不孕女性维生素D水平与抗苗勒氏管激素的相关性及对妊娠结局的预测

Correlation analysis of vitamin D level and anti-Müllerian hormone in infertile female and the role in predicting pregnancy outcome

目的:探讨不孕女性血清25(OH)D水平与抗苗勒氏管激素(anti-Müllerian hormone,AMH)间的关系及二者对体外受精和胚胎移植妊娠结局的预测作用。方法:纳入2018年11月至2019年9月间756例应用体外受精和胚胎移植助孕的不孕女性,根据体内维生素D水平将入组人群分为3组(血清25(OH)D≤10μg/L为A组,10μg/L<血清25(OH)D<20μg/L为B组,血清25(OH)D≥20μg/L为C组),检测患者血清AMH水平,分析组间差异并探讨各不孕类型[输卵管/男方因素、多囊卵巢综合征(polycystic ovary syndrome,PCOS)、排卵障碍(非PCOS原因)、子宫内膜异位症、不明原因不孕、其他]中维生素D水平与血清AMH水平之间的相关性,以及在全部不孕女性中血清25(OH)D水平和血清AMH水平对妊娠结局的独立/协同预测作用。结果:(1)87.7%的入组研究对象处于维生素D不足或缺乏的状态;(2)A、B、C三个不同维生素D水平组的血清AMH分别为1.960(1.155,3.655)μg/L、2.455(1.370,4.403)μg/L、2.360(1.430,4.780)μg/L,组间差异无统计学意义(P>0.05);(3)血清25(OH)D和AMH水平呈现季节性变化(P<0.05);(4)利用多重线性回归分析,调整潜在混杂因素后,各不孕类型女性的血清AMH水平与血清25(OH)D水平之间无明显相关性(P>0.05);(5)二元Logistics回归模型分析发现所有不孕女性中,血清AMH水平是预测生化妊娠结局的独立影响因素(P<0.05),血清25(OH)D无法单独预测妊娠结局(P>0.05),但能够与血清AMH协同预测生化妊娠结局(P<0.05)。结论:按照目前诊断标准,不孕女性维生素D缺乏或不足较为普遍,但未发现血清25(OH)D水平与卵巢储备功能相关。血清25(OH)D无法独立预测不孕女性妊娠结局,但AMH能够独立或与血清25(OH)D共同预测不孕女性的生化妊娠结局。

Objective:To investigate the relationship between serum 25(OH)D and anti-Müllerian hormone(AMH)among infertile females and their predictive impacts on in vitro fertilization and embryo transfer pregnancy outcome.Methods:Totally 756 infertile females treated with assisted reproductive technology were enrolled and divided into three groups according to their vitamin D levels(group A with serum 25(OH)D≤10μg/L,group B with serum(10-20)μg/L,and group C with serum≥20μg/L).The serum AMH levels were detected.The differences among the groups were analyzed,as well as the correlation between vitamin D levels and serum AMH levels in various infertility types(fallopian tube/male factor,polycystic ovary syndrome(PCOS),ovulation disorders excluded PCOS,endometriosis,unexplained infertility,and others).Also,the predictive roles of vitamin D and AMH in pregnancy outcome in all the infertile females were discussed.Results:(1)87.7%of the enrolled females were insufficient or deficient in vitamin D.(2)The serum AMH levels in the three groups with different vitamin D levels were 1.960(1.155,3.655)μg/L,2.455(1.370,4.403)μg/L,2.360(1.430,4.780)μg/L and there was no significant difference in serum AMH levels among the three groups(P>0.05).(3)Serum 25(OH)D and AMH levels presented seasonal variations(P<0.05).(4)There was no prominent correlation between the serum AMH level and serum 25(OH)D level in females of various infertility types after adjusting potential confounding factors[age,body mass index(BMI),antral follicle count(AFC),vitamin D blood collection season,etc.]by multiple linear regression analysis(P>0.05).(5)After adjusting for confounding factors,such as age,BMI,number of transplanted embryos and AFC,the results of binary Logistics regression model showed that in all the infertile females,the serum AMH level was an independent predictor of biochemical pregnancy outcome(P<0.05)while the serum 25(OH)D level might not act as a prediction factor alone(P>0.05).In the meanwhile,the serum 25(OH)D level and serum AMH level were synergistic predictors of biochemical or clinical pregnancy outcome(P<0.05).Conclusion:Based on the current diagnostic criteria,most infertile females had vitamin D insufficiency or deficiency,but there was not significant correlation between serum 25(OH)D and ovarian reserve.While vitamin D could not be used as an independent predictor of pregnancy outcome in infertile females,the serum AMH level could predict biochemical pregnancy outcome independently or jointly with vitamin D.