探讨维生素D辅助治疗对多囊卵巢综合征患者激素及代谢的影响
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摘要
目的观察维生素D辅助治疗对多囊卵巢综合征(PCOS)患者激素及代谢的影响。方法 64例多囊卵巢综合征患者,按随机数字表法分为对照组和维生素D组,每组32例。两组患者均给予炔雌醇环丙孕酮片(商品名:达英-35)治疗,如达到糖尿病诊断标准则同时给予二甲双胍治疗,在此基础上,维生素D组给予维生素D治疗,对照组给予安慰剂治疗。比较两组患者治疗前后血清维生素D、血清黄体生成素(LH)、血清卵泡刺激素(FSH)、LH/FSH、血清睾酮(T)、总胆固醇(TC)、血清甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、体质量指数(BMI)、空腹血糖(FBG)、血清空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(QUICKI)。结果 64例患者中, 91%(58/64)的患者维生素D水平<30 ng/ml,其中69%(44/64)的患者维生素D水平≤20 ng/ml, 22%(14/64)的患者维生素D水平为20～30 ng/ml。治疗前,两组维生素D、LH、FSH、LH/FSH、T水平比较,差异无统计学意义(P>0.05);治疗后,两组维生素D、FSH、LH、LH/FSH、T水平均优于治疗前,差异有统计学意义(P<0.05),维生素D组FSH、LH、LH/FSH、T水平与对照组比较,差异无统计学意义(P>0.05),维生素D组维生素D水平(43.91±9.02)ng/ml高于对照组的(20.05±9.14)ng/ml,差异有统计学意义(P<0.05)。治疗前,两组TC、TG及HDL-C水平比较差异无统计学意义(P>0.05);治疗后,两组TC、TG水平均低于治疗前, HDL-C水平高于治疗前,差异有统计学意义(P<0.05),维生素D组TC、TG水平与对照组比较,差异无统计学意义(P>0.05),维生素D组HDL-C水平高于对照组,差异有统计学意义(P<0.05)。治疗前,两组BMI、FBG、FINS、HOMA-IR及QUICKI比较差异无统计学意义(P>0.05);治疗后,维生素D组BMI、FBG、FINS、HOMA-IR及QUICKI均优于治疗前及对照组,差异有统计学意义(P<0.05)。结论大多数多囊卵巢综合征患者存在维生素D缺乏情况,在常规治疗基础上补充维生素D可以有效改善多囊卵巢综合征患者的BMI、HOMA-IR及HDL-C等代谢指标。
Objective To observe the effect of vitamin D adjuvant therapy on hormones and metabolism in patients with polycystic ovary syndrome(PCOS). Methods A total of 64 patients with polycystic ovary syndrome were divided by random number table method into control group and vitamin D group, with 32 cases in each group. Both groups received ethinylestradiol and cyproterone acetate tablets(trade name: Diane-35) treatment and metformin at the same time if reached the diagnostic criteria of diabetes mellitus. On this basis, vitamin D group received vitamin D treatment, and the control group received placebo treatment. Comparison were made on serum vitamin D, serum luteinizing hormone(LH), serum follicle stimulating hormone(FSH), LH/FSH, serum testosterone(T), total cholesterol(TC), serum triglyceride(TG), high density lipoprotein cholesterol(HDL-C), body mass index(BMI), fasting blood glucose(FBG), fasting insulin(FINS), homeostasis model assessment insulin resistance(HOMA-IR) and quantitative insulin-sensitivity check index(QUICKI) before and after treatment between the two groups. Results Among 64 patients, 91%(58/64) of patients had vitamin D levels < 30 ng/ml, 69%(44/64) of patients had vitamin D levels ≤ 20 ng/ml and 22%(14/64) of patients had vitamin D levels of 20-30 ng/ml. Before treatment, both groups had no statistically significant difference in D, LH, FSH, LH/FSH and T(P>0.05). After treatment, both groups had better vitamin D, LH, FSH, LH/FSH and T than those before treatment, and their difference was statistically significant(P<0.05). Vitamin D group had no statistically significant difference in FSH, LH, LH/FSH and T, comparing with the control group(P>0.05). Vitamin D group had higher vitamin D level as(43.91±9.02) ng/ml than(20.05±9.14) ng/ml in the control group, and the difference was statistically significant(P<0.05). Before treatment, both groups had no statistically significant difference in TC, TG and HDL-C(P>0.05). After treatment, both groups had lower TC and TG than those before treatment, and higher HDL-C than before treatment. Their difference was statistically significant(P<0.05). Vitamin D group had no statistically significant difference in TC and TG, comparing with control group(P>0.05). Vitamin D group had higher HDL-C than the control group, and the difference was statistically significant(P<0.05). Before treatment, both groups had no statistically significant difference in BMI, FBG, FINS, HOMA-IR and QUICKI(P>0.05). After treatment, vitamin D group had better BMI, FBG, FINS, HOMA-IR and QUICKI than those before treatment and the control group, and their difference was statistically significant(P<0.05). Conclusion Most patients with polycystic ovary syndrome have vitamin D deficiency. Supplementation of vitamin D on the basis of routine treatment can effectively improve BMI, HOMA-IR and HDL-C metabolic indicators in patients with polycystic ovary syndrome.
