维生素D与性激素及其受体对男性临床孤立综合征复发的预测价值

Predictive value of vitamin D,sex hormones and their receptors on relapse in male patients with clinically isolated syndrome

目的探讨维生素D、性激素及其受体对男性临床孤立综合征(CIS)患者发病及转归的预测价值。方法将40例男性CIS患者纳入CIS组,将年龄和长期居住地相匹配的30例健康体检者纳入对照组(HC组),采用超高效液相色谱-串联质谱法检测所纳入者和首次复发为多发性硬化患者(MS组)外周血维生素D水平[1,25(OH)2D2和1,25(OH)2D3],电化学发光法检测外周血睾酮(T)、孕酮(P)、雌二醇(E2)水平,采用酶联免疫吸附试验(ELISA)检测雌激素受体(ERα、ERβ)、雄激素受体(AR)及淋巴细胞上清液中维生素D受体(VDR)水平。结果中位随访31.5个月后发现,29例(72.5%)CIS患者转归为多发性硬化。与未复发的CIS患者相比,转归为多发性硬化的患者发病年龄小,易出现寡克隆区带阳性。与HC组比较,CIS组维生素D水平降低(P<0.05)。CIS患者转归为多发性硬化时,血清中E2、ERα和ERβ水平较复发前升高,T及AR水平下降(P<0.05)。相关性分析显示CIS患者外周血维生素D、性激素及其受体水平与临床扩展致残量表(EDSS)评分均无相关性。结论发病年龄小、寡克隆区带阳性的男性CIS患者易转归为多发性硬化。维生素D水平降低可能与男性CIS发病相关。维生素D、性激素及其受体在CIS转归为多发性硬化中无预测价值。

Objective To investigate the predictive value of vitamin D,sex hormones and their receptors in the development and regression of male patients with clinical isolated syndrome(CIS).Methods A total of 40 male CIS patients were included in the CIS group and 30 healthy subjects matched in age and long-term residence were included in the control group.The levels of vitamin D[1,25(OH)2D2 and 1,25(OH)2D3]inperipheral blood of the included individuals and the first relapsed multiple sclerosis patients(MS group)were detected by ultra-high-performance liquid chromatography-tandem mass spectrometry.The levels of testosterone(T),progesterone(P),and estradiol(E2)in peripheral blood were detected by electrochemiluminescence.Estrogen receptor(ERα,ERβ),androgen receptor(AR)and vitamin D receptor(VDR)levels in lymphocyte supernatant were detected by enzyme-linked immunosorbent assay(ELISA).Results After a median followup of 31.5 months,29 patients(72.5%)with CIS were converted to multiple sclerosis.Compared with patients with non-recurrent CIS patients,patients with multiple sclerosis had a younger age of onset and were prone to positive oligoclonal bands.Compared with HC group,vitamin D levels were reduced in CIS patients,and the difference was statistically significant(P<0.05).When CIS patients reverted to multiple sclerosis,serum levels of E2,ERα,and ERβwere elevated compared with those before relapse,and the levels of testosteroneand AR were decreased,and the difference was statistically significant(P<0.05).Correlation analysis showed no correlation between peripheral blood levels of vitamin D,sex hormones and their receptors and EDSS in CIS patients.Conclusion Male CIS patients with younger onset age and positive oligoclonal bands are prone to transition to multiple sclerosis.The decrease of vitamin D level may be associated with the onset of male CIS.Vitamin D,sex hormones,and their receptors have no predictive value in the conversion of CIS to multiple sclerosis.