马娟，何玉洁，许冰雪，阎梦民，范晶，刘师伟，王媛

(1. 山西医科大学第一临床医学院，太原　030001；2. 山西医科大学第一医院，太原　030001)

血清及卵泡液中25-羟维生素D水平与IVF-ET早期妊娠结局的关系

马娟1，何玉洁2*，许冰雪1，阎梦民2，范晶2，刘师伟2，王媛1

(1. 山西医科大学第一临床医学院，太原030001；2. 山西医科大学第一医院，太原030001)

【摘要】目的探讨血清及卵泡液中25-羟维生素D[25(OH)D]水平与IVF-ET助孕治疗早期妊娠结局的关系。方法选取2014年9月至2015年5月在山西医科大学第一医院生殖中心就诊，因输卵管因素不孕行IVF-ET助孕治疗的患者，共123例，测定血清及卵泡液中25(OH)D水平，根据血清及卵泡液25(OH)D水平分为<25 nmol/L组、25～50 nmol/L组和>50 nmol/L组，比较各组间的胚胎种植率、临床妊娠率和早期流产率有无差异。又按照妊娠结局分为妊娠组和未妊娠组，比较两组间血清及卵泡液25(OH)D水平有无差异。结果血清25(OH)D水平与卵泡液中25(OH)D水平呈显著正相关(r=0.811，P<0.001)；血清不同25(OH)D水平各组中，>50 nmol/L组的胚胎种植率(53.3%)及临床妊娠率(73.3%)均显著高于<25 nmol/L组(27.5%和28.0%)(P<0.05)。卵泡液不同25(OH)D水平各组中，25～50 nmol/L组及>50 nmol/L组的胚胎种植率(分别为42.3%、70.0%)及临床妊娠率(分别为66.7%、80.0%)均显著高于<25 nmol/L组(胚胎种植率为21.4%、临床种植率为28.6%)(P均<0.05)。各组间的早期流产率比较无显著性差异(P>0.05)。妊娠组血清及卵泡液25(OH)D水平[分别为(38.41±13.58)nmol/L、(32.03±13.35)nmol/L]均显著高于未妊娠组[分别为(29.68±12.23)nmol/L、(23.41±11.54)nmol/L](P<0.05)。结论不孕症患者普遍存在维生素D缺乏，IVF-ET患者的妊娠率下降可能与维生素D缺乏有关。

【关键词】体外受精-胚胎移植；妊娠；25-羟维生素D

Objective： To explore the association of 25-hydroxyvitamin D [25(OH)D] levels in serum or follicular fluid with early pregnancy outcomes of IVF-ET.

Methods： One hundred and twenty three infertile women with tubal factor participated in IVF-ET cycles in the reproductive center of The First Affiliated Hospital of Shanxi Medical University from September 2014 to May 2015. The 25(OH)D levels in serum or follicular fluid were detected by electrochemical luminescence. The patients were divided into three groups：<25 nmol/L，25-50 nmol/L，and>50 nmol/L group. Clinical pregnancy rate，embryo implantation rate and early abortion rate were compared among three groups. Furthermore，the patients were divided into pregnancy group and no-pregnancy group，and the 25(OH)D levels in serum or follicular fluid were compared among the groups.

Results： The levels of 25(OH)D in serum were significantly correlated with that in follicular fluid (r=0.811，P<0.001). Among the three groups with different 25(OH)D levels in serum，the implantation rate (53.3% vs. 27.5%) and pregnancy rate (73.3% vs. 28.0%) in >50 nmol/L group were significantly higher than these in <25 nmol/L group (P<0.05). Among the three groups with different 25(OH)D levels in follicular fluid，the implantation rate (42.3%，70.0%) and pregnancy rate (66.7%，80.0%) in 25-50 nmol/L group and >50 nmol/L group were significantly higher than these in <25 nmol/L group (21.4% and 28.6%，respectively) (P<0.05). There were no significant differences in the early abortion rate among the three groups (P>0.05). The 25(OH)D levels in serum [(38.41±13.58) vs. (29.68±12.23) nmol/L] or follicular fluid in pregnancy group [(32.03±13.35) vs. (23.41±11.54) nmol/L] were significantly higher than those in no-pregnancy group (P<0.05).

Conclusions： Vitamin D deficiency is common in infertile patients. The lack of 25(OH)D may be associated with lower pregnancy rate of IVF-ET patients.

Key words： IVF-ET；Pregnancy；25-hyroxy vitamin D

(J Reprod Med 2016，25(5)：411-416)

维生素D除参与钙磷代谢、维持骨骼稳态外，还具有调节细胞增殖、分化及免疫调节、抗炎、缓解胰岛素抵抗等作用，与心血管疾病、慢性肾脏病、肿瘤等的发生密切相关[1-2]。有研究表明，维生素D可调节人类的生殖过程[3]，还与多种妇科疾病的发生有关[4]，维生素D缺乏可导致女性生殖内分泌的紊乱，甚至不孕[3-5]。本研究旨在通过测定血清及卵泡液中25-羟维生素D[25(OH)D]水平，分析两者的相关性，并初步探讨其与IVF-ET妊娠结局的关系。……