Study On The Correlation Between Serum 25-hydroxyvitamin D Level And The Restless Legs Syndrome And The Therapeutic Effect Of Vitamin D In The Syndrome

Restless legs syndrome(RLS)is a sensorimotor disorder.It is characterized by unpleasant sensations in the body parts,especially the legs,leading to the urgent need to move the limbs,thereby alleviating related discomforts such as paresthesia and sensory disturbances.Although the most common effect of RLS in the legs,it also affects other parts of the body,such as the head,torso,and arms.These symptoms occur at rest and increase in intensity at night,which can lead to severe sleep disruption and impaired quality of life.Although the pathogenesis of RLS is unclear,it may be related to genetic factors,iron deficiency,and abnormal DA energy systems.Vitamin D is a fat-soluble,secostreoid prohormone,which is produced in skin by sunlight exposure.And play a key role in calcium and phosphorus metabolism.Recently,there has been increasing interest in the role of vitamin D in inflammation and immune regulation,as well as iron and dopamine metabolism.Following the discovery of vitamin D receptors in the thalamus,hypothalamus,sustantia nigra and cortex,the possible role of vitamin D in different neurological diseases recently been investigated.Vitamin D is suggested to have an active controller role on the genetic regulation of the synthesis of acetylcholine,dopamine,serotonin,and gammaaminobutryric acid.25-hydroxyvitamin D may affect the DA energy pathway of the nigrostriatal striatum.The literature has revealed its potential role in dopamine function.In rats,25-OH-VD deficiency is associated with changes in dopamine concentration in the cortex.In experiments,25-OH-VD increased dopamine levels and protected dopaminergic neurons.Similarly,25-OH-VD has been shown to increase glutathione levels,and decreased glutathione levels may also affect the activity of dopaminergic neurons.In addition,Orme observed the addition of 1,25-dihydroxyvitamin D to the medium,the number of rat DA energy neurons increased in a dose-dependent manner,and it was concluded that 25-OH-VD might increase the number of DA energy neurons.Therefore,it can be inferred that 25-OH-VD deficiency can cause dysfunction of the dopaminergic system,and eventually lead to RLS.However,the role of 25-OH-VD in RLS has not been well studied.Although a number of studies have been conducted on the relationship between 25-hydroxyvitamin D and RLS,the results have been mixed and are mainly cross-sectional studies or case compositions involving relatively small samples.Therefore,further treatment and follow-up studies are needed to clarify the link between RLS and 25-OH-VD levels.This lesson aims to explore the relationship between 25-OH-VD levels and the onset of RLS and the therapeutic effects of vitamin D on them.At the same time,this project further explored the correlation between RLS and anxiety,depression,and sleep disorders by improving the RLS severity rating scale,HAMA,HAMD,and PSQI.Assist in the diagnosis,treatment and management of RLS.Objective1.To explore the correlation between serum 25-hydroxyvitamin D level and the onset of RLS;2.The relationship between the severity of symptoms in patients with RLS and anxiety,depression and sleep disorders;3.The therapeutic effect of vitamin D in RLS.Materials and methods1.Research objectInformation collected is from patients who visited the Second Hospital of Shandong University in May,June,July,August,September and October from August 2017 to September;:2019(According to studies,a deficiency of VD is easy to be caused in Spring and Winter.To eliminate seasonable impacts on the test result,only information of patients of the above six months was collected).A total of 136 RLS cases have clear diagnosis results and can conform to the inclusion and exclusion criteria,including 52 male cases and 84 female cases.For various reasons,follow-up visit of 23 cases failed,and finally follow-up visit of 113 cases was finished,including 43 male cases and 70 female cases.Cases with matched sex,age,history of hypertension,smoking and history of drinking at the same period were required to have a physical examination.Upon strict screening,84 cases are not RLS cases and cannot meet the exclusion criteria,including 30 male cases and 54 female cases.All the selectees are Han Chinese who live in Shandong Province permanently.2.Inclusion and exclusion criteria2.1 Inclusion criteria(1)This study focuses on nonfamilial idiopathic RLS.(2)It complies with the RLS diagnostic standard proposed by IRLSSG in 2014.(3)Except for hypertension,no other chronic diseases were known before admission.2.2 Exclusion criteria(1)Prior to admission,polyneuropathy,diabetes,renal failure,chronic liver failure,hypothyroidism,Parkinson’s disease,osteoporosis,and various mental illnesses were identified.Pregnancy,alcoholism(40 g alcohol/day),BMI<18.5 or>24 or other known causes of secondary RLS,familial history of RLS.(2)History of corticosteroids,estrogen,bisphosphonates,calcitonin,calcium or vitamin D,antipsychotics,sedative hypnotic drugs.Medications are being taken to relieve symptoms of RLS.(3)Those with abnormal ferritin,serum iron,alkaline phosphatase(ALP),magnesium,hemoglobin(HGB),urea,creatinine,calcium,vitamin B12,glycosylated hemoglobin A1,fT3,fT4 and thyroid stimulating hormone indicators after admission.Data collection(1)Record demographic characteristics:gender,age,height,weight;record past history,personal history,family history;smoking history,drinking history.