孕妇维生素D缺乏及其对胎儿的影响

目的维生素D缺乏累及的人群非常广泛,而且与多种疾病的发生有关,特别是孕妇维生素D缺乏还可能影响到胎儿的健康。目前关于我国女性维生素D的资料报道很少。本研究的目的是了解健康孕妇(孕15~21w)以及同龄未孕对照组妇女维生素D水平以及孕妇维生素D水平对新生儿出生大小的影响。方法本文随机选取单胎妊娠孕妇63例和同龄对照妇女35例,用酶联免疫的方法测定血中25-羟维生素D水平。结果显示99%的检测病例25-羟维生素D水平低于正常值(≥75 nmol/L),有近93%的妇女为维生素D缺乏(50 nmol/L)。孕妇25-羟维生素D水平(28.40±9.19 noml/L)明显低于对照组妇女(38.46±10.77 noml/L;P0.001),两组维生素D缺乏的比率分别为孕妇96.8%,对照组85.7%,但重度维生素D缺乏的病例孕妇组接近半数,而对照组为零。新生儿身长与孕妇25-羟维生素D水平成显著正相关(r=0.323;P0.01。结论我国北方女性特别是孕妇是维生素D缺乏患病的高危人群,而且孕妇维生素D缺乏可能会影响到胎儿的生长发育。应该积极采用有效的措施防治维生素D的缺乏,从而减少维生素D缺乏对健康的影响对提高人口质量将具有重要的意义。     

维生素D受体基因TaqⅠ多态性与绝经后妇女骨密度的关系

目的 了解福州地区绝经后妇女维生素D受体基因TaqⅠ多态性的分布,探讨维生素D受体基因TaqⅠ多态性与绝经后妇女骨密度的关系.方法 用双能X线骨密度仪检测592例绝经后妇女的腰椎、股骨颈、大转子和Wards三角骨密度,应用PCR-RFLP技术检测维生素D受体基因TaqⅠ多态性.结果 ①维生素D受体基因型分布频率为TT型90.37%,tt型0.17%,Tt型9.46%.等位基因频率为T 95.1%,t 4.9%,基因型分布符合Hardy-Weinberg定律.②分析其基因型与骨密度的关系:TT、tt、Tt 3种基因型在腰椎、股骨颈、大转子、Ward's区4个部位骨密度差异均无显著性.结论 维生素D受体基因TaqⅠ多态性与骨密度间无关联,不能作为预测福州地区绝经后妇女发生骨质疏松危险性的遗传标志.     

北京城区老年妇女维生素D营养状况

目的 了解北京城区老年妇女维生素D营养状况.方法 随机选取北京市3个城区17个社区中60岁以上的老年妇女399人,在2008年5轮?旬至7月初采集清晨空腹静脉血分离血清,采用美国DiaSorin公司生产的放射免疫试剂盒测定血25-羟维生素D(25(OH)D)的浓度.结果 在春末夏初,北京市城区老年妇女血清25(OH)D平均水平为(14.4±5.7)ng/ml,维生素D缺乏率(25(OH)D<10 ng/ml)为21.8%,维生素D不足率(10 ng/ml≤25(OH)D<20 ng/ml)为62.4%;从5月到7月,研究对象血清25(OH)D水平逐渐升高.而随着年龄的增大,血清25(OH)D水平有下降的趋势.结论 北京市城区老年妇女维生素D不足的现象比较普遍.     

血清维生素E水平与绝经后早期女性骨密度相关性研究

目的评估绝经后早期妇女维生素E水平与骨质疏松症之间的关系。方法收集人体测量数据,骨质疏松症的危险因素,维生素E血清水平,和其他可能影响绝经后妇女骨密度的血清参数。通过多变量逻辑回归和多元线性回归分析232名绝经后早期女性骨质疏松症与年龄、绝经年龄、体质量指数、骨钙素、钙、维生素D和维生素E(分别以25羟维生素D和α-生育酚:脂质比率测定)、骨碱性磷酸酶、吸烟状况、体力活动和饮酒量之间的关系。结果在多变量逻辑回归中,较低的维生素E:脂质比率与骨质疏松症相关。在腰椎BMD作为因变量的多变量线性模型中,维生素E:脂质比率与腰椎BMD明显相关(F比率=6. 28,P=0. 001)。腰椎的BMD在维生素E:脂质比率的最高三分位数中显著高于最低三分位数。使用多变量调整的BMD后,绝经后女性(3. 1±0. 5μmol/mmol)的绝经后女性(3. 6±0. 6μmol/mmol)的平均维生素E:脂质比率显着低于正常(无骨质疏松症和骨质减少)。结论本研究表明维生素E可能会增加健康绝经后妇女的骨密度。     

