维生素D和钙联合应用对超重多囊卵巢综合征患者糖代谢和脂代谢的影响
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摘要
目的探讨维生素D和钙联合应用对超重多囊卵巢综合征(PCOS)患者糖、脂代谢的影响。方法选取该院2015年1月-2016年8月收治的176例年龄20~38岁超重PCOS患者为研究对象,对其进行双盲安慰剂对照试验,随机分为4组,每组各44例。其中联合给予维生素D与钙剂者设为联用组,单纯给予维生素D者设为维生素D组,单纯给予钙剂者设为钙剂组,另设给予安慰剂为对照组。药物干预8周,分别检测空腹血标本在治疗前后的糖代谢和血脂浓度。结果联用组中血清极低密度脂蛋白胆固醇(VLDL-C)含量、维生素D含量和钙浓度均明显高于其他3组(均P<0.05);而血清胰岛素水平明显低于其他3组(P<0.05)。4组高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)比较差异无统计学意义(P>0.05)。结论联合应用维生素D和钙剂可以有效改善超重PCOS患者的糖、脂代谢能力,可以作为超重PCOS治疗的新路径。
Objective To explore the effect of combined application of vitamin D and calcium on glucose metabolism and lipid metabolism in overweight women with polycystic ovary syndrome( PCOS). Methods A total of 176 overweight patients with PCOS aged 20-38 years old were treated in the hospital from January 2015 to August 2016,a double-blind placebo controlled trial was conducted,all the patients were randomly divided into four groups,44 patients in each group: combined application group( vitamin D and calcium),vitamin D group,calcium group,and control group( placebo). The patients in the four groups were treated for 8 weeks. Glucose metabolism and blood lipids concentrations in fasting blood before and after treatment were detected. Results The levels of serum very low density lipoprotein cholesterol( VLDL),vitamin D,and calcium levels in combined application group were statistically significantly higher than those in the other three groups( all P<0. 05); but the level of serum insulin in combined application group was statistically significantly lower than those in the other three groups( P < 0. 05). There was no statistically significant difference in the levels of high density lipoprotein cholesterol( HDL),low density lipoprotein cholesterol( LDL),and total cholesterol( TC) among the four groups( P>0. 05). Conclusion Combined application of vitamin D and calcium can effectively improve glucose metabolism and lipid metabolism of overweight patients with PCOS,which can be used as a new pathway for treatment of overweight patients with PCOS.
Objective To explore the effect of combined application of vitamin D and calcium on glucose metabolism and lipid metabolism in overweight women with polycystic ovary syndrome( PCOS). Methods A total of 176 overweight patients with PCOS aged 20-38 years old were treated in the hospital from January 2015 to August 2016,a double-blind placebo controlled trial was conducted,all the patients were randomly divided into four groups,44 patients in each group: combined application group( vitamin D and calcium),vitamin D group,calcium group,and control group( placebo). The patients in the four groups were treated for 8 weeks. Glucose metabolism and blood lipids concentrations in fasting blood before and after treatment were detected. Results The levels of serum very low density lipoprotein cholesterol( VLDL),vitamin D,and calcium levels in combined application group were statistically significantly higher than those in the other three groups( all P<0. 05); but the level of serum insulin in combined application group was statistically significantly lower than those in the other three groups( P < 0. 05). There was no statistically significant difference in the levels of high density lipoprotein cholesterol( HDL),low density lipoprotein cholesterol( LDL),and total cholesterol( TC) among the four groups( P>0. 05). Conclusion Combined application of vitamin D and calcium can effectively improve glucose metabolism and lipid metabolism of overweight patients with PCOS,which can be used as a new pathway for treatment of overweight patients with PCOS.
引文
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[10]徐晓航,陈圆辉,王倩,等.多囊卵巢综合征诊治新进展[J].国际生殖健康/计划生育杂志,2015,34(2):160-164.
