背景:尽管有证据表明维生素D状态与多发性硬化症(MS)的风险之间存在联系,没有系统评价,其中暴露量是维生素D缺乏,而不是25羟维生素D(25(OH)D)浓度.我们进行了更新的系统评价和荟萃分析,以估计维生素D缺乏之间的关系,在大多数研究中定义为血清25(OH)D浓度<50nmolL-1,和MS。
方法:我们搜索了MEDLINE,EMBASE,和CINAHL数据库,以确定相关出版物。我们使用维生素D缺乏和MS之间的关联的随机效应模型估计合并比值比(OR)。总体上和由几个因素分层,包括研究是否包括服用维生素D补充剂的参与者.我们还分析了平均25(OH)D浓度与MS之间的关系,并使用荟萃回归来评估补充维生素D的效果,纬度,年龄,种族,维生素D的定义和季节性对OR的估计。纽卡斯尔-渥太华量表用于评估研究质量。
结果:结果汇集了2007年至2021年发表的14项病例对照研究的结果(n=4130例,n=4604控件)。维生素D缺乏的人患多发性硬化症的风险比维生素D充足的人高54%(OR1.54;95%CI1.05,2.24)。在排除服用维生素D补充剂的参与者的研究中(N=7),OR为2.19(95%CI:1.44,3.35),然而,在不排除参与者服用补充剂的研究中,风险没有增加(OR0.82;95%CI:0.43,1.58)。平均年龄(R2=27.4%)和纳入/排除服用补充剂的参与者(R2=33.4%)对维生素D缺乏症和MS的OR差异的贡献最大。
结论:维生素D缺乏与多发性硬化症的可能性增加有关。保持足够的维生素D可能是MS的重要可改变的危险因素。
BACKGROUND: Although there is evidence of a link between vitamin D status and risk of multiple sclerosis (MS), there has been no systematic review where the exposure measure was vitamin D
deficiency rather than 25 hydroxy vitamin D (25(OH)D) concentration. We conducted an updated systematic review and meta-analysis to estimate the association between vitamin D
deficiency, defined in most studies as a serum 25(OH)D concentration of < 50 nmol L-1, and MS.
METHODS: We searched the MEDLINE, EMBASE, and CINAHL databases to identify relevant publications. We estimated the pooled odds ratio (OR) using a random effects model for the association between vitamin D
deficiency and MS, overall and stratified by several factors, including whether or not studies included participants who were taking vitamin D supplements. We also analysed the association between mean 25(OH)D concentration and MS, and used meta-regression to assess the effects of vitamin D supplementation, latitude, age, ethnicity, vitamin D definition and seasonality on the OR estimates. The Newcastle-Ottawa Scale was used to assess study quality.
RESULTS: Results were pooled across 14 case-control studies published between 2007 and 2021 (n = 4130 cases, n = 4604 controls). Persons with vitamin D
deficiency had a 54 % higher risk of multiple sclerosis than those with sufficient vitamin D status (OR 1.54; 95 % CI 1.05, 2.24). In studies that excluded participants taking vitamin D supplements (N = 7), the OR was 2.19 (95 % CI: 1.44, 3.35), whereas, in studies that did not exclude participants taking supplements, there was no increase in risk (OR 0.82; 95 % CI: 0.43, 1.58). Mean age (R2 = 27.4 %) and inclusion/exclusion of participants taking supplements (R2 = 33.4 %) contributed most to variability in the OR of vitamin D deficiency and MS.
CONCLUSIONS: Vitamin D
deficiency is associated with an increased likelihood of multiple sclerosis. Maintaining sufficient vitamin D may be an important modifiable risk factor for MS.