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},
"code": "E50",
"name": "Недостаточность витамина A",
"icd_name": "Недостаточность витамина A",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
0
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"slug": "e50_nedostatochnost_vitamina_a",
"lead": "Это патологическое состояние, возникающее вследствие дефицита в организме этого витамина и проявляющееся ухудшением зрения - в первую очередь гемералопией («куриная» слепота), конъюнктивитом, ксерофтальмией, гиперкератозом кожи. ",
"description": "",
"etiology": "<p>Недостаточность витамина А может быть обусловлена нарушением абсорбции витамина в кишечнике при его хронических заболеваниях, целиакии, болезнях печени и поджелудочной железы, железодефицитной анемии, длительном употреблении минерального масла. При потреблении с пищей небольших количеств жира также снижается абсорбция витамина А.</p>\r\n<p>Причиной недостаточности витамина могут быть и чрезмерные потери его организмом. Так, экскреция витамина А увеличивается при раке, болезнях мочевыводящих путей и хронических инфекционных заболеваниях. Низкое потребление белка приводит к недостаточности белка-переносчика и способствует снижению уровня витамина в плазме.</p>",
"pathogenesis": "",
"diagnostics": "<p>При гиповитаминозе А понижено содержание в крови ретинола или каротина (ниже 200 мкг/л), нарушена темновая адаптация, развивается гемералопия. При биомикроскопии глаза на слизистой конъюнктивы могут выявляться белесые и желтоватые мелкие бляшки.</p>",
"treatment": "<p>азначают диету, богатую витамином А и провитаминами, а также препараты ретинола. Растворы ретинола применяют внутрь и в виде внутримышечных инъекций.</p>\r\n<p>Суточная лечебная доза 25 000-100 000 ME ретинола (при приеме внутрь дозу делят на 2-3 приема, больше одной инъекции в сутки обычно не делают), продолжительность курса лечения 2-4 нед. Ретинол содержится в поливитаминных препаратах.</p>",
"prevention": "<p>Профилактика гиповитаминоза А состоит в рациональном питании и назначении внутрь препаратов ретинола (5000-10 000 ME) в течение не менее 2-3 нед. До и после проведенного профилактического курса целесообразно определить содержание в сыворотке крови ретинола или каротина.</p>",
"clinical_picture": "<p>Наблюдаются сухость в полости рта и носа, <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>, ее <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">шелушение</a>, повышенное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>. Ухудшается сумеречное зрение («куриная» <a href=\"/symptom/slepota/\" title=\"Перейти на страницу симптома Слепота \">слепота</a>). Одновременно возможны <a href=\"/symptom/svetoboyazn/\" title=\"Перейти на страницу симптома Светобоязнь\">светобоязнь</a> (<a href=\"/symptom/glaznaya_bol/\" title=\"Перейти на страницу симптома Глазная боль\">боль в глазах</a> при ярком освещении) и ксерофтальмия (сухость конъюнктивы с утратой присущего ей блеска, снижение секреции слезных желез, появление бляшек Искерского - Бито, разбросанных по склере). В наиболее тяжелых случаях воспалительные процессы в роговице могут осложняться ее некротическим размягчением (кератомаляция), что обычно заканчивается слепотой.</p>\r\n<p>Сочетание гемералопии с ксерофтальмией позволяет с высокой достоверностью думать о недостаточности витамина А.</p>",
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{
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},
{
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},
{
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},
{
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},
{
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},
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},
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{
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},
{
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},
{
"name": "У ребенка болит живот"
},
{
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},
{
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},
{
"name": "Боль под ложечкой"
},
{
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{
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"code": "E51",
"name": "Недостаточность тиамина",
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0
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"lead": "Заболевание протекающее с накоплением в крови и тканях пировиноградной кислоты, нарушением водного, углеводного, белкового и жирового обменов, сопровождающееся расстройством функций нервной системы, ослаблением сердечной деятельности.",
"description": "",
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"pathogenesis": "",
"diagnostics": "<p>Специалист назначает анализ крови и мочи. Для уточнения диагноза используют определение транскетолазной реакции.</p>",
"treatment": "<p>Как правило, терапия проводится амбулаторно. Во всех случаях больному назначается диета. Все продукты должны быть богаты витамином В1. Помимо этого, витамин вводится внутрь или принимается перорально.</p>\r\n<p>Пациентов с более тяжелыми формами болезни направляют в стационар. В этом случае микроэлемент вводят в организм парентерально по 1 мг наряду с кокарбоксилазой. Одновременно назначают другие витамины группы В.</p>",
"prevention": "<p>С целью профилактики медики рекомендуют потреблять пищу, богатую микроэлементами, особенно витамином В1.</p>",
