维生素D、二甲双胍联合炔雌醇环丙孕酮对育龄多囊卵巢综合征患者妊娠结局的影响  

The Effect of Vitamin D and Metformin Combined With Ethinylestradiol and Cyproterone Acetate on Pregnancy Outcome of Patients With Polycystic Ovary Syndrome at Reproductive Age

作　　者：史红珍[1] 王同力 孙立娟[3] 王倩[4] 林琳[1] SHI Hong-zhen;WANG Tong-li;SUN Li-juan;WANG Qian;LIN Lin(Department of Reproductive Medicine,First Hospital of Qinhuangdao,Hebei Qinhuangdao 066000,China;Department of Neurosurgery,First Hospital of Qinhuangdao,Hebei Qinhuangdao 066000,China;Department of Ultrasound,First Hospital of Qinhuangdao,Hebei Qinhuangdao 066000,China;Department of Gynecology,First Hospital of Qinhuangdao,Hebei Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院生殖医学科,河北秦皇岛066000 [2]秦皇岛市第一医院神经外科,河北秦皇岛066000 [3]秦皇岛市第一医院超声医学科,河北秦皇岛066000 [4]秦皇岛市第一医院妇科,河北秦皇岛066000

出　　处：《循证医学》2022年第5期277-281,共5页The Journal of Evidence-Based Medicine

基　　金：秦皇岛市科技支撑计划项目(201602A218)。

摘　　要：目的探讨维生素D(vitamin D,VD)、二甲双胍联合炔雌醇环丙孕酮对育龄多囊卵巢综合征(polycystic ovary syndrome,PCOS)伴VD缺乏患者妊娠结局的影响。方法选取2018年7月至2020年7月秦皇岛市第一医院育龄PCOS伴VD缺乏患者160例,依据随机表分为A组(n=80)和B组(n=80),A组给予二甲双胍联合炔雌醇环丙孕酮治疗,B组在此基础上给予VD治疗,比较两组性激素[促卵泡生成素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、游离睾酮(testosterone,T)]、糖代谢[空腹血糖(fasting glucose,FGS)、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(insulin resistance index,HOMA-IR)]、25-羟基维生素D(25-hydroxy vitamin D3,25(OH)D)、卵子质量(卵子成熟率、受精率、优质胚胎率)、妊娠结局。结果A组和B组治疗后FSH、LH、T、FGS、FINS、HOMA-IR优于治疗前,B组治疗后FSH、LH、T、FGS、FINS、HOMA-IR优于A组,差异有统计学意义(P<0.05);B组卵子成熟率、受精率、优质胚胎率高于A组,差异有统计学意义(P<0.05);B组妊娠率高于A组,B组流产率低于A组,差异有统计学意义(P<0.05)。结论VD、二甲双胍联合炔雌醇环丙孕酮可能改善育龄PCOS伴VD缺乏患者性激素、糖代谢、25(OH)D水平及卵子质量,有利于改善妊娠结局,值得临床推广。Objective To discuss the effect of vitamin D(VD)and metformin combined with ethinylestradiol and cyproterone acetate on the pregnancy outcome of patients with polycystic ovary syndrome(PCOS)and VD deficiency at reproductive age.Methods The 160 patients with PCOS and VD deficiency at reproductive age in First Hospital of Qinhuangdao from July 2018 to July 2020 were selected;they were divided into groups A(n=80)and B(n=80)according to the random table.Group A was treated with metformin combined with ethinylestradiol and cyproterone acetate,and group B was treated with VD on this basis.The sex hormone[follicle⁃stimulating hormone(FSH),luteinizing hormone(LH),free testosterone(T)],glucose metabolism[fasting glucose(FGS),fasting insulin(FINS),insulin resistance index(HOMA IR)],25⁃hydroxy vitamin D3(25(OH)D),quality of ovum(ovum maturation rate,fertilization rate,high⁃quality embryo rate)and pregnancy outcome were compared between the two groups.Results The FSH,LH,T,FGS,FINS,HOMA⁃IR after treatment in group A and group B were better than those before treatment.The FSH,LH,T,FGS,FINS,HOMA⁃IR after treatment in group B were better than those in group A,the difference was statistically significant(P<0.05).The ovum maturation rate,fertilization rate,and high⁃quality embryo rate in group B were higher than those in group A;the differences were statistically significant(P<0.05).The pregnancy rate of group B was higher than that of group A,and the abortion rate of group B was lower than that of group A,the difference was statistically significant(P<0.05).Conclusions VD and metformin combined with ethinylestradiol and cyproterone acetate can improve the sex hormones,glucose metabolism,25(OH)D levels,and quality of ovum in patients with PCOS and VD deficiency at reproductive age,which may be helpful to improve pregnancy outcome;it's worth for further clinical promotion.

关 键 词：维生素D 二甲双胍 炔雌醇环丙孕酮 育龄 多囊卵巢综合征 妊娠结局 

分 类 号：R711.75[医药卫生—妇产科学]