血清总25oh总维生素d检测重要性及临床应用汇编.ppt

血清总25OH总维生素D检测的 重要性及临床应用 、维生秦D3(胆骨化醇, cholecalciferol) 在皮肤内的生成:7-脱氢胆固醇在紫外线(B部分:290-315nm)和体温 能量作用下生成 在肝、肾的转变:与DBP结合——肝脏25羟化酶一DBP——肾脏1a羟 化酶,24羟化酶 维生素D代谢物的清除:不清楚,经胆汁排出为主要途径,少量成为水 溶性而降解,由尿液排出。 二、维生案D2(麦角骨化醇, Ergocalciferol) 植物体内的麦角甾醇经紫外线照射产生 在肝、肾的转变:同维生素D3,但25OHD的转换率比D3快25倍 ·代谢物的清除:同维生素D3但清除率均快于D3 ?(7-dehydrocholesterol), O ,+(奶 Circulation store at fat Skin Intestine Liver P. Ca? anc :5-OHase 24-CHase 2425H2D parathyroid Kidne Excretion 24,25(OHD3 24-OH3se H increase sorption Inhibits prolifertion Inhibits angiogenesis 阳光照射:90% 成年白人全身暴露,阳光照射10-12分钟,产生10000U维生素D3 健康的户外工作者如农民或救生员,血清25OH)D可以 达到54-652ng/ml 食物:10% 天然食品:野生三文鱼500-1000/100g 强化食品:婴儿配方奶粉:400U/100g 奶米粉:400|U/100g B 70.0 EE28E female male 25(OHD水平随季节的变化( New zealand) OSTEOPOROS INT 2008 Summer Study in England Population E 50 Autumm N 40 Spring wave 1 (autumn) wave 3 (spring) Winter wave 4(summer) 2 6 Vitamin D intake(ug/d) Figure 2 Relationship between plasma 25-hydroxyvitamin D concentration and dietary vitamin D intake among older people in the UK at different seasons of the year. Data from Bates et al. (2003)using values from the National Diet and Nutrition Survey: People Aged 65 Years and Over. They are for men and women combined living in the community (n=773). Reproduced from Bates et al. (2003)with permission. 25mnoM(≤10ng/mL)5omo∥(20ngmL) 100 nsf aronNso8 60 002 气气气电气 Figure 1 Vitamin D status in the UK(50 N) Percentage of males(M) and females(F)with a plasma 25-hydroxyvitamin D concentration below(a)25 nmol/L(10 ng/mL)and (b)50 nmol/L(20 ng/mL). From the National Diet and Nutrition Survey 1992-2001, all seasons combined, s-plus a population sample of British Asian Children. I Nutrition Rev 2008 小肠:空肠与回肠 促进肠钙吸收;空肠是回肠的3倍, 给予1,25(OH)2D,均促进小肠的钙吸收,回肠可以达到空肠水平 而且结肠的钙吸收率也明显升高 甲状旁腺:富含维生秦D受体,抑制PTH分泌 骨骼与肌肉 成骨细胞:1,25(0H)2D促进BGP(骨钙秦)生成;刺激骨桥蛋白和 碱性磷酸酶的合成,抑制成骨细胞凋亡 破骨细胞:仅前破骨细胞由维生秦D受体,促进其向成熟破骨细胞 分化 *增强肌力作用 肾脏 *促进钙磷重吸收 *对1a羟化酶和24羟化酶的调节,对机体保护性灭活维生素D 前列腺、大肠、乳腺细胞的分化与増殖 活化的巨噬细胞可产生1,25(oH)2D 免疫系统激活T和B淋巴细胞 70%的多发性硬化症病人