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目的 探讨维生素D干预对多囊卵巢综合征（PCOS）合并胰岛素抵抗（IR）的不孕患者体外受精-胚胎移植（IVF-ET）助孕周期中胚胎质量及妊娠结局的影响。方法 选取2021年1月至2023年12月泉州市妇幼保健院收治的PCOS合并IR的不孕患者100例为研究对象，采用随机数字表法分为试验组与对照组，每组50例。对照组补充复合维生素，试验组在对照组基础上额外补充维生素D滴剂。收集患者的一般资料、临床数据，比较两组患者IVF-ET周期的胚胎质量及妊娠结局；并根据基线血清25羟基维生素D[25(OH)D]水平将两组患者分别分为维生素D缺乏组[血清25(OH)D<20ng/ml]和非缺乏组[血清25(OH)D≥20ng/ml]，分析维生素补充干预的效果。结果 两组患者的年龄、不孕年限等一般资料比较均无显著性差异（P>0.05）。相较于对照组，试验组促性腺激素（Gn）总用量显著减少[（1 815.4±865.6）U vs.(2 191.8±991.7)U,P<0.05]，可移植胚胎率（96.28%vs.91.70%）和优质胚胎率（67.84%vs.54.06%）显著升高（P<0.05），但两组间累积临床妊娠率（66.00%vs.56.00%）和累积活产率（62.00%vs.54.00%）比较均无统计学差异（P>0.05）。100名纳入患者中维生素D缺乏者共51例（51.0%），其中试验组28例、对照组23例，两组间维生素D缺乏患者占比无统计学差异（P>0.05）。不同基线维生素D水平亚组分析显示，试验组的维生素D缺乏亚组、非缺乏亚组在补充治疗后，可移植胚胎率与优质胚胎率均显著高于对照组相应亚组（P<0.001）。结论 补充维生素D可显著提高合并IR的PCOS患者IVF-ET周期中的胚胎质量，减少促排卵药物用量，但其对妊娠结局的改善需进一步验证。
Abstract：Objective:To investigate the effects of vitamin D intervention on embryo quality and pregnancy outcomes of in vitro fertilization-embryo transfer(IVF-ET)for infertile patients with polycystic ovary syndrome(PCOS)and insulin resistance(IR).Methods:A total of 100infertile patients with PCOS and IR admitted to Quanzhou Women's and Children's Hospital from January 2021to December 2023were selected.Using a random number table method,they were divided into an experimental group and a control group,with 50cases in each group.The control group received multivitamin supplementation,while the experimental group was additionally supplemented with vitamin D drops based on the control regimen.The baseline characteristics and clinical data were collected to compare embryo quality and pregnancy outcomes between the two groups.Subgroup analysis was performed based on baseline vitamin D levels [deficient group:25(OH)D<20ng/ml;non-deficient group:25(OH)D≥20ng/ml]to evaluate the effects of vitamin supplementation intervention.Results:There was no significant difference in general information such as age and infertility duration between the two groups(P>0.05).Compared with the control group,the experimental group showed significantly lower total dosage of gonadotropin(Gn)use[(1 815.4±865.6)U vs.(2 191.8±991.7)U,P<0.05],significantly higher transferable embryo rate(96.28% vs.91.70%,P<0.05)and high-quality embryo rate(67.84% vs.54.06%,P<0.05).However,no statistical differences were observed in the cumulative clinical pregnancy rate(66.00% vs.56.00%)and the live birth rate(62.00% vs.54.00%)(P>0.05).Among the 100enrolled patients,51cases had vitamin D deficiency,28in the experimental group and 23in the control group.The proportion of vitamin D-deficient patients showed no statistical difference between the two groups(P>0.05).Subgroup analysis based on baseline vitamin D levels revealed that both the vitamin D-deficient subgroup and non-deficient subgroup in the experimental group achieved significantly higher transferable embryo rate and high-quality embryo rate than their corresponding subgroups in the control group after supplementation therapy(P<0.001).Conclusions:Vitamin D supplementation could significantly improve embryo quality and reduce medication dosage for ovarian stimulation during IVF-ET cycles in PCOS patients with IR.However,its potential benefits on pregnancy outcomes require further validation.
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基本信息:
中图分类号:R714.8;R711.75
引用信息:
[1]吴培雅,姚建凤,朱华芳,等.维生素D干预对胰岛素抵抗型多囊卵巢综合征患者体外受精-胚胎移植的胚胎质量与妊娠结局的影响[J].生殖医学杂志,2025,34(08):1030-1036.
基金信息:
泉州市科技局科技计划项目(2023N042S); 泉州市级科技计划项目(2023NS067)
2025-08-15
2025-08-15