血清维生素D在不同类型不孕女性中的表达及与卵巢功能和代谢指标的关系

Expression of serum vitamin D in women with different types of infertility and its relationship with ovarian function and metabolic indicators

摘要

目的 探究不同类型不孕女性血清维生素D(VitD)的表达及与卵巢功能和代谢指标的相关性。方法 选取2021年12月至2023年10月就诊于西安交通大学第二附属医院生殖医学中心的206名不孕症女性.根据不孕原因将其分为多囊卵巢综合征(PCOS)组(n=77)、卵巢储备功能减退(DOR)组(n=82)、对照组(n=47).比较三组不孕女性血清VitD水平,分析各组血清VitD水平与卵巢功能及代谢指标(脂代谢、甲状腺代谢、空腹血糖、同型半胱氨酸)的相关性。结果 DOR组、PCOS组及对照组的血清VitD水平比较,差异有统计学意义(F=3.235,P<0.05),其中DOR组及PCOS组均低于对照组,但只有PCOS组与对照组比较,差异有统计学意义(t=-2.518,P<0.05).在调整了年龄和体质量指数(BMI)与未调整年龄和BMI后,对三组不孕女性的血清VitD水平与各项卵巢功能进行相关性分析,结果显示:DOR组、PCOS组及对照组的血清VitD水平与抗苗勒管激素(AMH)、窦卵泡数(AFC)、基础卵泡刺激素(bFSH)及雌二醇(E₂)均无相关性(P>0.05);对三组不孕女性的血清VitD水平与各项代谢指标进行相关性分析,结果显示:DOR组、PCOS组及对照组的血清VitD水平与总胆固醇(TC)均呈负相关(调整了年龄和BMI前后,r值分别为-0.454、-0.455、-0.442、-0.432、-0.446、-0.475,P<0.05),血清VitD水平与高密度脂蛋白(HDL)均呈正相关(调整了年龄和BMI前后,r值分别为0.376、0.379、0.476、0.477、0.360、0.329,P<0.05),血清VitD水平与抗甲状腺过氧化物酶抗体(TPO-Ab)均呈负相关(调整了年龄和BMI前后,r值分别为-0.466、-0.479、-0.527、-0.534、-0.494、-0.502,P<0.05),而三组的血清VitD水平与甘油三酯(TG)、低密度脂蛋白(LDL)、空腹血糖、促甲状腺素(TSH)、游离T₃(FT₃)、游离T₄(FT₄)、抗甲状腺球蛋白抗体(Anti-TGAb)及同型半胱氨酸(HCY)均无相关性(P>0.05)。结论 合并卵巢病变的不孕女性更易出现血清VitD水平的降低,血清VitD水平与不孕女性的卵巢功能无直接相关性,与脂代谢TC呈负相关,与HDL呈正相关,与甲状腺代谢TPO-Ab呈负相关.血清VitD水平可能间接地通过调控不孕女性的脂代谢及甲状腺代谢影响其生育能力.

Abstract

Objective To explore the expression of serum vitamin D (VitD) with different types of infertility and its correlation with ovarian function and metabolic indicators. Methods A total of 206 women with infertility who visited the Reproductive Medicine Center of the Second Affiliated Hospital of Xi′an Jiaotong University from December 2021 to October 2023 were included. Based on the causes of infertility, they were divided into three groups: polycystic ovary syndrome (PCOS) group (n=77), the diminished ovarian reserve (DOR) group (n=82) and control group (n=47). Serum VitD levels were compared among the three groups, and the correlations between serum VitD levels and ovarian function as well as metabolic indicators (lipid metabolism, thyroid metabolism, fasting blood glucose, and homocysteine) were analyzed for each group. Results The serum VitD levels among DOR group, PCOS group and control group showed significant differences (F=3.235, P<0.05). Both the DOR and PCOS groups had lower serum VitD levels than the control group, but only the difference between the PCOS group and the control group was statistically significant (t=-2.518, P<0.05). Correlation analysis between serum VitD levels and ovarian function was performed in the three groups, both before and after adjusting for age and BMI. The results indicated that serum VitD levels in the DOR, PCOS, and control groups were not significantly correlated with anti-Müllerian hormone (AMH), antral follicle count (AFC), basal follicle-stimulating hormone (bFSH), or estradiol (E₂) (P>0.05). Correlation analysis between serum VitD levels and metabolic indicators showed: Serum VitD levels were negatively correlated with total cholesterol (TC) in all three groups (before and after adjusting for age and BMI, r=-0.454, -0.455, -0.442, -0.432, -0.446 and -0.475, respectively, P<0.05). Serum VitD levels were positively correlated with high-density lipoprotein (HDL) in all three groups (before and after adjusting for age and BMI, r=0.376, 0.379, 0.476, 0.477, 0.360 and 0.329, respectively, P<0.05). Serum VitD levels were negatively correlated with anti-thyroid peroxidase antibodies (TPO-Ab) in all three groups (before and after adjusting for age and BMI, r=-0.466, -0.479, -0.527, -0.534, -0.494 and -0.502, respectively, P<0.05). However, no correlations were observed between serum VitD levels and triglycerides (TG), low-density lipoprotein (LDL), fasting blood glucose, thyroid-stimulating hormone (TSH), free T₃ (FT₃), free T₄ (FT₄), anti-thyroglobulin antibodies (Anti-TGAb), or homocysteine (HCY) (P>0.05). Conclusion Women with infertility combined with ovarian disorders are more likely to exhibit lower serum VitD levels. Serum VitD levels are not directly associated with ovarian function in infertile women but are negatively correlated with lipid metabolism marker total cholesterol (TC), positively correlated with high-density lipoprotein (HDL), and negatively correlated with thyroid metabolism marker anti-thyroid peroxidase antibodies (TPO-Ab). Serum VitD levels may indirectly influence fertility by regulating lipid and thyroid metabolism in infertile women.

关键词

不孕症 / 维生素D / 卵巢功能 / 代谢指标

Key words

infertility / vitamin D / ovarian function / metabolic index

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基金资助

陕西省自然科学基础研究计划(JQ8068)