatrics，2009，123（4）：e752-7524.GillamMP，KoppP.Geneticregulationofthyroiddevelopment.CurrOpinPediatr.2001，13：358-3585.GlaserNS，StyneDM，OrganizationofPediatricEndocrinologistsofNorthernCaliforniaCollaborativeGraves’DiseaseStudyGroup.PredictingthelikelihoodofremissioninchildrenwithGraves’disease：aprospective，multicenterstudy.Pediatrics.2008，121：e481-4886.LazarL，PadoaA，PhillipM.GrowthPatternandFinalHeightafterCessationofGonadotropin-SuppressiveTherapyinGirlswithCentralsexualprecocity.JClinEndocrinolMetab，2007，92：3483-34837.Behrman，kliegman，Jenson.NelsonTextbookofPediatric.17thedition，20048.KyriakieSarafoglou.PediatricEndocrinologyandInbornErrorsofMetabolism.McGrawHillMedical，20099.SpeiserPW，AzzizR，BaskinLS，etal.Congenitaladrenalhyperplasiaduetosteroid21-hydroxylasedeficiency：anEndocrineSocietyclinicalpracticeguideline.JClinEndocrinolMetab，2010，95：4133-416010.SexualPrecocity.JClinEndocrinolMetab，92：3483-348311.SpeiserPW，AzzizR，BaskinLS，etal.Congenitaladrenalhyperplasiaduetosteroid21-hydroxylasedeficiency：anEndocrineSocietyclinicalpracticeguideline.JClinEndocrinolMetab.2010，95：4133-416012.沈水仙，付华，陈兆文，等.上海市儿童1型糖尿病发病率调查（1980—1991）.中华内分泌代谢杂志，1994（10）：20213.王伟，江静，孙文鑫，等.国产重组人生长激素治疗55例儿童生长激素缺乏症临床综合分析.中华儿科杂志，1999，37：206-20614.曾畿生，王德芬.现代儿科内分泌学基础与临床.上海：上海科学技术文献出版社，2001：355-35515.中华医学会儿科学分会内分泌遗传代谢学组.矮身材儿童诊治指南.中华儿科杂志，2008，46：428-43016.中华医学会儿科学分会内分泌遗传代谢学组.儿童糖尿病酮症酸中毒诊疗指南.中华儿科杂志，2009，47：421-42517.中华医学会儿科学分会内分泌遗传代谢学组.中枢性（真性）性早熟诊治指南.中华儿科杂志，2007，45：426-42718.胡亚美.诸福堂实用儿科学.第7版.北京：人民卫生出版社，2002 | [
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第四节血吸虫病血吸虫病（schistosomiasis）是血吸虫寄生人体所致的疾病。 | [
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在人体寄生的血吸虫主要有三种：即日本血吸虫（Schis-tosomajaponicum）、曼氏血吸虫（Schistosomamansoni）和埃及血吸虫（Schistosomahaematobium）。 | [
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日本血吸虫流行于日本、中国、菲律宾、印度尼西亚等国家。 | [
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在此仅叙述在我国流行的日本血吸虫病。 | [
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【病因学】日本血吸虫成虫雌雄异体。 | [
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尾蚴体壁侵入终宿主皮肤后，脱去尾部并迅速改变体壁一个单位膜（3层）为两个单位膜（7层）的构造，以适应宿主体内血清-盐水环境，以后至发育为成虫阶段均称童虫。 | [
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然后经淋巴管或小静脉进入血液循环。 | [
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约在感染后3～5天到达肝内门静脉分支，发育至性成熟期，约在感染后第25天雌虫开始产卵，感染后35天左右粪便中可发现虫卵。 | [
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【流行病学】（一）传染源患者为主要传染源，牛、羊、猪、马、猫、鼠、兔等30多种动物均可感染本病，因此血吸虫病是人畜共患的疾病。 | [
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（二）传染途径1.粪便入水方式很多，如河边涮洗马桶，河边粪坑外溢，随地大便，渔民、船民的粪便入河，粪船外溢，以及各种动物、尤以耕牛随处大便均可污染水源。 | [
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2.钉螺的存在有钉螺的地区才有血吸虫病流行，因此血吸虫病的分布基本与钉螺的分布一致，具有地方性。 | [
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3.接触疫水人体感染本病主要系因在生产或生活活动中接触疫水，5岁以上小儿多于生活中接触疫水，渔民小儿自幼即在疫水中洗涤臀部、洗手、洗脚、洗澡而感染，此种情况随着渔民陆居而减少。 | [
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（三）人群的易感性一般来说，人群对血吸虫普遍易感，通常5岁以下儿童感染率低，10岁以后感染率上升，15～30岁最高，然后逐渐下降；但这一流行的年龄曲线在重流行区并不明显。 | [
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此外流行区居民多重复感染，提示感染血吸虫后宿主虽能产生免疫，并不能完全防御再感染。 | [
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【发病机制及病理变化】自尾蚴进入人体后，血吸虫在人体的各个发育阶段，如童虫、成虫及虫卵均对人体有不同程度的致病作用，但其中以虫卵最为重要。 | [
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虫卵的致病作用是临床血吸虫病的主要病理基础。 | [
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尾蚴侵入皮肤后转变为童虫，在局部皮肤引起以瘙痒和小丘疹为特点的尾蚴性皮炎。 | [
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童虫移行经过肺脏时，可引起肺脏点状出血和血管周围嗜酸性粒细胞和巨噬细胞浸润。 | [
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病理变化主要是虫卵沉积在肝、结肠等脏器内所致的组织损伤，即虫卵肉芽肿的形成。 | [
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这种病变主要发生在成熟虫卵沉着的小血管内。 | [
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此种组织学病理变化与单个结核结节极相似，故又称为假结核结节。 | [
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日本血吸虫的寄生部位及其虫卵沉着的部位通常在门静脉系统的分支中，所以主要的器官病理变化也在与这系统相连的脏器内，尤以结肠和肝脏为最多、最严重。 | [
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肝脏病变可分早、晚两期。 | [
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早期主要由虫卵在门静脉细支内形成嗜酸性脓肿，发生坏死性血管炎，形成血栓；病变表面尚光滑，唯可见粟粒状黄色颗粒。 | [
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晚期见汇管区较大门静脉分支管腔阻塞及周围渐显结缔组织增生，增生显著者可致肝脏发生纤维性变血吸虫病肝硬化。 | [
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【临床表现】按病程发展及主要临床表现，可分为急性、慢性及晚期血吸虫病。 | [
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（一）急性血吸虫病多见于夏秋季，以小儿及青壮年为多。 | [
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主要症状如下：1.发热急性感染者均有发热，热型不一，常为弛张热、间歇热或不规则热；体温多达39℃以上，早晨低，晚间高，开始有寒冷感。 | [
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2.消化系统症状要表现为结肠炎症状，腹泻最多见；重症或重复感染患者常排黏血便，且有腹痛、腹胀，偶有便秘。 | [
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此外有食欲缺乏、恶心等。 | [
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肝脏中等度肿大压痛，脾脏轻度肿大。 | [
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"id": 2,
"entity": "压痛",
"start_offset": 7,
"end_offset": 9,
"label": "sym"
},
{
"id": 3,
"entity": "脾脏轻度肿大",
"start_offset": 10,
"end_offset": 16,
"label": "sym"
}
] |
3.呼吸系统症状约半数以上病例可出现咳嗽、胸痛、血痰等症状，系虫卵沉积肺部引起的组织反应，体征不明显。 | [
{
"id": 0,
"entity": "呼吸系统",
"start_offset": 2,
"end_offset": 6,
"label": "bod"
},
{
"id": 1,
"entity": "咳嗽",
"start_offset": 18,
"end_offset": 20,
"label": "sym"
},
{
"id": 2,
"entity": "胸痛",
