维生素d缺乏性佝偻病课件_4

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1、RicketsofVitaminDDeficiency维生素D缺乏性佝偻病DefinitionRickets,adeformativediseasethatoccursamongchildren,arecharacterizedbydeficientmineralizationofthebonematrix（骨基质）asaresultofdeficienciesofcalciumorphosphorusorboth.DefectivemineralizationatthegrowthplateOsteomalacia（骨软化）atthecorticoendosteallev

2、elSourceandMetabolismofVitaminDAnimalfood：VitD3Vegetalfood:VitD2ergosterin(麦角固醇)ergocalciferol(麦角骨化醇)EndogenicVitD3——mainsourceEctogenicVitD——fromfoodintestinebloodliver25-hydroxylaseDBPkidney1--hydroxylaseintestine、kidney、boneMother-fetustransportation7-dehydrocholesterol296—310nmultravi

3、oletraysCholecalciferol胆骨化醇VitDliver25-hydroxylasekidney1--hydroxylase25-（OH）D31，25-（OH）2D3Ca（-）（-）（-）P（+）GH（+）（-）维生素DRegulation（-）CaPEtiologylessoutdooractivityhighbuildingspollutionseasonInadequateexposuretosunlightPrevalenceSpring>AutumnCity>CountrysideNorth>SouthDarkskin>Whiteskin

4、EtiologyVitD3calciuminhibitionP↑fibersvegetableInsufficientintakelittleVitDininfantfoodEtiologyprematurelow-birthweighttwinsinfantsadolescentsRapidgrowthEtiologyDiseasesCeliacdiseaseCysticdiseaseAnticonvulsanttherapyGlucocorticoidOthersVitDdeficiencyparathyroidglandsCaCa＆PabsorptionPreab

5、sorption(renaltubules)PTHPTHosteoclastPDefectivemineralizationPeriostealosteoidCareabsorptionCa±CaCaPPathologyClinicalsignsricketstetanyClinicalmanifestationMostcommoninthreemonthstotwoyearsoldSkeletonchangesLoosemuscleNeurologicexcitementClinicalmanifestationInitialstageBelow6mon

6、thNeurologicexcitement:restless,nightcryorterror,sweatSkeletonchangesLaboratorialtests:25(OH)D3，Ca±，P，PTH，AKP±ClinicalmanifestationActivestageskeletonhead<6moncraniotabes(颅骨软化)6-12moncaputquadratum(方颅)Largeanteriorfontanel(囟门大)Teetheruptiondelay(出牙延迟）ClinicalmanifestationActivestages

7、keletonThoraxRachiticrosary（肋串珠）Chickenbreast(鸡胸)Funnelbreast(漏斗胸)Harrisongroove(哈氏沟)ClinicalmanifestationActivestageskeletonextremities>6monepiphysealenlargementatwristsandankles>12monbowlegs,knock-kneesClinicalmanifestationActivestageskeletonSpinekyphosis(驼背