D'Souza Ryan S, Lin Ge, Oh Terry, Vincent Ann, Orhurhu Vwaire, Jiang Li, Mauck William D, Qu Wenchun
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
Pain Med. 2020 Dec 25;21(12):3470-3478. doi: 10.1093/pm/pnz377.
To evaluate the association between hypovitaminosis D and outcomes of symptom severity, mood disorders, fatigue, and quality of life in fibromyalgia (FM) patients.
Five hundred ninety-three FM patients were surveyed from May 2012 to November 2013. Patients with serum vitamin D <25 ng/mL were considered to have hypovitaminosis D. The primary outcome was FM symptom severity (FIQ-R questionnaire). Secondary outcomes included quality of life (SF-36), fatigue (MFI-20), anxiety (GAD-7), and depression (PHQ-9). Independent t tests and chi-square tests were performed for continuous and categorical variables, respectively. Regression analysis was performed adjusting for age, gender, body mass index, ethnicity, and season. A post hoc analysis examined for correlation between outcomes and serum vitamin D (ng/mL) as a continuous variable.
One hundred twenty-two patients (20.6%) had hypovitaminosis D. In our adjusted regression analysis, the total FIQ-R score in patients with hypovitaminosis D was higher compared with control patients with adequate serum vitamin D (57.85 ± 18.09 vs 62.79 ± 18.10, P = 0.04). Adjusted regression analysis revealed higher total GAD-7 (P = 0.01) and higher total PHQ-9 scores (P = 0.04) in patients with hypovitaminosis D compared with control patients. There were no differences based on severity of depression or anxiety. No differences in fatigue or quality of life were identified. Unadjusted post hoc analysis revealed that as serum vitamin D increased, there was an association with lower total FIQ-R (β coefficient = -0.11, P = 0.02) and lower SF-36 subscale scores of role-physical (β coefficient = -0.10, P = 0.03). Adjusted post hoc analysis revealed no significant associations.
Hypovitaminosis D may be a risk factor for worse symptom severity, anxiety, and depression in FM patients.
评估维生素D缺乏与纤维肌痛（FM）患者症状严重程度、情绪障碍、疲劳及生活质量之间的关联。
2012年5月至2013年11月期间，对593例FM患者进行了调查。血清维生素D<25 ng/mL的患者被视为维生素D缺乏。主要结局指标为FM症状严重程度（FIQ-R问卷）。次要结局指标包括生活质量（SF-36）、疲劳（MFI-20）、焦虑（GAD-7）和抑郁（PHQ-9）。分别对连续变量和分类变量进行独立t检验和卡方检验。进行回归分析时对年龄、性别、体重指数、种族和季节进行了校正。事后分析将结局指标与作为连续变量的血清维生素D（ng/mL）之间的相关性作为研究对象。
122例患者（20.6%）存在维生素D缺乏。在我们的校正回归分析中，维生素D缺乏患者的FIQ-R总分高于血清维生素D水平正常的对照患者（57.85±18.09对62.79±18.10，P=0.04）。校正回归分析显示，与对照患者相比，维生素D缺乏患者的GAD-7总分更高（P=0.01），PHQ-9总分更高（P=0.04）。在抑郁或焦虑严重程度方面无差异。未发现疲劳或生活质量方面存在差异。未校正的事后分析显示，随着血清维生素D水平升高，FIQ-R总分降低（β系数=-0.11，P=0.02），角色-身体功能的SF-36子量表得分降低（β系数=-0.10，P=0.03）。校正后的事后分析未发现显著关联。
维生素D缺乏可能是FM患者症状严重程度加重、焦虑和抑郁的危险因素。
