「前沿傳遞」復發性流產患者維生素D缺乏與高胰島素血症有相幹性

作者：Catherine McCormack, et al

翻譯：湖北省中醫院熊麗桂([email protected]）

譯者簡介：女，副主任醫師，湖北省中醫院免疫生殖門診負責人。湖北省風濕免疫學會委員，武漢市醫師協會風濕分會理事,湖北省醫學生物免疫學會風濕免疫學分會首屆委員,中國婦幼健康研究會生殖免疫學專業委員會委員中國老年學和老年醫學學會骨質疏松分會骨內科專家委員會委員,湖北省骨內科學組委員,第一屆湖北省免疫學會生殖免疫專業委員會委員。

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【摘要】

目的：一些研究發現，維生素D不足與頭三個月復發性流產的風險增加相幹，另外的研究顯示，維生素D不足與高胰島素血症/胰島素抵抗和發展為懷孕糖尿病風險增加相幹。高胰島素血症也認為會增加復發性流產風險。我們在一個復發性流產病人中進行維生素D水平與高胰島素水平之間關係的隊列研究。

方法：對復發性流產患者進行胰島素和維生素D水平檢測。維生素D水平分類為：充足（≥75nmol/L），不足（50–74.9 nmol/L），缺乏（<50nmol/L）。高胰島素通過糖耐量實驗和胰島素釋放試驗進行評估。

結果：155個病人進行了檢測。維生素D缺乏的人群中有58.3%被測出有高胰島素血症。維生素D不足的人群中有38.7%被測出有高胰島素血症，在維生素D充足的患者中有33.3%測出有高胰島素血症（智方 p¼034）。體重指數與維生素D水平沒有明顯的相幹性，或者說體重指數與高胰島素血症沒有明顯的相幹性。

結論：我們發現，在復發性流產患者中，維生素D缺乏或不足與高胰島素血症有明顯相幹性。維生素D缺乏也與不良懷孕結局風險增加相幹，包括先兆子癇、早產、小於胎齡兒、懷孕期糖尿病、復發性流產。需要進行更大水平的實驗，來確認，是否在孕前或者孕早期增加血清維生素D的水平能夠改善不良懷孕結局。

附原文

ABSTRACT Aims: Some studies have suggested that vitamin D deficiency is associated with an increased risk of first trimester miscarriages, others have suggested that it is associated with an
increased risk of hyperinsulinism/insulin resistance and the development of gestational diabetes. Hyperinsulinism is also thought to increase miscarriages. We investigated the association between
vitamin D levels and hyperinsulinism in a cohort of recurrent miscarriage patients. Methods: Patients undergoing miscarriage investigations had insulin and vitamin D levels tested.Vitamin D levels
were classified as: sufficient (75nmol/L), insufficient (50–74.9 nmol/L) or deficient(<50nmol/L).

Hyperinsulinism was assessed via a 75 g oral glucose tolerance test (OGTT)with insulin studies. Results: One hundred and fifty-five patients underwent the testing. Hyperinsulinism was detected in
58.3% of the vitamin D deficient group, 38.7% of the insufficient group, and 33.3% of the sufficient group (chi-square p¼.034). There were no significant associations between BMIand vitamin D levels,
or BMI and hyperinsulinism. Caucasians comprised 82% of the clinic, and67% of these women had vitamin D insufficiency/deficiency. Noncaucasians comprised 18% ofthe clinic but 89% of these patients
had vitamin D insufficiency/deficiency. Discussion: We found that insufficient or deficient vitamin D levels were significantly associatedwith hyperinsulinism in these patients. Vitamin D deficiency
is also thought to contribute to anincreased risk of adverse pregnancy outcomes including preeclampsia, preterm birth, small-forgestational-age gestational diabetes mellitus, and miscarriages. Larger
level >

引自

Catherine McCormack etal.Association between vitamin D status and hyperinsulinism, The Journal of Maternal-Fetal & Neonatal Medicine.

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