"clinical_picture": "<p>К ранним проявлениям заболевания относят:</p>\r\n<ul>\r\n<li>неприятные ощущения в животе;</li>\r\n<li>ухудшение памяти;</li>\r\n<li>проблемы со сном;</li>\r\n<li>плохой аппетит;</li>\r\n<li>уменьшение веса;</li>\r\n<li><a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>;</li>\r\n<li><a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>.</li>\r\n</ul>\r\n<p>Необходимо своевременно обращаться к врачу при возникновении подобной симптоматики. При несвоевременном обращении к специалисту развивается тяжелый дефицит витамина В1. Впоследствии наблюдаются нарушения работы мозга, сердца, нервной системы. Во всех ситуациях изменяются процессы обмена в эритроцитах, а уровень микроэлемента в моче резко снижается.</p>\r\n<p>Наблюдается <a href=\"/symptom/onemenie_kozhi/\" title=\"Перейти на страницу симптома Онемение кожи\">покалывание</a> в пальцах нижних конечностей, жжение в стопах, которое усиливается в ночное время суток, также возникают судороги в мышцах икр и появляются боли в стопах. Во многих случаях развития болезни вибрационная чувствительность пальцев ног снижена.</p>",
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"code": "E52",
"name": "Недостаточность никотиновой кислоты [пеллагра]",
"icd_name": "Недостаточность никотиновой кислоты [пеллагра]",
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"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме. ",
"description": "При выраженном дефиците развивается пеллагра, в менее тяжелых случаях — гиповитаминоз РР, проявляющийся нарушениями функции нервной системы, кишечника, дистрофическими изменениями кожи.",
"etiology": "<p>• Первичная — недостаток в поступающей пище, например, при преобладании в рационе кукурузы, поскольку витамин РР, хотя и содержится в ней, находится в связанном состоянии и не ассимилируется вЖКТ. Кроме того, белки кукурузы бедны триптофаном, используемого в организме для синтеза эндогенноговитамина РР<br />• Вторичная — обусловлена нарушением всасывания или усвоения витамина РР, а также увеличениемпотребности в нём <br />• Длительная <a href=\"/symptom/diareya/\" title=\"Перейти на страницу симптома Диарея\">диарея</a> <br />• Заболевания печени (чаще всего к недостаточности приводит цирроз)<br />• Алкоголизм<br />• Парентеральное питание без достаточного возмещения витаминов<br />• Злокачественные карциноидные опухоли (увеличивается потребность в триптофане)<br />• Сахарный диабет <br />• Болезнь Хартнапа</p>",
"pathogenesis": "",
"diagnostics": "<p>• Выделение N'-метилникотинамида с мочой менее 4 мг/сут<br />• Снижение содержания никотиновой кислоты<br />• Снижается содержание в крови и моче других витаминов группы В.</p>",
"treatment": "<p>В среднетяжёлых и тяжёлых случаях необходима госпитализация.<br />• Диета. Включение в рацион продуктов, богатых витамином РР (мясо, яйца) и триптофаном (молоко).<br />• Назначение никотиновой кислоты (или никотинамида) от 300 до 1000 мг/сут внутрь в начале лечения привыраженном снижении содержания витамина РР в плазме крови, затем по 300-500 мг.<br />• При заболеваниях ЖКТ никотиновую кислоту (или никоти-намид) вводят парентерально (50-100 мг в/м 2-5раз/сут или 25-100мг <br />• Одновременно назначают по 5 мг тиамина, рибофлавина и пиридоксина.</p>",
"prevention": "<p>• Питание с достаточным содержанием в пищевом рационе продуктов, богатых никотиновой кислотой<br />• При эндогенной форме — своевременная диагностика и лечение заболеваний, нарушающих всасывание иусвоение витамина РР, профилактическое введение препаратов никотиновой кислоты; дополнительноевведение витамина РР лицам с увеличенной в нём потребностью.</p>",
"clinical_picture": "<p>При недостаточности витамина РР возникают нарушения функций кожи, слизистых оболочек, ЖКТ и ЦНС. Характерно наличие трёх Д (дерматит, <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">диарея</a>, <a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">деменция</a>) и поражение слизистых оболочек.<br />• Стадия прегиповитаминоза — неспецифические нарушения (<a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Утомляемость\" href=\"../../../symptom/utomlyaemost/\">утомляемость</a>, <a title=\"Перейти на страницу симптома Снижение аппетита\" href=\"../../../symptom/snizhenie_appetita/\">снижение аппетита</a> ит.д.).<br />• Стадии гипо- и авитаминоза<br />• Дерматит. Поражение кожи может быть четырёх типов. Чаще всего оно симметрично и возникает научастках кожи, подвергающихся солнечному облучению или травматизации (давлению)<br />• Остро возникают кожные проявления в виде пеллагрической эритемы с последующим образованиемпузырьков, пузырей, корочек. Часто присоединяется вторичная инфекция <br />• Поражение кожных складок — <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"../../../symptom/pokrasnenie_kozhi/\">покраснение</a>, мацерация, эрозирование и присоединение вторичнойинфекции</p>\r\n<full></full>\r\n<p><br />• Хронические гипертрофические изменения -кожа утолщена, теряет эластичность, становится складчатой. Отмечают выраженную пигментацию на открытых участках тела и в местах, подвергающихся давлению. Очаги поражения имеют чёткую границу и окружены бордюром восстанавливающегося эпителия<br />• Хронические атрофические изменения кожи с потерей эластичности и шелушением. Характерны длядлительно текущих форм пеллагры. <br />• Поражение слизистых оболочек первично затрагивает ротовую полость, хотя возможно вовлечениеслизистых оболочек влагалища и уретры<br />• Для острой недостаточности характерны <a title=\"Перейти на страницу симптома Глоссит\" href=\"../../../symptom/glossit/\">глоссит</a> и стоматит, причём язык приобретает ярко-краснуюокраску. Первоначально в процесс вовлекаются кончик и края языка, а также участки слизистой оболочки, окружающие выходное отверстие стенбнова протока<br />• Постепенно вовлекается вся слизистая оболочка, язык становится болезненным и отёчным, возникаетгиперсаливация<br />• На поздних стадиях заболевания возникает характерная картина лакового языка (ярко-красный язык сгладкой поверхностью вследствие атрофии сосочков)<br />• Возможно появление язв на слизистой оболочке дна полости рта, нижней губы, а также напротив моляров. <br />• <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">Диарея</a> — самый характерный признак нарушения функций пищеварительной системы. Поражение ЖКТвозникает на поздних стадиях заболевания. Характеризуется появлением чувства жжения слизистой оболочкиполости рта, глотки, пищевода; возникает желудочная <a title=\"Перейти на страницу симптома Диспепсия\" href=\"../../../symptom/dispepsiya/\">диспепсия</a> в виде тошноты, реже рвоты, чтообусловлено атрофическими изменениями слизистой оболочки желудка и возникновением ахилии. Возможнадиарея, чередующийся с запорами. О тяжёлом течении свидетельствует <a title=\"Перейти на страницу симптома Диарея\" href=\"../../../symptom/diareya/\">диарея</a> с прожилками крови врезультате образования эрозий и язв слизистой оболочки кишечника.