[11]居星耀,盛红斌,沈健.锌、维生素D、钙联用对婴幼儿佝偻病疗效及对生化指标和骨密度的影响[J].儿科药学杂志,2015,21(5):21-24.
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[13]汪宇,王丽岩,贺立新,等.钙网质蛋白在多囊卵巢综合征大鼠子宫内膜的表达及意义[J].现代生物医学进展,2011,11(11):1521-1523.
[14]Spritzer PM,Lecke SB,Satler F,et al.Adipose tissue dysfunction,adipokines,and low-grade chronic inflammation in polycystic ovary syndrome[J].Reproduction,2015,149(5):R219-R227.
[15]Shorakae S,Teede H,de Courten B,et al.The emerging role of chronic low-grade inflammation in the pathophysiology of polycystic ovary syndrome[J].Semin Reprod Med,2015,33(4):257-269.
[16]Dal Canto M,Brambillasca F,Miqnini Renzini M.Cumulus cell-oocyte complexes retrieved from antral follicles in IVM cycles:relationship between COCs morphology,gonadotropin priming and clinical outcome[J].J Assist Reprod Genet,2012.513-519.
[17]Elizur SE,Lebovitz O,Orvieto R,et al.Reactive oxygen species in follicular fluid may serve as biochemical markers to determine ovarian aging and follicular metabolic age[J].Gynecol Endocrinol,2014,30(10):705-707.
[18]王萍,江钟立,林枫,等.应用肥胖国际功能、失能和健康分类综合核心组合描述肥胖型多囊卵巢综合征的疾病特征[J].中华物理医学与康复杂志2015,37(1):56-59.
[19]Lerchbaum E,Obermayer-Pietsch B,Vitamin D and fertility:a systematic review[J].Eur J Endocrinol,2012,166(5):765-778.
[20]高雯,张翠萍,冷俊宏.妊娠期糖尿病病患孕前体质指数与妊娠结局的关系[J].中国慢性病预防与控制,2015,23(6):921-924.
[21]Koninger A,Koch L,Edimiris P,et al.Anti-Müllerian hormone:an indicator for the severity of polycystic ovarian syndrome[J].Arch Gynecol Obstet,2014,290(5):1023-1030.
[22]何冰,万里凯,谭卫红,等.不孕症非肥胖型与肥胖型多囊卵巢综合征肥胖指标对比研究[J].实用妇产科杂志,2013,29(10):1326-1330.
[23]Thys Jacobs S,Donovan D,Papadopoulos A,et al.Vitamin D and calcium dysregulation in the polycystic ovarian syndrome[J].Steroids,1999,64(6):430-435.
[24]Rashidi B,Haghollahi F,Shariat M,et al.The effects of calciumvitamin D and metformin on polycystic ovary syndrome:a pilot study[J].Taiwan J Obstet Gynecol,2009,48(2):142-147.
[25]Tournis S,Mitrakou A.The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults:response to Pittas et al[J].Diabetes Care,2007,30(7):980-986.
[2]何峻,陈朝军,刘娟.IVF-ET周期中多囊卵巢综合征患者不同血清雌二醇变化组的比较分析[J].实用临床医学,2015,16(11):59-63
[3]王小飞,马晓玲,周燕,等.不同促排方案对PCOS患者ART妊娠结局的影响[J].中国生育健康杂志,2013,19(1):8-11.
[4]高霞,唐奕,蔡素芬,等.多囊卵巢综合征患者血浆血管活性肠肽水平变化及其潜在病理意义[J].中南医学科学杂志,2015,43(6):637-640.
[5]Das M,Djahanbakhch O,Hacihanefioglu B,et al.Granulosa cell survival and proliferation are altered in polycystic ovary syndrome[J].J Clin Endocrinol Metab,2008,93(3):881-887.
[6]Ngo D,Chan WP,Rajendran S,et Determinants of insulin responsi veness young women:impact of polycystic ovarian syndrome,nitric oxide,and vitamin D[J].Nitric Oxide,2011,25(3):326-330.