"start_offset": 21,
"end_offset": 23,
"label": "sym"
},
{
"id": 3,
"entity": "血痰",
"start_offset": 24,
"end_offset": 26,
"label": "sym"
},
{
"id": 4,
"entity": "虫卵",
"start_offset": 31,
"end_offset": 33,
"label": "mic"
},
{
"id": 5,
"entity": "肺部",
"start_offset": 35,
"end_offset": 37,
"label": "bod"
}
] |
（二）慢性血吸虫病流行区所见的患者大多为慢性早期血吸虫病，分无症状型及有症状型两种。 | [
{
"id": 0,
"entity": "慢性血吸虫病",
"start_offset": 3,
"end_offset": 9,
"label": "dis"
},
{
"id": 1,
"entity": "血吸虫病",
"start_offset": 24,
"end_offset": 28,
"label": "dis"
}
] |
早期肝脏肿大，质地可稍硬，肝功能可正常或轻度损害，脾脏亦可轻度肿大血吸虫病系指慢性期病情较严重的情况。 | [
{
"id": 0,
"entity": "肝功能可正常或轻度损害",
"start_offset": 13,
"end_offset": 24,
"label": "sym"
},
{
"id": 1,
"entity": "脾脏",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
},
{
"id": 2,
"entity": "脾脏亦可轻度肿大",
"start_offset": 25,
"end_offset": 33,
"label": "sym"
},
{
"id": 3,
"entity": "血吸虫病",
"start_offset": 33,
"end_offset": 37,
"label": "dis"
}
] |
病理上呈典型的干线型肝纤维化改变。 | [
{
"id": 0,
"entity": "干线型肝纤维化改变",
"start_offset": 7,
"end_offset": 16,
"label": "sym"
}
] |
临床上主要表现为门脉高压全身代谢紊乱，甚至肝功能减退等症状和体征。 | [
{
"id": 0,
"entity": "门脉",
"start_offset": 8,
"end_offset": 10,
"label": "bod"
},
{
"id": 1,
"entity": "门脉高压",
"start_offset": 8,
"end_offset": 12,
"label": "sym"
},
{
"id": 2,
"entity": "全身代谢紊乱",
"start_offset": 12,
"end_offset": 18,
"label": "sym"
},
{
"id": 3,
"entity": "肝",
"start_offset": 21,
"end_offset": 22,
"label": "bod"
},
{
"id": 4,
"entity": "肝功能减退",
"start_offset": 21,
"end_offset": 26,
"label": "sym"
}
] |
根据突出的临床表现，一般分为巨脾、腹水及侏儒三型。 | [
{
"id": 0,
"entity": "巨脾",
"start_offset": 14,
"end_offset": 16,
"label": "sym"
},
{
"id": 1,
"entity": "腹水",
"start_offset": 17,
"end_offset": 19,
"label": "sym"
},
{
"id": 2,
"entity": "侏儒",
"start_offset": 20,
"end_offset": 22,
"label": "sym"
}
] |
巨脾型最为多见，脾肿大往往达脐部或脐下，超过中线；或脾肿大虽未达脐或超过中线，但已伴白细胞及血小板减少、贫血等脾功能亢进现象。 | [
{
"id": 0,
"entity": "巨脾",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "脾",
"start_offset": 8,
"end_offset": 9,
"label": "bod"
},
{
"id": 2,
"entity": "脐部",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "脐下",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 4,
"entity": "脾",
"start_offset": 26,
"end_offset": 27,
"label": "bod"
},
{
"id": 5,
"entity": "脐",
"start_offset": 32,
"end_offset": 33,
"label": "bod"
},
{
"id": 6,
"entity": "白细胞及血小板减少",
"start_offset": 42,
"end_offset": 51,
"label": "sym"
},
{
"id": 7,
"entity": "贫血",
"start_offset": 52,
"end_offset": 54,
"label": "sym"
},
{
"id": 8,
"entity": "脾功能亢进",
"start_offset": 55,
"end_offset": 60,
"label": "sym"
}
] |
腹水型是晚期血吸虫病的严重症状，由门脉阻塞、营养不良、低蛋白血症、淋巴循环障碍等原因引起。 | [
{
"id": 0,
"entity": "腹水",
"start_offset": 0,
"end_offset": 2,
"label": "sym"
},
{
"id": 1,
"entity": "血吸虫病",
"start_offset": 6,
"end_offset": 10,
"label": "dis"
},
{
"id": 2,
"entity": "门脉阻塞",
"start_offset": 17,
"end_offset": 21,
"label": "sym"
},
{
"id": 3,
"entity": "营养不良",
"start_offset": 22,
"end_offset": 26,
"label": "sym"
},
{
"id": 4,
"entity": "低蛋白血症",
"start_offset": 27,
"end_offset": 32,
"label": "sym"
},
{
"id": 5,
"entity": "淋巴循环障碍",
"start_offset": 33,
"end_offset": 39,
"label": "sym"
}
] |
异位损害及并发症系指成虫或虫卵寄生及迷走在门静脉系统之外的器官所致的病变。 | [
{
"id": 0,
"entity": "成虫",
"start_offset": 10,
"end_offset": 12,
"label": "mic"
},
{
"id": 1,
"entity": "虫卵",
"start_offset": 13,
"end_offset": 15,
"label": "mic"
},
{
"id": 2,
"entity": "门静脉系统",
"start_offset": 21,
"end_offset": 26,
"label": "bod"
}
] |
异位寄生主要见于大量尾蚴感染时，因侵入人体的童虫过多引起满溢现象，或离开了移行常轨而被阻留于异常部位所致，或正常寄生部位成虫排卵随血管交通支沉着于门脉系统以外的脏器。 | [
{
"id": 0,
"entity": "童虫",
"start_offset": 22,
"end_offset": 24,
"label": "mic"
},
{
"id": 1,
"entity": "门脉系统",
"start_offset": 73,
"end_offset": 77,
"label": "bod"
}
] |
肺、脑异位损害最为常见，肺脏的异位损害多为虫卵经过肝窦或侧支循环到达肺脏，偶亦见于成虫寄生于肺小血管产卵引起，可有咳嗽、咳白色痰等症状。 | [
{
"id": 0,
"entity": "肺脏的异位损害",
"start_offset": 12,
"end_offset": 19,
"label": "dis"
},
{
"id": 1,
"entity": "虫卵",
"start_offset": 21,
"end_offset": 23,
"label": "mic"
},
{
"id": 2,
"entity": "肝窦",
"start_offset": 25,
"end_offset": 27,
"label": "bod"
},
{
"id": 3,
"entity": "侧支循环",
"start_offset": 28,
"end_offset": 32,
"label": "bod"
},
{
"id": 4,
"entity": "肺脏",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
},
{
"id": 5,
"entity": "成虫",
"start_offset": 41,
"end_offset": 43,
"label": "mic"
},
{
"id": 6,
"entity": "肺小血管",
"start_offset": 46,
"end_offset": 50,
"label": "bod"
},
{
"id": 7,
"entity": "咳嗽",
"start_offset": 57,
"end_offset": 59,
"label": "sym"
},
{
"id": 8,
"entity": "咳白色痰",
"start_offset": 60,
"end_offset": 64,
"label": "sym"
}
] |
脑部造成的异位损害，常见者主要为急性感染时童虫移行至脑血管中，致使成虫产卵沉积在脑部，急性期可发生类似脑炎、脑膜炎的症状，经病原学治疗症状很快消失。 | [
{
"id": 0,
"entity": "脑部",
"start_offset": 0,
"end_offset": 2,
"label": "bod"
},
{
"id": 1,
"entity": "异位损害",
"start_offset": 5,
"end_offset": 9,
"label": "dis"
},
{
"id": 2,
"entity": "急性感染",
"start_offset": 16,
"end_offset": 20,
"label": "dis"
},
{
"id": 3,
"entity": "童虫",
"start_offset": 21,
"end_offset": 23,
"label": "mic"
},
{
"id": 4,
"entity": "脑血管",
"start_offset": 26,
"end_offset": 29,
"label": "bod"
},
{
"id": 5,
"entity": "脑部",
"start_offset": 40,
"end_offset": 42,
"label": "bod"
},
{
"id": 6,
"entity": "脑炎",
"start_offset": 51,
"end_offset": 53,
"label": "dis"
},
