摘要
目的评价维生素D联合二甲双胍对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)不孕合并肥胖患者妊娠结局、胰岛素抵抗(insulin resistance,IR)及血清氧化应激(oxidative stress,OS)指标的影响。方法选杭州市临平区第一人民医院2021年1月至2022年12月收治的85例PCOS不孕合并肥胖患者,将其中采用二甲双胍治疗的42例患者纳入对照组,采用维生素D联合二甲双胍治疗的43例纳入观察组。观察并比较两组治疗前后体质指数(body mass index,BMI)、腰臀比(waist-to-hip ratio,WHR)、卵巢体积、卵泡个数及妊娠结局、IR和血清OS指标[总抗氧化能力(total antioxidant capacity,TAC)、超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)]变化。结果两组治疗后BMI、WHR、卵泡个数和卵巢体积均较治疗前明显减少(P<0.05)。观察组患者BMI从治疗前的(25.76±1.93)kg/m^(2)下降到治疗后的(24.34±1.77)kg/m^(2),观察组的腰臀比(WHR)也从治疗前(0.78±0.08)kg/m^(2)降低到治疗后的(0.83±0.10)kg/m^(2),显著低于对照组(P<0.05)。两组治疗后卵泡个数和卵巢体积比较差异无统计学意义(P>0.05)。与治疗前相比,两组治疗后血清25(OH)D水平、TAC和SOD活性明显升高,空腹血糖(fasting plasma glucose,FPG)和空腹胰岛素(fasting insulin,FINS),稳态模型胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)和MDA显著降低(P<0.05)。观察组治疗后25(OH)D水平从治疗前的(23.45±4.91)ng/mL增加到治疗后(40.67±5.48)ng/mL、TAC从治疗前的(11.07±1.46)U/mL增加到治疗后的(14.23±1.31)U/mL,SOD活性从治疗前的(38.04±3.95)U/L增加到治疗后的(50.22±5.01)U/L,这些指标显著高于对照组(P<0.05)。FPG水平从治疗前的(5.81±0.79)mmol/L降低到治疗后的(4.69±0.73)mmol/L,FINS水平从治疗前的(12.07±2.08)mU/L降低到治疗后的(9.64±2.01)mU/L,HOMA-IR从治疗前的3.12±0.44降低到治疗后的2.01±0.41,MDA从治疗前的(4.97±1.22)μmol/L降低到治疗后的(4.24±0.96)μmol/L,这些指标显著低于对照组(P<0.05)。两组妊娠率及妊娠成功患者早期流产率、妊娠期高血压发生率和胎儿早产率比较差异无统计学意义(P>0.05)。观察组妊娠成功患者妊娠期糖尿病发生率为9.52%,显著低于对照组42.86%(P<0.05)。结论维生素D补充联合二甲双胍可有效改善肥胖型PCOS不孕患者糖脂代谢及卵巢功能,减轻IR及OS状态,尽管不能提高妊娠率,但可显著减少GDM发生率。
Objective To evaluate the effect of vitamin D supplementation combined with metformin on pregnancy outcome,insulin resistance(IR)and serum oxidative stress(OS)in infertile patients with obese polycystic ovary syndrome(PCOS).Methods 85 patients with PCOS infertility and obesity admitted to Hangzhou Linping District First People’s Hospital from Jan.2021 to Dec.2022 were selected.Among them,42 patients treated with metformin were divided into a control group,and 43 patients treated with vitamin D supplementation combined with metformin were divided into an observation group.The changes of body mass index(BMI),Waist-to-hip ratio(WHR),ovarian volume,follicles number,pregnancy outcome,IR and serum levels of OS indexes[total antioxidant capacity(TAC),superoxide dismutase(SOD)and malondialdehyde(MDA)]were observed and compared between the two groups before and after treatment.Results After two groups of treatment,BMI,WHR,the number of follicles,and ovarian volume all significantly decreased compared to before the treatment(P<0.05).The BMI of the observation group decreased from 25.76±1.93 kg/m^(2) before the treatment to 24.34±1.77 kg/m^(2) after the treatment,and the WHR of the observation group also decreased from 0.78±0.08 kg/m^(2) before the treatment to 0.83±0.10 kg/m^(2) after the treatment,significantly lower than the control group(P<0.05).After treatment,the difference in the number of follicles and ovarian volume between the two groups was not statistically significant(P>0.05).Compared to before treatment,the levels of serum 25(OH)D,TAC,and SOD activity in both groups significantly increased after treatment,and FPG,FINS,HOMA-IR,and MDA significantly decreased(P<0.05).After treatment in the observation group,the level of 25(OH)D increased from 23.45±4.91 ng/mL before treatment to 40.67±5.48 ng/mL after treatment,TAC from 11.07±1.46 U/mL before treatment to 14.23±1.31 U/mL after treatment,SOD activity from 38.04±3.95 U/L before treatment to 50.22±5.01 U/L after treatment,these indicators were significantly higher than those in the control group(P<0.05).FPG level decreased from 5.81±0.79 mmol/L before treatment to 4.69±0.73 mmol/L after treatment,FINS level from 12.07±2.08 mU/L before treatment to 9.64±2.01 mU/L after treatment,HOMA-IR from 3.12±0.44 before treatment to 2.01±0.41 after treatment,MDA from 4.97±1.22μmol/L before treatment to 4.24±0.96μmol/L after treatment,these indicators were significantly lower than those in the control group(P<0.05).The differences in pregnancy rates and early miscarriage rates,the incidence of gestational hypertension,and the rate of preterm birth in pregnant patients between the two groups were not statistically significant(P>0.05).The incidence of gestational diabetes in pregnant patients in the observation group was 9.52%,significantly lower than 42.86%in the control group(P<0.05).Conclusion Vitamin D supplementation combined with Metformin can effectively improve glucose and lipid metabolism,ovarian function in obese PCOS infertile patients,reduce IR and OS status.Vitamin D supplementation can not increase pregnancy rate,significantly reduces the incidence of GDM.
作者
吴於萍
薛惠
卢艺
Wu Yuping;Xue Hui;Lu Yi(Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Gynaecology and Obstetrics,the First People’s Hospital of Linping District,Hangzhou 311103,China)
出处
《中华内分泌外科杂志（中英文）》
CAS
2024年第2期293-298,共6页
Chinese Journal of Endocrine Surgery
基金
杭州市卫生科技计划项目(B20231187)。
关键词
多囊卵巢综合征
维生素D
二甲双胍
肥胖型
不孕
妊娠结局
胰岛素抵抗
氧化应激
Polycystic ovary syndrome
Vitamin D
Metformin
Obese type
Infertility
Pregnancy outcome
Insulin resistance
Oxidative stress
