补充维生素D对体外受精胚胎移植患者胚胎质量及妊娠结局的影响  

Effect of vitamin D supplementation on embryo quality and pregnancy outcome in patients undergoing in vitro fertilization and embryo transfer

作　　者：马志宾 王颖[1] 翟俊英[1] MA Zhi-bin;WANG Ying;ZHAI Jun-ying(Department of Reproductive Medicine Nanyang First People's Hospital,Nanyang 473000,Henan,CHINA)

机构地区：[1]南阳市第一人民医院生殖医学科,河南南阳473000

出　　处：《海南医学》2024年第7期955-959,共5页Hainan Medical Journal

基　　金：2018年河南省医学科技攻关计划项目(编号:2018020979)。

摘　　要：目的探讨补充维生素D对体外受精胚胎移植(IVF-ET)患者胚胎质量和妊娠结局的影响,为临床治疗提供参考依据。方法选取2020年6月至2022年6月南阳市第一人民医院收治的106例维生素D缺乏IVF-ET患者纳入研究,按随机数表法分为对照组和观察组各53例。对照组仅补充复合维生素,观察组在对照组基础上补充维生素D滴剂,补充至取卵前。比较两组患者补充前后血清和卵泡液中25羟基维生素D[25(OH)D]水平、基础日及人绒毛膜促性腺激素(HCG)日性激素水平[雌二醇(E2)、孕酮(P)、黄体生成素(LH)]、促排卵、获卵情况、胚胎情况及妊娠结局,采用Pearson相关性分析25(OH)D水平与胚胎质量评分、优质胚胎率、妊娠结局的相关性。结果补充后,观察组患者血清、卵泡液中25(OH)D水平分别为(35.79±8.22)ng/mL、(32.35±6.64)ng/mL,明显高于对照组的(25.28±7.14)ng/mL、(23.96±6.03)ng/mL,差异均有统计学意义(P<0.05);观察组和对照组患者HCG日的E2、LH、P水平较基础日升高,差异均具有统计学意义(P<0.05),但两组患者HCG日的E2、LH、P水平比较差异均无统计学意义(P>0.05);观察组患者的优质胚胎率、临床妊娠率、活产率分别为67.90%、69.81%、97.30%,明显高于对照组的51.95%、49.06%、73.08%,早期流产率为2.70%,明显低于对照组的23.08%,差异均具有统计学意义(P<0.05);观察组患者的胚胎质量评分为(8.66±0.41)分,明显高于对照组的(8.02±0.19)分,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,血清、卵泡液中25(OH)D水平与胚胎质量评分、优质胚胎率、临床妊娠率、活产率呈正相关(P<0.05),与早期流产率呈负相关(P<0.05)。结论维生素D缺乏IVF-ET患者补充维生素D后不仅能提高血清和卵泡液25(OH)D水平,还可改善妊娠结局、提高优质胚胎,且血清和卵泡液25(OH)D水平升高有助于改善IVF-ET助孕结局。Objective To explore the effect of vitamin D supplementation on embryo quality and pregnancy outcome in patients undergoing in vitro fertilization and embryo transfer(IVF-ET),and to provide a reference for clinical practice.Methods A total of 106 IVF-ET patients with vitamin D deficiency admitted to Nanyang First People's Hospital from June 2020 to June 2022 were included and randomly divided into a control group and an observation group using a random number table method,with 53 cases in each group.The control group received complex vitamins supplementation,while the observation group received vitamin D drops on the basis of the control group,until egg retrieval.The levels of 25-hydroxyvitamin D[25(OH)D]in serum and follicular fluid before and after supplementation,sex hormone levels[estradiol(E2),progesterone(P),luteinizing hormone(LH)]at basal and human chorionic gonadotropin(HCG)day,ovulation induction,egg acquisition,embryo status,and pregnancy outcome were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between 25(OH)D levels and embryo quality score,high-quality embryo rate,and pregnancy outcome.Results After supplementation,the levels of 25(OH)D in the serum and follicular fluid of the patients in the observation group were(35.79±8.22)ng/mL and(32.35±6.64)ng/mL,respectively,which were significantly higher than(25.28±7.14)ng/mL and(23.96±6.03)ng/mL in the control group(P<0.05).The levels of E2,LH,and P on HCG day in the observation group and control group were higher than those on the basal day(P<0.05).However,there was no significant difference in E2,LH,and P levels on HCG day between the two groups(P>0.05).The high-quality embryo rate,clinical pregnancy rate,and live birth rate in the observation group were 67.90%,69.81%,and 97.30%,respectively,which were significantly higher than 51.95%,49.06%,and 73.08%in the control group,and the early abortion rate was 2.70%,which was significantly lower than 23.08%in the control group,with statistically significan

关 键 词：不孕症 维生素D 体外受精胚胎移植 胚胎质量评分 优质胚胎率 妊娠结局 

分 类 号：R715[医药卫生—妇产科学]