{
"id": 7,
"entity": "脑膜炎",
"start_offset": 54,
"end_offset": 57,
"label": "dis"
}
] |
【实验室诊断】（一）粪便查虫卵直接涂片找虫卵，或经沉淀后涂片找虫卵。 | [
{
"id": 0,
"entity": "粪便",
"start_offset": 10,
"end_offset": 12,
"label": "bod"
},
{
"id": 1,
"entity": "虫卵",
"start_offset": 13,
"end_offset": 15,
"label": "mic"
},
{
"id": 2,
"entity": "虫卵",
"start_offset": 20,
"end_offset": 22,
"label": "mic"
},
{
"id": 3,
"entity": "虫卵",
"start_offset": 31,
"end_offset": 33,
"label": "mic"
}
] |
大面积普查均用粪便沉淀孵化法。 | [
{
"id": 0,
"entity": "粪便",
"start_offset": 7,
"end_offset": 9,
"label": "bod"
}
] |
另外，改良加藤厚涂片法，为定量检查粪便中虫卵的常用方法。 | [
{
"id": 0,
"entity": "改良加藤厚涂片",
"start_offset": 3,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "粪便",
"start_offset": 17,
"end_offset": 19,
"label": "bod"
},
{
"id": 2,
"entity": "虫卵",
"start_offset": 20,
"end_offset": 22,
"label": "mic"
}
] |
（二）直肠黏膜活组织压片检查一般用直肠镜，于距肛门10～12cm处夹取三小块组织活检，可查见活卵、变性卵及死卵。 | [
{
"id": 0,
"entity": "直肠黏膜活组织压片检查",
"start_offset": 3,
"end_offset": 14,
"label": "pro"
},
{
"id": 1,
"entity": "直肠镜",
"start_offset": 17,
"end_offset": 20,
"label": "equ"
},
{
"id": 2,
"entity": "活卵",
"start_offset": 46,
"end_offset": 48,
"label": "mic"
},
{
"id": 3,
"entity": "变性卵",
"start_offset": 49,
"end_offset": 52,
"label": "mic"
},
{
"id": 4,
"entity": "死卵",
"start_offset": 53,
"end_offset": 55,
"label": "mic"
}
] |
（三）免疫学检查1.成虫抗原皮内试验现用成虫干粉抗原，可作为初筛方法。 | [
{
"id": 0,
"entity": "成虫抗原皮内试验",
"start_offset": 10,
"end_offset": 18,
"label": "pro"
},
{
"id": 1,
"entity": "成虫",
"start_offset": 20,
"end_offset": 22,
"label": "mic"
}
] |
2.环卵沉淀试验（COPT）阳性率平均为97.3%，假阳性率3.1%，对肺吸虫及丝虫病交叉反应，3～4年阴转率为82.5%，可作为考核疗效的参考。 | [
{
"id": 0,
"entity": "环卵沉淀试验",
"start_offset": 2,
"end_offset": 8,
"label": "pro"
},
{
"id": 1,
"entity": "COPT",
"start_offset": 9,
"end_offset": 13,
"label": "pro"
}
] |
3.间接血细胞凝集试验（IHA）具有高度敏感性及一定的特异性。 | [
{
"id": 0,
"entity": "间接血细胞凝集试验",
"start_offset": 2,
"end_offset": 11,
"label": "pro"
},
{
"id": 1,
"entity": "IHA",
"start_offset": 12,
"end_offset": 15,
"label": "pro"
}
] |
4.酶联免疫吸附试验（enzymelinkedimmunsorbentassay，ELISA）阳性率达97.6%～100%，假阳性仅0%～2.4%，但晚期血吸虫患者血中特异性IgE抗体的阳性率仅27.5%，远比IgG抗体阳性率低，治疗后6～8个月各种抗体的阴转率不同。 | [
{
"id": 0,
"entity": "酶联免疫吸附试验",
"start_offset": 2,
"end_offset": 10,
"label": "pro"
},
{
"id": 1,
"entity": "enzymelinkedimmunsorbentassay",
"start_offset": 11,
"end_offset": 40,
"label": "pro"
},
{
"id": 2,
"entity": "ELISA",
"start_offset": 41,
"end_offset": 46,
"label": "pro"
},
{
"id": 3,
"entity": "阳性率达97.6%～100%",
"start_offset": 47,
"end_offset": 61,
"label": "sym"
},
{
"id": 4,
"entity": "假阳性仅0%～2.4%",
"start_offset": 62,
"end_offset": 73,
"label": "sym"
},
{
"id": 5,
"entity": "血吸虫",
"start_offset": 77,
"end_offset": 80,
"label": "mic"
},
{
"id": 6,
"entity": "血",
"start_offset": 82,
"end_offset": 83,
"label": "bod"
},
{
"id": 7,
"entity": "特异性IgE抗体",
"start_offset": 84,
"end_offset": 92,
"label": "ite"
}
] |
可有助于鉴别急性和慢性血吸虫病和疗效考核。 | [
{
"id": 0,
"entity": "急性和慢性血吸虫病",
"start_offset": 6,
"end_offset": 15,
"label": "dis"
}
] |
5.血清中循环抗原的检测在感染血吸虫的宿主体液内可检出3种游离的血吸虫循环抗原，即肠相关抗原（gutassociatedantigens，GAA）、膜相关抗原（membraneassociatedantigens，MAA）、可溶性虫卵抗原（SEA），通常在感染后1～4周出现，GAA出现最早。 | [
{
"id": 0,
"entity": "血吸虫",
"start_offset": 15,
"end_offset": 18,
"label": "mic"
},
{
"id": 1,
"entity": "血吸虫",
"start_offset": 32,
"end_offset": 35,
"label": "mic"
}
] |
【鉴别诊断】1.急性期需与上呼吸道感染、急性胃肠炎、肠炎、痢疾、伤寒和急性粟粒结核、败血症等鉴别。 | [
{
"id": 0,
"entity": "上呼吸道感染",
"start_offset": 13,
"end_offset": 19,
"label": "dis"
},
{
"id": 1,
"entity": "急性胃肠炎",
"start_offset": 20,
"end_offset": 25,
"label": "dis"
},
{
"id": 2,
"entity": "肠炎",
"start_offset": 26,
"end_offset": 28,
"label": "dis"
},
{
"id": 3,
"entity": "痢疾",
"start_offset": 29,
"end_offset": 31,
"label": "dis"
},
{
"id": 4,
"entity": "伤寒",
"start_offset": 32,
"end_offset": 34,
"label": "dis"
},
{
"id": 5,
"entity": "急性粟粒结核",
"start_offset": 35,
"end_offset": 41,
"label": "dis"
},
{
"id": 6,
"entity": "败血症",
"start_offset": 42,
"end_offset": 45,
"label": "dis"
}
] |
2.慢性期应与无黄疸性肝炎鉴别，后者肝功能损害较明显，嗜酸性粒细胞增多，粪便孵化始终阴性。 | [
{
"id": 0,
"entity": "黄疸性肝炎",
"start_offset": 8,
"end_offset": 13,
"label": "dis"
},
{
"id": 1,
"entity": "肝功能损害",
"start_offset": 18,
"end_offset": 23,
"label": "dis"
},
{
"id": 2,
"entity": "嗜酸性粒细胞",
"start_offset": 27,
"end_offset": 33,
"label": "ite"
},
{
"id": 3,
"entity": "嗜酸性粒细胞增多",
"start_offset": 27,
"end_offset": 35,
"label": "sym"
},
{
"id": 4,
"entity": "粪便",
"start_offset": 36,
"end_offset": 38,
"label": "bod"
},
{
"id": 5,
"entity": "粪便孵化始终阴性",
"start_offset": 36,
"end_offset": 44,
"label": "sym"
}
] |
血吸虫肝纤维化慢性腹泻，少见黄疸、蜘蛛痣及肝掌等，而巨脾与食管下端静脉曲张消灭传染源在流行区每年进行普查、普治。 | [
{
"id": 0,
"entity": "血吸虫",
"start_offset": 0,
"end_offset": 3,
"label": "mic"
},
{
"id": 1,
"entity": "肝",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 2,
"entity": "血吸虫肝纤维化",
"start_offset": 0,
"end_offset": 7,
"label": "sym"
},
{
"id": 3,
"entity": "慢性腹泻",
"start_offset": 7,
"end_offset": 11,
"label": "dis"
},
{
"id": 4,
"entity": "黄疸",
"start_offset": 14,
"end_offset": 16,
"label": "dis"
},
{
"id": 5,
"entity": "蜘蛛痣",
"start_offset": 17,
"end_offset": 20,
"label": "dis"
},
{
"id": 6,
"entity": "肝掌",
"start_offset": 21,
"end_offset": 23,
"label": "dis"
