佝偻病维生素d缺乏（Rickets of vitamin D deficiency）课件.ppt

Rickets of vitamin D deficiency Rickets The term rickets evolved from the old English word wrick, meaning to twist. This twisting or bending of the bones has been known since antiquity and was described in detail by F. Glisson in 1650 a term signifying failure to mineralize growing bone or osteoid tissue many causes, mainly vitamin D deficiency Synonym of rachitis Vitamin D Fat soluble, stable to heat, acid alkali, and oxidation bile necessary for absorption In 1824, cod-liver oil was firstly be prescribed for the treatment of rickets by D. Scheutte. In1906, Hopkins postulated the existence of essential dietary factors necessary for the prevention of rickets. In 1928, the Nobel prize for chemistry was awarded to Adolf Windaus for his discovery of vitamin D. Vitamin D actually refers to a group of steroid molecules Two forms: vitamin D2 (calciferol)and vitamin D3 (cholecalciferol) Both are produced synthetically and are available as dietary supplements Each of the forms of vitamin D is hydrophobic, and is transported in blood bound to carrier proteins, mainly vitamin D-binding protein. The halflife of 25-hydroxycholecalciferol is several weeks, while that of 1,25-dihydroxycholecalciferol is only a few hours. 1,25-dihydroxycholecalciferol Receptors are present in most cells if not all most dramatic effect is to facilitate intestinal absorption of calcium, although it also stimulates absorption of phosphate and magnesium ions facilitate renal reabsorption of phosphorus possibly a direct effect on bone deposition and reabsorption of calcium and phosphorus Coordinated with parathormone(PTH) and calcitonin The Vitamin D Receptor and Mechanism of Action The active form of vitamin D binds to intracellular receptors which forms heterodimer with another intracellular receptor, the retinoid-X receptor, and binds to DNA to modulate gene expression In most cases studied, the effect is to activate transcription, but situations are also known in which vi