<br />• <a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">Деменция</a> — самый яркий признак поражения ЦНС; может сопровождаться органическим психозом и/илиэнцефало-патическим синдромом. На ранних стадиях появляется <a title=\"Перейти на страницу симптома Раздражительность и озлобление\" href=\"../../../symptom/razdrazhitelnost_i_ozloblenie/\">раздражительность</a>, возможны признакиполиневрита<br />• Органический <a title=\"Перейти на страницу симптома Психоз\" href=\"../../../symptom/psihoz/\">психоз</a> проявляется галлюцинаторно-параноидной, аффективной симптоматикой, психомоторным возбуждением<br />• Энцефалопатический синдром, характеризующийся затемнением сознания, гипертонусом мышцконечностей, появлением неконтролируемых сосательного и хватательного рефлексов.<br />• На поздних стадиях нарушаются функции эндокринной системы, возникает гипопротеинемия.</p>",
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},
"code": "E53.9",
"name": "Недостаточность витаминов группы B неуточненная",
"icd_name": "Недостаточность витаминов группы B неуточненная",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "e53.9_nedostatochnost_vitaminov_gruppy_b_neutochnennaya",
"lead": "витамины группы В относятся к водорастворимым, соответственно, не могут накапливаться в тканях, поскольку избыток выводится мочевыделительной системой. Исключение составляет витамин В12. Для нормальной жизнедеятельности организма они должны поступать с пищей ежедневно в необходимых количествах, а недостаток ведет к различным нарушениям.",
"description": "<p><span id=\"docs-internal-guid-02f0785a-7fff-e09c-08a1-d7a7c8c623f6\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Витамины группы В отвечают за нормальное функционирование нервной системы, а значит и за психическое здоровье. Они играют немаловажную роль в процессе метаболизма углеводов, способствуют их превращению в глюкозу, которая необходима для поддержания работы мозга. Это способствует улучшению настроения и умственной деятельности.</span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделяют следующие предпосылки дефицита витаминов группы B:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Первичные — экзогенные и алиментарные:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">нарушение принципов рационального питания;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">низкое содержание витаминов в пище;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">голодание и применение несбалансированных диет;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">неправильное хранение и приготовление продуктов, ведущее к дефициту витаминов группы B в них;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">особенности национальной, традиционной или религиозной кухни.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\">Вторичные — эндогенные:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">снижение синтеза витаминов группы B нормальной кишечной микрофлорой из-за заболевания органов ЖКТ, а также дефицит в результате побочного действия лекарственных препаратов, например, из-за приема антибиотиков или химиотерапии;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">снижение всасывания из-за заболеваний ЖКТ — синдром мальабсорбции, болезни печени, генетические поломки;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">наследственные или врожденные дефекты, приводящие к незрелости транспортных форм витаминов группы B;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">наличие внутрикишечных паразитов, которые потребляют поступающие питательные вещества;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">инактивация применяемыми лекарственными препаратами или ксенобиотиками;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">повышенная экскреция из-за заболеваний почек.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кроме того, отдельной группой стоят причины, при которых возникает повышенная потребность в витаминах:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">период интенсивного роста — детский возраст, беременность;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">интенсивные физические и психические нагрузки;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">длительные стрессовые ситуации;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">неблагоприятные факторы окружающей среды — воздействие радионуклидов, тяжелых металлов, пестицидов и других ксенобиотиков.</span></li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для подтверждения диагноза дефицита витамина В используются следующие процедуры:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клинический опрос. В беседе пациенты предъявляют жалобы, характерные для анемического и неврологического синдрома: слабость, головокружения, одышка в сочетании с ощущением онемения и покалывания в ногах, снижением чувствительности в конечностях. В анамнезе может отмечаться приверженность вегетарианству и строгим диетам, недоедание, хронические заболевания кишечника и синдром мальабсорбции.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Общий анализ крови. В результатах анализа определяется сниженный уровень эритроцитов и гемоглобина, гиперхромия, макроцитоз, пойкилоцитоз, лейкопения, тромбоцитопения, лимфоцитоз, сниженное или нормальное количество ретикулоцитов. </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Анализ на витамин B. Исследуется концентрация витамина в сыворотке крови из вены.