(2)Serum 25-OH-VD level monitoring should be improved for all recruits.In addition,RLS patients were evaluated by the RLS Rating Scale,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),and Pittsburgh Sleep Quality Index(PSQI)developed by the International Restless Leg Syndrome Study Group(IRLSSG).Grouping and experimental methods(1)136 confirmed RLS patients who met the inclusion criteria were used as the experimental group,and 84 non-RLS groups were used as the control group.Using Roche e602 instrument electrochemiluminescence method to detect the serum 25-OH-VD level of all individuals in the RLS group and non-RLS group that met the inclusion criteria.Comparative analysis of the relationship between serum 25-OH-VD and RLS;(2)The same trained and qualified neurologist will complete the RLS assessment scale,HAMA,HAMD,and PSQI assessment for all individuals in the RLS group.Analyze whether the severity of RLS symptoms is correlated with serum 25-OH-VD level,anxiety,depression and sleep disorders;(3)All RLS patients enrolled were given 800 units of vitamin D orally(the drugs taken were all vitamin D drops).After 90 days of follow-up,23 patients had various reasons(including inability to take regular medication,There are adverse reactions of vitamin D drops and so on)failed to complete the follow-up,and 113 patients were finally followed up,including 43 males and 70 females.The same doctor retested the above scale and rechecked the serum 25-OH-VD again.Most patients were followed up by telephone or WeChat after the follow-up visit to the hospital.The serum 25-OH-VD level was small after treatment,so there was no It performs statistical analysis.(4)113 patients who completed the follow-up were taken as the experimental group,and the 113 patients were used as the control group before treatment.The scores of the relevant scales before and after treatment were statistically analyzed to evaluate the effect of vitamin D on improving RLS symptoms.Statistical analysisThe statistical analysis uses SPSS23.0 software.For the measurement data that conforms to the normal distribution,it is expressed as mean ± standard deviation,using paired t testor independent t test;for gender,whether or not the data is frequency and percentage,x2 Test;use multivariate logistic regression analysis to calculate odds ratio(OR),95%confidence interval(95%confidence interval,95%CI),and receiver receiver characteristic(ROC)curve The diagnostic value of 25-OH-VD level for RLS,the best cutoff value was obtained by calculating the Yoden index.α=0.05 was used as the criterion for significance level.Result1.Compared with the non-RLS healthy control group,the proportion of 25-hydroxyvitamin D normal in the experimental group was lower:(27.4%vs 9.6%).In the case of 25-hydroxyvitamin D deficiency,ie<30 ngl ml,The risk of developing RLS is higher than the situation where 25-OH-VD is sufficient.(OR 3.567,P<0.001,95%CI 1.692～7.523).2.Compared with the control group(24.83±8.3ng/ml),the average serum 25-hydroxyvitamin D levels of patients with RLS were significantly reduced(17.82 ± 7.83ng/ml).3.The RLS syndrome rating scale score(21.69±7.44)is inversely related to serum 25-OH-VD level(r=-0.222,P=0.009),that is,the lower the serum 25-OH-VD level,the more RLS symptoms Severe;RLS syndrome rating scale score and HAMA score(15.57 ± 5.53)was positively correlated(r=0.664,P<0.01);the RLS syndrome rating scale score was positively correlated with the HAMD score(12.71 ± 6.20)(r=0.494,P<0.01);the RLS syndrome rating scale score was positively correlated with PSQI(12.74±3.60)(r=0.463,P<0.01),that is,the more severe the symptoms of RLS,the more severe the anxiety,depression,and sleep problems.4.RLS scale score before treatment(22.09±7.75)and after treatment(19.37±6.82),symptoms improved significantly(P<0.001);Hamilton Anxiety Scale(HAMA)score before treatment(15.47±5.28)and after treatment(14.95±5.79),no significant improvement in anxiety symptoms(P>0.05);Hamilton depression scale(HAMD)score before treatment(12.90±6.23)and after treatment(12.16±5.97),depression symptoms were alleviated(P<0.05);before the treatment of the Pittsburgh Sleep Index(PSQI)(12.95±3.56)and after treatment(10.99±3.07),the sleep status improved significantly(P<0.001).5.According to the subgroup score of the RLS rating scale,it was found that the symptom severity items before and after treatment(5.89± 3.00)were compared with those before treatment(6.80 ± 3.36)and the sleep items were treated after treatment(3.55±2.11)and before treatment(4.32 ± 2.19),there was a significant improvement(P<0.001);but the frequency of episodes after treatment(4.50±2.13)and before treatment(4.67±2.06),the emotional aspect after treatment(4.50± 2.13)and treatment Compared with the previous(4.67± 2.06),there was no significantly improvement(P>0.05).6.Using the ROC curve,the area under the curve used to predict the occurrence of RLS was 0.75;the 95%confidence interval:(0.680,0.820).Calculate the Youden index and obtain the best cut-off value of 19.50ng/ml.The serum 25-OH-VD level can predict the occurrence of RLS very well,with a sensitivity of 76.20%and a specificity of 68.10%.7.The rate of lost interviews in this study was about 16.9%.Through statistical analysis of the baseline data of the lost followers and those who completed the follow-up,we found that the difference was not statistically significant,so the missed follow-up will not bias the final results.Conclusions1.There is a correlation between low serum 25-OH-VD level and the onset of RLS.The lower the level,the more severe the symptoms and the higher the risk of disease;2.Vitamin D is effective in treating RLS,which can relieve the severity of symptoms and sleep problems in patients with RLS,but the frequency of attacks and anxiety states can not be relieved.3.The severity of RLS is positively related to anxiety,depressive symptoms,and sleep problems.