维生素D辅治对多囊卵巢综合征患者脂代谢及相关激素水平和抑郁情绪的影响
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摘要
目的:观察维生素D(VD)辅治对多囊卵巢综合征(PCOS)患者脂代谢及相关激素水平和抑郁情绪的影响。方法:将120例PCOS患者随机分为对照组和观察组,每组60例。对照组给予炔雌醇环丙孕酮片口服治疗,观察组在对照组基础上加服VD,于治疗3个月经周期后评价患者抑郁、焦虑情绪,检测血糖、血脂、胰岛素抵抗、相关激素水平及子宫内膜厚度、类型,并比较两组妊娠率。结果:治疗后,观察组较对照组抑郁自评量表(SDS)、焦虑自评量表(SAS)评分均明显降低(t=-7.632,-5.840;P<0.001);治疗后,观察组较对照组空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平均明显降低(t=-7.192,-6.885,-17.382,-8.656,-12.990;P<0.001),高密度脂蛋白胆固醇(HDL-C)水平明显升高(t=7.109,P<0.001);治疗后,两组促黄体生成素(LH)、睾酮(TEST)比较无显著差异(t=0.804,1.705;P>0.05);治疗后,观察组较对照组子宫内膜厚度明显降低(t=-12.271,P<0.001),但两组子宫内膜类型比较无显著差异(χ~2=0.682,P>0.05);治疗后,观察组妊娠率为46.67%,较对照组的35.00%有所升高,但差异无统计学意义(χ~2=0.853,P<0.05)。结论:VD辅治PCOS,可有效缓解患者抑郁情绪,调节糖脂代谢,改善胰岛素抵抗及子宫内膜容受性,但对性激素水平及妊娠率无明显影响。
Objective:To observe the effects of vitamin D(VD)therapy on lipid metabolism and related hormone levels and depression in patients with polycystic ovary syndrome(PCOS).Methods:A total of 120 cases of PCOS patients were randomly divided into the control group and the observation group,with 60 cases in each group.The control group was given oral treatment of ethinyloestradiol cyproterone tablets and the observation group was additionally given VD on the basis of treatment in the control group.After treatment for 3 menstrual cycles,depression and anxiety of patients were evaluated,and the levels of blood glucose,blood lipid,insulin resistance,related hormone,and endometrial thickness and type were compared,and the pregnancy rates were compared between the two groups.Results:After treatment,the scores of the self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were significantly lower in the observation group than those in the control group(t=-7.632,-5.840,P<0.001).After treatment,the levels of fasting blood glucose(FPG),insulin resistance index(HOMA-IR),total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)in the observation group were significantly decreased compared with those in the control group(t=-7.192,-6.885,-17.382,-8.656,12.990,P <0.001)while the level of high-density lipoprotein cholesterol(HDL-C)were significantly increased(t=7.109,P <0.001).After treatment,there was no significant difference in luteinizing hormone(LH)and testosterone(TEST)between the two groups(P>0.05).After treatment,the endometrial thickness of the observation group was significantly decreased compared with that of the control group(t=-12.271,P<0.001),but there was no significant difference in endometrial types between the two groups(P>0.05).After treatment,the pregnancy rate was 46.67% in the observation group,which was higher than that in the control group with 35.00%,but the difference was not statistically significant(P>0.05).Conclusion:VD in the adjuvant treatment of PCOS can effectively relieve depressive mood,regulate glucose and lipid metabolism,improve insulin resistance and endometrial tolerance,but has no effect on the sex hormone levels and pregnancy rate.
Objective:To observe the effects of vitamin D(VD)therapy on lipid metabolism and related hormone levels and depression in patients with polycystic ovary syndrome(PCOS).Methods:A total of 120 cases of PCOS patients were randomly divided into the control group and the observation group,with 60 cases in each group.The control group was given oral treatment of ethinyloestradiol cyproterone tablets and the observation group was additionally given VD on the basis of treatment in the control group.After treatment for 3 menstrual cycles,depression and anxiety of patients were evaluated,and the levels of blood glucose,blood lipid,insulin resistance,related hormone,and endometrial thickness and type were compared,and the pregnancy rates were compared between the two groups.Results:After treatment,the scores of the self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were significantly lower in the observation group than those in the control group(t=-7.632,-5.840,P<0.001).After treatment,the levels of fasting blood glucose(FPG),insulin resistance index(HOMA-IR),total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)in the observation group were significantly decreased compared with those in the control group(t=-7.192,-6.885,-17.382,-8.656,12.990,P <0.001)while the level of high-density lipoprotein cholesterol(HDL-C)were significantly increased(t=7.109,P <0.001).After treatment,there was no significant difference in luteinizing hormone(LH)and testosterone(TEST)between the two groups(P>0.05).After treatment,the endometrial thickness of the observation group was significantly decreased compared with that of the control group(t=-12.271,P<0.001),but there was no significant difference in endometrial types between the two groups(P>0.05).After treatment,the pregnancy rate was 46.67% in the observation group,which was higher than that in the control group with 35.00%,but the difference was not statistically significant(P>0.05).Conclusion:VD in the adjuvant treatment of PCOS can effectively relieve depressive mood,regulate glucose and lipid metabolism,improve insulin resistance and endometrial tolerance,but has no effect on the sex hormone levels and pregnancy rate.
