Thouvenot E, Orsini M, Daures J-P, Camu W
Neurology Department, CHRU Caremeau, Nîmes, France; Institut de Génomique Fonctionnelle, UMR5203, Université Montpellier 1 et 2, Montpellier, France.
Eur J Neurol. 2015 Mar;22(3):564-9. doi: 10.1111/ene.12617. Epub 2014 Dec 20.
Vitamin D deficiency is a recognized risk factor for multiple sclerosis (MS) and is associated with increased disease activity. It has also been proposed that the lower the vitamin D levels are, the higher is the handicap.
To refine the links between vitamin D insufficiency and disability in MS patients, a retrospective cohort analysis was performed including 181 patients prospectively followed without previous vitamin D supplementation, and age, gender, age at MS onset, MS type, MS activity, Expanded Disability Status Scale (EDSS) were analysed in correlation with plasma vitamin D levels.
Vitamin D levels were significantly higher in relapsing-remitting MS than in progressive forms of MS in multivariate analyses adjusted for age, ethnicity, gender, disease duration and season (P = 0.0487). Overall, there was a negative correlation between vitamin D level and EDSS score (P = 0.0001, r = -0.33). In relapsing-remitting MS, vitamin D levels were only correlated with disability scores for EDSS < 4 (P = 0.0012). Patients with >20 ng/ml of vitamin D were 2.78 times more likely to have an EDSS < 4 (P = 0.0011, 95% confidence interval 1.49-5.00).
Data support previous work suggesting that vitamin D deficiency is associated with higher risk of disability in MS. Vitamin D levels also correlated with the degree of disability in fully ambulatory patients with relapsing-remitting MS. These additional results support the pertinence of randomized controlled trials analysing the interest of an early vitamin D supplementation in MS patients to influence evolution of disability.
维生素D缺乏是多发性硬化症（MS）公认的风险因素，且与疾病活动增加相关。也有人提出，维生素D水平越低，残疾程度越高。
为了明确MS患者维生素D不足与残疾之间的联系，进行了一项回顾性队列分析，纳入181例此前未补充维生素D且接受前瞻性随访的患者，并分析年龄、性别、MS发病年龄、MS类型、MS活动、扩展残疾状态量表（EDSS）与血浆维生素D水平的相关性。
在根据年龄、种族、性别、病程和季节进行校正的多变量分析中，复发缓解型MS患者的维生素D水平显著高于进展型MS患者（P = 0.0487）。总体而言，维生素D水平与EDSS评分呈负相关（P = 0.0001，r = -0.33）。在复发缓解型MS中，维生素D水平仅与EDSS < 4的残疾评分相关（P = 0.0012）。维生素D水平>20 ng/ml的患者EDSS < 4的可能性高2.78倍（P = 0.0011，95%置信区间1.49 - 5.00）。
数据支持此前的研究工作，提示维生素D缺乏与MS患者更高的残疾风险相关。维生素D水平也与复发缓解型MS完全能走动患者的残疾程度相关。这些额外结果支持了开展随机对照试验分析早期补充维生素D对MS患者残疾进展影响的相关性。
