Harvard School of Public Health, Boston, Massachusetts.
University of British Columbia, Vancouver, Canada.
JAMA Neurol. 2014 Mar;71(3):306-14. doi: 10.1001/jamaneurol.2013.5993.
It remains unclear whether vitamin D insufficiency, which is common in individuals with multiple sclerosis (MS), has an adverse effect on MS outcomes.
To determine whether serum concentrations of 25-hydroxyvitamin D (25[OH]D), a marker of vitamin D status, predict disease activity and prognosis in patients with a first event suggestive of MS (clinically isolated syndrome).
DESIGN, SETTING, AND PARTICIPANTS: The Betaferon/Betaseron in Newly Emerging multiple sclerosis For Initial Treatment study was a randomized trial originally designed to evaluate the impact of early vs delayed interferon beta-1b treatment in patients with clinically isolated syndrome. Serum 25(OH)D concentrations were measured at baseline and 6, 12, and 24 months. A total of 465 of the 468 patients randomized had at least 1 25(OH)D measurement, and 334 patients had them at both the 6- and 12-month (seasonally asynchronous) measurements. Patients were followed up for 5 years clinically and by magnetic resonance imaging.
New active lesions, increased T2 lesion volume, and brain volume on magnetic resonance imaging, as well as MS relapses and disability (Expanded Disability Status Scale score).
Higher 25(OH)D levels predicted reduced MS activity and a slower rate of progression. A 50-nmol/L (20-ng/mL) increment in average serum 25(OH)D levels within the first 12 months predicted a 57% lower rate of new active lesions (P < .001), 57% lower relapse rate (P = .03), 25% lower yearly increase in T2 lesion volume (P < .001), and 0.41% lower yearly loss in brain volume (P = .07) from months 12 to 60. Similar associations were found between 25(OH)D measured up to 12 months and MS activity or progression from months 24 to 60. In analyses using dichotomous 25(OH)D levels, values greater than or equal to 50 nmol/L (20 ng/mL) at up to 12 months predicted lower disability (Expanded Disability Status Scale score, -0.17; P = .004) during the subsequent 4 years.
Among patients with MS mainly treated with interferon beta-1b, low 25(OH)D levels early in the disease course are a strong risk factor for long-term MS activity and progression.
多发性硬化症（MS）患者普遍存在维生素 D 不足，但其对 MS 结局是否有不良影响仍不清楚。
确定血清 25-羟维生素 D（25[OH]D）浓度，一种维生素 D 状态的标志物，是否可预测首次提示 MS 的临床孤立综合征患者的疾病活动度和预后。
设计、地点和参与者：Betaferon/Betaseron 在新发多发性硬化症中的初始治疗研究是一项随机试验，最初旨在评估早期与延迟干扰素β-1b 治疗对临床孤立综合征患者的影响。在基线和 6、12 和 24 个月时测量血清 25（OH）D 浓度。468 名随机患者中有 465 名至少有 1 次 25（OH）D 测量值，334 名患者在 6 个月和 12 个月（季节异步）测量时有该值。对患者进行了 5 年的临床和磁共振成像随访。
新的活跃病变、T2 病变体积增加和磁共振成像上的脑体积，以及 MS 复发和残疾（扩展残疾状况量表评分）。
较高的 25（OH）D 水平预示着 MS 活动度降低和进展速度减慢。在最初的 12 个月内，平均血清 25（OH）D 水平增加 50nmol/L（20ng/mL）可预测新活跃病变的发生率降低 57%（P<0.001）、复发率降低 57%（P=0.03）、T2 病变体积每年增加减少 25%（P<0.001），从第 12 个月到第 60 个月，脑体积每年减少 0.41%（P=0.07）。在使用至 12 个月的 25（OH）D 测量值与从第 24 个月到第 60 个月的 MS 活动度或进展之间的相似关联。在使用二分法 25（OH）D 水平的分析中，12 个月内至少达到 50nmol/L（20ng/mL）的水平预示着在随后的 4 年内残疾程度（扩展残疾状况量表评分）降低 0.17（P=0.004）。
在主要接受干扰素β-1b 治疗的 MS 患者中，疾病早期低 25（OH）D 水平是长期 MS 活动度和进展的一个强危险因素。
