| 作者：Allison Gandey | | 出處：WebMD醫學新聞 |
August 18, 2008 — 一篇新研究發現，維他命D值低的女性比較會有慢性廣泛疼痛。研究者認為，這個發現並不支持使用維他命D的狀態是慢性疼痛的關鍵因素，但他們引起內分泌或者免疫因素可能之影響的興趣；本研究線上登載於8月21日的風濕疾病學誌。
慢性廣泛疼痛被視為多因素狀況，倫敦大學院兒童健康研究中心的Kate Atherton醫師領導的研究團隊指出，迄今，聚焦在心理社會的影響。不過，慢性疼痛被視為與一般心理壓力、憂鬱、身心症和其他因素有關，而將這些轉為治療的策略則鮮少成功。
缺乏維他命D被視為慢性疼痛一種新的可調整的風險因素，維他命D是一種荷爾蒙前驅物質，從飲食或者皮膚合成中獲得；研究者使用全英國白人為樣本，檢視維他命D和慢性疼痛之間的關聯。
【維他命D值在75-99 nmol/L的女性較少有疼痛】
研究者寫道，就我們所知，這是迄今最大型的族群基礎方式，檢視維他命D狀態和慢性廣泛疼痛之間關聯性的研究；他們指出，該研究也是首次注意生活型態因素中的相關變項，以及注意白種人。
該研究包括了來自英格蘭、蘇格蘭或者威爾斯超過9,300名的參與者，他們出生於1958年3月某週內，在45歲時完成生物醫學評估；其中，6,824名參與者有25-羥基維他命D (25-hydroxyvitamin D)和疼痛的資料。
研究者發現，女性的慢性疼痛程度和25-羥基維他命D 的濃度變化有關，男性則無此關聯；Atherton醫師等人報告此研究發現時表示，在我們的研究中，25-羥基維他命D濃度為75-99 nmol/L 的女性，其慢性廣泛疼痛比率最低。這是引人注意的，因為之前認為25-羥基維他命D濃度為75 nmol/L 是適當骨骼健康的切點。
女性慢性疼痛發生率與維他命D濃度之間的關聯 25- 羥基維他命 D (nmol/L)
| 慢性疼痛女性比率 (%)
| < 25 | 14.4 | 25 – 49 | 14.8 | 50 – 74 | 11.6 | 75 – 99 | 8.2 | > 100 | 9.8 |
研究者報告指出，維他命D濃度和性別與慢性疼痛關聯之間有相互影響(相互影響P = .006)，這無法用生活型態或者社會因素之差異來完整解釋(校正相互影響P = .03)。
研究有一些限制；研究者指出，研究中獲得之參與者的維他命D狀態不代表這段期間發生慢性疼痛的病患狀態，疼痛可能早幾年出現。
他們也認為，因為本研究為橫斷面設計，無法確定是否不適當的維他命D值會導致疼痛風險增加，或者是研究對象的行為改變導致維他命D濃度減少。
研究者寫道，在我們的一般樣本中，缺乏維他命D和慢性疼痛之間的強烈關聯，顯示疼痛是嚴重缺乏維他命D的前兆，而非濃度改變的漸進式反應。
Atherton醫師等人報告指出，仍不清楚只有女性維他命D和疼痛之間有關聯的原因，他們認為，因為該世代中的女性大部分都還未停經，或許維他命D對於調節雌激素活性的影響，是造成此性別差異的一部份原因。
他們指出，不過，因為這些資料屬於觀察性質，我們無法排除女性維他命D狀態和慢性疼痛之間的關聯(也無法排除男性沒有任何關聯)，還有一些未能測得的因素。
他們結論表示，需要後續研究，以評估是否較高的維他命D值對於慢性廣泛疼痛有所助益。
研究者宣稱沒有相關資金上的往來。
Ann Rheum Dis. 線上發表於2008年8月12日。摘要。 | |
Low Vitamin D Levels Linked to Chronic Pain in Women
By Allison Gandey
Medscape Medical News
August 18, 2008 — Women with low vitamin D levels have more chronic widespread pain, a new study has found. The modest findings do not support the use of vitamin D status as a key determinant for chronic pain, researchers suggest, but they do raise interesting questions about the possible influence of endocrine or immunological factors. The work is published online August 12 in the Annals of the Rheumatic Diseases.
