妊娠早期血清25羟基维生素D水平对多囊卵巢综合征孕妇糖脂代谢指标与妊娠结局的影响  

The effect of serum 25 hydroxyvitamin D levels in early pregnancy on glucose and lipid metabolism indicators and pregnancy outcomes in women with polycystic ovary syndrome

作　　者：李丹丹 沙伟 梁静一 李改先 杨春霞 Li Dandan;Sha Wei;Liang Jingyi;Li Gaixian;Yang Chunxia(Department of Reproductive Medicine,Hebei Yanda Hospital,Sanhe 065201,China)

机构地区：[1]河北燕达医院生殖医学科,三河065201

出　　处：《中国医师杂志》2023年第9期1340-1344,共5页Journal of Chinese Physician

基　　金：河北省医学科学研究重点课题计划(20190147)。

摘　　要：目的探讨妊娠早期血清25羟基维生素D(25OHD)水平对多囊卵巢综合征(PCOS)孕妇糖脂代谢指标和妊娠结局的影响。方法前瞻性选择河北燕达医院2021年1月至2022年6月收治的132例PCOS孕妇作为研究对象,根据血清25OHD水平将其分成4组,即维生素D严重缺乏组(25OHD<10 ng/ml)12例,维生素D缺乏组(25OHD:10~<20 ng/ml)28例,维生素D不足组(25OHD:20~<30 ng/ml)55例,维生素D充足组(25OHD≥30 ng/ml)37例。比较四组血清糖脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]以及不良妊娠结局。结果随着妊娠早期维生素D缺乏程度的加重,血清TC、TG、LDL-C、FPG、FINS水平以及HOMA-IR均逐渐升高(均P<0.05),血清HDL-C水平逐渐降低(均P<0.05)。PCOS孕妇妊娠早期血清25OHD水平与血清TG、FINS水平以及HOMA-IR均呈负相关(r=-0.523、-0.612、-0.354,均P<0.05),与血清HDL-C水平呈正相关(r=0.484,P<0.05),与血清TC、LDL-C、FPG水平均无明显相关性(均P>0.05)。维生素D充足组不良妊娠结局发生率显著低于其余三组[8.11%(3/37)vs 34.55%(19/55)、46.43%(13/28)、8/12,P<0.05],维生素D不足组不良妊娠结局发生率显著低于维生素D严重缺乏组(34.55%vs 8/12,P<0.05)。结论随着妊娠早期血清25OHD水平的降低,PCOS孕妇体内糖脂代谢紊乱逐渐加重,不良妊娠结局发生率逐渐增加。Objective To investigate the effect of serum 25 hydroxyvitamin D(25OHD)levels in early pregnancy on glucose and lipid metabolism indicators and pregnancy outcomes in women with polycystic ovary syndrome(PCOS).Methods A prospective study was conducted on 132 pregnant women with PCOS admitted to the Yanda Hospital in Hebei from January 2021 to June 2022.They were divided into four groups based on serum 25OHD levels:severe vitamin D deficiency group(12 cases with 25OHD<10 ng/ml),vitamin D deficiency group(28 cases with 25OHD:10-<20 ng/ml),vitamin D deficiency group(55 cases with 25OHD:20-<30 ng/ml),and vitamin D sufficient group(37 cases with 25OHD≥30 ng/ml).Four groups of serum glucose and lipid metabolism indicators[total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),fasting insulin(FINS),insulin resistance index(HOMA-IR)]and poor pregnancy outcomes were compared.Results As the degree of vitamin D deficiency worsens in early pregnancy,serum levels of TC,TG,LDL-C,FPG,FINS,and HOMA-IR gradually increased(all P<0.05),while serum levels of HDL-C gradually decreased(all P<0.05).The serum 25OHD level in early pregnancy of PCOS pregnant women was negatively correlated with serum TG,FINS levels,and HOMA-IR levels(r=-0.523,-0.612,-0.354,all P<0.05),and positively correlated with serum HDL-C levels(r=0.484,P<0.05).There was no significant correlation with serum TC,LDL-C,and FPG levels(all P>0.05).The incidence of adverse pregnancy outcomes in the vitamin D sufficient group was significantly lower than the other three groups[8.11%(3/37)vs 34.55%(19/55),46.43%(13/28),8/12,P<0.05],while the incidence of adverse pregnancy outcomes in the vitamin D insufficient group was significantly lower than that in the vitamin D severely deficient group(34.55%vs 8/12,P<0.05).Conclusions With the decrease of serum 25OHD levels in early pregnancy,the disorder of glucose and lipid metabolism in PCOS pregnant women gradually worsens,and the i

关 键 词：妊娠初期 25-羟基维生素-D 多囊卵巢综合征 糖脂代谢 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]