[1]邢冠琳,王芳,柳胜贤.维生素D缺乏对多囊卵巢综合征患者糖脂代谢及妊娠结局的影响[J].新乡医学院学报,2024,(4):372-377.[doi:10.7683/xxyxyxb.2024.04.014]
　XING Guanlin,WANG Fang,LIU Shengxian.Effect of vitamin D deficiency on glycolipid metabolism and pregnancy outcome of patients with polycystic ovary syndrome[J].Journal of Xinxiang Medical University,2024,(4):372-377.[doi:10.7683/xxyxyxb.2024.04.014]
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维生素D缺乏对多囊卵巢综合征患者糖脂代谢及妊娠结局的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年4
页码:
372-377
栏目:
临床研究
出版日期:
2024-04-05

文章信息/Info

Title:
Effect of vitamin D deficiency on glycolipid metabolism and pregnancy outcome of patients with polycystic ovary syndrome
作者:
邢冠琳; 王芳; 柳胜贤
（郑州大学附属洛阳中心医院生殖医学科，河南　洛阳　471000）
Author(s):
XING Guanlin; WANG Fang; LIU Shengxian
(Department of Reproductive Medicine,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,Henan Province,China)
关键词:
维生素D; 多囊卵巢综合征; 糖脂代谢; 妊娠结局
Keywords:
vitamin D; polycystic ovary syndrome; glycolipid metabolism; pregnancy outcome
分类号:
R711.75
DOI:
10.7683/xxyxyxb.2024.04.014
文献标志码:
A
摘要:
目的　探讨维生素D（VD）缺乏对多囊卵巢综合征（PCOS）患者的临床指标及妊娠结局的影响。
方法　选择2019年1月至2021年12月于郑州大学附属洛阳市中心医院生殖医学科行常规体外受精-胚胎移植（IVF-ET）或卵泡浆内单精子显微注射技术（ICSI）助孕的358例PCOS患者为研究对象，根据VD水平将患者分为VD缺乏PCOS组和VD充足PCOS组。通过电子病历收集患者的年龄、不孕年限等一般临床资料。进入IVF-ET/ICSI周期前，测量患者身高、体质量，计算体质量指数（BMI）；抽取空腹静脉血，应用电化学发光法检测血清25-羟维生素D［25-(OH)D］、血糖、胰岛素、三酰甘油、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平，并计算稳态模型胰岛素抵抗指数（HOMA-IR）。于月经第2~3天，抽取空腹静脉血2~3 mL，应用电化学发光仪检测血促卵泡激素（FSH）、促黄体激素（LH）、雌二醇（E2）、泌乳素（PRL）、睾酮（T）、孕酮（P）、抗苗勒管激素（AMH）水平。记录促性腺激素（Gn）用量、Gn使用天数以及扳机日LH、E2、P 水平。记录获卵数、移植胚胎数、获卵率、分裂中期（MII）卵率、两原核胚胎（2PN）率、2PN卵裂率、优质胚胎率、移植日内膜厚度，计算生化妊娠率、临床妊娠率、流产率。应用logistic 线性回归分析PCOS患者VD水平相关影响因素，多因素logistic回归分析PCOS患者临床妊娠影响因素。
结果　VD缺乏PCOS组患者E2水平、LDL-C、空腹血糖显著高于VD充足 PCOS组，AMH水平显著低于VD充足 PCOS组（P<0.05）；2组患者的年龄、不孕年限、BMI、FSH、LH、PRL、T、三酰甘油、TC、HDL-C、空腹胰岛素、HOMA-IR比较差异无统计学意义（P>0.05）。2组患者的GN用量、GN使用天数、扳机日LH水平、扳机日E2水平、扳机日P水平、平均获卵数、移植胚胎数、获卵率、MⅡ卵率、2PN受精率、2PN卵裂率、优质胚胎率、移植日内膜厚度、生化妊娠率、临床妊娠率、流产率比较差异无统计学意义（P>0.05）。去除年龄及体质量等混杂因素后，logistic线性回归分析结果显示，PCOS患者的25-（OH）D水平与AMH、胆固醇、FSH呈正相关（P<0.05），与三酰甘油、HDL-C、LDL-C、空腹血糖呈负相关（P<0.05），与空腹胰岛素、HOMA-IR、LH、E2水平无相关性（P>0.05）。多因素logistic回归分析结果显示，PCOS 患者的BMI、25-（OH）D水平、三酰甘油、HOMA-IR、优质胚胎数、内膜厚度、扳机日孕酮水平与临床妊娠相关（P<0.05）；而年龄、AMH、HDL-C、LDL-C与临床妊娠无相关性（P>0.05）。
结论　VD缺乏可影响PCOS患者的糖脂代谢及妊娠结局。
Abstract:
Objective　To investigate the impact of vitamin D (VD) deficiency on clinical indicators and pregnancy outcomes of patients with polycystic ovary syndrome (PCOS).
Methods　A total of 358 PCOS patients who underwent conventional in vitro fertilization embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) assisted pregnancy at the Department of Reproductive Medicine,the Affiliated Luoyang Central Hospital of Zhengzhou University from January 2019 to December 2021 were selected as the research subjects.They were divided into the VD deficient PCOS group and the VD sufficient PCOS group based on their VD levels.The general clinical data such as age and infertility years of patients were collected through electronic medical records.Before entering the IVF/ICSI cycle,the patient′s height and body mass were measured,and the body mass index (BMI) was calculated;fasting venous blood of the patients was extracted,and the