血清维生素D水平及添加治疗对多发性硬化患者预后的影响

Levels of vitamin D and the effect of added treatment on Multiple Sclerosis

目的:评估多发性硬化(MS)患者与正常健康人群体内血清25-羟维生素D3[25-(OH)D_3]水平,以及添加1,25-羟维生素D3[1,25-(OH)2D_3,骨化三醇]口服对于MS预防复发和疾病进展的关系。方法:缓解复发型多发性硬化(RRMS)患者组60例和健康组68例,评估统计两组性别、年龄、25-(OH)D_3水平的差异。同时将60例MS患者随机分成激素治疗组和添加治疗组,每组30例,添加治疗组在激素治疗组的基础上添加骨化三醇胶丸口服,在治疗6、12、24个月后对两组进行EDSS分值评估,在24个月后统计复发次数以及复发时间间隔。结果:患者组与健康组血清25-(OH)D_3水平分别为(18.75±8.35)nmol/L和(23.28±9.31)nmol/L,差异有显著统计学意义。治疗后激素治疗组与添加治疗组在复发次数(P<0.01)、复发时间间隔(P<0.05)、EDSS分值(24月后)(P<0.05),具有统计学差异,而EDSS分值(6个月后)(P=0.457)、EDSS分值(12个月后)(P=0.118)两组间比较差异无统计学意义。结论:MS患者血清25-(OH)D_3水平显著低于正常健康人群。添加骨化三醇有助于防治MS复发,延长复发时间间隔,维持较长时间口服有助于延缓疾病残疾进展。

Objective To evaluate the serum 25- hydroxy vitamin D3 level in patients with multiple sclerosis （MS） and normal healthy population, as well as the correlation between addition of oral 1,25-hydroxy vitamin D3 and the prevention of MS relapse and progression. Methods There were 60 cases in the relapsing- remitting MS （RRMS） group and 68 cases in the healthy group, respectively; and the differences in the sex, age, serum 25-hydroxy vitamin D3 level of the two groups were counted and evaluated. In addition, the 60 cases of patients were divided randomly into the hormone therapy group and the addition treatment group, with 30 cases in each group ; the addition treatment group was added oral calcitriol soft capsules on the basis of the hormone therapy group ; EDSS score evaluation was conducted on the two groups 6, 12 and 24 months after treatment, the relapse frequency was counted after 24 months, and the relapse interval was calculated. Results The serum 25-hydroxy vitamin D3 levels in the patient group and the healthy group were （18.75 ± 8.35）nmol/L and （23.28 ± 9.31 ）nmol/L, respectively. There were statistically significant differences in the relapse frequency （P 〈 0.01） , the relapse interval （P 〈 0.05）, and EDSS score （after 24 months） （P 〈 0.05） between the hormone therapy group and the addition treatment group after treatment; while the differences in the EDSS score （after 6 months） （P = 0.457） and the EDSS score （after 12 months） （P = 0.118） between the two groups showed no statistically significance. Conclusion The serum 25- hydroxy vitamin D3 level in MS patients was markedly lower than that in normal healthy population. Addition of 1,25 -hydroxy vitamin D3 contributes to preventing the relapse rate of MS and extending the relapse interval; in addition, maintaining long-term of oral 1,25-hydroxy vitamin D3 facilitates to delaying the progression of disabled disease.