维生素D缺乏与复发性流产的相关性及补充维生素D对防治复发性流产的作用机制  

The relationship between Vitamin D and recurrent spontaneous abortions together with the mechanism of Vitamin D supplement on the prevention and treatment of Recurrent spontaneous abortions

作　　者：徐玉庭 王华伟[1] 苏梦驰 唐莉[1] XU Yu-Ting;WANG Hua-Wei;SU Meng-Chi(The First Afiliated Hospital of Kunming Medical University,Kunming,Yunnan 650000,China)

机构地区：[1]昆明医科大学第一附属医院,云南昆明650000

出　　处：《中国妇幼保健》2022年第17期3103-3107,共5页Maternal and Child Health Care of China

基　　金：国家自然科学基金(82160281)。

摘　　要：复发性流产(RSA)在育龄期女性中的发病率较高(约1%~2%)。维生素D及其受体(VDR)广泛存在于免疫、内分泌及生殖器官中,与卵子发育、精子生成、配子受精、胚胎着床及妊娠维持都有着密切关系。维生素D缺乏女性细胞免疫及体液免疫受损,表现为Th1/Th2细胞比率增高、外周血NK细胞水平升高、NK细胞毒性增加及更容易出现自身免疫性疾病,维生素D缺乏还容易诱发RAS相关的胰岛素抵抗(IR)、血糖血脂异常等代谢问题,影响精子的产生、获能及活力,影响卵子的发育与成熟。维生素D缺乏会增加妊娠早期流产的风险,补充维生素D可以作为一种自然疗法,将早期自然流产的风险降至最低。该文就维生素D缺乏与RSA病因中免疫、代谢、配子异常的相关性及相关机制进行论述,探讨维生素D缺乏对RSA的不利影响及补充维生素D对防治RSA的作用机制,指导临床医生关注RAS患者体内的维生素D状态,对RAS伴维生素D不足患者予以积极的维生素D治疗。Objective Recurrent spontaneous abortions(RSA)is more common in women of childbearing age(about 1%~2%).Vitamin D and its receptor(VDR)are widely present in the immune,endocrine and reproductive organs,which is closely related to egg development,sperm production,gamete fertilization,embryo implantation,and pregnancy maintenance.Studies have found that female cellular immunity and humoral immunity are impaired by Vitamin D deficiency,which was manifested as increasing Th1/Th2 cell ratio,increasing NK cell level in peripheral blood,increasing NK cell toxicity and more prone to autoimmune diseases.Vitamin D deficiency can easily induce RAS related Metabolic problems such as insulin resistance(IR),abnormal blood glucose and lipids.Vitamin D deficiency also can affect the production,capacitation and vitality of sperm,and affect the development and maturation of eggs.So Vitamin D deficiency increases the risk of miscarriage in early pregnancy.Vitamin D Supplementation can be used as a natural therapy to minimize the risk of early spontaneous miscarriage.This article reviews the correlation together with specific mechanism between Vitamin D deficiency and the etiology of RSA on abnormal immunity,metabolism and gamete,discusses the adverse effects of Vitamin D deficiency on RSA as well as the mechanism of Vitamin D supplement on the prevention and treatment of RSA,so as to guide clinicians to pay attention to the Vitamin D state in RAS patients and provide active Vitamin D supplement therapy for RAS patients with Vitamin D deficiency.

关 键 词：复发性流产 维生素D 免疫调节 代谢调节 配子质量 治疗 

分 类 号：R714.21[医药卫生—妇产科学]