引文
[1]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
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[3]Legro R.Diagnosis and treatment of polycystic ovary syndrome(PCOS):An interview with Richard Legro[J].Bmc Medicine,2015,13(1):1-5
[4]郑思远,张莹,龙涛,等.不同胰岛素抵抗及肥胖水平对多囊卵巢综合征患者高雄激素血症特征的影响[J].广东医学,2017,38(3):406-409
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[6]江丽琴,周静,黄伟政.达英35与二甲双胍治疗多囊卵巢综合征患者妊娠分娩的结局研究[J].西部医学,2014,26(5):564-566
[7]朱望珍,程建慧,程英惠.多囊卵巢综合征患者心理状态调查分析[J].中国初级卫生保健,2016,30(9):36-37
[8]孙明雅,周晓梅.维生素D与多囊卵巢综合征代谢紊乱的研究进展[J].医学综述,2015,21(12):2217-2220
[9]叶碧绿.维生素D与多囊卵巢综合征相关性的研究进展[J].生殖医学杂志,2014,23(6):431-434
[10]贾丽娜.从“肾藏精”看维生素D与多囊卵巢综合征的关系[J].中华中医药杂志,2015,30(11):4081-4083
[11]檀丽,彭巧捷,陈丽春.维生素D辅助治疗对多囊卵巢综合征内分泌代谢相关指标及胰岛素抵抗的影响[J].数理医药学杂志,2016,29(10):1497-1499
[12]贾新转,魏兰,甄秀丽.维生素D联合二甲双胍及中药对PCOS患者内分泌代谢紊乱的治疗作用分析[J].时珍国医国药,2014,25(6):1415-1417
[13]项守奎,王龙,吴阳,等.多囊卵巢综合征患者血清维生素D水平与抑郁症的关系[J].临床荟萃,2015,30(6):649-653
[14]金博弘,周馥贞.多囊卵巢综合征的诊断标准[J].国际生殖健康/计划生育杂志,2005,24(3):152-154
[15]Gonen Y,Casper R F.Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization(IVF)[J].Journal of in Vitro Fertilization&Embryo Transfer Ivf,1990,7(3):146-152
[16]王波.维生素D抗多囊卵巢综合征合并抑郁患者免疫过激的效果[J].实用临床医药杂志,2016,20(21):210-212
[17]廖媚,龙建,崔咏怡,等.广州妊娠期糖尿病孕妇生活事件与孕妇心理健康状况的关系[J].中国健康心理学杂志,2017,25(3):336-339
[18]李富军,李杨,王立新,等.焦虑抑郁状态对冠心病介入治疗患者预后的影响[J].中国健康心理学杂志,2013,21(8):1171-1173
[19]吴苗敏,刘娜,韩璐.丹参酮胶囊对多囊卵巢综合征患者脂代谢及下丘脑-垂体-肾上腺轴的影响[J].山东医药,2016,56(32):94-96
[20]刘丽华.糖脂代谢紊乱与多囊卵巢综合征相关性分析[J].江西医药,2016,51(8):808-810
[21]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[J].中国妇幼保健,2015,30(21):3636-3638
[22]Cantorna M T,Mahon B D.Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence[J].Experimental Biology&Medicine,2004,229(11):1136-1142
[23]张淼苗,朱岚,喇端端,等.维生素D联合达英-35治疗多囊卵巢综合征的临床效果观察[J].中国妇幼保健,2015,30(32):5704-5707
[24]Abbasi M,Hashemipour S,Hajmanuchehri F,et al.Is Vitamin DDeficiency associated with Non Specific Musculoskeletal Pain?[J].Global Journal of Health Science,2013,5(1):107-111
[25]Rudick B J,Ingles S A,Chung K,et al.Influence of vitamin Dlevels on in vitro fertilization outcomes in donor-recipient cycles[J].Fertility&Sterility,2014,101(2):447-452
