临床医学佝偻病课件

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1、儿科医院徐秀VitaminDdeficiencyProvitaminD3UltravioletlightIntheskin:7-dehydrocholesterolVitaminD3(aninactiveform)25-hydroxyvitaminD3HydroxylationIntheLiver:foods1,25-hydroxyvitaminD3(activeform)HydroxylationInthekidneys:VitaminDSynthesisandActivationVitaminDrolesFacilitateintestinalabsorptionofcalcium

2、andphosphorusPromoterenalreabsorptionofphosphorusDirecteffectonbonedepositionandreabsorptionofcalciumandphosphorusMaintaincalciumandphosphorushomeostasisCa,PHomeostasis+1,25(OH)2D+PTH-CT+1,25(OH)2D-PTH-CT+1,25(OH)2DBoneIntestineKidneysParathormone(PTH)Calcitonin(CT)1,25(OH)2DCa,PHomeostasisCause

3、sofVitaminDdeficiencyInadequatedirectexposuretosunlightInadequatevitaminDintakeHigherrequirementSomediseases,whichinterferewithvitaminDabsorptionormetabolicandactivationVitaminD-DeficientRicketsEpidemiology:rareinindustrializedcountriesCommoninChina20%intheSouthofChina30-40%intheNorthofChinaVita

4、minDdeficiencyOsteoidtissuefailuretomineralizeOsteoidtissueaccumulationLessCaabsorbedfromtheintestineUrinephosphorusincreasedParathormonesecretedSerumAKPincreasedMobilizedboneCa,PVitaminD-deficientRicketsSerumCaconcentrationdecreaseLowserumphosphorusPathophysiologyofVitaminD-deficientRicketsNorm

5、alorslightdecreaseinserumcalciumconcentrationGeneralmanifestations:irritability,temporaryteetheruptiondelayed，anteriorfontanelclosuredelayedMuscleslackoftoneHead:craniotabes,Ping-Pongball,caputquadratumChest:beadingoftheribs,pigeonbreastdeformity,HarrisongrooveLimb:Thickeningofthewristsandankles

6、Bow-legs,knock-kneesCliniaclmanifestationsCaputquadratumPigeonbreastdeformityThebeaningofribs(Rachiticrosary)HarrisongrooveThickingofthewristsboxlegsknock-kneesThickingoftheanklesBiochemicalchangesNormalorlowserumcalciumSerumphosphoruslevellessthan4mg/dlSerumAKPlevelelevatedLowserum25-hydroxycho

7、lecalciferolActiverickets:Distalends,cuppingandfrayingoftheradiusandulnaHealingrickets:Zonesofpreparatorycalcificaiton(ZPC);rachiticmetaphysiscalcificationtakenplaceRadiographicfindingsBasedon:ahistoryofinadequateintakeofvit