多发性硬化患者血清维生素D水平变化及与临床相关性研究

Alterations in circulating levels of vitamin D and the association with clinical characteristics in multiple sclerosis patients

目的观察多发性硬化(MS)患者体内维生素D水平,探讨维生素D水平与MS临床表型的关系。方法收集MS患者72例,包括复发缓解型MS(RRMS)62例、继发进展型MS(SPMS)7例及原发进展型MS(PPMS)3例;视神经脊髓炎(NMO)患者24例;以32名健康体检者为健康对照组(NC组)。采用电化学发光法对血清25-羟维生素D_3[25-hydroxyvitamin D_3,25(OH)D_3]进行检测,所有MS患者在留取血标本的同时进行扩展残疾状态量表(EDSS)评分,对其中15例急性复发期RRMS患者在缓解期再次行血清25(OH)D_3检测和EDSS评分。结果 MS组、NC组及NMO组间血清25(OH)D_3水平比较差异有统计学意义(F=10.55,P<0.01),MS组及NMO组均低于NC组(分别P<0.01,P<0.05),但MS组与NMO组相比差异无统计学意义(P>0.05);SPMS患者血清25(OH)D_3水平低于NC组(P<0.01),但与RRMS患者比较无统计学差异(P>0.05);RRMS患者血清25(OH)D_3水平缓解期高于急性复发期(t=2.92,P<0.05),但仍低于NC组(P<0.01)。结论 MS及NMO患者体内维生素D不足,且维生素D不足贯穿于MS的不同病程阶段,RRMS患者急性复发期维生素D不足更为明显。

Objective To investigate the circulating levels of vitamin D in patients with multiple sclerosis （MS）, and to explore the relationship between vitamin D and the ctinical characteristics of MS. Methods Serum samples from 72 MS patients, 24 neuromyelitis optica （NMO） patients and 32 normal controls were collected for 25-hydroxyvitamin D3 [25 （OH） D3]measurement. There were 62 relapsing-remitting MS patients （RRMS）, 7 secondary progressive MS （SPMS） patients and 3 primary progressive MS （PPMS）. The expanded disability status scale （EDSS） of all MS patients were assessed at the date of serum sampling. Serum 25 （OH） Da and EDSS were reassessed during remission for 15 active RRMS patients. Results （1） There were significant differences among normal control group, MS group and NMO group （F = 10.55, P〈.0.01）. Compared with normal controls, both MS and NMO patients had significantly lower levels of 25 （OH） D3 （P〈 0.01, P〈0.05）. There was no significant difference between MS patients and NMO patients （P〉0.05）. （2） The levels of 25 （OH） D3 in SPMS patients were significantly lower than that in normal controls （P〈0.01）, but not significantly lower than RRMS patients （P〉0.05）. （3） The levels of 25 （OH） D3 were significantly lower in RRMS patients during exacerbation compared with patients in remission （t=2.92, P〈0. 05）, hut still lower than the normal control group （P〈0.01）. Conclusions These data suggested that MS and NMO patients were both in a state of vitamin D insufficiency. Both RRMS and SPMS patients showed vitamin D insufficiency. The insufficiency existed in different stages of disease course. Vitamin D insufficiency exacerbated during relapse stage in RRMS patients.