摘要
目的探讨血清及卵泡液中25-羟维生素D[25(OH)D]与体外受精-胚胎移植(IVF-ET)妊娠结局的关系。方法选取2017年7月至2018年7月于山西医科大学第一医院生殖中心首次接受IVF-ET助孕治疗的67例不孕患者,按照妊娠结局分为妊娠组和未妊娠组。采用t检验或秩和检验比较2组间的实验室检查数据以及血清及卵泡液中25(OH)D的差异,差异具有统计学意义的变量进行Logistic多因素回归分析;采用Pearson相关分析法分析血清25(OH)D水平与卵泡液25(OH)D水平的相关性,采用Spearman相关分析法分析血清25(OH)D水平与三酰甘油、促甲状腺素、受精率的相关性。结果所有患者平均血清25(OH)D水平为26.27μg/L。(1)妊娠组与未妊娠组促甲状腺素[2.34(1.80~3.20)mIU/ml vs 2.93(2.28~4.53)mIU/ml]、三酰甘油[0.93(0.73~1.22)mmol/L vs 1.14(0.87~1.56)mmol/L]、Gn起始剂量[225.0(150.0~300.0)IU/L vs 262.5(225.0~300.0)IU/L]比较均低,差异均具有统计学意义(Z=-2.237、-2.138、-2.107,P=0.020、0.032、0.035);妊娠组与未妊娠组的受精率[85.7%(78.3%~94.4%)vs 76.3%(63.5%~92.5%)]、血清及卵泡液中25(OH)D[血清:(37.08±13.39)mmol/L vs(28.90±12.53)mmol/L;卵泡液:(31.18±13.10)mmol/L vs(21.92±9.24)mmol/L]比较均高,差异均具有统计学意义(Z=-2.178,P=0.029;t=2.579、3.282,P=0.012、0.020)。(2)IVF-ET患者血清25(OH)D与卵泡液25(OH)D水平呈正相关(r=0.836,P<0.01),与三酰甘油水平呈负相关(r=-0.286,P=0.019),与促甲状腺素水平无相关性(r=-0.007,P=0.958),与受精率呈正相关性(r=0.43,P<0.01)。(3)Logistic回归分析临床妊娠结局的影响因素结果显示血清25(OH)D、卵泡液25(OH)D、三酰甘油、促甲状腺素、Gn起始剂量、受精率在去除混杂因素后,对IVF-ET患者妊娠结局无明显影响(P均>0.05),将血清与卵泡液25(OH)D联合之后再进行回归分析发现在去除混杂因素后,对IVF-ET患者妊娠结局也无明显影响(比值比=1.001,P=0.058)。结论不孕症患者普遍存在维生素D缺乏,但维生素D和IVF-ET临床妊娠结局无明显相关性。
Objective To investigate the relationship between 25 hydroxyvitamin D[25(OH)D]in serum and follicular fluid and the pregnancy outcome of in vitro fertilization and embryo transfer(IVF-ET).Methods From July 2017 to July 2018,67 infertile patients who received IVF-ET for the first time at the Reproductive Center of the First Hospital of Shanxi Medical University were divided into a pregnant group and non-pregnant group according to the pregnancy outcome.The general data,laboratory data,and 25(OH)D in serum and follicular fluid were compared between the two groups.The t-test or rank test was used to compare the differences between the two groups,and the variables with statistical significance were further analyzed by logistic regression.The correlation between serum 25(OH)D levels and follicular fluid 25(OH)D levels was evaluated by Pearson correlation analysis,and the correlation between serum 25(OH)D level and triglyceride,thyroid stimulating hormone(TSH),and fertilization rate was evaluated by Spearman correlation analysis.Results The average level of 25(OH)D in serum in all patients was 26.27μg/L.The levels of TSH[2.34(1.80-3.20)mIU/ml vs 2.93(2.28-4.53)mIU/ml]and triglyceride[0.93(0.73-1.22)mmol/L vs 1.14(0.87-1.56)mmol/L]and the initial dose of gonadotropins[225.0(150.0-300.0)IU/L vs 262.5(225.0-300.0)IU/L]in the pregnant group were significantly lower than those in the non-pregnant group(Z=-2.237,-2.138,and-2.107;P=0.020,0.032,and 0.035,respectively).The fertilization rate[85.7(78.3-94.4)%vs 76.3(63.5-92.5)%]and 25(OH)D in serum and follicular fluid[serum:(37.08±13.39)mmol/L vs(28.90±12.53)mmol/L;follicular fluid:(31.18±13.10)mmol/L vs(21.92±9.24)mmol/L]in the pregnant group were significantly higher than those in the non-pregnant group(Z=-2.178,P=0.029;t=2.579 and 3.282,P=0.012 and 0.020,respectively).There was a positive correlation between 25(OH)D in serum and 25(OH)D in follicular fluid in IVF-ET patients(r=0.836,P<0.01).25(OH)D in serum had a negative correlation with triglyceride(r=-0.286,P=0.019),no correlation with TSH(r=-0.007,P=0.958),and a positive correlation with fertilization rate(r=-0.43,P<0.01).The results of logistic regression analysis showed that serum 25(OH)D,follicular fluid 25(OH)D,triglyceride,TSH,initial gonadotropins dose,and fertilization rate had no significant effect on the pregnancy outcome of IVF-ET patients after excluding confounding factors(P>0.05).The regression analysis after the combination of serum and follicular fluid 25(OH)D showed that it had no significant effect on the pregnancy outcome of IVF-ET patients after excluding confounding factors(OR=1.001,P=0.058).Conclusion There is a general lack of vitamin D in infertility patients,but there is no significant correlation between vitamin D and clinical pregnancy outcome of IVF-ET.
作者
路红琴
何玉洁
Lu Hongqin;He Yujie(Reproductive Medicine Centre,the First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China)
出处
《中华临床医师杂志（电子版）》
CAS
2020年第6期407-412,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
山西省重点研发计划项目(201603D321070)。
关键词
25-羟维生素D
体外受精-胚胎移植
妊娠结局
25 hydroxyvitamin D
In vitro fertilization and embryo transfer
Pregnancy outcome
