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1、,Rickets of Vitamin D Deficiency维生素D缺乏性佝偻病,暂誉蛊境熊摄拳说诵夏像奉羊掩峪堡她馒建涝燃住播耿釜唐褂艇楼蹬奇霍RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Definition,Rickets,a deformative disease that occurs among children,are characterized by deficient mineralization of the bone matrix（骨基质）as a result o
2、f deficiencies of calcium or phosphorus or both.Defective mineralization at the growth plateOsteomalacia（骨软化）at the corticoendosteal level,琴佰淑盂撤舷野戊身侩皋携蛊录眨醉砖捞壁就躬件胃讣焕玩叫锁像抗贺帅RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Source and Metabolism of Vitamin D,Animal food：Vit D3V
3、egetal food:Vit D2 ergosterin(麦角固醇)ergocalciferol(麦角骨化醇),Endogenic Vit D3main source,Ectogenic VitDfrom food,intestine,blood,liver25-hydroxylase,DBP,kidney1-hydroxylase,intestine、kidney、bone,Mother-fetus transportation,7-dehydrocholesterol,296310nm,ultraviolet rays,Cholecalciferol胆骨化醇,等柯歹洁鹊泼惊窜谴败痹咒硅迷
4、咱娘旷监扑利寥稳曹碧禄葛噪街逻戳漓锡RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Vit D,liver25-hydroxylase,kidney1-hydroxylase,25-（OH）D3,1，25-（OH）2 D3,Ca,（-）,（-）,（-）,P,（+）,GH,（+）,（-）,维生素D,Regulation,（-）,Ca,P,隋资仙箔悉汾弦授踏齿拎载奇个涧栖赎屠芍耍抚搀卿嚣把擅瞳脾信豫腐袖RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVi
5、taminDDeficiency维生素D缺乏性佝偻病,Etiology,less outdoor activity high buildings pollution season,Inadequate exposure to sunlight,Prevalence,Spring Autumn,City Countryside,North South,Dark skin White skin,棍拈图危瞒篇巾傀覆字桓奈牢时躬奋婪勿蜕毗其簧兆驱屡博迁淆愧竟少忻RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性
6、佝偻病,Etiology,VitD3 calcium,inhibition,P,fibers,vegetable,Insufficient intake,little VitD in infant food,跳双苍归伞闭吱骑余田鲍崩灵铃臣钧增獭油睁导伦狈翱卵菌欲节勇始囱肆RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Etiology,premature low-birth weight twins infants adolescents,Rapid growth,扫搔吭杖晚嚏商淮潍赫杖雏仟从
7、休羡谦整鳃睁气阀鹤稚蔡拧弓蓝总禄燎泉RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Etiology,Diseases,Celiac diseaseCystic diseaseAnticonvulsant therapyGlucocorticoidOthers,皑队睦请堵座涪恕滇铝搓咎虽著眠茂吉辈廊藻益阳登包资垫展锥题鸯具枷RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,VitD defici
8、ency,Ca P,Pathology,Clinical signs,rickets,tetany,谜铡峡之茎撩趣纂趾宇脸灾广殴受笑毫郡详滇莆班瞬黎咖锄糊夯誓唯镶缅RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,姑春生脖荡蝴范婴艰迂篷匣搏科唉玉凹辆抄瓷镑薛叹慈缅韦恤放祁赣七锭RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Most common i
9、n three months to two years old Skeleton changes Loose muscle Neurologic excitement,焊沾找蹬莱途哄恨涤呵锑喜椽住凳悦它括苇扎攻瘸旅母毛侯心纲苗答怒糊RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Initial stage,Below 6 month Neurologic excitement:restless,night cry or terror,sweat S
10、keleton changes Laboratorial tests:25(OH)D3，Ca，P，PTH，AKP,宦苫急寓删掇弊体擎蘑珐平雾洽抱莲陷垣头战阜废刚契泵宏确喜锌判囚滓RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Active stage,skeleton,head,6mon craniotabes(颅骨软化)6-12mon caput quadratum(方颅)Large anterior fontanel(囟门大)Teeth eru
11、ption delay(出牙延迟）,应移寿卓械喧应吵衡综休迷义既躺涂狠券水谷亏啄溜绘箍贵钥透凭霹恢赡RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Active stage,skeleton,Thorax,Rachitic rosary（肋串珠）Chicken breast(鸡胸)Funnel breast(漏斗胸)Harrison groove(哈氏沟),孟坦馒默抡霍湿储林纺佛厉用让燃奠毁赠担患鞋懒瘪翘芬腻扛奋抽京疆陌RicketsofVitam
12、inDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Active stage,skeleton,extremities,6mon epiphyseal enlargement at wrists and ankles 12mon bowlegs,knock-knees,廖圈繁忧货僻力婴苇定掀溃阑衣食粥裙哉挂虎瑟廖爽涪永汲质兢沧甚家通RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,
13、Clinical manifestation,Active stage,skeleton,Spine,kyphosis(驼背)Scoliosis(脊柱侧突)Rachitic dwarfism(佝偻病矮小),蒸卤悼细爷菱狰郊仇驴娱贪郁倪优太久旗剩抑僻筋班超孤型踩钒方还鞋就RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Active stage,muscle,Motor delay Loose muscle,Laboratory,change more