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделяют два вида коррекции дефицита витаминов группы B: лечебную и профилактическую.</span></p>\r\n<p> </p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечебная тактика подразумевает применение высоких доз витаминов группы B длительными курсами. Коррекция проводится под строгим контролем врача при наличии клинических и лабораторных данных, подтверждающих витаминный дефицит. В настоящее время первичные алиментарные авитаминозы встречаются редко. В основном данная форма дефицита витаминов группы B развивается на фоне патологии желудочно-кишечного тракта или при наследственных нарушениях витаминного обмена. В этом случае прием пероральных форм препаратов не всегда оказывает ожидаемое лечебное воздействие, поэтому некоторым группам пациентов назначается инъекционное введение витаминных поли- или монопрепаратов.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактическая тактика устранения дефицита витаминов группы B подразумевает прием препаратов в дозировке, близкой к суточной потребности. Такая терапия может назначаться и без доказанной витаминной недостаточности.</span></li>\r\n</ul>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Авитаминоз, как многие заболевания и патологические отклонения гораздо проще предупредить, чем впоследствии бороться с их последствиями. Профилактика недостатка витаминов группы В озвучена такими рекомендациями:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Первое - это нормализация и сбалансированность рациона питания. Продукты, поступающие на стол человека должны перекрывать суточную норму всего спектра витаминов, необходимых для здоровой работы организма.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ведение здорового образа жизни. Нет курению, алкоголю и наркотикам.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исключить гиподинамию.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При появлении первых признаков авитаминоза, пересмотреть меню, обратиться за консультацией к диетологу или своему лечащему доктору.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #454343; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Проходить периодические профилактические курсы, пропивая витаминно – минеральные комплексы. Особенно это актуально в весенне - осенний период, во время послеоперационной реабилитации или инфекционного поражения организма.</span></p>\r\n</li>\r\n</ul>",
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},
"code": "E53",
"name": "Недостаточность других витаминов группы B",
"icd_name": "Недостаточность других витаминов группы B",
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3
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"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме и проявляющееся нарушениями преимущественно со стороны нервной системы, сердца и кишечника.",
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"etiology": "<p>Гиповитаминоз B1 в развитых странах встречается нередко и наблюдается в основном у больных с хроническими заболеваниями желудочно-кишечного тракта, хроническим алкоголизмом, полиневритами, эндокринными заболеваниями (сахарный диабет, токсический зоб) и др. Недостаточность тиамина часто сочетается с дефицитом других витаминов группы В.</p>",
"pathogenesis": "<p>Витамин B1 хорошо растворяется в воде; кофермент тиаминдифосфат (кокарбоксилаза) играет существенную роль в углеводном обмене. Наряду с этим тиамин участвует в обмене аминокислот, нуклеотидов, ацетилхолина и холинэстеразы. При дефиците витамина В1 в тканях и крови накапливаются недоокисленные продукты: пировиноградная кислота, молочная кислота и др. При этом нарушается деятельность различных отделов нервной системы (особенно периферической нервной системы), скелетных мышц и миокарда, а также функция желудочно-кишечного тракта.</p>",
"diagnostics": "<p>Диагноз гиповитаминоза B1 подтверждается уменьшением содержания тиамина в крови (в сыворотке ниже 5 мкг/л, в эритроцитах ниже 30 мкг/л), резким повышением концентрации пировиноградной кислоты в крови (выше 0,01 г/л) и моче (выше 30 мг/сут), повышением содержания в крови молочной кислоты (выше 200 мг/л). В последнее время с этой целью используют также ряд более сложных современных методов.</p>",
"treatment": "<p>Лечение больных обычно проводится амбулаторно. Рекомендуется диета, богатая тиамином, в сочетании с препаратами тиамина внутрь (50-100 мг/сут) или парентерально (30-60 мг/сут).</p>\r\n<p>Больные с выраженными формами болезни часто нуждаются в стационарном лечении. Парентерально вводят тиамин по 1 мл и кокарбоксилазу. Одновременно назначают другие витамины группы В (рибоксин, пиридоксин, никотиновая кислота) и аскорбиновую кислоту.</p>",
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"clinical_picture": "<p>Характерны ухудшение аппетита, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, наклонность к запорам, парестезии в ногах, боль в икроножных мышцах при ходьбе, ухудшение сна, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, плаксивость, снижение физической и психической работоспособности. Иногда умеренное похудание, лабильность пульса на фоне общей психоэмоциональной лабильности. Язык суховат, живот нерезко вздут, умеренно снижена болевая и глубокая чувствительность в области стоп и голеней, нерезко ослаблены сухожильные рефлексы (больше на ногах).</p>",
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"description": "Недостаточность аскорбиновой кислоты (гиповитаминоз С) обусловлена дефицитом ее в организме. Тяжелый дефицит ее приводит к развитию цинги.",
"etiology": "<p>Гиповитаминоз С может развиваться при приеме ацетилсалициловой кислоты, эстрогенов, пероральных контрацептивов, а также при алкоголизме, гипертиреозе, проведении гемодиализа.</p>",