Chronic widespread pain is thought to be a multifactorial condition. To date, the focus has been on psychosocial influences, note the study investigators, led by Kate Atherton, MD, from the University College London Institute of Child Health, in the United Kingdom. Although associations between chronic pain and general psychological distress, depression, somatization, and other factors have been consistently reported, translating these observations into management strategies has been fairly unsuccessful, they note.
Vitamin D deficiency has been suggested as a new modifiable risk factor for chronic pain. Vitamin D is a hormone precursor, which is obtained either through diet or skin synthesis. Using a nationwide population sample of white British adults, the researchers wanted to examine the link between vitamin D and chronic pain.
Women With Vitamin D Levels of 75 to 99 nmol/L Had Less Pain
"To our knowledge, this study is the largest population-based examination of the association between vitamin D status and chronic widespread pain to date," write the researchers. The work is also the first to consider related variations in lifestyle factors or to focus on white ethnic groups, they add.
The study included more than 9300 participants in England, Scotland, or Wales born during 1 week in March in 1958 who had completed a biomedical assessment at age 45 years. Of these, 6824 participants had data on 25-hydroxyvitamin D and pain.
Investigators found that chronic pain levels varied by 25-hydroxyvitamin D concentration in women, but not in men. "In our study, the lowest prevalence of chronic widespread pain was observed for women with 25-hydroxyvitamin D 75 to 99 nmol/L," Dr. Atherton and her team report. "This is intriguing given that 25-hydroxyvitamin D 75 nmol/L has been previously suggested as the cutoff point for optimal bone health."
Prevalence of Chronic Pain in Relation to Vitamin D Concentrations in Women | 25-Hydroxyvitamin D (nmol/L) | Women with Chronic Pain (%) | | < 25 | 14.4 | | 25 – 49 | 14.8 | | 50 – 74 | 11.6 | | 75 – 99 | 8.2 | | > 100 | 9.8 |
The investigators report there was an interaction between vitamin D concentration and sex in relation to chronic pain (interaction P = .006), which was not fully explained by differences in lifestyle or social factors (adjusted interaction P = .03).
The researchers point to a number of limitations of the work. They note the vitamin D status of participants was obtained during the study and may not represent the patient's status during the time that chronic pain developed, which may have been years earlier.
They also suggest that given the cross-sectional design of the study, it is not possible to establish whether suboptimal vitamin D status results in an increased risk for pain or whether changes in the behavior of subjects with pain result in reduced vitamin D concentrations.
"The lack of a stronger association between vitamin D and chronic pain in our general population sample may suggest that pain is primarily indicative of a severe vitamin D deficiency rather than a more gradual response to varying concentrations," the researchers write.
Dr. Atherton and her team report that it is unclear why an association between vitamin D and pain was observed in women but not in men. They suggest that since the women in the cohort are still mostly premenopausal, perhaps the influences of hormonal vitamin D on the regulation of estrogen activity may at least partly contribute to this sex difference.
"Nevertheless," they add, "given the observational nature of these data, we cannot exclude the possibility that our finding of an association between vitamin D status and chronic pain in women (or the lack of any association in men) is confounded by unmeasured factors.
"Follow-up studies are needed to evaluate whether higher vitamin D intake might have beneficial effects on [chronic widespread pain] risk," they conclude.
The researchers have disclosed no relevant financial relationships.
Ann Rheum Dis. Published online August 12, 2008. Abstract
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[ 本帖最後由 goodcat1111 於 2008-8-29 20:11 編輯 ] |
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