维生素D受体基因Apa I多态性与绝经后妇女骨密度的关系

目的了解福州地区绝经后妇女维生素D受体基因ApaI多态性的分布,探讨维生素D受体基因ApaI多态性与绝经后妇女骨密度的关系。方法用双能X线骨密度仪检测592例绝经后妇女的L2-4、股骨颈,大转子和Ward三角区骨密度,应用PCR-RFLP技术检测维生素D受体基因ApaI多态性。结果①维生素D受体基因型分布频率为AA型10.1%,aa型46.6%,Aa型43.2%。等位基因频率为A31.8%,a68.2%,基因型分布符合Hardy-Weinberg定律。②骨质疏松组与对照组基因型及等位基因分布频率差异均无显著性。③分析其基因型与骨密度的关系:AA、aa、Aa3种基因型在腰椎、股骨颈、大转子、Ward区4个部位骨密度均无显著性差异。结论维生索D受体基因ApaI多态性与骨密度间无关联,不能作为预测福州地区绝经后妇女发生骨质疏松危险性的遗传标志。     

安徽省育龄妇女多囊卵巢综合征患病状况流行病学研究

目的了解安徽省育龄妇女多囊卵巢综合征（PCOS）的患病状况、临床特点及危险因素。方法以2003年鹿特丹PCOS诊断标准,按照临床流行病学多阶段分层随机抽样方法,抽取1,024名育龄妇女进行调查。结果安徽省育龄妇女PCOS群体患病率为5．4％;检出的PCOS患者中月经稀发、高雄激素血症和卵巢多囊样改变（PCO）分别占90．9％、63．6％、72．7％,月经稀发为最主要临床表现;PCOS人群月经不规则、多毛、痤疮、皮肤油腻／溢脂、PCO、不育症的发生率显著高于非PCOS人群（P≤0．01）,PCOS组的血清睾酮、雄烯二酮和游离睾酮指数均显著高于非PCOS组（P〈O．05）;不同特征育龄妇女PCOS发病率比较,初潮后建立规则月经周期时间延长、母亲不育与育龄妇女PCOS相关性有显著统计学意义（P〈0．05）。结论安徽省育龄妇女PCOS的群体患病率为5．4％;PCOS妇女不育症的发生率为10．9％;月经稀发可作为PCOS的首先筛选指标,初潮后建立规则月经周期延长及母亲不育可能是PCOS的危险因素。     

上海市绝经后妇女冬季维生素D状况

目的调查上海市绝经后妇女在冬季(12月份)维生素D的状况。方法在社区101例年龄63.7±7.0岁健康绝经后妇女中,检测血清25羟维生素D[25(OH)D]、甲状旁腺激素(PTH),同时检测血钙、磷、碱性磷酸酶、肝肾功能及空腹血糖。所有研究对象均用双能X线吸收仪检测腰椎和股骨近端骨密度(BMD),同时用问卷调查生活方式。结果本研究101例绝经后女性血清25(OH)D平均值为17.09 ng/ml,PTH平均值51.0 pg/ml,维生素D缺乏者占(<20 ng/ml)68%,维生素D不足者(20～29 ng/ml)占了30%,只有2例维生素D充足(>30 ng/ml)占2%。PTH均值在维生素D缺乏组中(53.7 pg/ml)高于维生素D不足组(44.8 pg/ml),有统计学差异(P<0.05);但未发现血清25(OH)D与PTH有线性回归关系。同时未发现血清25(OH)D与血钙、BMD或BMI相关。结论上海市健康绝经后妇女在冬季维生素D普遍不足,维生素D缺乏组的PTH显著高于维生素D不足组,不良的生活方式及低维生素D和钙的摄入应引起重视。     

