摘要
目的分析卵泡液中维生素D水平与体外受精(IVF)妊娠结局的关系。方法收集2021年1月-2022年12月期间在北京市海淀区妇幼保健院生殖中心实施IVF-胚胎移植(ET)助孕的不孕患者200例作为研究对象。根据美国内分泌学会临床实践指南标准,将患者血清25羟维生素D[25(OH)D]水平<30 ng/mL定义为维生素D不足或缺乏。将维生素D不足或缺乏的患者采用随机数字表法随机分为两组,一组给予维生素D滴剂进行干预治疗(干预组),另一组不进行干预(未干预组)。比较干预组(79例)、未干预组(79例)及维生素D充足组(42例)3组患者卵泡液中维生素D水平。根据是否妊娠分为未妊娠组和妊娠组;采用液相色谱-串联质谱法检测卵泡液中25(OH)D水平;采用Spearman法分析卵泡液中25(OH)D水平和妊娠结局相关指标的相关性。采用受试者工作特征(ROC)曲线分析卵泡液中25(OH)D对IVF-ET妊娠结局的预测价值。结果干预组和充足组的卵泡液25(OH)D水平[(36.37±3.11)、(38.42±3.16)ng/mL]、获卵数[(13.35±4.43)、(12.64±3.99)个]、受精率[(82.03±27.29)%、(80.76±25.89)%]、优质胚胎率[(48.11±15.67)%、(50.75±16.88)%]及临床妊娠率[51.90%(41/79)、71.43%(30/42)]均显著高于未干预组[(20.68±4.57)ng/mL、(10.43±3.45)个、(69.11±23.02)%、(42.53±14.14)%及35.44%(28/79)],差异均有统计学意义(F/χ^(2)=457.526、11.251、5.811、4.685、14.506,P均<0.05),充足组25(OH)D水平及临床妊娠率显著高于干预组,差异有统计学意义(t/χ^(2)=3.433、4.314,P<0.05)。妊娠组卵泡液25(OH)D水平(35.22±3.14)ng/mL、获卵数(12.94±4.25)个、受精率(81.88±27.06)%、优质胚胎率(50.77±16.71)%和移植日内膜厚度(11.64±1.48)mm显著高于未妊娠组(22.21±4.71)ng/mL、(10.43±3.43)个、(67.17±22.13)%、(38.63±12.79)%和(10.15±1.54)mm,差异均有统计学意义(t=22.937、4.601、4.212、5.776、6.977,P均<0.05)。根据Spearman相关性分析得知,卵泡液中25(OH)D水平与获卵数、受精率、优质胚胎率和移植日内膜厚度成正相关(r=0.602、0.564、0.581、0.534,P均<0.05)。根据ROC曲线得知,卵泡液中25(OH)D预测IVF-ET妊娠结局的曲线下面积(AUC)为0.858(95%CI:0.808~0.908),灵敏度为81.28%,特异度为79.35%。结论卵泡液中25(OH)D缺乏可能与IVF妊娠结局密切相关。
Objective To analyze the relationship between vitamin D level in follicular fluid and pregnancy outcomes of in vitro fertilization(IVF).Methods From January 2021 to December 2022,200 infertile patients who underwent IVF-embryo transfer(ET)assisted pregnancy in the Reproductive Center of Beijing Haidian District Maternal and Child Health Care Hospital were collected as the subjects of this study.According to the American Endocrine Society clinical practice guidelines,a patient's serum 25-hydroxyvitamin D[25(OH)D]level<30 ng/mL was defined as vitamin D insufficiency or deficiency.Patients with vitamin D insufficiency or deficiency were randomly divided into two groups using a random number table,one given vitamin D drops for intervention(intervention group)and the other no intervention(non-intervention group).Vitamin D levels in follicular fluid were compared in the vitamin D intervention group(79 cases),no intervention group(79 cases)and vitamin D adequacy group(42 patients).They were divided into non pregnant group and pregnant group based on pregnancy status;25(OH)D levels in follicular fluid were detected by liquid chromatography-tandem mass spectrometry;Spearman method was applied to analyze the correlation between 25(OH)D in follicular fluid and pregnancy outcome related indicators.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of 25(OH)D in follicular fluid for pregnancy outcomes of IVF-ET.Results Follicular fluid levels of 25(OH)D[(36.37±3.11),(38.42±3.16)ng/mL],egg acquisition[(13.35±4.43),(12.64±3.99)],fertilization rate[(82.03±27.29)%,(80.76±25.89)%],quality embryo rate[(48.11±15.67)%,(50.75±16.88)%],and clinical pregnancy rate[51.90%(41/79),71.43%(30/42)]in intervention group and adequacy group were significantly higher than those in the non-intervention group[(20.68±4.57)ng/mL,(10.43±3.45),(69.11±23.02)%,(42.53±14.14)%and 35.44%(28/79)];all the differences were statistically significant(F/χ^(2)=457.526,11.251,5.811,4.685,14.506;all P<0.05).The level of 25(OH)D and the clinical pregnancy rate in the adequacy group were significantly higher than those in the intervention group;all the differences were statistically significant(t/χ^(2)=3.433,4.314;all P<0.05).The follicular fluid 25(OH)D(35.22±3.14)ng/mL,egg acquisition(12.94±4.25),fertilization rate(81.88±27.06)%,high-quality embryo rate(50.77±16.71)%and endomembrane thickness(11.64±1.48)mm in the pregnant group were significantly higher than those in the non-pregnant group[(22.21±4.71)ng/mL,(10.43±3.43),(67.17±22.13)%and(38.63±12.79)%and(10.15±1.54)mm];all the differences were statistically significant(t=22.937,4.601,4.212,5.776,6.977;all P<0.05).According to Spearman correlation analysis,the level of 25(OH)D in follicular fluid was positively correlated with egg harvest,fertilization rate,high-quality embryo rate and endomembrane thickness during transfer(r=0.602,0.564,0.581,0.534;all P<0.05).According to the ROC curve,the area under the curve(AUC)of 25(OH)D in follicular fluid to predict IVF-ET pregnancy outcome was 0.858(95%CI:0.808-0.908)with a sensitivity of 81.28%and a specificity of 79.35%.Conclusion The deficiency of 25(OH)D in follicular fluid might be closely related to the pregnancy outcome of IVF.
作者
习艳霞
王慧春
刘慧文
李颖
于淼
XI Yanxia;WANG Huichun;LIU Huiwen;LI Ying;YU Miao(Department of Reproductive Center,Haidian Maternal and Child Health Care Hospital,Beijing 100088,China)
出处
《热带医学杂志》
CAS
2023年第11期1546-1550,共5页
Journal of Tropical Medicine
基金
北京市自然科学基金(7172077)
北京市海淀区卫生健康发展科研培育计划项目(HP2022-05-103001)
关键词
25羟维生素D
卵泡液
体外受精
胚胎移植
妊娠结局
25(OH)D
Follicular fluid
In vitro fertilization
Embryo transfer
Pregnancy outcome
