营养性佝偻病
Nutritional rickets.
作者信息
Ozkan Behzat
机构信息
Atatürk University, Faculty of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey.
出版信息
J Clin Res Pediatr Endocrinol. 2010;2(4):137-43. doi: 10.4274/jcrpe.v2i4.137. Epub 2010 Nov 1.
Nutritional rickets (NR) is still the most common form of growing bone disease despite the efforts of health care providers to reduce the incidence of the disease. Today, it is well known that the etiology of NR ranges from isolated vitamin D deficiency (VDD) to isolated calcium deficiency. In Turkey, almost all NR cases result from VDD. Recent evidence suggests that in addition to its short- or long-term effects on skeletal development, VDD during infancy may predispose the patient to diseases such as diabetes mellitus, cancer and multiple sclerosis. Among the factors responsible for the high prevalence of VDD in developing countries and its resurgence in developed countries is limited sunshine exposure due to individuals' spending more time indoors (watching television and working on computer) or avoiding sun exposure intentionally for fear of skin cancer. Traditional clothing (covering the entire body except the face and hands) further limits the exposure time to sunlight and, thus, decreases the endogenous synthesis of vitamin D. In Turkey, maternal VDD and exclusive breastfeeding without supplementation were reported to be the most prominent reasons leading to NR. The diagnosis of NR is established by a thorough history and physical examination and confirmed by laboratory evaluation. Recent reports draw attention to the supplemental doses of vitamin D required to achieve a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l) - the serum concentration that is needed to optimize absorption of dietary calcium and to suppress excessive secretion of parathyroid hormone. This type of prevention will also reduce fracture risk as well as prevent long-term negative effect of vitamin D insufficiency.
尽管医疗保健人员努力降低营养性佝偻病(NR)的发病率,但它仍是最常见的儿童骨骼疾病形式。如今,众所周知,NR的病因范围从单纯维生素D缺乏(VDD)到单纯钙缺乏。在土耳其,几乎所有NR病例都由VDD导致。最近的证据表明,除了对骨骼发育有短期或长期影响外,婴儿期的VDD可能使患者易患糖尿病、癌症和多发性硬化症等疾病。在发展中国家VDD高发及其在发达国家再度出现的原因中,有个人在室内待的时间更长(看电视和使用电脑工作)或因害怕皮肤癌而刻意避免阳光照射导致的阳光暴露受限。传统服装(覆盖除面部和手部以外的全身)进一步限制了阳光照射时间,从而减少了维生素D的内源性合成。在土耳其,据报道母亲VDD和纯母乳喂养且不补充维生素是导致NR的最主要原因。NR的诊断通过全面的病史和体格检查确定,并通过实验室评估证实。最近的报告提请注意达到血清25-羟基维生素D水平至少20 ng/ml(50 nmol/l)所需的维生素D补充剂量,这是优化膳食钙吸收和抑制甲状旁腺激素过度分泌所需的血清浓度。这种预防措施还将降低骨折风险,并防止维生素D不足的长期负面影响。