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1、RicketsofVitaminDDeficiencyPengJingXiangyaHospital,CSU2010.11BackgroundWhathappenedtothesechildren?FirstthoroughaccountofricketsFrancisGlisson(1650)MartinseSilvaJ.ActaReumatolPort,2007.32:205.MellanbyEdward(1918)Isolationoftheantiricketicfactorfromliv
2、eroilMellanbyE.BrMedJ,1924,24:895Adolfwindaus(1922)SyntheticallypreparevitaminD3“nomorecampaignonrickets”Inthe1970sVeenaBahl.Nutrition&FoodScience,1993,81:2RowePM.Lancet,2001,357:1100Inthe2000s“IthinkthisisamajorunrecognizedepidemicintheUnitedStates.I
3、taffectschildrenandadultsofallages,allraces,andbothsexes.It’sverysignificant.”“VitaminDdeficiencysymptomsinchildrenhavelongbeenoverlooked.”TheLancet:“re-emergenceofrickets”RicketsofvitaminDdeficiency营养性维生素D缺乏性佝偻病Tobefamiliarwithitspathology,diagnosisa
4、nddifferentialdiagnosisTeachingaimsTomasteritsetiology,clinicalmanifestations,treatmentandpreventionofRicketsDefinitionWhatisRickets?Mineralization:矿化Osteoid:骨样组织Osteomalacia:骨软化症Ricketsisthetermsignifyingafailureinmineralizationofgrowingboneorosteoid
5、tissueduetodeficiencyofvitaminDThesourceandconversionofVitaminDResourceofVitDCalciferol(vitD2)Cholecalciferol(vitD3)7-dehydrocholesterolinskin296~310nmMaterno-fetusDietaryandtherapeuticsourceActivationofVitDVitD2VitD325(OH)D31,25(OH)2D3DBPHydrooxylate
6、dintherenalHydrooxylatedintheLiverCirculatingformBiologicallyactiveformFunctionof1,25(OH)2D3FacilitationofintestinalabsorptionofcalciumandphosphorusReabsorptionofphosphorusinthekidneysDirecteffectonmineralmetabolismofboneAccommodationofcellproliferati
7、onandimmunesystemReceptors（intestins,renal,bone）Functionof1,25(OH)2DQuizTellusthefunctionof1,25(OH)2D3.WhatisthebiologicallyactiveformofvitaminD?25(OH)D3WhatisthemajorcirculatingformofvitaminD?1,25(OH)2D3Antiricketicfunction：intestines,renal,boneOther
8、s：anticancer，immunomodulationEtiologyetiologyDiseaseInadequateintakeRapidgrowthInadequateexposureinsunlightVitDdeficiencyduringperinatalperiodchildrenVitDdeficiencyduringperinatalperiodWhetherallpregnanciesshouldbegivenvitaminDneedforalargepla
