湘雅儿科课件-rickets of vitd deficiency（可编辑）

湘雅儿科课件RICKETSOFVITDDEFICIENCY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2PURPOSEBEFAMILIARWITHETIOLOGYANDPATHOGENESISOFRICKITSANDTETANYOFVITAMINDDEFICIENCYTOMASTERTHEIRCLINICALMANIFESTATIONS,DIAGNOSIS,TREATMENTANDPREVENTIONTOUNDERSTANDTHEIRDIFFERENTIALDIAGNOSISDEFINITIONRICKETSISAVERYCOMMONNUTRITIONALDEFICIENTDISEASEINYOUNGCHILDRENESPECIALLYUNDERTWOYEARSOLDOFAGEVITDDEFICIENCYCAUSERICKETS,AMETABOLICDISORDEROFCALCIUMANDPHOSPHORUSWITHAFAILURETOMINERALIZEOSTEOIDTISSUEOFGROWINGBONERESULTINGINBONYDEFORMITIES皮肤中7脱氢胆固醇主要7DEHYDROCHOLESTEROL食物中摄取麦角固醇次要PLANTERGOSTEROLVITD2ORIGINATESOFVITD紫外线照射ULTRAVIOLET内源性VITD31,25OH2D3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INGESTEDFROMFOODHUMANSKINCONTAINS7DEHYDROCHOLESTEROLULTRAVIOLETRAIRRADIATIONVITD3LIVER25HYDROXYLASEKIDNEY1HYDROXYLASE1,25OH2D31,25DIHYDROXYCHOLECALCIFEROLMETABOLISMOFVITD25OHD325DIHYDROXYCHOLECALCIFEROLVITDLIVER25OHD3HYPOSERUMPHYPERSERUMPKIDNEYPTHCALCITONINHYPOSERUMCAHYPERSERUMCA1,25OH2D3REGULATIONOFMETABOLISMOFVITD3病因ETIOLOGY日光照射不足LACKOFSUNSHINE摄入不足UNDERFEEDING生长过快RAPIDGROWTH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400800IU/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VITDDEFICIENCYDISTURBANCEOFCALCIFICATIONOFOSTEOIDTISSUEDECALCIFICATIONOFSKELETONDIMINISHEDABSORPTIONOFCAANDPFROMINTESTINEAFALLOFSERUMCACOMPENSATORYFUNCTIONOFPARATHYROIDPROLIFERATIONOFOSTEOIDTISSUEINCREASEDINSUFFICIENTPATHOGENESISRACHITICMETAPHASESANDSOFTENSHAFTEXCRETIONOFURINEPINCREASEDINCREASEDDECALCIFICATIONOFOLDBONECAOFOLDBONECANTBEMOBILIZEDSERUMCADECREASEDAFALLOFSERUMPSERUMCAREMAINNORMALORSLIGHTLYLOWEREDRACHITICTETANYCAPPRODUCTDECREASEDRICKETSPATHOGENESIS初期THEEARLYSTAGE年龄3MONTHS症状神经精神症状NEUROPSYCHICSYMPTOMS体征枕秃THELOSSOFHAIRINTHEOCCIPITALPOSITION生化改变CANORMAL,PNORMALOR,CAP,AKPX线NOOBVIOUSSKELETALCHANGES临床表现CLINICALMANIFESTATIONS枕秃THELOSSOFHAIRINTHEOCCIPITALPOSITION激期THEADVANCEDSTAGE症状和体征生化改变CA,PCAP30,AKPX线CLINICALMANIFESTATIONS方颅SQUAREHEAD肋骨串珠RACHITICROSARY漏斗胸FUNNELBREAST赫氏沟HARRISONGROOVES脊柱弯曲SPINALCOLUMN鸡胸CHICKENBREAST猫背CATBACK手镯BRACELETSOFHANDSO型腿BOWLEGSX型腿KNOCKKNEESCLINICALMANIFESTATIONS恢复期RECOVEREDSTAGEOFRICKETS症状THESEBECOMESUBSIDED体征生化CAANDPRETURNTONORMALCAPRETURNSTONORMALAKPMAYBERETURNSLOWLYTONORMALX线ITRETURNSTONORMALAFTER2TO3WEEKS后遗症期SEQUELASTAGEOFRICKETS年龄MORETHAN2YEARSOLD症状WITHOUTANYCLINICALSYMPTOMS体征INSEVERECASETHEDEFORMITIESOFBONESMAYREMAIN生化ALLTHESERUMLEVELOFCA,PANDAKPARENORMALX线CLINICALMANIFESTATIONS诊断DIAGNOSIS病史症状尤其注意早期症状骨骼改变注意年龄不同而出现的骨骼畸形有所不同实验室检查结合年龄、季节做出综合判断鉴别诊断DIFFERENTIALDIAGNOSIS先天性甲低CONGENTALHYPOTHYROIDISM骨软骨营养不良ACHONDROPLASIA脑积水HYDROCEPHALUSVITD抵抗性佝偻病VITDRESITANTRICKETS先天性甲状腺功能低下CONGENTALHYPOTHYROIDISM骨软骨营养不良ACHONDROPLASIA脑积水HYDROCEPHALUS治疗T