Karadağ Cihan, Yoldemir Tevfik, Yavuz Dilek Gogas
Department of Obstetrics and Gynecology, Marmara University School of Medicine, Istanbul, Turkey.
Department of Internal Medicine, Section of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey.
J Obstet Gynaecol Res. 2018 Feb;44(2):270-277. doi: 10.1111/jog.13516. Epub 2017 Nov 2.
The aim of this study was to identify the effects of vitamin D supplementation on insulin sensitivity and androgen levels in vitamin-D-deficient polycystic ovary syndrome (PCOS) patients.
Sixty-seven vitamin-D-deficient (25-hydroxyvitamin D [25(OH)D] levels below 20 ng/mL) PCOS patients and 54 vitamin-D-deficient non-PCOS volunteer subjects matched for age and body mass index were enrolled to this prospective study. All participants were given 50 000 IU/week cholecalciferol orally for 8 weeks and 1500 IU/day for 4 weeks. Insulin sensitivity was calculated with the Matsuda insulin sensitivity index (ISI) based on an oral glucose tolerance test. Matsuda ISI, gonadal hormones (estrogen, testosterone, androstenedione), and 25(OH)D levels were studied before and at the end of the 12th week of vitamin D load.
After vitamin D supplementation, serum androstenedione levels had decreased significantly (P = 0.007) and Matsuda ISI values had increased significantly (P = 0.001) in the PCOS group but no significant changes were seen in those parameters in controls. We observed positive correlations between 25(OH)D levels and Matsuda ISI (r = 0.307; P < 0.01), and negative correlations between 25(OH)D levels and total testosterone (r = -0.306; P < 0.01) and androstenedione (r = -0.275; P < 0.01) levels in the PCOS group.
Vitamin D supplementation increased insulin sensitivity and decreased androgen levels in vitamin-D-deficient women with PCOS but did not have any effect in vitamin-D-deficient non-PCOS women. These results may indicate the possible role of vitamin D in the complex pathogenesis of PCOS.
本研究旨在确定补充维生素D对维生素D缺乏的多囊卵巢综合征(PCOS)患者胰岛素敏感性和雄激素水平的影响。
本项前瞻性研究纳入了67例维生素D缺乏(25-羟维生素D[25(OH)D]水平低于20 ng/mL)的PCOS患者和54例年龄及体重指数相匹配的维生素D缺乏的非PCOS志愿者。所有参与者口服50000 IU/周胆钙化醇,持续8周,之后1500 IU/天,持续4周。基于口服葡萄糖耐量试验,用松田胰岛素敏感性指数(ISI)计算胰岛素敏感性。在维生素D负荷第12周开始前及结束时,研究松田ISI、性腺激素(雌激素、睾酮、雄烯二酮)和25(OH)D水平。
补充维生素D后,PCOS组血清雄烯二酮水平显著降低(P = 0.007),松田ISI值显著升高(P = 0.001),但对照组这些参数未见显著变化。我们观察到PCOS组中25(OH)D水平与松田ISI呈正相关(r = 0.307;P < 0.01),25(OH)D水平与总睾酮(r = -0.306;P < 0.01)和雄烯二酮(r = -0.275;P < 0.01)水平呈负相关。
补充维生素D可提高维生素D缺乏的PCOS女性的胰岛素敏感性并降低雄激素水平,但对维生素D缺乏的非PCOS女性没有任何影响。这些结果可能表明维生素D在PCOS复杂发病机制中的潜在作用。