},
{
"id": 7,
"entity": "巨脾",
"start_offset": 26,
"end_offset": 28,
"label": "sym"
},
{
"id": 8,
"entity": "食管下端静脉",
"start_offset": 29,
"end_offset": 35,
"label": "bod"
},
{
"id": 9,
"entity": "食管下端静脉曲张",
"start_offset": 29,
"end_offset": 37,
"label": "sym"
},
{
"id": 10,
"entity": "消灭传染源",
"start_offset": 37,
"end_offset": 42,
"label": "pro"
}
] |
目前人畜同步化疗已列为消灭传染源的措施。 | [
{
"id": 0,
"entity": "消灭传染源",
"start_offset": 11,
"end_offset": 16,
"label": "pro"
}
] |
2.切断传染环节粪便管理和消灭钉螺。 | [
{
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{
"id": 2,
"entity": "消灭钉螺",
"start_offset": 13,
"end_offset": 17,
"label": "pro"
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] |
3.保护易感人群尽量避免接触疫水。 | [
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"entity": "保护易感人群",
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{
"id": 1,
"entity": "尽量避免接触疫水",
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"label": "pro"
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] |
免疫预防，血吸虫疫苗仍在试验阶段。 | [
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"id": 0,
"entity": "血吸虫疫苗",
"start_offset": 5,
"end_offset": 10,
"label": "dru"
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] |
4.药物预防包括吡喹酮、蒿甲醚和青蒿琥酯。 | [
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"entity": "吡喹酮",
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{
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【治疗】（一）一般疗法除特异性疗法以外应注意一般疗法，如增进营养、补充蛋白质与维生素等，特别是晚期营养不良、贫血、肝功能不佳者更应注意支持疗法。 | [
{
"id": 0,
"entity": "增进营养",
"start_offset": 28,
"end_offset": 32,
"label": "pro"
},
{
"id": 1,
"entity": "补充蛋白质",
"start_offset": 33,
"end_offset": 38,
"label": "pro"
},
{
"id": 2,
"entity": "维生素",
"start_offset": 39,
"end_offset": 42,
"label": "pro"
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{
"id": 3,
"entity": "营养不良",
"start_offset": 49,
"end_offset": 53,
"label": "dis"
},
{
"id": 4,
"entity": "贫血",
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"end_offset": 56,
"label": "dis"
},
{
"id": 5,
"entity": "肝功能不佳",
"start_offset": 57,
"end_offset": 62,
"label": "dis"
}
] |
（二）驱虫疗法吡喹酮具有高效、低毒、口服简便、疗程短等特点，便于推广，可用于急、慢性各期以及伴有并发症的血吸虫病的治疗。 | [
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"id": 0,
"entity": "吡喹酮",
"start_offset": 7,
"end_offset": 10,
"label": "dru"
},
{
"id": 1,
"entity": "口服",
"start_offset": 18,
"end_offset": 20,
"label": "pro"
},
{
"id": 2,
"entity": "血吸虫病",
"start_offset": 52,
"end_offset": 56,
"label": "dis"
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] |
有建议用120mg/kg，儿童140mg/kg的六日疗法治疗急性血吸虫病，其中1/2量在第1、2天内服用，余下的1/2量分4天内服完。 | [
{
"id": 0,
"entity": "急性血吸虫病",
"start_offset": 30,
"end_offset": 36,
"label": "dis"
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] |
2.不良反应少而轻，且多为一过性，可有神经肌肉系统症状，如头昏、头痛、乏力、四肢酸痛、眩晕等较为多见，其次为晕厥、肌颤动、视力模糊、失眠、嗜睡、多汗、肢端麻木、耳鸣、步态不稳等。 | [
{
"id": 0,
"entity": "神经肌肉系统",
"start_offset": 19,
"end_offset": 25,
"label": "bod"
},
{
"id": 1,
"entity": "头昏",
"start_offset": 29,
"end_offset": 31,
"label": "sym"
},
{
"id": 2,
"entity": "头痛",
"start_offset": 32,
"end_offset": 34,
"label": "sym"
},
{
"id": 3,
"entity": "乏力",
"start_offset": 35,
"end_offset": 37,
"label": "sym"
},
{
"id": 4,
"entity": "四肢酸痛",
"start_offset": 38,
"end_offset": 42,
"label": "sym"
},
{
"id": 5,
"entity": "眩晕",
"start_offset": 43,
"end_offset": 45,
"label": "sym"
},
{
"id": 6,
"entity": "晕厥",
"start_offset": 54,
"end_offset": 56,
"label": "sym"
},
{
"id": 7,
"entity": "肌颤动",
"start_offset": 57,
"end_offset": 60,
"label": "sym"
},
{
"id": 8,
"entity": "视力模糊",
"start_offset": 61,
"end_offset": 65,
"label": "sym"
},
{
"id": 9,
"entity": "失眠",
"start_offset": 66,
"end_offset": 68,
"label": "sym"
},
{
"id": 10,
"entity": "嗜睡",
"start_offset": 69,
"end_offset": 71,
"label": "sym"
},
{
"id": 11,
"entity": "多汗",
"start_offset": 72,
"end_offset": 74,
"label": "sym"
},
{
"id": 12,
"entity": "肢端麻木",
"start_offset": 75,
"end_offset": 79,
"label": "sym"
},
{
"id": 13,
"entity": "耳鸣",
"start_offset": 80,
"end_offset": 82,
"label": "sym"
},
{
"id": 14,
"entity": "步态不稳",
"start_offset": 83,
"end_offset": 87,
"label": "sym"
}
] |
心血管系统症状为胸闷、心悸、期前收缩等较为多见，偶见室上性心动过速。 | [
{
"id": 0,
"entity": "心血管系统",
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"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "胸闷",
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"label": "sym"
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{
"id": 2,
"entity": "心悸",
"start_offset": 11,
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"label": "sym"
},
{
"id": 3,
"entity": "期前收缩",
"start_offset": 14,
"end_offset": 18,
"label": "sym"
},
{
"id": 4,
"entity": "室上性心动过速",
"start_offset": 26,
"end_offset": 33,
"label": "sym"
}
] |
3.疗效多数患者于治疗半个月后粪便检查转阴。 | [
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"entity": "粪便检查",
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"end_offset": 19,
"label": "pro"
},
{
"id": 1,
"entity": "粪便检查转阴",
"start_offset": 15,
"end_offset": 21,
"label": "sym"
}
] |
（三）外科治疗门脉高压引起食管静脉曲张者，或巨脾Ⅲ级及Ⅱ级并发脾功能亢进者，为脾切除和分流手术的指征。 | [
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"entity": "门脉高压",
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"end_offset": 11,
"label": "dis"
},
{
"id": 1,
