佝偻病---终稿.ppt

rickets of vitamin D deficiency （营养性维生素D缺乏性佝偻病）;问题;教学大纲;definition;summarize;Vitamin D Metabolism and Physiology 代谢与生理;The natural source of vitamin D for the human is the cholecalciferol produced in the skin following exposure to the ultraviolet radiation of sunshine, which activates the skin 7- dehydrocholesterol;VD的活化;;肝脏羟化部位在肝细胞微粒体和线粒体中。 肾脏羟化部位在肾近曲小管上皮细胞线粒体中。;;软骨的生长发育及与佝偻病发生;骨由细胞和间质组成， 间质中含有无机盐和有机质。 骨盐的成分主要是钙与磷酸化合而成的羟化磷灰石。;;;;; 软骨内成骨 软骨细胞静止区 ?????????????? 软骨细胞增生区????? 软骨细胞肥大区????? 基质钙化区 成骨区;;【长骨发生】;;;成骨区;佝偻病病理;;;; ? 佝偻病X线片示意图;钙磷乘积：;儿童之所以患佝偻病，是因为维生素D缺乏时，钙磷乘积下降(40)，使成熟软骨细胞及成骨细胞不能钙化而继续增殖，形成骨骺端骨样组织堆积，临时钙化带增厚，骨骼膨大，形成临床所见肋骨串珠、手镯、脚镯征等，颅骨骨样组织堆积造成方颅。 ;儿童、成人、老人钙磷代谢表现异同;Sun exposure;Sources of Vitamin D;Vitamin D – Sources;Natural foods Breast milk　　 1 μg /L Cow’s milk　 0.5-1μg /L Egg　　　 1.75 μg /100g Butter　 0.75-1.5μg /100g;表1 富含维生素D食物一览表(国际单位/100克) ;VD代谢的调节;;VD代谢的调节-PTH( parathormone);低血钙;VD代谢的调节-CT (calcitonin);;VD的生理;VD的生理功能;Antirachitic function 抗佝偻病作用;Antirachitic function 抗佝偻病作用;;病 因—掌握;Etiology;Etiology;Etiology;Etiology;发病机制 pathogenesis（掌握）：;VitD缺乏;;Clinical Manifestations ;Clinical manifestation-Early stage;Clinical manifestation-Early stage;Early stage;枕秃;;活动期（激期） Advanced stage ： 症状 symptom 体征 physical sign X线表现 X-ray manifestation 血生化改变 blood biochemistry;Clinical manifestation- Advanced stage; Skull change 头颅骨的改变 ①One of the early signs of rickets in the infant under 6 months of age is craniotabes. The thin skull bone can be indented like a ping - pong ball by pressure of the finger, snapping back when the pressure is released. 六个月以内的婴儿颅骨软化，用指尖压枕骨或顶骨的后部有压乒乓球样的感觉，松手后很快恢复。; Skull change 头颅骨的改变 ② The central parts of the parietal and frontal bones are often thickened, forming prominences or bosses, which give the head a boxlike appearance 六个月后额骨和顶骨中心增厚，形成方盒样头 ;;马鞍颅 saddle like head; Skull change 头颅骨的改变 ③Growth of the skull bones is de