Munger Kassandra L, Hongell Kira, Åivo Julia, Soilu-Hänninen Merja, Surcel Heljä-Marja, Ascherio Alberto
From the Departments of Nutrition (K.L.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; Division of Clinical Neurosciences (K.H., J.Å., M.S.-H.), Turku University Hospital and University of Turku; and National Institute for Health and Welfare (H.-M.S.), Oulu, Finland.
Neurology. 2017 Oct 10;89(15):1578-1583. doi: 10.1212/WNL.0000000000004489. Epub 2017 Sep 13.
To determine whether and to what extent vitamin D deficiency is associated with multiple sclerosis (MS) risk.
We conducted a prospective nested case-control study among women in the Finnish Maternity Cohort (FMC). The FMC had 1.8 million stored serum samples taken during the pregnancies of over 800,000 women at the time of this study. Through linkages with hospital and prescription registries, we identified 1,092 women with MS diagnosed between 1983 and 2009 with at least 1 serum sample collected prior to date of MS diagnosis; ≥2 serum samples were available for 511 cases. Cases were matched to up to 3 controls (n = 2,123) on date of birth (±2 years) and area of residence. 25-Hydroxyvitamin D (25[OH]D) levels were measured using a chemiluminescence assay. We used conditional logistic regression adjusted for year of sample collection, gravidity, and parity to estimate relative risks (RRs) and 95% confidence intervals (CIs).
A 50 nmol/L increase in 25(OH)D was associated with a 39% reduced risk of MS (RR 0.61, 95% CI 0.44-0.85), = 0.003. Women with 25(OH)D levels <30 nmol/L had a 43% higher MS risk (RR 1.43, 95% CI 1.02-1.99, = 0.04) as compared to women with levels ≥50 nmol/L. In women with ≥2 samples, MS risk was 2-fold higher in women with 25(OH)D <30 nmol/L as compared to women with 25(OH)D ≥50 nmol/L (RR 2.02, 95% CI 1.18-3.45, = 0.01).
These results directly support vitamin D deficiency as a risk factor for MS and strengthen the rationale for broad public health interventions to improve vitamin D levels.
确定维生素D缺乏是否与多发性硬化症（MS）风险相关以及相关程度如何。
我们在芬兰孕产妇队列（FMC）中的女性中开展了一项前瞻性巢式病例对照研究。在本研究开展时，FMC拥有超过800,000名女性孕期采集并储存的180万份血清样本。通过与医院和处方登记处的关联，我们确定了1983年至2009年间被诊断为MS且在MS诊断日期之前至少采集了1份血清样本的1,092名女性；511例病例有≥2份血清样本。病例按出生日期（±2岁）和居住地区与最多3名对照（n = 2,123）进行匹配。使用化学发光法测定25-羟基维生素D（25[OH]D）水平。我们采用经样本采集年份、妊娠次数和产次校正的条件逻辑回归来估计相对风险（RRs）和95%置信区间（CIs）。
25(OH)D每增加50 nmol/L，MS风险降低39%（RR 0.61，95% CI 0.44 - 0.85），P = 0.003。与25(OH)D水平≥50 nmol/L的女性相比，25(OH)D水平<30 nmol/L的女性患MS的风险高43%（RR 1.43，95% CI 1.02 - 1.99，P = 0.04）。在有≥2份样本的女性中，与25(OH)D≥50 nmol/L的女性相比，25(OH)D<30 nmol/L的女性患MS的风险高2倍（RR 2.02，95% CI 1.18 - 3.45，P = 0.01）。
这些结果直接支持维生素D缺乏是MS的一个风险因素，并强化了进行广泛公共卫生干预以提高维生素D水平的理论依据。