"pathogenesis": "<p>Аскорбиновая кислота играет важную роль в окислительно-восстановительных процессах, углеводном обмене, оказывает универсальное влияние на проницаемость сосудистой стенки, развитие и функцию костной, хрящевой ткани, кожи, надпочечников и других органов. Недостаток аскорбиновой кислоты со временем приводит к угнетению Т-системы иммунитета, что способствует развитию инфекционных осложнений.</p>",
"diagnostics": "<p>Важное значение особенно в I стадии заболевания имеет определение экскреции аскорбиновой кислоты с мочой.</p>\r\n<p>Во II и III стадиях цинги клиническая симптоматика (гингивит, стоматит, выпадение зубов, распространенные петехиальные сыпи и кровоизлияния под кожу в мышцы, суставы, остеопороз и др.) в сочетании с анамнестическими данными о неполноценном питании дает возможность установить правильный диагноз.</p>",
"treatment": "<p>Лечение больных цингой в I стадии можно проводить амбулаторно. Назначают аскорбиновую кислоту по 0,1 г 3—5 раз в сутки. При ухудшенном всасывании витамина С его вводят внутримышечно по 1—2 мл 5% раствора. Одновременно назначают витамин Р (рутин, кверцетин и др.) 100—150 мг/сут. <br />Больные с II и III стадиями цинги должны лечиться в стационаре. Им показана диета, богатая белками (до 120—150 г/сут). При цинге II стадии суточная доза аскорбиновой кислоты должна быть не менее 500 мг, при III стадии — 1000 мг, при этом не менее 1/3 дозы следует вводить парентерально.</p>\r\n<p>Эффективно введение в вену 1—2 мл 5% раствора аскорбината натрия вместе с глюкозой. Назначают также витамины Р (150—300 мг), B1 (20 мг), рибофлавин (10 мг). Активную витаминотерапию проводят не менее месяца, затем дозы постепенно снижают.</p>",
"prevention": "",
"clinical_picture": "<p>К I стадии цинги относят случаи, характеризующиеся умеренной слабостью, болью в ногах, повышенной кровоточивостью, цинготной пурпурой, нерезким гингивитом; трудоспособность снижена умеренно.</p>\r\n<p>Во II стадии геморрагии приобретают распространенный характер. Отмечается геморрагический <a href=\"/symptom/vypot/\" title=\"Перейти на страницу симптома Выпот\">выпот</a> в суставы, плевру. Гингивит и стоматит резко выражены; у больных повышается температура. Они нуждаются в стационарном лечении.</p>\r\n<p>Стадия III характеризуется тяжелым общим состоянием больных, резким исхуданием, дальнейшим нарастанием кровоточивости, анемизации, возникновением долго незаживающих язв конечностей, развитием инфекционных осложнений (пневмонии, туберкулез, дизентерия, <a href=\"/symptom/sistemnoe_vospalenie/\" title=\"Перейти на страницу симптома Системное воспаление\">сепсис</a> одонтогенный и др.).</p>",
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"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рахит — это заболевание, которое возникает при нарушениях обмена фосфора и кальция, из-за чего растущая костная ткань не минерализируется. Болезнью страдают только дети, преимущественно грудного и раннего возраста.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причины рахита</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Недоношенность. В последние месяцы беременности к плоду максимально поступает кальций и фосфор, поэтому недоношенные дети попадают в группу риска развития рахита с вероятностью до 80%.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Неправильное вскармливание. В группу риска попадают дети на искусственном или нерациональном вскармливании, при котором в организм с пищей поступает недостаточное количество кальция и фосфора, витамина А, В, микроэлементов, с однообразным белковым или липидным рационом.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Недостаток минералов, вызванный их повышенной потребностью в период интенсивного роста организма.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение транспортировки кальция и фосфора в ЖКТ, почках и костях, что вызвано незрелостью ферментных систем, патологиями развития или нарушениями в работе указанных органов.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Особенности экологии, когда в окружающей среде содержится избыток хрома, железа, стронция, солей свинца или, наоборот, обнаруживается дефицит магния.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Половые особенности. По статистике к развитию рахита больше предрасположены мальчики, они же и переносят его тяжелее, чем девочки.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дефицит витамина D.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эндокринные нарушения, например, поражение щитовидной или паращитовидных желез.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Генетическая предрасположенность.</span></li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамин D поступает в организм с едой и пищевыми добавками, а также образуется в коже под воздействием солнечного света. Чтобы поступивший из пищи витамин D стал активным, ему предстоит пройти две последовательные реакции окисления:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">первая реакция протекает в печени, в результате образуется кальцидиол;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">вторая реакция проходит в почках и завершается выработкой активной формы — кальцитриола.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кальцитриол контролирует обмен кальция в организме. При низкой концентрации ионов кальция он способствует его мобилизации из костной ткани. Также кальцитриол повышает содержание кальция и фосфора во внеклеточной жидкости, что укрепляет растущие кости.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В метаболизме витамина D важная роль принадлежит паратгормону — гормону паращитовидной железы. При дефиците витамина D развивается гипокальциемия, из-за чего избыточно вырабатывается паратгормон, что ведёт к потере фосфора и снижает отложение кальция в костях.