湘雅儿科精品课件RicketsofVitDDeficiency.ppt

维生素D缺乏性佝偻病Rickets of VitD Deficiency 中南大学儿科学教研室 刘晓艳 初期 The early stage ? 年龄 3 months ? 症状 神经精神症状 （neuro-psychic symptoms） ? 体征 枕秃 （ the loss of hair in the occipital position） ? 生化改变 Ca normal ,P normal or ?, Ca ?P ? , AKP ? ? X线 No obvious skeletal changes * 第五章第五节（2） Purpose Be familiar with etiology and pathogenesis of rickits and tetany of Vitamin D deficiency. To master their clinical manifestations, diagnosis ,treatment and prevention . To understand their differential diagnosis. Definition Rickets is a very common nutritional deficient disease in young children especially under two years old of age. VitD deficiency cause rickets, a metabolic disorder of calcium and phosphorus with a failure to mineralize osteoid tissue of growing bone resulting in bony deformities. 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 ergosterol VitD2 Originates of VitD 紫外线照射 ultraviolet 内源性VitD3 1，25（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 Ingested from food Human skin contains 7- dehydrocholesterol (ultraviolet rairradiation) Vit D3 Liver(25-hydroxylase)  kidney (1-hydroxylase) 1,25-(OH) 2-D3 (1, 25-dihydroxycholecalciferol) Metabolism of VitD 25-(OH) -D3（ 25-dihydroxycholecalciferol） Vit D Liver 25-(OH) D3 Hypo serum P Hyper serum P Kidney? PTH Calcitonin Hypo serum Ca Hyper serum Ca 1,25- (OH)2 D3 (-) (+) (-) (-) (+) (+) (+) (-) (-) Regulation of metabolism of Vit D3 病因 Etiology 日光照射不足 Lack of sunshine 摄入不足 Underfeeding 生长过快 Rapid growth 疾病影响 Influence of diseases 药物影响 Influence of medicine 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 Vit D deficiency Disturbance of calcification of osteoid tissue + decalcification of skeleton Diminished absorption of Ca and P from intestine A fall of serum Ca Compen