R,ickets,of Vitamin D Deficiency,Crying baby at night,夜哭郎,VitDs Discovery,1650,Francis Glisson found Rickets common among the rich person,1822,reported:Rickets related to lack of sun exposure,1824,found:fish liver oil could treat Rickets,1918,a English man mistake for rickets caused by the lack of VitA,1921,was named VitD,the 4,th,Vit,1936,chemical characteristics of,VitD,ascertained,The course of VitDs discovery is the results of people to fight against rickets,Objective,&,Requirement,Vit Ds source and metabolicprocess,VitD,來源、代謝過程生理功能,Etiology and pathogenesis,發(fā)病機理、病因,Symptoms and signs,各期臨床表現(xiàn),P,revent,ion and Treatment,治療原則和方法,Vit Ds function,生理功能,Definition,Rickets,is the softening and weakening of,bones,(failure to assimilate and use calcium and phosphorus normally,),in,children,usually because of an extreme and prolonged,vitamin D deficiency,.,Where does Vitamin D come from?,A main source of vitamin D is made by our own bodies.,made in the skin by exposure to sunlight,in some foods,:,certainly be helpful,not satisfactory,not a daily dose,Oily fish,Fortified foods:infant formula milk,Egg yolk,liver,and wild mushrooms contain only small quantities of vitamin D.,maternal-fetal tranship,：,infants,The sunshine vitamin,Skin produce vitamin D when exposed to sunlight,10-15 minutes of direct sunlight can generate 10,000 to 20,000 IU,Note,:it is not the same as sunbathing;the skin simply needs to be exposed to sunlight.But,the sunlight has to fall directly on to bare skin(through a window is not enough).,Note,:too much exposure to the suns rays can be damaging.Sunburn should be avoided(it can increase the risk of skin cancer).,absorb more ultraviolet-B(UVB)in the melanin(,黑色素,)of their skin,sunlight,food,25-OHase,1-OHase,feedback regulation,Regulation of Wit D,feedback,：,blood calcium&phosphorus concentration,parathyroidglands and Calcitonin,血鈣、磷濃度與甲狀旁腺、降鈣素,自身反饋作用,Why do we need Vitamin D?,A main action of vitamin D is to help calcium,and phosphorus,in our diet to be absorbed from the,gut,.,Increase,renal,tubular reabsorption of calcium phosphate,especially phosphorus,bone,calcium mobilization:release calcium from old bone,calcium deposites on osteoblast,Calcium and phosphorus are needed to keep bones healthy and strong.,In addition,vitamin D seems to be important for muscles and general health.There is also some evidence that vitamin D may also help to prevent other diseases such as cancer,diabetes and heart disease,Adults:,osteoporosis,hypertension,coronaryheartdisease,immunedisease,diabetes,kidney disease,etc,.,When/Why Vitamin D Deficiency Happen?,Vitamin D deficiency means that there is not enough vitamin D in your body.Broadly speaking,this can occur in three situations:,The body has an increased need for vitamin D,grow too fast,The body is unable to make enough vitamin D,gastrointestinaltract disease,hepatic and gall diseases,medicine,etc,.,Not enough vitamin D is being taken,mother,food,sunlight,Causes of rickets,-,lack of Vitamin D,Sunlight:,children now tend to spend less time outdoors.,日照不足,Food:,breast feeding,食物中補充不足,Need more:,grow rapidly,需要增加,生長速度快,Mothers store of Vit D,:twins,preterm,圍生期不足,Absorption problems:,diseases,drugs:,diarrhea,Inflammatory bowel disease,Cystic fibrosis,Kidney problems,疾病影響,Risk Factors,Age,：,3-36 months,Dark skin,Northern latitudes,Premature birth,Anti-seizure medications,Exclusive breast-feeding,pathogenesis,發(fā)病機制,長骨鈣化帶消失,Diagnosis,:Clinical Stages,Early stage/Initial stage,(,初期,/,早期）,:2y,pillow bald,枕禿,square head,方顱,pressure alopecia,Skeletal changes-,head,Craniotabes,（,顱骨軟化,）,:Ping-Pong-ball sensation is felt,Delayed eruption of milk teeth,（,出牙延遲,）,:,Delayed closure of anterior fontanelle,(,前囟閉合延遲）,:,Rachitic rosary,(,肋骨串珠）,：,Chicken breast,(,雞胸）,:,Funnel breast,（漏斗胸）,：,Harrison groove,(,郝氏溝）,：,Skeletal changes,thorax(chest),Rachitic bracelet,(,手鐲、腳鐲）,Genu varum,(,膝內翻）,knock knees,(O,形腿）,Genu valgum,(,膝外翻）,bow legs,(X,形腿,),Skeletal changes,extremities,Rachitic bracelet,Knock knees,Bow legs,X-ray,cupping and fraying the distal ends of the radius and ulna,The epiphyseal end calcify is disappear,like a cup and brush.The bone become thinning.Greenstick fractures occur in the long bones,there are no clinical symptoms,may be only late in standing and walking.,骨鈣化帶消失，干骺端呈毛刷狀、杯口狀改變,骨質稀疏，骨皮質變薄,可有青枝骨折，而無臨床癥狀,recoveryphase:2-,3 weeks later,恢復期,12 ds treatment:Zones of preparatory calcification,出現(xiàn)不規(guī)則的鈣化線,18 ds treatment:the zones of preparatory calcification are well defined,形成鈣化帶,29 ds:zones of preparatory calcification become dense and shafts have become united,.,鈣化帶致密增厚,Kyphosis,駝背,Scoliosis,脊柱側彎,Skeletal changes,Spinal,colum,The disease is characterized by deformities of the long bones,enlargement of the wrists and costochondral junctions,hypotonia and craniotabes and delayed fontanelle closure.,會坐或站立后，因韌帶松弛可致脊柱畸形,Other,Symptoms and Signs,Poor development and growth:,usually start walking very late,生長發(fā)育落后：,站立、行走晚,Vulnerable to infections,:,especially respiratory system,容易。