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На начальной стадии рахита снижается концентрация кальция в сыворотке крови. При этом активируется паратгормон, что возвращает уровень кальция в норму, но содержание фосфора остаётся низким. Щелочная фосфатаза просачивается во внеклеточную жидкость, её концентрация повышается от умеренной до очень высокой. </span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Щелочная фосфатаза вырабатывается остеобластами — сверхактивными клетками костной ткани, играющими важную роль в её формировании и обновлении. Чем выше их активность, тем больше концентрация щелочной фосфатазы в крови, поэтому её уровень высок после переломов.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ди­аг­ноз ра­хи­та устанавливается на основании клинических признаков, подтвержденных лабо­ра­тор­ными и рент­ге­но­ло­ги­че­скими данными. Для уточнения степени нарушения минерального обмена проводится биохимическое исследование крови и мочи. Важнейшими лабораторными признаками, позволяющими думать о рахите, служат гипокаль­ци­е­мия и ги­по­фос­фа­те­мия; увеличение ак­тив­но­сти щелочной фосфатазы; снижение уровня ли­мон­ной ки­с­ло­ты, каль­ци­ди­о­ла и каль­ци­т­ри­о­ла. При исследовании КОС крови выявляется аци­доз. Изменения в анализах мочи характеризуются гипераминоа­ци­ду­рией, ги­пер­фос­фа­ту­рией, ги­по­каль­ци­у­рией. Про­ба Сул­ковича при рахите от­ри­ца­тель­ная.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При рентгенографии трубчатых костей выявляются характерные для рахита изменения: бокаловидное расширение метафизов, нечеткость гра­ниц ме­ж­ду ме­та­фи­зом и эпи­фи­зом, ис­тон­че­ние кор­ко­во­го слоя диа­фи­зов, неотчетливая визуализация ядер око­сте­не­ния, остеопороз. Для оценки состояния костной ткани может использоваться денситометрия и КТ трубчатых костей. Проведение рентгенографии позвоночника, ребер, черепа, нецелесообразно ввиду выраженности и специфичности в них клинических изменений.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Комплексная медицинская помощь ребенку с рахитом складывается из организации правильного режима дня, рационального питания, медикаментозной и немедикаментозной терапии. Детям, страдающим рахитом, необходимы ежедневное пребывание на свежем воздухе в течение 2-3 часов, достаточная инсоляция, более раннее введение прикорма, закаливающие процедуры (воздушные ванны, обтирания). Важное значение имеет правильное питание кормящей мамы с приемом витаминно-минеральных комплексов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфическая терапия рахита требует назначения витамина D в лечебных дозах в зависимости от степени тяжести заболевания: при I ст. – в суточной дозе 1000-1500 МЕ (курс 30 дней), при II - 2000-2500 МЕ (курс 30 дней); при III - 3000-4000 МЕ (курс – 45 дней). После окончания основного курса витамин D назначается в профилактической дозе (100-200 МЕ/сут.). Лечение рахита следует проводить под контролем пробы Сулковича и биохимических маркеров для исключения развития гипервитаминоза D. Поскольку при рахите часто отмечается полигиповитаминоз, детям показан прием мультивитаминных комплексов, препаратов кальция, фосфора.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Неспецифическое лечение рахита включает массаж с элементами ЛФК, общее УФО, бальнеотерапию (хвойные и хлоридно-натриевые ванны), аппликации парафина и лечебных грязей.</span></p>\r\n<p><span id=\"docs-internal-guid-d860e7dd-7fff-b1ab-cc79-4480cb9d89a6\"> </span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактику рахита нужно начинать ещё до рождения ребёнка. Пища беременной женщины должна содержать достаточно калорий, белков, жиров, углеводов, минеральных солей и витаминов. Обязательны прогулки на свежем воздухе и здоровый образ жизни. Специфическая профилактика в этом периоде заключается в приёме витамина D. Учитывая, что в России часто встречается его дефицит, всем женщинам, готовящимся к зачатию, желательно получать витамин D в профилактических дозах (не менее 600–800 МЕ витамина D в сутки). При наступлении беременности дозу увеличивают до 800–1200 МЕ в сутки.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постнатальная профилактика рахита начинается сразу после рождения ребёнка. Предпочтительнее естественное вскармливание, но важно своевременно ввести прикорм. Также нужно заниматься гимнастикой, принимать воздушные ванны, проводить массаж, водные процедуры, гулять на свежем воздухе и поддерживать положительный эмоциональный тонус ребёнка.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфическая профилактика рахита заключается в приёме витамина D.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Начальный период рахита приходится на 2-3-й месяцы жизни ребенка, а у недоношенных детей - на середину или конец 1-го месяца жизни. Первичная симптоматика незначительна, поэтому зачастую не привлекает внимания родителей. Ранними признаками рахита служат:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">беспокойство, гипервозбудимость,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">тревожный сон, частые вздрагивания во сне,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">плохой аппетит,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">потливость, особенно в области волосистой части головы (пот имеет специфический кислый запах),</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">появление стойких опрелостей,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">мышечная гипотония,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">большой размер родничка, очаговое размягчение затылочных костей,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">на голове появляется четкий рисунок подкожных вен,</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">стул неустойчивый, моча приобретает резкий запах аммиака.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Продолжительность начального периода рахита составляет от 1 до 3 месяцев.