Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway.
Neurology. 2012 Jul 17;79(3):267-73. doi: 10.1212/WNL.0b013e31825fdf01. Epub 2012 Jun 13.
Studies based on deseasonalized vitamin D levels suggest that vitamin D may influence the disease activity in multiple sclerosis (MS), and high doses are suggested as add-on treatment to interferon-β (IFN-β). Seasonal fluctuation of vitamin D varies between individuals, thus the relationship to disease activity should preferentially be studied by repeated and simultaneous vitamin D and MRI measurements from each patient.
This was a cohort study comprising 88 patients with relapsing-remitting MS who were followed for 6 months with 7 MRI and 4 25-hydroxyvitamin D measurements before initiation of IFN-β, and for 18 months with 5 MRI and 5 25-hydroxyvitamin D measurements during IFN-β treatment.
Prior to IFN-β treatment, each 10 nmol/L increase in 25-hydroxyvitamin D was associated with 12.7% (p = 0.037) reduced odds for new T1 gadolinium-enhancing lesions, 11.7% (p = 0.044) for new T2 lesions, and 14.1% (p = 0.024) for combined unique activity. Patients with the most pronounced fluctuation in 25-hydroxyvitamin D displayed larger proportion of MRI scans with new T1 gadolinium-enhancing lesions (51% vs 23%, p = 0.004), combined unique activity (60% vs 32%, p = 0.003), and a trend for new T2 lesions (49% vs 28%, p = 0.052) at the lowest compared to the highest 25-hydroxyvitamin D level. No association between 25-hydroxyvitamin D and disease activity was detected after initiation of IFN-β. HLA-DRB1*15 status did not affect the results.
In untreated patients with MS, increasing levels of 25-hydroxyvitamin D are inversely associated with radiologic disease activity irrespective of their HLA-DRB1*15 status.
基于去季节性维生素 D 水平的研究表明，维生素 D 可能影响多发性硬化症（MS）的疾病活动，并且建议高剂量作为干扰素-β（IFN-β）的附加治疗。个体之间维生素 D 的季节性波动不同，因此，应优先通过对每个患者进行重复和同步的维生素 D 和 MRI 测量来研究其与疾病活动的关系。
这是一项队列研究，共纳入 88 例复发缓解型多发性硬化症患者，在开始 IFN-β治疗前，每 6 个月进行 7 次 MRI 和 4 次 25-羟维生素 D 测量，在 IFN-β治疗期间，每 18 个月进行 5 次 MRI 和 5 次 25-羟维生素 D 测量。
在开始 IFN-β治疗之前，25-羟维生素 D 每增加 10 nmol/L，新发 T1 钆增强病变的几率降低 12.7%（p = 0.037），新发 T2 病变的几率降低 11.7%（p = 0.044），联合独特活动的几率降低 14.1%（p = 0.024）。25-羟维生素 D 波动最大的患者，其 MRI 扫描中出现新的 T1 钆增强病变（51% vs 23%，p = 0.004）、联合独特活动（60% vs 32%，p = 0.003）和新 T2 病变的比例（49% vs 28%，p = 0.052）均显著更高，而 25-羟维生素 D 最低水平时则更低。在开始 IFN-β治疗后，未发现 25-羟维生素 D 与疾病活动之间存在关联。HLA-DRB1*15 状态并不影响结果。
在未经治疗的多发性硬化症患者中，25-羟维生素 D 水平升高与影像学疾病活动呈负相关，与 HLA-DRB1*15 状态无关。