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"end_offset": 19,
"label": "dis"
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{
"id": 2,
"entity": "巨脾Ⅲ级及Ⅱ级",
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"end_offset": 29,
"label": "dis"
},
{
"id": 3,
"entity": "脾功能亢进",
"start_offset": 31,
"end_offset": 36,
"label": "dis"
},
{
"id": 4,
"entity": "脾切除",
"start_offset": 39,
"end_offset": 42,
"label": "pro"
},
{
"id": 5,
"entity": "分流手术",
"start_offset": 43,
"end_offset": 47,
"label": "pro"
}
] |
二、正常新生儿的外观特点（一）整体外观新生儿头大、躯干长四肢短头部和全身的比例为1∶4。 | [
{
"id": 0,
"entity": "头大",
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"end_offset": 24,
"label": "sym"
},
{
"id": 1,
"entity": "躯干",
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},
{
"id": 2,
"entity": "躯干长",
"start_offset": 25,
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"label": "sym"
},
{
"id": 3,
"entity": "四肢",
"start_offset": 28,
"end_offset": 30,
"label": "bod"
},
{
"id": 4,
"entity": "四肢短",
"start_offset": 28,
"end_offset": 31,
"label": "sym"
},
{
"id": 5,
"entity": "头部",
"start_offset": 31,
"end_offset": 33,
"label": "bod"
},
{
"id": 6,
"entity": "全身",
"start_offset": 34,
"end_offset": 36,
"label": "bod"
}
] |
初生新生儿往往呈屈曲状，这与胎儿在母亲宫内呈屈曲状姿势有关。 | [
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"id": 0,
"entity": "初生新生儿往往呈屈曲状",
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},
{
"id": 1,
"entity": "宫",
"start_offset": 19,
"end_offset": 20,
"label": "bod"
}
] |
（二）皮肤外观1.胎脂出生后皮肤覆盖一层白色脂质物，有保护皮肤的作用；若呈黄色，提示有黄疸、窒息或过期产存在；若呈黄绿色，提示有胎粪污染羊水黄疸生理性黄疸多在生后2～3天内出现，5～6天左右为高峰，1周后消失。 | [
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"id": 0,
"entity": "皮肤",
"start_offset": 3,
"end_offset": 5,
"label": "bod"
},
{
"id": 1,
"entity": "胎脂",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 2,
"entity": "皮肤",
"start_offset": 14,
"end_offset": 16,
"label": "bod"
},
{
"id": 3,
"entity": "白色脂质物",
"start_offset": 20,
"end_offset": 25,
"label": "bod"
},
{
"id": 4,
"entity": "皮肤",
"start_offset": 29,
"end_offset": 31,
"label": "bod"
},
{
"id": 5,
"entity": "黄疸",
"start_offset": 43,
"end_offset": 45,
"label": "dis"
},
{
"id": 6,
"entity": "窒息",
"start_offset": 46,
"end_offset": 48,
"label": "dis"
},
{
"id": 7,
"entity": "过期产",
"start_offset": 49,
"end_offset": 52,
"label": "dis"
},
{
"id": 8,
"entity": "胎粪",
"start_offset": 64,
"end_offset": 66,
"label": "bod"
},
{
"id": 9,
"entity": "羊水",
"start_offset": 68,
"end_offset": 70,
"label": "bod"
},
{
"id": 10,
"entity": "胎粪污染羊水",
"start_offset": 64,
"end_offset": 70,
"label": "sym"
},
{
"id": 11,
"entity": "黄疸",
"start_offset": 70,
"end_offset": 72,
"label": "dis"
},
{
"id": 12,
"entity": "生理性黄疸",
"start_offset": 72,
"end_offset": 77,
"label": "dis"
}
] |
3.水肿生后3～5天在手、足、小腿、耻骨区及眼窝等处有明显的水肿，2～3天后可以消退，可能与新生儿水代谢有关。 | [
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"id": 0,
"entity": "水肿",
"start_offset": 2,
"end_offset": 4,
"label": "dis"
},
{
"id": 1,
"entity": "手",
"start_offset": 11,
"end_offset": 12,
"label": "bod"
},
{
"id": 2,
"entity": "足",
"start_offset": 13,
"end_offset": 14,
"label": "bod"
},
{
"id": 3,
"entity": "小腿",
"start_offset": 15,
"end_offset": 17,
"label": "bod"
},
{
"id": 4,
"entity": "耻骨区",
"start_offset": 18,
"end_offset": 21,
"label": "bod"
},
{
"id": 5,
"entity": "眼窝",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 6,
"entity": "水肿",
"start_offset": 30,
"end_offset": 32,
"label": "dis"
}
] |
4.新生儿红斑生后1～2天在头面部、躯干和四肢有散在的多形红斑，大小不等，1～2天退清。 | [
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"id": 0,
"entity": "新生儿红斑",
"start_offset": 2,
"end_offset": 7,
"label": "dis"
},
{
"id": 1,
"entity": "头面部",
"start_offset": 14,
"end_offset": 17,
"label": "bod"
},
{
"id": 2,
"entity": "躯干",
"start_offset": 18,
"end_offset": 20,
"label": "bod"
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{
"id": 3,
"entity": "四肢",
"start_offset": 21,
"end_offset": 23,
"label": "bod"
},
{
"id": 4,
"entity": "多形红斑",
"start_offset": 27,
"end_offset": 31,
"label": "dis"
}
] |
5.粟粒疹在鼻尖、鼻翼、面颊部因皮脂腺堆积形成针头样黄白色皮疹，蜕皮后自然消退。 | [
{
"id": 0,
"entity": "粟粒疹",
"start_offset": 2,
"end_offset": 5,
"label": "dis"
},
{
"id": 1,
"entity": "鼻尖",
"start_offset": 6,
"end_offset": 8,
"label": "bod"
},
{
"id": 2,
"entity": "鼻翼",
"start_offset": 9,
"end_offset": 11,
"label": "bod"
},
{
"id": 3,
"entity": "面颊部",
"start_offset": 12,
"end_offset": 15,
"label": "bod"
},
{
"id": 4,
"entity": "皮脂腺",
"start_offset": 16,
"end_offset": 19,
"label": "bod"
},
{
"id": 5,
"entity": "黄白色皮疹",
"start_offset": 26,
"end_offset": 31,
"label": "dis"
},
{
"id": 6,
"entity": "皮",
"start_offset": 33,
"end_offset": 34,
"label": "bod"
}
] |
6.汗疱疹因新生儿汗腺功能欠佳，在前胸和前额多见针头样水疱疹，与周围温度过高有关。 | [
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"id": 0,
"entity": "汗疱疹",
"start_offset": 2,
"end_offset": 5,
"label": "dis"
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{
"id": 1,
"entity": "汗腺功能",
"start_offset": 9,
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"label": "ite"
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{
"id": 2,
"entity": "前胸",
"start_offset": 17,
"end_offset": 19,
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{
"id": 3,