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В период разгара заболевания, который обычно приходится на 5-6-й месяцы жизни, отмечается прогрессирование остеомаляции. Об остром течении рахита могут говорить следующие признаки:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">медленный набор веса и роста;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">«олимпийский» лоб (увеличение лобных бугров);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">реберные «четки» (полушаровидное утолщение в месте перехода хрящевой части ребра в костную);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">дугообразная впадина под ребрами – Гаррисонова борозда;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">деформация грудной клетки в виде «куриной груди» (килевидная грудная клетка) или «груди сапожника» (воронкообразная грудная клетка);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">формирование кифоза («рахитического горба»);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рахитические «браслетики» на лучезапястных суставах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">«нити жемчуга» (утолщения в области фаланг пальцев);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">О и Х-образное искривление нижних конечностей, плоскостопие из-за слабости мышц и связок;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">деформация костей таза (плоский таз);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выпуклый («лягушачий») живот;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">позднее прорезывание зубов, дефекты эмали и кариес молочных, а позже и коренных зубов;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">задержка психомоторного развития: неспособность удерживать голову, сидеть, стоять, ползать, ходить.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кроме костных деформаций, рахит сопровождается увеличением печени и селезенки, выраженной анемией.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
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"name": "Болит голова"
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},
"code": "E55.9",
"name": "Недостаточность витамина D неуточненная",
"icd_name": "Недостаточность витамина D неуточненная",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "e55.9_nedostatochnost_vitamina_d_neutochnennaya",
"lead": "микронутриентная недостаточность, приводящая к нарушению фосфорно-кальциевого обмена, противоинфекционного и противоопухолевого иммунитета, репродуктивных функций",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Жирорастворимый витамин D присутствует в организме в двух основных формах: D2 поступает исключительно с пищей, D3 синтезируется в коже под воздействием УФ-лучей и содержится в пищевых продуктах. Дефицит микронутриента развивается по причине его недостаточного эндогенного синтеза или экзогенного поступления, чему способствуют:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Климатические условия. Географически большая часть территории РФ расположена в северной широте. Ограниченное количество солнечных дней в году и низкие температуры в осенне-зимний период приводят к тому, что с ноября по март эндогенный витамин D в коже практически не вырабатывается. Применение солнцезащитных кремов снижает синтез витамина D более чем на 90%.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Особенности диеты. Риск витаминодефицита повышен у пациентов с лактазной недостаточностью, аллергией на молочный белок. В группе риска – приверженцы вегетарианства, лица с однообразным питанием, в рационе которых отсутствует жирная рыба, молочные продукты, яйца, грибы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение всасывания и метаболизма. Формированию гиповитаминоза D способствует мальабсорбция жиров, наблюдаемая у пациентов с НЯК, болезнью Крона, целиакией, муковисцидозом, лучевым энтероколитом. С аналогичной проблемой сталкиваются лица, перенесшие бариатрическое вмешательство.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Повышенный расход микронутриента. Увеличение потери белка, связанного с 25(OH)D, отмечается при нефротическом синдроме. Ускорение катаболизма витамина D вызывает прием антиконвульсантов, ГКС, антиретровирусных препаратов. Усиленное расходование запасов нутриента отмечается при гранулематозном поражении легких (саркоидозе, туберкулезе, бериллиозе), грибковых инфекциях (кокцидиомикозе, гистоплазмозе).</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дефекты гена рецептора витамина Д. Снижение чувствительности к витамину в ряде случаев может быть вызвано генетическими мутациями гена VDR на хромосоме 12q12-q14. При дефектах VDR нарушается связывание одноименного белка с витамином D, вследствие чего страдает кальциевый обмен. Данное состояние проявляется витамин D-резистентным рахитом, патологическими переломами, первичным гиперпаратиреозом.</span></li>\r\n<li></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Факторы риска</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Определенные состояния и заболевания ассоциированы с более высоким риском дефицита витамина D. К категории лиц, в первую очередь нуждающихся в проведении биохимического скрининга, относятся:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">беременные и кормящие: особенно при наличии гестационного диабета, ожирения, отказе от профилактического приема добавок витамина D;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пожилые люди: у лиц старше 65 лет отмечается 4-кратное снижение синтеза эндогенного витамина D;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">темнокожие: меланин защищает кожу от солнечной инсоляции и снижает способность к синтезу холекальциферола;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пациенты с хроническими заболеваниями: ХПН, нарушениями всасывания, ожирением, легочными инфекциями.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основным методом распознавания дефицита витамина D служит определение его сывороточного уровня. Результаты анализа интерпретируются в совокупности с жалобами и объективными данными. Обследование, назначаемое врачом-терапевтом, включает.