孕早期女性维生素D水平及补充效果的一项单中心前瞻性研究  

A single-center prospective study of vitamin D levels and its supplementary effect in the first trimester

作　　者：王佳佳 王鸥 李蕊 陈莹莹 刘燕萍 邢小平 Wang Jiajia;Wang Ou;Li Rui;Chen Yingying;Liu Yanping;Xing Xiaoping(Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Key Laboratory of Endocrinology,National Health Commission,Beijing 100730,China;Department of Clinical Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院内分泌科、国家卫生健康委员会内分泌重点实验室,北京100730 [2]中国医学科学院、北京协和医学院、北京协和医院临床营养科,北京100730

出　　处：《中华内科杂志》2024年第11期1104-1110,共7页Chinese Journal of Internal Medicine

基　　金：中央高水平医院临床科研业务费资助项目(2022-PUMCH-B-014, 2022-PUMCH-B-055)。

摘　　要：目的了解孕早期女性维生素D水平及其影响因素,并分析外源性维生素D的补充效果。方法前瞻性队列研究。收集2020年12月1日至2021年12月1日在北京协和医院规律产检及随访的孕早期女性,排除合并干扰维生素D吸收、代谢的严重基础疾病,最终纳入98名孕早期女性为研究对象,进行问卷调查,采用液相色谱串联质谱法检测基线血清25羟维生素D[25(OH)D]水平后予不同剂量维生素D补充,4周后复测25(OH)D,评估补充效果。采用t检验、单因素方差分析、χ^(2)检验、多元线性回归分析进行统计学分析。结果98名研究对象妊娠年龄(33.5±4.0)岁,基线血清25(OH)D为(41.2±20.0)nmol/L,70.4%(69/98)存在维生素D缺乏。42.9%(42/98)的研究对象初次检测时已使用维生素D补充剂。单因素分析显示维生素D是否补充(t=-4.21,P<0.001)、检测季节(t=2.59,P=0.011)及坚果摄入频次(t=2.67,P=0.009)与孕早期基线25(OH)D水平有关,多元线性回归分析示仅维生素D补充与基线25(OH)D水平有关(B=13.84,P=0.006)。研究对象维生素D3补充剂量范围400~5000 U/d,规律用药(4.1±2.5)周后复测25(OH)D水平显著升高[(64.1±18.1)nmol/L比(37.3±16.6)nmol/L,t=-9.36,P<0.001],升高幅度与基线25(OH)D水平负相关(B=-0.66,P<0.001),与维生素D补充剂量正相关,每补充1μg/d(40 U/d),25(OH)D平均增加0.51 nmol/L(B=0.51,P<0.001)。结论本中心孕早期女性维生素D缺乏比例高,外源性维生素D补充可显著改善维生素D缺乏状态,且补充效果与基线维生素D水平负相关,与补充剂量正相关。Objective:To investigate vitamin D levels and the effect of exogenous vitamin D supplementation in the first trimester among pregnant women in our center.Methods:This was a prospective cohort study.A total of 98 women in the first trimester who were followed-up regularly in Peking Union Medical College Hospital from December 1 st 2020 to December 1 st 2021 were enrolled.Subjects who had medical conditions that affect vitamin D absorption or metabolism were excluded.Questionnaires were administered,and 25-hydroxyvitamin D[25(OH)D]levels were detected using liquid chromatography tandem mass spectrometry(LC/MS/MS)method.According to the basic 25(OH)D level,different dosages of exogenous vitamin D were supplemented.After 4 weeks,25(OH)D levels were detected again to evaluate the effect of supplementation.T test,analysis of variance,χ^(2) test,and multiple linear regression analysis were used for analysis.Results:The mean age of enrolled subjects was(33.5±4.0)years.The baseline 25(OH)D level was(41.2±20.0)nmol/L.Briefly,70.4%(69/98)subjects were deficient in vitamin D,and 42.9%(42/98)patients were using vitamin D supplementation at the time of 25(OH)D testing.Single-factor analysis showed that vitamin D supplementation(t=-4.21,P<0.001),season(t=2.59,P=0.011),and nut-eating frequency(t=2.67,P=0.009)were related to 25(OH)D levels.Multiple linear regression analysis showed that only vitamin D supplementation had a relationship with 25(OH)D level(B=13.84,P=0.006).According to the baseline 25(OH)D level,400-5000 U/d vitamin D3 was supplemented regularly for(4.1±2.5)weeks,and 25(OH)D levels significantly increased after supplementation[(64.1±18.1)vs(37.3±16.6)nmol/L,t=-9.36,P<0.001].The ascending range was negatively associated with basic 25(OH)D level(B=-0.66,P<0.001)and positively associated with supplementary dosage(B=0.51,P<0.001).25(OH)D levels increased by 0.51 nmol/L on average per 1μg(40 U)of vitamin D supplementation daily.Conclusions:The proportion of vitamin D deficiency was high in the first trimester amo

关 键 词：妊娠初期 维生素D 影响因素 维生素D补充 

分 类 号：R153.1[医药卫生—营养与食品卫生学]