"entity": "前额",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
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{
"id": 4,
"entity": "水疱疹",
"start_offset": 27,
"end_offset": 30,
"label": "dis"
}
] |
7.青记在新生儿的背部或臀部有蓝绿色色斑，为色素细胞沉着有关，随年龄增加而自动消退。 | [
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"id": 0,
"entity": "青记",
"start_offset": 2,
"end_offset": 4,
"label": "dis"
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{
"id": 1,
"entity": "背部",
"start_offset": 9,
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"label": "bod"
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{
"id": 2,
"entity": "臀部",
"start_offset": 12,
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{
"id": 3,
"entity": "蓝绿色色斑",
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{
"id": 4,
"entity": "色素细胞",
"start_offset": 22,
"end_offset": 26,
"label": "bod"
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] |
（三）头面颈部外观1.头颅新生儿颅骨较软骨缝可呈分离状产道时受到挤压而有骨缝重叠，数天后可以自行恢复；另有部分新生儿可有头皮水肿眼部生儿经常闭眼部分新生儿可以有球结膜毛细血管破裂而出血数天后可自行吸收。 | [
{
"id": 0,
"entity": "头",
"start_offset": 3,
"end_offset": 4,
"label": "bod"
},
{
"id": 1,
"entity": "面",
"start_offset": 4,
"end_offset": 5,
"label": "bod"
},
{
"id": 2,
"entity": "颈",
"start_offset": 5,
"end_offset": 6,
"label": "bod"
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{
"id": 3,
"entity": "头颅",
"start_offset": 11,
"end_offset": 13,
"label": "bod"
},
{
"id": 4,
"entity": "颅骨",
"start_offset": 16,
"end_offset": 18,
"label": "bod"
},
{
"id": 5,
"entity": "颅骨较软",
"start_offset": 16,
"end_offset": 20,
"label": "sym"
},
{
"id": 6,
"entity": "骨缝",
"start_offset": 20,
"end_offset": 22,
"label": "bod"
},
{
"id": 7,
"entity": "骨缝可呈分离状",
"start_offset": 20,
"end_offset": 27,
"label": "sym"
},
{
"id": 8,
"entity": "产道",
"start_offset": 27,
"end_offset": 29,
"label": "bod"
},
{
"id": 9,
"entity": "头皮",
"start_offset": 60,
"end_offset": 62,
"label": "bod"
},
{
"id": 10,
"entity": "头皮水肿",
"start_offset": 60,
"end_offset": 64,
"label": "sym"
},
{
"id": 11,
"entity": "眼部",
"start_offset": 64,
"end_offset": 66,
"label": "bod"
},
{
"id": 12,
"entity": "眼",
"start_offset": 71,
"end_offset": 72,
"label": "bod"
},
{
"id": 13,
"entity": "生儿经常闭眼",
"start_offset": 66,
"end_offset": 72,
"label": "sym"
},
{
"id": 14,
"entity": "球结膜毛细血管破裂",
"start_offset": 80,
"end_offset": 89,
"label": "dis"
},
{
"id": 15,
"entity": "出血",
"start_offset": 90,
"end_offset": 92,
"label": "dis"
},
{
"id": 16,
"entity": "部分新生儿可以有球结膜毛细血管破裂而出血",
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"end_offset": 92,
"label": "sym"
},
{
"id": 17,
"entity": "数天后可自行吸收",
"start_offset": 92,
"end_offset": 100,
"label": "sym"
}
] |
3.鼻新生儿鼻梁较低鼻腔黏膜容易肿胀透气困难而张口呼吸。 | [
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"id": 0,
"entity": "鼻",
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"end_offset": 3,
"label": "bod"
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{
"id": 1,
"entity": "鼻梁",
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"label": "bod"
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{
"id": 2,
"entity": "新生儿鼻梁较低",
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"label": "sym"
},
{
"id": 3,
"entity": "鼻腔黏膜",
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"end_offset": 14,
"label": "bod"
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{
"id": 4,
"entity": "鼻腔黏膜容易肿胀",
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"label": "sym"
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{
"id": 5,
"entity": "透气困难",
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},
{
"id": 6,
"entity": "张口呼吸",
"start_offset": 23,
"end_offset": 27,
"label": "sym"
}
] |
4.口腔新生儿牙龈上可有黄白色小颗粒板牙”或“马牙”，此系上皮细胞堆积或黏液包裹，不应挑破；在硬腭中线上有大小为2～4mm的黄色小结，称为彭氏结，也系上皮细胞堆积，数周后自行消退；新生儿两颊各有一个隆起的黄色脂肪垫，俗称“螳螂嘴”，这是新生儿吸吮的重要工具，不可损伤。 | [
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"entity": "两颊",
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"entity": "脂肪垫",
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},
{
"id": 13,
"entity": "螳螂嘴",
"start_offset": 111,
"end_offset": 114,
"label": "bod"
}
] |
5.耳新生儿耳部的大小、外形、结构和坚硬度，均和遗传及成熟度相关，在新生儿胎龄评分中，耳廓的坚硬程度是其中的一项重要指标。 | [
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"entity": "耳廓",
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] |
6.颈部新生儿颈短皱褶处容易潮湿和糜烂胸部新生儿胸部呈圆筒状剑突有时可以上翘肋外翻乳晕增深可触及乳房小结激素经过胎盘到达胎儿所致，2～3周后可以自行消退；也是判定新生儿胎龄的指标之一。 | [
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"entity": "胸部",
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"label": "bod"
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"entity": "新生儿胸部呈圆筒状",
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"id": 9,
"entity": "剑突",
"start_offset": 30,
"end_offset": 32,
"label": "bod"
},
{
"id": 10,
"entity": "剑突有时可以上翘",
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"label": "sym"
},
{
"id": 11,
"entity": "肋",
"start_offset": 38,
"end_offset": 39,
"label": "bod"
},
{
"id": 12,
"entity": "肋外翻",
"start_offset": 38,
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"label": "sym"
},
{
"id": 13,
"entity": "乳晕",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
},
{
"id": 14,
"entity": "乳晕增深",
"start_offset": 41,
"end_offset": 45,
"label": "sym"
},
{
"id": 15,