Objective To observe the effect of vitamin D adjuvant therapy on hormones and metabolism in patients with polycystic ovary syndrome(PCOS). Methods A total of 64 patients with polycystic ovary syndrome were divided by random number table method into control group and vitamin D group, with 32 cases in each group. Both groups received ethinylestradiol and cyproterone acetate tablets(trade name: Diane-35) treatment and metformin at the same time if reached the diagnostic criteria of diabetes mellitus. On this basis, vitamin D group received vitamin D treatment, and the control group received placebo treatment. Comparison were made on serum vitamin D, serum luteinizing hormone(LH), serum follicle stimulating hormone(FSH), LH/FSH, serum testosterone(T), total cholesterol(TC), serum triglyceride(TG), high density lipoprotein cholesterol(HDL-C), body mass index(BMI), fasting blood glucose(FBG), fasting insulin(FINS), homeostasis model assessment insulin resistance(HOMA-IR) and quantitative insulin-sensitivity check index(QUICKI) before and after treatment between the two groups. Results Among 64 patients, 91%(58/64) of patients had vitamin D levels < 30 ng/ml, 69%(44/64) of patients had vitamin D levels ≤ 20 ng/ml and 22%(14/64) of patients had vitamin D levels of 20-30 ng/ml. Before treatment, both groups had no statistically significant difference in D, LH, FSH, LH/FSH and T(P>0.05). After treatment, both groups had better vitamin D, LH, FSH, LH/FSH and T than those before treatment, and their difference was statistically significant(P<0.05). Vitamin D group had no statistically significant difference in FSH, LH, LH/FSH and T, comparing with the control group(P>0.05). Vitamin D group had higher vitamin D level as(43.91±9.02) ng/ml than(20.05±9.14) ng/ml in the control group, and the difference was statistically significant(P<0.05). Before treatment, both groups had no statistically significant difference in TC, TG and HDL-C(P>0.05). After treatment, both groups had lower TC and TG than those before treatment, and higher HDL-C than before treatment. Their difference was statistically significant(P<0.05). Vitamin D group had no statistically significant difference in TC and TG, comparing with control group(P>0.05). Vitamin D group had higher HDL-C than the control group, and the difference was statistically significant(P<0.05). Before treatment, both groups had no statistically significant difference in BMI, FBG, FINS, HOMA-IR and QUICKI(P>0.05). After treatment, vitamin D group had better BMI, FBG, FINS, HOMA-IR and QUICKI than those before treatment and the control group, and their difference was statistically significant(P<0.05). Conclusion Most patients with polycystic ovary syndrome have vitamin D deficiency. Supplementation of vitamin D on the basis of routine treatment can effectively improve BMI, HOMA-IR and HDL-C metabolic indicators in patients with polycystic ovary syndrome.
引文
[1]Tai K, Need AG, Horowitz M, et al. Vitamin D glucose, insulin, and insulin sensitivity. Nutrition, 2008(24):279-285.
[2]Wehr E, Pilz S, Schweighofer N, et al. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol, 2009(161):575-582.
[3]Yildizhan R, Kurdoglo M, Adali E, et al. Serum 25-hydroxyvitamin D concentrations in obese and non obese women with polycystic ovary syndrome. Arch Gynaecol Obstet, 2009(280):559-563.
[4]ESPCW Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome(PCOS).Fertility Sterility, 2004, 81(1):41-47.
[5]Li HWR, Brereton RE, Anderson RA, et al. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metab, Clin Exp, 2010(60):1475-1481.
[6]母义明,刘敏.胰岛素抵抗和多囊卵巢综合.中华内分泌代谢杂志, 2013, 29(3):185-188.
[7]Ba?uls C, Rovira-Llopis S, Martinez de Mara?on A, et al. Metabolic syndrome enhances endoplasmic reticulum, oxidative stress and leukocyte-endothelium interactions inPCOS. Metabolism,2017(71):153-162.
[8]Kmsa K, Yavropouhu MP, Anastnsiou O, et al. Role of vitamin D treatment in glucose metabolism in polycysfic ovary syndrome. Fertil Steril, 2009, 92(3):1053-1058.
[9]李茜西,伍萍芝,何琳琳,等.血清维生素D缺乏与多囊卵巢综合征的关联研究.中国妇幼保健, 2015, 30(21):3636-3638.
[10]Maktabi M, Chamani M, Asemi Z. The Effects of Vitamin D Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome:A Randomized, Double-Blind, Placebo-Controlled Trial. Horm Metab Res, 2017, 49(7):493-498.
[2]Wehr E, Pilz S, Schweighofer N, et al. Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome. Eur J Endocrinol, 2009(161):575-582.
[3]Yildizhan R, Kurdoglo M, Adali E, et al. Serum 25-hydroxyvitamin D concentrations in obese and non obese women with polycystic ovary syndrome. Arch Gynaecol Obstet, 2009(280):559-563.
[4]ESPCW Group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome(PCOS).Fertility Sterility, 2004, 81(1):41-47.
[5]Li HWR, Brereton RE, Anderson RA, et al. Vitamin D deficiency is common and associated with metabolic risk factors in patients with polycystic ovary syndrome. Metab, Clin Exp, 2010(60):1475-1481.
[6]母义明,刘敏.胰岛素抵抗和多囊卵巢综合.中华内分泌代谢杂志, 2013, 29(3):185-188.
[7]Ba?uls C, Rovira-Llopis S, Martinez de Mara?on A, et al. Metabolic syndrome enhances endoplasmic reticulum, oxidative stress and leukocyte-endothelium interactions inPCOS. Metabolism,2017(71):153-162.
[8]Kmsa K, Yavropouhu MP, Anastnsiou O, et al. Role of vitamin D treatment in glucose metabolism in polycysfic ovary syndrome. Fertil Steril, 2009, 92(3):1053-1058.
[9]李茜西,伍萍芝,何琳琳,等.血清维生素D缺乏与多囊卵巢综合征的关联研究.中国妇幼保健, 2015, 30(21):3636-3638.
[10]Maktabi M, Chamani M, Asemi Z. The Effects of Vitamin D Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome:A Randomized, Double-Blind, Placebo-Controlled Trial. Horm Metab Res, 2017, 49(7):493-498.