探讨血清25羟维生素D水平与体外受精—胚胎移植妊娠率的关系

发布时间：2018-05-30 05:59

本文选题：体外受精-胚胎移植 + 25羟维生素D　；参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨体外受精(in vitro fertilization,IVF)和卵母细胞浆内单精子显微注射(intrac ytoplasmic sperminjection,ICSI)不孕女性外周血中25羟维生素D的水平与其妊娠率的关系。资料与方法回顾性分析2015年12月至2017年1月郑州大学第三附属医院生殖中心首次实施常规IVF/ICSI治疗移植两枚第三天新鲜胚胎,具有完整病例资料的618例年轻且卵巢储备功能良好的不孕患者,收集病例资料包括一般信息、临床治疗、实验室及随访资料。(1)纳入标准:(1)符合行IVF、ICSI指征,新鲜周期移植两枚第三天胚胎;(2)年龄≤35岁;(3)体重指数(body mass index,BMI)18-kg/m2;(4)卵巢储备功能正常:双侧窦卵泡数(AFC)6个,基础卵泡刺激素(Basic Follicle Stimulating Hormone,bFSH)10 IU/L,基础雌激素(Basic Estradial,bE2)50 ng/L。(2)排除标准:排除恶性肿瘤(史)、高血压、糖尿病、多发性硬化症、需要长期药物治疗的内分泌代谢性病、肝脏或肾脏疾病、高泌乳素血症、多囊卵巢综合征(Polycystic ovarian syndrome,PCOS)、口服复合维生素制剂或维生素D合剂补充维生素D。(3)采用化学发光法检测血清25羟维生素D水平。将临床诊断结果分为临床妊娠组和未临床妊娠组,将潜在影响血清25(OH)D水平和妊娠结局相关联的变量进行单因素分析,将单因素分析有统计学差异的结果作为自变量,临床妊娠作为因变量,纳入Logistic回归模型分析影响体外受精一胚胎移植妊娠结局的因素,进行影响临床妊娠混杂因素的评估,观察血清25(OH)D缺乏是否影响IVF/ICSI妊娠结局。(4)根据血清25(OH)D水平将研究对象分为A组:血清25(OH)D25nmol/L;B组:血清25(OH)D 25~50nmol/L;C组:血清25(OH)D50nmol/L,比较各组间的总获卵数、成熟卵子总数、优质胚胎数、受精卵子总数、可利用胚胎数、生化妊娠率、临床妊娠率有无差异。(5)所得数据运用SPSS21.0统计软件进行整理分析,P0.05差异有统计学意义。结果(1)在618例研究对象中,维生素D严重缺乏的有167例,占本次研究对象总数的27%;维生素D缺乏的有173例,占调查人数的28%;维生素D不足的有275,占本次调查人数的44.5%;维生素D正常的有3人,占本次调查人数的0.5%;未发现有出现维生素D过量的情况。618例患者普遍存在普遍存在VD严重缺乏或缺乏,血清25-(OH)D均值为36.04±5.388nmol/L低于国外学者提出的75 nmol/L的成人维生素D标准;根据成人VD标准,仅有3名女性VD水平在正常范围内,占0.5%,余95.5%的患者均不同程度存在VD缺乏或不足。(2)618例患者平均年龄28.81±3.55岁,妊娠组为387例(62.6%),未妊娠组231例(37.4%)。单因素分析结果显示:妊娠组年龄小于未妊娠组[(28.59±3.49)vs.(29.28±3.64)岁],妊娠组HCG日子宫内膜厚度大于未妊娠组[(11.63±2.09)vs.(10.52±2.54)mm],妊娠组已移植胚胎质量高于未妊娠组[优质胚胎205(52.9)vs.99(42.9)],[非优质胚胎182(47.1)vs.132(57.1)],妊娠组的维生素D缺乏小于未妊娠组[维生素D缺乏187(48.3)vs.156(67.5)],[维生素D不缺乏200(51.7)vs.75(32.5)](P值均0.05)。将单因素分析有差异的年龄、子宫内膜厚度、已移植胚胎质量、血清25(OH)D水平纳入logistics回归模型,结果显示:子宫内膜厚度(OR=1.251,95%CI:1.013-1.545,p=0.037)、已移植胚胎质量(OR=1.903,95%CI:1.123-3.226,p=0.017)、血清25羟维生素D缺乏(OR=0.995,95%CI:0.991-0.998,p=0.004)有统计学差异。(3)其中A组(维生素D25mol/L)167例,B组(维生素D 25~50mol/L)173例,C组(维生素D50mol/L)278例。三组在年龄、BMI、不孕年限、窦卵泡总数、E2、LH、FSH比较,差异均无统计学意义(P0.05)。三组生化妊娠率、临床妊娠率相比较,差异有统计学意义(P0.05)。不同维生素D水平组间生化妊娠率比较,结果:A组64.2%(52/81),B组74.1%(60/81),C组83.3%(50/60)各组间的差异有统计学意义(P=0.039)。不同维生素D水平组间临床妊娠率比较,结果:A组50.9%(85/167),B组59.1%(102/173),C组71.9%(200/278)各组间的差异有统计学意义(P=0.020)。而三组间Gn总量、Gn天数、HCG日E2、成熟卵子总数、优质胚胎数、受精卵子总数、可利用胚胎数、HCG日P、HCG日子宫内膜厚度、总获卵数、相比较差异无统计学意义(P0.05)。结论(1)行IVF/ICSI的年轻且卵巢储备功能良好的不孕不孕症女性患者血清维生素D水平普遍的缺乏或不足。(2)维生素D缺乏是IVF/ICSI患者临床妊娠率的独立影响因素。(3)血清维生素D缺乏可降低IVF/ICSI助孕的临床妊娠率。(4)血清25(OH)D水平与获卵数、成熟卵子总数、可利用胚胎数及胚胎质量无显著关系。
[Abstract]:Objective to investigate the relationship between the level of 25 hydroxyvitamin D in peripheral blood and the pregnancy rate in the peripheral blood of infertile women with in vitro fertilization (IVF) and oocyte plasma single sperm injection (intrac ytoplasmic sperminjection, ICSI). The data and methods reviewed the reproduction of the Third Affiliated Hospital of Zhengzhou University from December 2015 to January 2017. The center for the first time carried out conventional IVF/ICSI therapy for two third day