Simpson Steve, der Mei Ingrid van, Taylor Bruce
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Med Chem. 2018 Feb 6;14(2):129-143. doi: 10.2174/1573406413666170921143600.
Multiple sclerosis (MS) is a progressive, demyelinating condition of the central nervous system, manifesting in loss or alterations in function of sensory, motor and cognitive function. Of the various environmental and behavioural risk factors identified as playing a role in MS onset and progression, perhaps none has been as consistent as vitamin D.
In this review, we will endeavour to present a general background on the role of vitamin D in human health and particularly in MS, as well as the substantial epidemiological evidence in support of vitamin D's role in MS.
Initially identified via the oft-noted latitudinal gradient in MS prevalence and incidence, vitamin D has since been demonstrated to have a strong and consistent inverse association with MS risk and clinical course. Cases have much lower levels of the diagnostic metabolite of vitamin D, 25- hydroxyvitamin D (25(OH)D) compared to healthy controls, while those with more active disease have lower levels of 25(OH)D than other cases with less active disease. These case-control and crosssectional study results led the way to cohort studies which indicated significant inverse associations between serum 25(OH)D and clinical activity in MS. The combined weight of indirect and direct observational evidence have been the impetus for completed and ongoing randomised trials of vitamin D supplementation, alone or in addition to standard immunomodulatory medications, as an intervention in MS onset and clinical course. Moreover, in addition to being a distinct factor in MS aetiology, vitamin D has been demonstrated to interact with a variety of other risk factors, from genetic predictors like HLA-DR1 genotype to behavioural factors like smoking.
There is an abundance of epidemiological evidence, both direct and indirect, as well as significant biological plausibility substantiating a role for vitamin D in the onset and progression of multiple sclerosis.
多发性硬化症（MS）是一种中枢神经系统的进行性脱髓鞘疾病，表现为感觉、运动和认知功能的丧失或改变。在已确定的与MS发病和进展相关的各种环境和行为风险因素中，维生素D的作用可能最为一致。
在本综述中，我们将努力介绍维生素D在人类健康尤其是MS中的作用的一般背景，以及支持维生素D在MS中作用的大量流行病学证据。
维生素D最初是通过MS患病率和发病率中常提到的纬度梯度确定的，此后已证明它与MS风险和临床病程呈强烈且一致的负相关。与健康对照相比，MS患者的维生素D诊断代谢物25-羟基维生素D（25(OH)D）水平要低得多，而疾病活动度较高的患者的25(OH)D水平低于疾病活动度较低的其他患者。这些病例对照研究和横断面研究结果为队列研究指明了方向，队列研究表明血清25(OH)D与MS临床活动之间存在显著的负相关。间接和直接观察证据的综合权重推动了维生素D补充剂单独或与标准免疫调节药物联合使用作为MS发病和临床病程干预措施的已完成和正在进行的随机试验。此外，除了是MS病因中的一个独特因素外，维生素D还被证明与多种其他风险因素相互作用，从HLA-DR1基因型等遗传预测因素到吸烟等行为因素。
有大量直接和间接的流行病学证据，以及显著的生物学合理性，证实了维生素D在多发性硬化症发病和进展中的作用。