[7]张秀琴,许飞,孙慧.2517例妊娠期妇女25羟基维生素D水平营养分析[J].现代医学,2014,42(3):323-324.
[8]Lautatzis ME,Goulis DG,Vrontakis M.Efficacy and safety of metformin during pregnancy in women with gestational diabetes mellitus or polycystic ovary syndrome:a systematic review[J].Metabolism,2013,62(11):1522-1534.
[9]林琳,朱燕波,史会梅,等.中国成年人群体质量指数与健康相关生命质量的关系:健康与慢病不同亚组的分层分析[J].2014,23(7):1023-1027.
[10]徐晓航,陈圆辉,王倩,等.多囊卵巢综合征诊治新进展[J].国际生殖健康/计划生育杂志,2015,34(2):160-164.
[11]居星耀,盛红斌,沈健.锌、维生素D、钙联用对婴幼儿佝偻病疗效及对生化指标和骨密度的影响[J].儿科药学杂志,2015,21(5):21-24.
[12]Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome[J].Fertil Steril,2004,81(1):19-25.
[13]汪宇,王丽岩,贺立新,等.钙网质蛋白在多囊卵巢综合征大鼠子宫内膜的表达及意义[J].现代生物医学进展,2011,11(11):1521-1523.
[14]Spritzer PM,Lecke SB,Satler F,et al.Adipose tissue dysfunction,adipokines,and low-grade chronic inflammation in polycystic ovary syndrome[J].Reproduction,2015,149(5):R219-R227.
[15]Shorakae S,Teede H,de Courten B,et al.The emerging role of chronic low-grade inflammation in the pathophysiology of polycystic ovary syndrome[J].Semin Reprod Med,2015,33(4):257-269.
[16]Dal Canto M,Brambillasca F,Miqnini Renzini M.Cumulus cell-oocyte complexes retrieved from antral follicles in IVM cycles:relationship between COCs morphology,gonadotropin priming and clinical outcome[J].J Assist Reprod Genet,2012.513-519.
[17]Elizur SE,Lebovitz O,Orvieto R,et al.Reactive oxygen species in follicular fluid may serve as biochemical markers to determine ovarian aging and follicular metabolic age[J].Gynecol Endocrinol,2014,30(10):705-707.
[18]王萍,江钟立,林枫,等.应用肥胖国际功能、失能和健康分类综合核心组合描述肥胖型多囊卵巢综合征的疾病特征[J].中华物理医学与康复杂志2015,37(1):56-59.
[19]Lerchbaum E,Obermayer-Pietsch B,Vitamin D and fertility:a systematic review[J].Eur J Endocrinol,2012,166(5):765-778.
[20]高雯,张翠萍,冷俊宏.妊娠期糖尿病病患孕前体质指数与妊娠结局的关系[J].中国慢性病预防与控制,2015,23(6):921-924.
[21]Koninger A,Koch L,Edimiris P,et al.Anti-Müllerian hormone:an indicator for the severity of polycystic ovarian syndrome[J].Arch Gynecol Obstet,2014,290(5):1023-1030.
[22]何冰,万里凯,谭卫红,等.不孕症非肥胖型与肥胖型多囊卵巢综合征肥胖指标对比研究[J].实用妇产科杂志,2013,29(10):1326-1330.
[23]Thys Jacobs S,Donovan D,Papadopoulos A,et al.Vitamin D and calcium dysregulation in the polycystic ovarian syndrome[J].Steroids,1999,64(6):430-435.
[24]Rashidi B,Haghollahi F,Shariat M,et al.The effects of calciumvitamin D and metformin on polycystic ovary syndrome:a pilot study[J].Taiwan J Obstet Gynecol,2009,48(2):142-147.
[25]Tournis S,Mitrakou A.The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults:response to Pittas et al[J].Diabetes Care,2007,30(7):980-986.