Atherton K, Berry D J, Parsons T, Macfarlane G J, Power C, Hyppönen E
MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK.
Ann Rheum Dis. 2009 Jun;68(6):817-22. doi: 10.1136/ard.2008.090456. Epub 2008 Aug 12.
Identified aetiological factors for chronic widespread pain (CWP) are largely related to emotional and behavioural factors, but current management leads to modest improvement in symptoms. Vitamin D deficiency has been suggested as a new modifiable risk factor for CWP.
To examine the association between vitamin D status (measured by 25-hydroxyvitamin D (25(OH)D)) and CWP in a nationwide population sample of white British adults, accounting for potential mediating and confounding lifestyle factors.
9377 participants born 1 week in March 1958, in England, Scotland or Wales and completing a biomedical assessment at age 45; 6824 eligible participants had data on 25(OH)D and completed pain manikins.
Prevalence of CWP varied by 25(OH)D concentration in women but not in men, with the lowest prevalence observed for women with 75-99 nmol/l (14.4% for <25 nmol/l, 14.8% for 25-49 nmol/l, 11.6% for 50-74 nmo/l, 8.2% for 75-99 nmol/l and 9.8% for participants with > or =100 nmol/l). There was an interaction between 25(OH)D concentration and gender in relation to CWP (interaction, p = 0.006), which was not fully explained by differences in lifestyle or social factors (adjusted interaction, p = 0.03). For women, the association between 25(OH)D concentration and CWP persisted after full adjustment (odds ratio (OR) for <75 nmol/l vs 75-99 nmol/l 1.57, 95% CI 1.09 to 2.26), while no evidence for an association was apparent in men (OR = 1.03, 95% CI 0.75 to 1.43).
Current vitamin D status was associated with CWP in women but not in men. Follow-up studies are needed to evaluate whether higher vitamin D intake might have beneficial effects on the risk of CWP.
已确定的慢性广泛性疼痛（CWP）病因大多与情绪和行为因素有关，但目前的治疗只能使症状有适度改善。维生素D缺乏被认为是CWP一个新的可改变的风险因素。
在一个全国性的英国白人成年人群样本中，研究维生素D状态（通过25-羟基维生素D（25(OH)D）测量）与CWP之间的关联，同时考虑潜在的中介和混杂生活方式因素。
9377名参与者于1958年3月的某一周出生在英格兰、苏格兰或威尔士，并在45岁时完成了一次生物医学评估；6824名符合条件的参与者有25(OH)D的数据并完成了疼痛模拟评分。
CWP的患病率在女性中随25(OH)D浓度而变化，在男性中则不然，25(OH)D浓度为75 - 99 nmol/l的女性患病率最低（<25 nmol/l的女性患病率为14.4%，25 - 49 nmol/l的为14.8%，50 - 74 nmol/l的为11.6%，75 - 99 nmol/l的为8.2%，≥100 nmol/l的参与者为9.8%）。在CWP方面，25(OH)D浓度与性别之间存在交互作用（交互作用，p = 0.006），生活方式或社会因素的差异并未完全解释这一现象（校正后的交互作用，p = 0.03）。对于女性，在完全校正后，25(OH)D浓度与CWP之间的关联仍然存在（<75 nmol/l与75 - 99 nmol/l相比的优势比（OR）为1.57，95%置信区间为1.09至2.26），而在男性中未发现明显关联证据（OR = 1.03，95%置信区间为0.75至1.43）。
目前的维生素D状态与女性的CWP有关，与男性无关。需要进行后续研究以评估更高的维生素D摄入量是否可能对CWP风险产生有益影响。