fresh embryos and 618 young and good ovarian reserve patients with complete case data. The collection of case data included general information, clinical treatment, laboratory and follow-up data. (1) included the criteria: (1) conformed to the line IVF, ICSI indications, and two fresh cycle transplants. Three days embryos; (2) age less than 35 years old; (3) body mass index (body mass index, BMI) 18-kg/m2; (4) normal ovarian reserve function: 6 of bilateral sinus follicles (AFC), basal follicle stimulating hormone (Basic Follicle Stimulating Hormone, bFSH) 10 IU/L, basic estradiol 50 (2) exclusion criteria: elimination of malignant tumor (History), hypertension, sugar Urinary and multiple sclerosis, requiring long-term drug treatment of endocrine and metabolic diseases, liver or kidney disease, hyperprolactinemia, polycystic ovary syndrome (Polycystic ovarian syndrome, PCOS), oral compound vitamin preparation or vitamin D mixture supplemented vitamin D. (3) by chemiluminescence detection of serum 25 hydroxyvitamin D level. The results of bed diagnosis were divided into clinical pregnancy group and unclinical pregnancy group. Single factor analysis was carried out on the variables associated with the potential influence of serum 25 (OH) D level and pregnancy outcome. The results of statistical difference in single factor analysis were taken as independent variables. Clinical pregnancy was used as the dependent variable, and the Logistic regression model was incorporated into the analysis of the embryo transfer in vitro fertilization. The factors affecting the outcome of pregnancy were evaluated to affect the clinical pregnancy confounding factors and to observe whether the serum 25 (OH) D deficiency affected the IVF/ICSI pregnancy outcome. (4) according to the serum 25 (OH) D levels, the subjects were divided into A group: serum 25 (OH) D25nmol/L; B group: serum 25 (OH) D 25~50nmol/L; serum 25 The total number of mature eggs, the number of high quality embryos, the total number of fertilized eggs, the number of embryos, biochemical pregnancy rate and clinical pregnancy rate have no difference. (5) the data obtained by SPSS21.0 statistical software were analyzed, and the difference of P0.05 was statistically significant. (1) among the 618 subjects, there were 167 cases of severe vitamin D deficiency, which accounted for the total object of the study. 27% of the number, 173 cases of vitamin D deficiency, 28% of the number of investigators, 275 of vitamin D deficiency, 44.5% of the present survey, 3 of the normal vitamin D, 0.5% of the present survey, and the prevalence of VD severe deficiency or lack of serum 25- (OH) D mean in cases of vitamin D overdose 36.04 + 5.388nmol/L was lower than the 75 nmol/L standard of adult vitamin D proposed by foreign scholars. According to the adult VD standard, only 3 women were in the normal range, accounting for 0.5%, and the remaining 95.5% patients had VD deficiency or deficiency in varying