"entity": "乳房小结",
"start_offset": 48,
"end_offset": 52,
"label": "bod"
},
{
"id": 16,
"entity": "可触及乳房小结",
"start_offset": 45,
"end_offset": 52,
"label": "sym"
},
{
"id": 17,
"entity": "激素",
"start_offset": 52,
"end_offset": 54,
"label": "bod"
},
{
"id": 18,
"entity": "胎盘",
"start_offset": 56,
"end_offset": 58,
"label": "bod"
}
] |
（五）腹部新生儿腹部有时可以较为膨隆蛙状腹”；由于新生儿肋间肌不能完成呼吸做功，需要膈肌的升降来帮助呼吸，所以新生儿可有腹式呼吸脐带结扎后，留有的脐残端经无菌包扎后，一般在7天内自行脱落；部分新生儿脐残端脱落前后，脐部可有浆液性分泌物或渗血肛门与生殖器为排除新生儿畸形，应做肛指检查，胎粪的排出情况可提示新生儿肛门有无异常。 | [
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{
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{
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"entity": "呼吸",
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"entity": "脐带",
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{
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"entity": "脐部",
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{
"id": 16,
"entity": "浆液性分泌物",
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"label": "bod"
},
{
"id": 17,
"entity": "血",
"start_offset": 119,
"end_offset": 120,
"label": "bod"
},
{
"id": 18,
"entity": "渗血",
"start_offset": 118,
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"label": "sym"
},
{
"id": 19,
"entity": "肛门",
"start_offset": 120,
"end_offset": 122,
"label": "bod"
},
{
"id": 20,
"entity": "生殖器",
"start_offset": 123,
"end_offset": 126,
"label": "bod"
},
{
"id": 21,
"entity": "肛指检查",
"start_offset": 137,
"end_offset": 141,
"label": "pro"
},
{
"id": 22,
"entity": "胎粪",
"start_offset": 142,
"end_offset": 144,
"label": "bod"
},
{
"id": 23,
"entity": "肛门",
"start_offset": 155,
"end_offset": 157,
"label": "bod"
}
] |
部分新生儿生后可以有会阴部水肿，数天后可自行消退；少数男婴可以有双侧或单侧睾丸未降睾丸在腹股沟处单侧或双侧鞘膜积液假月经”，此系母体来源的雌激素撤退后引起，表现为新生女婴在生后2～7天内有灰白色或血性黏液从阴道流出，可持续2周左右。 | [
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"entity": "阴部水肿",
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{
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{
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{
"id": 5,
"entity": "睾丸在腹股沟处",
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{
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"entity": "鞘膜",
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{
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"entity": "单侧或双侧鞘膜积液",
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"end_offset": 57,
"label": "sym"
},
{
"id": 8,
"entity": "假月经",
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},
{
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"entity": "雌激素",
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"label": "bod"
},
{
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"entity": "灰白色或血性黏液从阴道流出",
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] |
参考文献1.许积德.小儿内科学.北京：人民卫生出版社，1995：122-1222.尹音，胡敏.儿童口腔学.北京：人民军医出版社，1995：34-343.郑麟蕃，张震康，余光岩.实用口腔科学.北京：人民卫生出版社，1999：143-143 | [
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"end_offset": 51,
"label": "dep"
},
{
"id": 2,
"entity": "口腔",
"start_offset": 90,
"end_offset": 92,
"label": "bod"
}
] |
四、耐药结核菌的治疗耐药结核病一般分为4类：1.单耐药（monoresistance）结核病患者感染的结核分枝杆菌经体外证实对1种抗结核药物耐药。 | [
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"label": "dis"
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"entity": "结核病",
"start_offset": 43,
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"label": "dis"
},
{
"id": 3,
"entity": "结核分枝杆菌",
"start_offset": 51,
"end_offset": 57,
"label": "mic"
},
{
"id": 4,
"entity": "抗结核药物",
"start_offset": 65,
"end_offset": 70,
"label": "dru"
}
] |
2.多耐药（polyresistance）结核病患者感染的结核分枝杆菌经体外证实对1种以上的抗结核药物耐药，但不包括同时耐异烟肼、利福平。 | [
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{
"id": 4,
"entity": "利福平",
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] |
3.耐多药（multidrugresistance，MDR）结核病患者感染的结核分枝杆菌经体外证实至少同时对异烟肼、利福平耐药。 | [
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{
"id": 3,
"entity": "利福平",
"start_offset": 58,
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"label": "dru"
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] |
4.广泛耐药（extensivelydrugresistance，XDR）结核病患者感染的结核分枝杆菌体外被证实除至少同时对异烟肼、利福平耐药外，还对任何氟喹诺酮类药物产生耐药，以及3种二线抗结核注射药物（卷曲霉素、卡那霉素和阿米卡星）中的至少1种耐药。 | [
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{
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"entity": "氟喹诺酮类药物",
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{
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"entity": "卷曲霉素",
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{
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"entity": "卡那霉素",
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{
"id": 7,
"entity": "阿米卡星",
"start_offset": 113,
"end_offset": 117,
"label": "dru"
}
] |
对耐药结核病的预防胜于治疗。 | [
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"entity": "耐药结核病",
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"label": "dis"
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] |
首先要实施国家控制结核病规划（NTP），做好原发性耐药结核病易感人群的防治。 | [
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"id": 0,
"entity": "结核病",
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"entity": "原发性耐药结核病",
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"label": "dis"