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исследование уровня витамина D. Скрининговым анализом является определение концентрации 25(OH)D (референсные значения 30-100 нг/мл). Кроме этого, может потребоваться проведение комплексного анализа на витамины D2 и D3, метаболиты витамина.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие анализы. Для получения полной картины состояния минерального обмена целесообразно определение сывороточного кальция, фосфора, магния, ПТГ, остазы. Исключить D-резистентный рахит позволяет выявление мутаций гена рецептора витамина D.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исследование костной системы. При скелетных деформациях и переломах показана рентгенография трубчатых костей, костей черепа, таза, позвоночника, грудной клетки. Для исследования минеральной плотности костной ткани выполняется ультразвуковая или рентгеновская остеоденситометрия.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основными направлениями коррекции гиповитаминоза Д являются пересмотр рациона питания и прием витаминных препаратов. С пациентами, имеющими дефицит витамина D, работают нутрициологи, эндокринологи. В рамках консервативной терапии показаны:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диетотерапия. Пищевыми источниками микронутриента служат рыба (лосось, сельдь, тунец, сардина, макрель), молоко, сливочное масло, сметана, яичный желток, грибы, говяжья печень. Однако суточная потребность в витамине, как правило, не покрывается только диетой, особенно при нарушении функции печени, почек, мальабсорбции.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Прием препаратов витамина D. Является обязательным компонентом терапии дефицита витамина D. Применяются препараты в форме холекальциферола (D3) и эргокальциферола (D2). Доза и длительность приема зависит от возраста, выраженности витаминодефицита, сопутствующих состояний, климатических условий. Сначала препараты назначаются в насыщающих дозах, затем – в поддерживающих. При необходимости используются кальцийсодержащие добавки.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Физическая реабилитация. При рахите рекомендован массаж с элементами лечебной гимнастики, общее УФО. Полезны морские и хвойные ванны. Методы восстановительного лечения взрослых с последствиями дефицита витамина D включают двигательную реабилитацию: ЛФК, дозированную ходьбу, гидрокинезотерапию. Проводится массаж, озонотерапия, электрофорез, миостимуляция, ультразвуковая терапия.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<p><span id=\"docs-internal-guid-9d6129a0-7fff-2253-1d80-4b58c203e7f9\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В качестве профилактики гиповитаминоза D рекомендуется пребывание на солнце в теплое время года в течение 5-15 минут дважды в день без использования солнцезащитного крема. Целесообразно ежедневное употребление продуктов, обогащенных витамином D, профилактический прием препаратов микронутриента с октября по март включительно.</span></span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациенты с дефицитом витамина D могут предъявлять различные жалобы, многие из которых являются неспецифическими:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение физической выносливости, общая слабость даже при достаточном объёме сна;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">мышечная слабость, особенно в области шеи, плечевого и тазoвого пояса, бедра, лопаточной области;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">спазмы в мышцах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли в суставах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">диффузные боли в мышцах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушение равновесия;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">хроническая боль;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">плохая концентрация внимания;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">головные боли;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">перепады настроения, беспокойство или депрессия;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">нарушения сна (неполноценный беспокойный сон);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">повышенная потливость;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">повышенное артериальное давление;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">набор веса;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">сухость кожи;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выпадение волос;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">частые простудные заболевания;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">плохое заживление ран.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Костные проявления дефицита витамина D: недостаток витамина D отрицательно сказывается на обмене кальция и фосфора, поэтому основными проявлениями дефицита витамина D у детей являются рахит. Остеомаляция (размягчение костей) и остеопороз (разряжение костной ткани) чаще проявляются у взрослых.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Рахит (снижение образования костной ткани) — это нарушение минерализации растущей кости из-за несоответствия между потребностями организма ребёнка в фосфоре и кальции и недостаточностью систем их доставки в организм.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Остеомаляция (размягчение кости) — это нарушение минерализации уже созревшей костной ткани после завершения её роста.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Остеопороз (хрупкость, ломкость костей у взрослых) — заболевание, при котором происходит снижение костной массы из-за образования дефектов в органическом каркасе кости, что приводит к повышенной ломкости костей и склонности к переломам.</span></li>\r\n</ul>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": 6257,
"block_rubric": 50,
"standards": []
}
]
}