[2]陈东思,刘建新.多囊卵巢综合征发病机制研究进展[J].青岛大学医学院学报,2015,51(6):750-752
[3]Legro R.Diagnosis and treatment of polycystic ovary syndrome(PCOS):An interview with Richard Legro[J].Bmc Medicine,2015,13(1):1-5
[4]郑思远,张莹,龙涛,等.不同胰岛素抵抗及肥胖水平对多囊卵巢综合征患者高雄激素血症特征的影响[J].广东医学,2017,38(3):406-409
[5]周晓梅,孙明雅.过氧化物还原酶2与多囊卵巢综合征患者发生心血管疾病危险因素的相关性研究[J].中国基层医药,2017,24(11):1609-1611
[6]江丽琴,周静,黄伟政.达英35与二甲双胍治疗多囊卵巢综合征患者妊娠分娩的结局研究[J].西部医学,2014,26(5):564-566
[7]朱望珍,程建慧,程英惠.多囊卵巢综合征患者心理状态调查分析[J].中国初级卫生保健,2016,30(9):36-37
[8]孙明雅,周晓梅.维生素D与多囊卵巢综合征代谢紊乱的研究进展[J].医学综述,2015,21(12):2217-2220
[9]叶碧绿.维生素D与多囊卵巢综合征相关性的研究进展[J].生殖医学杂志,2014,23(6):431-434
[10]贾丽娜.从“肾藏精”看维生素D与多囊卵巢综合征的关系[J].中华中医药杂志,2015,30(11):4081-4083
[11]檀丽,彭巧捷,陈丽春.维生素D辅助治疗对多囊卵巢综合征内分泌代谢相关指标及胰岛素抵抗的影响[J].数理医药学杂志,2016,29(10):1497-1499
[12]贾新转,魏兰,甄秀丽.维生素D联合二甲双胍及中药对PCOS患者内分泌代谢紊乱的治疗作用分析[J].时珍国医国药,2014,25(6):1415-1417
[13]项守奎,王龙,吴阳,等.多囊卵巢综合征患者血清维生素D水平与抑郁症的关系[J].临床荟萃,2015,30(6):649-653
[14]金博弘,周馥贞.多囊卵巢综合征的诊断标准[J].国际生殖健康/计划生育杂志,2005,24(3):152-154
[15]Gonen Y,Casper R F.Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization(IVF)[J].Journal of in Vitro Fertilization&Embryo Transfer Ivf,1990,7(3):146-152
[16]王波.维生素D抗多囊卵巢综合征合并抑郁患者免疫过激的效果[J].实用临床医药杂志,2016,20(21):210-212
[17]廖媚,龙建,崔咏怡,等.广州妊娠期糖尿病孕妇生活事件与孕妇心理健康状况的关系[J].中国健康心理学杂志,2017,25(3):336-339
[18]李富军,李杨,王立新,等.焦虑抑郁状态对冠心病介入治疗患者预后的影响[J].中国健康心理学杂志,2013,21(8):1171-1173
[19]吴苗敏,刘娜,韩璐.丹参酮胶囊对多囊卵巢综合征患者脂代谢及下丘脑-垂体-肾上腺轴的影响[J].山东医药,2016,56(32):94-96
[20]刘丽华.糖脂代谢紊乱与多囊卵巢综合征相关性分析[J].江西医药,2016,51(8):808-810
[21]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[J].中国妇幼保健,2015,30(21):3636-3638
[22]Cantorna M T,Mahon B D.Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence[J].Experimental Biology&Medicine,2004,229(11):1136-1142
[23]张淼苗,朱岚,喇端端,等.维生素D联合达英-35治疗多囊卵巢综合征的临床效果观察[J].中国妇幼保健,2015,30(32):5704-5707
[24]Abbasi M,Hashemipour S,Hajmanuchehri F,et al.Is Vitamin DDeficiency associated with Non Specific Musculoskeletal Pain?[J].Global Journal of Health Science,2013,5(1):107-111
[25]Rudick B J,Ingles S A,Chung K,et al.Influence of vitamin Dlevels on in vitro fertilization outcomes in donor-recipient cycles[J].Fertility&Sterility,2014,101(2):447-452