湘雅儿科精品课件-Rickets of VitD Deficiency.ppt

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1、维生素D缺乏性佝偻病RicketsofVitDDeficiency中南大学儿科学教研室刘晓艳第五章第五节（2）PurposeBefamiliarwithetiologyandpathogenesisofrickitsandtetanyofVitaminDdeficiency.Tomastertheirclinicalmanifestations,diagnosis,treatmentandprevention.Tounderstandtheirdifferentialdiagnosis.DefinitionRicketsisaverycom

2、monnutritionaldeficientdiseaseinyoungchildrenespeciallyundertwoyearsoldofage.VitDdeficiencycauserickets,ametabolicdisorderofcalciumandphosphoruswithafailuretomineralizeosteoidtissueofgrowingboneresultinginbonydeformities.皮肤中7-脱氢胆固醇（主要）7-dehydrocholesterol食物中摄取麦角固醇（次要）plant

3、ergosterolVitD2OriginatesofVitD紫外线照射ultraviolet内源性VitD31，25（OH）2D3的作用促进小肠粘膜对钙磷的吸收促进肾小管对钙磷的重吸收促进旧骨脱钙，增加细胞外液钙磷的浓度IngestedfromfoodHumanskincontains7-dehydrocholesterol(ultravioletrairradiation)VitD3Liver(25-hydroxylase)kidney(1-hydroxylase)1,25-(OH)2-D3(1,25-dihydroxycholecal

4、ciferol)MetabolismofVitD25-(OH)-D3（25-dihydroxycholecalciferol）VitDLiver25-(OH)D3HyposerumPHyperserumPKidneyPTHCalcitoninHyposerumCaHyperserumCa1,25-(OH)2D3(-)(+)(-)(-)(+)(+)(+)(-)(-)RegulationofmetabolismofVitD3病因Etiology日光照射不足Lackofsunshine摄入不足Underfeeding生长过快Rapidgrowth

5、疾病影响Influenceofdiseases药物影响Influenceofmedicine预防Prevention多晒太阳补充VitD制剂，预防剂量为400~800IU/d提倡母乳喂养，及时添加辅食积极治疗原发病孕妇多户外活动，注意营养VitDdeficiencyDisturbanceofcalcificationofosteoidtissue+decalcificationofskeletonDiminishedabsorptionofCaandPfromintestineAfallofserumCaCompensatoryf

6、unctionofparathyroidProliferationofosteoidtissueIncreasedInsufficientPathogenesisRachiticmetaphasesandsoftenshaftExcretionofurinePincreasedincreaseddecalcificationofoldboneCaofoldbonecan’tbemobilizedSerumCadecreasedAfallofserumPSerumCaremainnormalorslightlyloweredRachiticT

7、etanyCaPproductdecreasedRicketsPathogenesis初期Theearlystage年龄3months症状神经精神症状（neuro-psychicsymptoms）体征枕秃（thelossofhairintheoccipitalposition）生化改变Canormal,Pnormalor,CaP,AKPX线Noobviousskeletalchanges临床表现Clinicalmanifestations枕秃thelossofhairintheoccipitalposition激期The

8、advancedstage症状和体征生化改变Ca↓,P↓↓CaP<30,AKP↑X线Clinicalmanifestations方颅Squarehead肋骨串珠Rachi