维生素 D 补充对多囊卵巢综合征妇女排卵和妊娠的影响：系统评价和荟萃分析。
Effects of vitamin D supplementation on ovulation and pregnancy in women with polycystic ovary syndrome: a systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
出版信息
Front Endocrinol (Lausanne). 2023 Aug 1;14:1148556. doi: 10.3389/fendo.2023.1148556. eCollection 2023.
OBJECTIVE
To evaluate the effect of vitamin D supplementation on pregnancy and ovulation in patients with polycystic ovary syndrome.
METHOD
We searched Pubmed, Medline (via Ovid, 1974 to 2020), EMBASE (via Ovid, 1974 to 2020), Cochrane Central Register of Controlled Trials (via Ovid), Web of Science, CNKI, WangFang and the Vip database from inception until April 2021. Two researchers independently screened articles, collected data and evaluated the quality, with Review manager 5.3 for meta-analysis.
RESULTS
Totally 20 randomized controlled studies with 1961 subjects were included. Meta analysis showed that pregnancy rate [RR=1.44 (1.28, 1.62), p<0.00,001], ovulation rate [RR=1.42 (1.14, 1.78), p=0.002] and matured oocytes rate [RR=1.08 (1.03, 1.13), p=0.002] of vitamin D supplementation group were significantly higher than those of control group. Meanwhile, early miscarriage rate [RR=0.44 (0.30, 0.66), p<0.00,001], androgen level [MD=-2.31 (-3.51, -1.11), p=0.0002], luteinizing hormone [MD=-1.47 (-2.57, -0.36), p=0.009], follicle stimulating hormone [MD=-0.15 (-0.24, -0.05), p=0.002], and premature delivery rate [RR=0.38, 95% CI (0.21, 0.70), p=0.002] were declined significantly than the controls. However, only one article suggested that the progesterone [MD=6.52 (4.52, 8.52), p<0.05] in the vitamin D intervention group was increased. There was no notable difference in the biochemical pregnancy rate [RR=0.95 (0.55, 1.63), p=0.84], gestational hypertension rate [RR=0.40, 95% CI (0.15, 1.11), p=0.08], gestational diabetes mellitus rate [RR=0.27, 95% CI (0.05, 1.39), p=0.11], fertilization rate [RR=1.05 (1.00, 1.10), p=0.04], cleavage rate [RR=1.03 (0.99, 1.06), p=0.17], high-quality embryo rate [RR=1.08 (0.98, 1.20), p=0.10], endometrial thickness [MD=0.10], 77 (-0.23, 1.77), p=0.13], estrogen level [MD=-0.34 (-1.55, 0.87), p=0.59], LH/FSH [MD=-0.14, 95% CI (-0.48, 0.20), p=1.00] and anti-Mullerian hormone [MD=-0.22 (-0.65, 0.21), p=0.32].
CONCLUSION
Vitamin D supplementation contribute to the higher pregnancy and ovulation rates, and lower androgen, LH, FSH and early miscarriage rates in women with PCOS, regardless of the use of ovulation induction drugs or assisted reproductive technologies. However, no significant improvement was observed in fertilization rate or cleavage rate. Due to the limitation in quality of involved studies, more high-quality RCTs are needed for further validation.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42021250284.
目的
评估维生素 D 补充剂对多囊卵巢综合征患者妊娠和排卵的影响。
方法
我们检索了 Pubmed、Medline（通过 Ovid，1974 年至 2020 年）、EMBASE（通过 Ovid，1974 年至 2020 年）、Cochrane 对照试验中心注册库（通过 Ovid）、Web of Science、中国知网、万方和维普数据库，检索时间截至 2021 年 4 月。两位研究人员独立筛选文章、收集数据并评估质量，使用 Review Manager 5.3 进行荟萃分析。
结果
共纳入 20 项随机对照研究，涉及 1961 例受试者。Meta 分析显示，维生素 D 补充组的妊娠率[RR=1.44（1.28，1.62），p<0.001]、排卵率[RR=1.42（1.14，1.78），p=0.002]和成熟卵母细胞率[RR=1.08（1.03，1.13），p=0.002]均显著高于对照组。同时，维生素 D 补充组的早期流产率[RR=0.44（0.30，0.66），p<0.001]、雄激素水平[MD=-2.31（-3.51，-1.11），p=0.0002]、黄体生成素[MD=-1.47（-2.57，-0.36），p=0.009]、卵泡刺激素[MD=-0.15（-0.24，-0.05），p=0.002]和早产率[RR=0.38，95%CI（0.21，0.70），p=0.002]均显著低于对照组。然而，仅有一篇文章提示维生素 D 干预组的孕激素[MD=6.52（4.52，8.52），p<0.05]增加。维生素 D 补充组的生化妊娠率[RR=0.95（0.55，1.63），p=0.84]、妊娠期高血压发生率[RR=0.40（0.15，1.11），p=0.08]、妊娠期糖尿病发生率[RR=0.27（0.05，1.39），p=0.11]、受精率[RR=1.05（1.00，1.10），p=0.04]、卵裂率[RR=1.03（0.99，1.06），p=0.17]、优质胚胎率[RR=1.08（0.98，1.20），p=0.10]、子宫内膜厚度[MD=0.10（-0.23，1.77），p=0.13]、雌激素水平[MD=-0.34（-1.55，0.87），p=0.59]、LH/FSH[MD=-0.14（-0.48，0.20），p=1.00]和抗苗勒管激素[MD=-0.22（-0.65，0.21），p=0.32]无显著差异。
结论
维生素 D 补充剂可提高多囊卵巢综合征患者的妊娠和排卵率，降低雄激素、LH、FSH 和早期流产率，无论是否使用促排卵药物或辅助生殖技术。然而，受精率或卵裂率未见显著改善。由于纳入研究的质量有限，需要更多高质量的 RCT 进一步验证。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO，标识符 CRD42021250284。
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