degrees. (2) the average age of 618 patients was 28.81 + 3.55, the pregnancy group was 387 (62.6%), and no pregnancy group 231 (3) 7.4%). The results of single factor analysis showed that the age of pregnancy group was less than that of non pregnancy group [(28.59 + 3.49) vs. (29.28 + 3.64) years old], the endometrium thickness of pregnancy group was higher than that of non pregnancy group [11.63 + 2.09) vs. (11.63 + 2.09) vs. (10.52 + 2.54) mm], and the quality of the transplanted embryos in pregnancy group was higher than that of non pregnancy pregnancy group [205 (52.9) vs.99 (42.9)], [non quality embryo 182 (47.1) vs.1]. 32 (57.1)] the vitamin D deficiency in the pregnancy group was less than that of the non pregnancy group [vitamin D deficiency 187 (48.3) vs.156 (67.5)], [vitamin D without 200 (51.7) vs.75 (32.5)] (P value 0.05)). The age, the thickness of the endometrium, the transplanted embryo quality, the serum 25 (OH) D level were included in the logistics regression model, and the results showed that the uterus was in the uterus. Membrane thickness (OR=1.251,95%CI:1.013-1.545, p=0.037), the quality of transplanted embryos (OR=1.903,95%CI:1.123-3.226, p=0.017), serum 25 hydroxyvitamin D deficiency (OR=0.995,95%CI:0.991-0.998, p=0.004) had statistical differences. (3) 167 cases of A (vitamin D25mol/L), B group (vitamin D 25~50mol/L) 173 cases, three group (vitamin p=0.017) in 278 cases. Age, BMI, infertile years, total number of sinus oocytes, E2, LH, FSH, the difference was not statistically significant (P0.05). The difference between the three groups of biochemical pregnancy rates and the clinical pregnancy rate was statistically significant (P0.05). The results were compared between the groups of 64.2% (52/81), B group 74.1% (60/81) in group A and the differences among the 83.3% C groups. Statistical significance (P=0.039). The comparison of clinical pregnancy rates among groups of different vitamin D levels: group A 50.9% (85/167), group B, 59.1% (102/173), C group 71.9% (200/278), but three groups of Gn total, Gn days, HCG day, the number of mature eggs, the number of high-quality embryos, the total number of fertilized oocytes, the number of embryos can be utilized. The endometrium thickness and total number of acquired eggs on day P, HCG day were not statistically significant (P0.05). Conclusion (1) the prevalence of vitamin D in female patients with infertility and infertility with IVF/ICSI is generally deficient or inadequate. (2) vitamin D deficiency is an independent factor in the clinical pregnancy rate of IVF/ICSI patients. (3) serum (3) serum Vitamin D deficiency can reduce the clinical pregnancy rate of IVF/ICSI pregnancy. (4) the level of serum 25 (OH) D, the number of eggs obtained, the total number of mature eggs, and the number of embryos and the quality of embryo have no significant relationship.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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