MS Center, Department of Neurology, University of California, San Francisco, San Francisco, CA 94117, USA.
Ann Neurol. 2010 May;67(5):618-24. doi: 10.1002/ana.21972.
We sought to determine if vitamin D status, a risk factor for multiple sclerosis, is associated with the rate of subsequent clinical relapses in pediatric-onset multiple sclerosis.
This is a retrospective study of patients with pediatric-onset multiple sclerosis or clinically isolated syndrome who were consecutively recruited into a prospective cohort at their clinical visit at the pediatric multiple sclerosis center of University of California, San Francisco or State University of New York at Stony Brook. Of 171 eligible patients, 134 (78%) with multiple sclerosis/clinically isolated syndrome were included in the cohort; a further 24 were excluded from this analysis due to lack of available serum (n = 7) or lack of follow-up (n = 17). Serum 25-hydroxyvitamin D(3) levels were measured and were adjusted to reflect a deseasonalized value. The adjusted serum 25-hydroxyvitamin D(3) level was the primary predictor in a multivariate negative binomial regression model in which the main outcome measure was the number of subsequent relapses.
Among the 110 subjects, the mean unadjusted 25-hydroxyvitamin D(3) level was 22 +/- 9 ng/ml. After adjustment for age, gender, race, ethnicity, disease duration, disease-modifying therapy, and length of follow-up, every 10 ng/ml increase in the adjusted 25-hydroxyvitamin D(3) level was associated with a 34% decrease in the rate of subsequent relapses (incidence rate ratio, 0.66; 95% confidence interval, 0.46-0.95; p = 0.024).
Lower serum 25-hydroxyvitamin D(3) levels are associated with a substantially increased subsequent relapse rate in pediatric-onset multiple sclerosis or clinically isolated syndrome, providing rationale for a randomized controlled trial of vitamin D supplementation.
我们旨在探究维生素 D 状态（多发性硬化症的一个风险因素）是否与儿科发病型多发性硬化症患者的后续临床复发率相关。
这是一项回顾性研究，研究对象为在加利福尼亚大学旧金山分校儿科多发性硬化症中心或纽约州立大学石溪分校临床就诊时连续招募到前瞻性队列中的儿科发病型多发性硬化症或临床孤立综合征患者。在 171 名符合条件的患者中，有 134 名（78%）多发性硬化症/临床孤立综合征患者被纳入队列；由于缺乏可用血清（n=7）或缺乏随访（n=17），另有 24 名患者被排除在此分析之外。测量血清 25-羟维生素 D（3）水平，并对其进行调整以反映去季节性值。调整后的血清 25-羟维生素 D（3）水平是多元负二项回归模型中的主要预测因子，主要结局指标为随后的复发次数。
在 110 名受试者中，未经调整的平均 25-羟维生素 D（3）水平为 22±9ng/ml。在校正年龄、性别、种族、民族、疾病持续时间、疾病修正治疗和随访时间后，调整后的 25-羟维生素 D（3）水平每增加 10ng/ml，随后的复发率降低 34%（发病率比，0.66；95%置信区间，0.46-0.95；p=0.024）。
血清 25-羟维生素 D（3）水平较低与儿科发病型多发性硬化症或临床孤立综合征患者的后续复发率显著增加相关，为维生素 D 补充的随机对照试验提供了依据。