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] |
耐异烟肼或耐利福平者，根据病情可选择氟喹诺酮中的氧氟沙星或左氧氟沙星。 | [
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"entity": "异烟肼",
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"entity": "左氧氟沙星",
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] |
耐链霉素者可选用乙胺丁醇替代，也可选择1种二线注射剂药物。 | [
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] |
PZA可全疗程应用。 | [
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"entity": "PZA",
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] |
单耐利福平者疗程一般为12个月，单耐其他药物者疗程至少9个月，耐2种药物者疗程为12个月，耐3～4种药物者疗程至少18个月。 | [
{
"id": 0,
"entity": "利福平",
"start_offset": 2,
"end_offset": 5,
"label": "dru"
}
] |
对病变广泛者宜同时选择氟喹诺酮类药物和注射剂，或适当延长疗程。 | [
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"id": 0,
"entity": "氟喹诺酮类药物",
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"end_offset": 18,
"label": "dru"
}
] |
参考文献1.吴育锦，隋邦森，贾礼明，等.脑内小脓肿40例临床研究.中华神经精神科杂志，1988，21：352-3522.董宇为，夏学巍，杜怡庆等.儿童脑脓肿的显微外科治疗体会.中华小儿外科杂志，2010，31（1）：1-13.SuTM，LinYC，LuCH，etal.Streptococcalbrainabscess：analysisofclinicalfeaturesin20patients.SurgNeurol.2001，56（3）：189-1894.HabibAA，MozaffarT.Brainabscess.ArchNeurol.2001，58（8）：1302-13025.Bair-MerrittMH，ShahSS，ZaoutisTE，BellLM，FeudtnerC.Suppurativeintracranialcomplicationsofsinusitisinpreviouslyhealthychildren.PediatrInfectDisJ.2005，24（4）：384-3846.MarquardtG，SchickU，Moller-HartmannW.Brainabscess.JNeurosurg.2001，94（6）：1020-10207.HakanT，CeranN，ErdemI，BerkmanMZ，GoktasP.Bacterialbrainabscesses：anevaluationof96cases.JInfect.2006，52（5）：359-3598.TononE，ScottonPG，GallucciM，etal.Brainabscess：clinicalaspectsof100patients.IntJInfectDis.2006，10（2）：103-1039.Shachor-MeyouhasY，Bar-JosephG，GuilburdJN，etal.Brainabscessinchildren-epidemiology，predisposingfactorsandmanagementinthemodernmedicineera.ActaPaediatr.2010，99（8）：1163-1163 | [
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"id": 0,
"entity": "脑内小脓肿",
"start_offset": 20,
"end_offset": 25,
"label": "dis"
},
{
"id": 1,
"entity": "神经精神科",
"start_offset": 35,
"end_offset": 40,
"label": "dep"
},
{
"id": 2,
"entity": "儿童脑脓肿",
"start_offset": 73,
"end_offset": 78,
"label": "dis"
},
{
"id": 3,
"entity": "外科",
"start_offset": 81,
"end_offset": 83,
"label": "dep"
},
{
"id": 4,
"entity": "外科",
"start_offset": 92,
"end_offset": 94,
"label": "dep"
}
] |
二、常见疾病的影像诊断（一）食管闭锁和食管气管瘘先天性食管闭锁及食管气管瘘（congenitalesophagealatresiaandtracheoesophagealfistula）是新生儿常见的胃肠道畸形。 | [
{
"id": 0,
"entity": "食管闭锁",
"start_offset": 14,
"end_offset": 18,
"label": "dis"
},
{
"id": 1,
"entity": "食管气管瘘",
"start_offset": 19,
"end_offset": 24,
"label": "dis"
},
{
"id": 2,
"entity": "先天性食管闭锁",
"start_offset": 24,
"end_offset": 31,
"label": "dis"
},
{
"id": 3,
"entity": "食管气管瘘",
"start_offset": 32,
"end_offset": 37,
"label": "dis"
},
{
"id": 4,
"entity": "congenitalesophagealatresiaandtracheoesophagealfistula",
"start_offset": 38,
"end_offset": 92,
"label": "dis"
},
{
"id": 5,
"entity": "胃肠道畸形",
"start_offset": 100,
"end_offset": 105,
"label": "dis"
}
] |
根据畸形的解剖关系将食管闭锁分为五型：A型：食管近、远段均闭锁，无食管气管瘘B型：食管远段呈盲端C型：食管近段闭锁，远段有瘘与气管相通D型：食管近、远两段均与气管相通；E型：食管无闭锁，仅有食管气管瘘生后数小时开始流口水、吐白沫、喂奶时咳呛、呕吐甚至气促青紫为特征。 | [
{
"id": 0,
"entity": "食管闭锁",
"start_offset": 10,
"end_offset": 14,
"label": "dis"
},
{
"id": 1,
"entity": "A型",
"start_offset": 19,
"end_offset": 21,
"label": "dis"
},
{
"id": 2,
"entity": "食管",
"start_offset": 22,
"end_offset": 24,
"label": "bod"
},
{
"id": 3,
"entity": "食管近、远段均闭锁，无食管气管瘘",
"start_offset": 22,
"end_offset": 38,
"label": "sym"
},
{
"id": 4,
"entity": "B型",
"start_offset": 38,
"end_offset": 40,
"label": "dis"
},
{
"id": 5,
"entity": "食管",
"start_offset": 41,
"end_offset": 43,
"label": "bod"
},
{
"id": 6,
"entity": "食管远段呈盲端",
"start_offset": 41,
"end_offset": 48,
"label": "sym"
},
{
"id": 7,
"entity": "C型",
"start_offset": 48,
"end_offset": 50,
"label": "dis"
},
{
"id": 8,
"entity": "食管",
"start_offset": 51,
"end_offset": 53,
"label": "bod"
},
{
"id": 9,
"entity": "食管近段闭锁，远段有瘘与气管相通",
"start_offset": 51,
"end_offset": 67,
"label": "sym"
},
{
"id": 10,
"entity": "D型",
"start_offset": 67,
"end_offset": 69,
"label": "dis"
},
{
"id": 11,
"entity": "食管近、远两段均与气管相通",
"start_offset": 70,
"end_offset": 83,
"label": "sym"
},
{
"id": 12,
"entity": "E型",
"start_offset": 84,
"end_offset": 86,
"label": "dis"
},
{
"id": 13,
"entity": "食管",
"start_offset": 87,
"end_offset": 89,
"label": "bod"
},
{
"id": 14,
"entity": "食管无闭锁，仅有食管气管瘘",
"start_offset": 87,
"end_offset": 100,
"label": "sym"
},
{
"id": 15,
"entity": "生后数小时开始流口水、吐白沫、喂奶时咳呛",
"start_offset": 100,
"end_offset": 120,
"label": "sym"
},
{
"id": 16,
"entity": "呕吐甚至气促青紫",
"start_offset": 121,
"end_offset": 129,
"label": "sym"
}
] |
X线表现：①胸腹部平片：由于食管气管瘘的存在，大多数均有吸入性肺炎，右上肺最常受累。 | [
{
"id": 0,
"entity": "X线",
"start_offset": 0,
"end_offset": 2,
"label": "pro"
},
{
"id": 1,
"entity": "胸腹部平片",
"start_offset": 6,
"end_offset": 11,
"label": "pro"
},
{
"id": 2,
"entity": "食管气管瘘",
"start_offset": 14,
"end_offset": 19,
"label": "dis"
},
{
"id": 3,
"entity": "吸入性肺炎",
"start_offset": 28,
"end_offset": 33,
"label": "dis"
},
{
"id": 4,
"entity": "右上肺",
"start_offset": 34,
"end_offset": 37,
"label": "bod"
}
] |
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