Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis
Vitamin D status predicts new brain magnetic resonance imaging activity in multiple sclerosis
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DOI：
10.1002/ana.23591
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发表时间：
2012-08-01
影响因子：
11.2
通讯作者：
Pelletier, Daniel
中科院分区：
文献类型：
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作者：
Mowry, Ellen M.;Waubant, Emmanuelle;Pelletier, Daniel
目的：我们试图确定维生素D状态是否与复发性多发性硬化症（MS）脑磁共振成像（MRI）上出现新的T2病变或对比增强病变有关。方法：EPIC是在弗朗西斯科的加州大学进行的一项为期5年的纵向MS队列研究。参与者每年进行临床评估，脑部MRI和抽血。从整个队列中，我们评估了基线时临床孤立综合征或复发缓解型MS患者。在单变量和多变量（根据年龄、性别、种族、吸烟和MS治疗调整）重复测量分析中，评价了每年25-羟基维生素D水平与随后脑MRI上新发T2加权和钆增强T1加权病变、临床复发和残疾（扩展残疾状态量表[EDSS]）的相关性。结果：469名受试者共获得2，362次3 T脑部MRI扫描。在多变量分析中，25-羟基维生素D水平每升高10 ng/ml，新发T2病变的风险降低15（发生率比[IRR]，0.85; 95%置信区间[CI]，0.760.95; p = 0.004），钆增强病变的风险降低32%（IRR，0.68; 95% CI，0.530.87; p = 0.002）。维生素D水平每升高10 ng/ml，随后的残疾程度就降低（-0.047; 95% CI，-0.091至-0.003; p = 0.037）。较高的维生素D水平与较低的复发风险相关，但没有统计学意义。除了EDSS模型，当维生素D水平的人内变化是预测因素时，所有相关性都更强。解释：维生素D水平与脑MRI上的MS活动呈负相关。这些结果为补充维生素D的随机试验提供了进一步的支持。神经网络2012;72：234240。
Objective: We sought to determine whether vitamin D status is associated with developing new T2 lesions or contrast-enhancing lesions on brain magnetic resonance imaging (MRI) in relapsing multiple sclerosis (MS). Methods: EPIC is a 5-year longitudinal MS cohort study at the University of California at San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. From the overall cohort, we evaluated patients with clinically isolated syndrome or relapsingremitting MS at baseline. In univariate and multivariate (adjusted for age, sex, ethnicity, smoking, and MS treatments) repeated measures analyses, annual 25-hydroxyvitamin D levels were evaluated for their association with subsequent new T2-weighted and gadolinium-enhancing T1-weighted lesions on brain MRI, clinical relapses, and disability (Expanded Disability Status Scale [EDSS]). Results: A total of 2,362 3T brain MRI scans were acquired from 469 subjects. In multivariate analyses, each 10ng/ml higher 25-hydroxyvitamin D level was associated with a 15% lower risk of a new T2 lesion (incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], 0.760.95; p = 0.004) and a 32% lower risk of a gadolinium-enhancing lesion (IRR, 0.68; 95% CI, 0.530.87; p = 0.002). Each 10ng/ml higher vitamin D level was associated with lower subsequent disability (-0.047; 95% CI, -0.091 to -0.003; p = 0.037). Higher vitamin D levels were associated with lower, but not statistically significant, relapse risk. Except for the EDSS model, all associations were stronger when the within-person change in vitamin D level was the predictor. Interpretation: Vitamin D levels are inversely associated with MS activity on brain MRI. These results provide further support for a randomized trial of vitamin D supplementation. ANN NEUROL 2012;72:234240.