levels of serum 25-hydroxyvitamin D ［25-(OH) D］,blood glucose,insulin,triglycerides,total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),and low density lipoprotein cholesterol (LDL-C) were detected by electrochemiluminescence,and the homeostasis model assessment-insulin resistance index (HOMA-IR) was calculated.On the 2nd to 3rd day of menstruation,2-3 mL of fasting venous blood was extracted,and the levels of follicle-stimulating hormone (FSH),luteinizing hormone (LH),estradiol (E2),prolactin (PRL),testosterone (T),progesterone (P),and anti-Müllerian hormone (AMH) were measured by using an electrochemiluminescence instrument.The dosage of gonadotropin (Gn),days of Gn use,and levels of LH,E2,and P on trigger day.The number of retrieved oocytes,number of transferred embryos,the rate of oocyte-obtained,mid-division (MII) oocyte rate,rate of two pronucleus embryo (2PN) rate,2PN cleavage rate,rate of high-quality embryos,and endometrial thickness on the day of transfer were recorded;and the biochemical pregnancy rate,clinical pregnancy rate,and miscarriage rate were calculated.The influencing factors of vitamin D in PCOS patients were analyzed by logistic linear regression,and the influencing factors of clinical pregnancy in PCOS patients were analyzed by multivariate analysis of logistic regression.
Results　The levels of E2,LDL-C,and fasting blood glucose of patients in the VD deficiency PCOS group were significantly higher than those in the VD sufficient PCOS group,while the AMH level was significantly lower than that in the VD sufficient PCOS group (P<0.05);there was no statistically significant difference in age,infertility years,BMI,FSH,LH,PRL,T,triglycerides,TC,HDL-C,fasting insulin,and HOMA-IR of patients between the two groups (P>0.05).There was no statistically significant difference in terms of GN dosage,days of GN use,LH level on trigger day,E2 level on trigger day,P level on trigger day,average number of retrieved oocytes,number of transferred embryos,the rate of oocyte-obtained,MII oocyte rate,2PN fertilization rate,2PN cleavage rate,high-quality embryo rate,endometrium thickness on transfer day,biochemical pregnancy rate,clinical pregnancy rate,and miscarriage rate of patients between the two groups (P>0.05).After removing confounding factors such as age and body mass,the results of logistic linear regression analysis showed that the 25-(OH) D levels were positively correlated with AMH,cholesterol,and FSH (P<0.05);and negatively correlated with triglycerides,HDL-C,LDL-C,and fasting blood glucose in PCOS patients (P<0.05);there was no correlation between 25-(OH) D levels and fasting insulin,HOMA-IR,LH and E2 levels (P>0.05).The results of multivariate logistic regression analysis showed that BMI,25 (OH) D levels,triglycerides,HOMA-IR,number of high-quality embryos,endometrial thickness,and P level on trigger day were correlated with clinical pregnancy in PCOS patients (P<0.05);however,there was no correlation between age,AMH,high HDL-C,LDL-C and clinical pregnancy (P>0.05).
Conclusion　VD deficiency can affect glycolipid metabolism and pregnancy outcomes in PCOS patients.

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更新日期/Last Update: 2024-04-05