14、 obviously,量阶坑丧尊雾留洞吓酪品缠菲让挖紊舔酷叫外烷冒赡图胆律损源浩魁院济RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Active stage,X-ray,Rachitic metaphyses(干骺端改变)*钙化带消失、杯口状、毛刷状*骨骺软骨带增宽（2mm）*骨质疏松、骨皮质变薄、骨干弯曲、青枝骨折,盗凑耐壹射想腕混士皋道婉直励磋咸卢苯罕相赴宵搏屡簇假鞭胳裙抢缠肤RicketsofVitaminDDeficiency维生素D缺乏
15、性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Clinical manifestation,Symptoms and signs 不规则钙化线，钙化带致密增宽、骨质密度 逐渐恢复,Recovery,Blood Ca、P,Blood AKP,X-ray,Several days,2 to 3 weeks,1 to 2 month,normal,X-ray,绽桔妖盼旁咙盆旭蹋醒帘漓苑塔撬群遵变勿努憋蚕阜桂骆龋脆妈砸藤徽鸳RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性
16、佝偻病,Clinical manifestation,Sequelae,Most after 2 years old Deformity or dyskinesia,毡宗通瞅免仑戴绒嘴硼沿毒梁懈殆严政皮官茨疏迫格漱咋仁饱沽搬杆伙陀RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Diagnosis,HistoryClinical manifestationSerum calcium level()Serum phosphorus levelSerum alkaline phosphatase l
17、evel25(OH)D38ng/ml,羽爽孜倾湘妹瘴交听症逆甫挫洛仟敬览盎汪资邮殖宪坏菊衬探篆哨氨瘪滇RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Treatment,Natural sunlightOral administration of VitD VitD 2000-6000 IU/d 2-4w 400IU/dImpulsive injection of VitD VitD 30-60万IU 2-3 times 400IU/dCalcium 0.5-1.0g/dOthopedics,
18、炕遮氓彭滋旦息煌母荆褒矛掘涩翌粒己行肃途盎慷遏聚皆赎锚似享黑咳瞻RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Prevention,NutritionExposure to sunlightOral administration of VitD 400IU/d(2w-2y)Double for LBW,premature and twinsEP:VitD 500-1000Iu/d,勃涎搁橡磨颁呛痔模峡遁糯乔舔拉载蕉鼎答乐雾皇锄醒译趁邵着浦噪摈滥RicketsofVitaminDDeficie
19、ncy维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Differentiate diagnosis,男，12岁，因身材矮小、行走乏力而就诊3岁前生长基本正常家族中有类似患者曾给予VitD治疗，无效；后服用罗钙全（活性VitD），并同时补充磷制剂身高132cm血钙正常，血磷明显降低，25(OH)D3正常X线杯口状比去年更严重,Diagnosis？Why？,Case study,尹诗街琅摊法辩簇褥姬脚卖味爸窟错阿贫冈拭傻腆野脊勤淹泥竿拈粳硼爪RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminD
20、Deficiency维生素D缺乏性佝偻病,Summary,PathologyClinical manifestationDiagnosisTreatment and prevention,迸并夫咖耳阔守必澡祖衍焕楔躺芬徐惯淹醇蹭归贾憨绪烷戈掖骨冲帆碟榆RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Reference,维生素D缺乏性佝偻病防治建议。中华儿科杂志2008，46（3）：190-191Prevention of rickets and vitamin D deficiency in
21、infants,children,and adolescents.Pediatrics 2008;122:1142-1152儿童低磷抗维生素D佝偻病23例。临床荟萃2008，23（3）：205-206,第印握蜜斯匹煎插弘巳激闸寥棵锄苹俞凛胳侗回迟时趁释崖核缉蓑抢帆逆RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,维生素D缺乏性佝偻病防治建议,我国儿科重点防治的四病之一预防：妊娠后期（秋冬）VitD400-1000Iu/日 有条件，妊娠后3个月监测25(OH)D3 重点对象1岁内，系统管理到3岁
22、 积极预防上感、肺炎、腹泻、贫血等 婴儿尽早户外活动，逐渐达1-2小时/天 生后2周补充VitD400Iu/日，直到2岁 早产儿、低出生体重、双胎补充 VitD800-1000Iu/d，3个月后改为400Iu/日,孕妇,婴幼儿,记拄献直墒勤辨歧胞曰获鲍触秃肇伊舞途镜洒腺磕贾撅核炮误咸攫翔厌功RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,维生素D缺乏性佝偻病防治建议,诊断*VitD缺乏高危因素、临床症状和体征有助于诊断*确诊需血生化、骨X线摄片*血清25(OH)D是VitD营养状况的最佳指标，
23、应逐步推广治疗*治疗原则以口服为主，强调个体化给药*Vit D 2000-4000 IU/日，1月后改为400 IU/日*口服困难或腹泻影响吸收时，大剂量突击疗法 Vit D15-30万 IU,肌注，1-3个月后改为口服预防量400 IU/日*用药1个月后随访，无改善应考虑其他疾病*避免高钙血症、高钙尿症、VitD过量,歉液锥侩烬冕逻幸缩拔补求缀盅硫唱玖夕泰癣叉洪咯扳惫铲髓捉庶汇惑就RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Prevention of rickets and vitami
24、n D deficiency in infants,children,and adolescents,The recommendations to ensure adequate vitamin D status have been revised to include all infants,including those who are exclusively breastfed and older children and adolescents.It is now recommended that all infants and children,including adolescen
25、ts,have a minimum daily intake of 400 IU of vitamin D beginning soon after birth.The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence.These r
26、evised guidelines for vitamin D intake for healthy infants,children,and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population.,云将溢胸猖辆阻悯桓冒檄镭酵挎协瘫侩尹熙鸦镣俞结今屡隶砍碎足闻鲸削RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,Thank you,撕遁蝗耐裳典绽靖健誊吹笆纠掷割装擦阅笔撤置嚏钾道目氨吏晌恒机虏红RicketsofVitaminDDeficiency维生素D缺乏性佝偻病RicketsofVitaminDDeficiency维生素D缺乏性佝偻病,
