Vitamin D Status Is Associated with Relapse Rate in Pediatric-Onset Multiple Sclerosis
Vitamin D Status Is Associated with Relapse Rate in Pediatric-Onset Multiple Sclerosis
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DOI：
10.1002/ana.21972
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发表时间：
2010-05-01
影响因子：
11.2
通讯作者：
Waubant, Emmanuelle
中科院分区：
文献类型：
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作者：
Mowry, Ellen M.;Krupp, Lauren B.;Waubant, Emmanuelle
目的：我们试图确定维生素 D 状态（多发性硬化症的危险因素）是否与儿科发病的多发性硬化症随后的临床复发率相关。方法：这是一项对儿科发病的多发性硬化症或临床孤立综合征患者的回顾性研究，这些患者在加州大学旧金山分校或纽约州立大学石溪分校的儿科多发性硬化症中心进行临床访问时连续招募到前瞻性队列中。在 171 名符合条件的患者中，队列中包括 134 名（78%）患有多发性硬化症/临床孤立综合征的患者；由于缺乏可用血清 (n = 7) 或缺乏随访 (n = 17)，另外 24 人被排除在本次分析之外。测量血清 25-羟基维生素 D(3) 水平并进行调整以反映去季节值。调整后的血清 25-羟基维生素 D(3) 水平是多变量负二项式回归模型中的主要预测因子，其中主要结果指标是随后复发的次数。结果：在 110 名受试者中，平均未调整的 25-羟基维生素 D(3) 水平为 22 +/- 9ng/ml。调整年龄、性别、人种、民族、病程、疾病缓解治疗和随访时间后，调整后的 25-羟基维生素 D(3) 水平每增加 10 ng/ml，后续复发率就会降低 34%（发病率比，0.66；95% 置信区间，0.46-0.95；p = 0.024）。解释：血清水平降低25-羟基维生素 D(3) 水平与儿童发病的多发性硬化症或临床孤立综合征的后续复发率大幅增加相关，这为补充维生素 D 的随机对照试验提供了理论依据。安神经学 2010；67:618-624
Objective: We sought to determine if vitamin D status, a risk factor for multiple sclerosis, is associated with the rate of subsequent clinical relapses in pediatric-onset multiple sclerosis.Methods: This is a retrospective study of patients with pediatric-onset multiple sclerosis or clinically isolated syndrome who were consecutively recruited into a prospective cohort at their clinical visit at the pediatric multiple sclerosis center of University of California, San Francisco or State University of New York at Stony Brook. Of 171 eligible patients, 134 (78%) with multiple sclerosis/clinically isolated syndrome were included in the cohort; a further 24 were excluded from this analysis due to lack of available serum (n = 7) or lack of follow-up (n = 17). Serum 25-hydroxyvitamin D(3) levels were measured and were adjusted to reflect a deseasonalized value. The adjusted serum 25-hydroxyvitamin D(3) level was the primary predictor in a multivariate negative binomial regression model in which the main outcome measure was the number of subsequent relapses.Results: Among the 110 subjects, the mean unadjusted 25-hydroxyvitamin D(3) level was 22 +/- 9ng/ml. After adjustment for age, gender, race, ethnicity, disease duration, disease-modifying therapy, and length of follow-up, every 10ng/ml increase in the adjusted 25-hydroxyvitamin D(3) level was associated with a 34% decrease in the rate of subsequent relapses (incidence rate ratio, 0.66; 95% confidence interval, 0.46-0.95; p = 0.024).Interpretation: Lower serum 25-hydroxyvitamin D(3) levels are associated with a substantially increased subsequent relapse rate in pediatric-onset multiple sclerosis or clinically isolated syndrome, providing rationale for a randomized controlled trial of vitamin D supplementation. ANN NEUROL 2010;67:618-624