多囊卵巢综合征患者静息心率与糖脂代谢及血压等指标关系的研究

目的探讨多囊卵巢综合征(PCOS)患者静息心率与心血管疾病相关危险因素的关系。方法采用对照的研究方法,收集2011年8月至2012年6月,海军总医院生殖中心就诊育龄期妇女,年龄为25～35岁,选取PCOS患者(77例)为PCOS组,正常妇女(73例)为正常对照组,分别测定体重、血压、静息心率、血脂,并进行糖耐量及胰岛素释放试验。采用独立样本的t检验及偏相关分析评价PCOS患者静息心率与心血管疾病危险因素的关系。结果 (1)PCOS组静息心率为(82.09±7.86)/min,显著高于正常对照组(79.55±5.66)/min(P<0.05),PCOS组体重指数(BMI)、血压(收缩压和舒张压)、空腹及餐后血糖及胰岛素均高于正常对照组(P<0.05);(2)静息心率与BMI、收缩压、空腹胰岛素、餐后1h胰岛素、甘油三酯具有相关性(r分别为0.177、0.191、0.199、0.204、0.216,P均<0.05);(3)把两组再分成肥胖组与非肥胖组后比较,PCOS非肥胖组静息心率、收缩压、餐后1 h血糖、血脂等均高于正常肥胖组;(4)多因素线性回归分析显示:在控制BMI、舒张压、空腹血糖及空腹胰岛素等因素后,收缩压升高(β=0.237)及甘油三酯升高(β=0.222)是静息心率增快的显著危险因素。结论 PCOS患者静息心率的增快与收缩压及甘油三酯的升高有密切相关性,并随着收缩压及甘油三酯等心血管疾病相关风险因素的增加,PCOS患者的静息心率也随之增快。     

妊娠期母体维生素D对子代骨骼生长的影响

妊娠期母体维生素D水平及生物活性上调,同时钙吸收水平也较孕前增加.孕期母体维生素D缺乏会影响胎儿血钙浓度,从而影响胎儿骨骼骨化,影响胎儿骨密度和骨矿积累,甚至导致胎儿出生低体重风险增加.妊娠期母体维生素D水平对婴儿期、儿童期的体重增长和骨量及骨密度也有一定的影响.这种影响与母体维生素D受体基因多态性和子代维生素D受体基因及蛋白的表达有关.鉴于维生素D不足普遍存在,孕期妇女需补充维生素D,然而对维生素D的补充剂量目前尚未有统一意见.     

维生素D在妇科肿瘤患者中的表达变化

目的探讨维生素D在妇科肿瘤患者中的表达变化,研究其作用。方法检测62例妇科肿瘤患者（观察组）及62例常规体检的妇女（对照组）的空腹静脉血维生素D含量,并进行比较。结果观察组维生素D的平均水平为（20.54±10.16）ng/mL,明显低于对照组为（49.22±21.76）ng/mL（P〈0.05）。结论在妇科肿瘤患者中维生素D的表达下降,提示维生素D可能对妇科肿瘤的发生发挥一定的作用。     

现代社会维生素D缺乏及其预防

维生素D缺乏是目前社会所面临的严重健康问题。维生素D(VD)是人体不可缺少的一种脂溶性维生素,其主要作用是增加肠钙的吸收利用,对维持各年龄段骨骼健康矿化都起着非常重要的作用。维生素D缺乏在儿童导致佝偻病;在成年人会发生软骨病和骨质疏松。此外近年来发现维生素D缺乏还与肿瘤、糖尿病、心血管疾病等多种疾病的发生有关,使其重新引起了人们的关注。造成现代社会维生素D缺乏的原因是多方面的,主要是由于各种原因导致的阳光照射不足。血中的25(OH)D的水平可以作为了解人体内VD状况的指标,多数学者认为25(OH)D的水平低于30ng/mL为维生素D不足,现代社会维生素D缺乏发生率非常高,推测全球可能有10亿人口患有维生素D缺乏。合理补充维生素D对预防维生素D缺乏是非常重要的。     

Obesity,Bariatric Surgery,and Vitamin D

The high prevalence of obesity is a worldwide problem associated with multiple comorbidities, including cardiovascular diseases. Vitamin D deficiency with secondary hyperparathyroidism is common in obese individuals and can be aggravated after bariatric surgery. Moreover, there is no consensus on the optimal supplementation dose of vitamin D in postbariatric surgical patients. We present new data on the variability of 25(OH)D response to supplementation in postmenopausal obese women. It is important to recognize and treat vitamin D deficiency before bariatric surgery to avoid postoperative complications, such as metabolic bone disease with associated high fracture risk. The objective of this article is to discuss the bone metabolism consequences of vitamin D deficiency after bariatric surgery.     

Bone Health in Women With Polycystic Ovary Syndrome: A Narrative Review

Bone as an active connective and endocrine tissue is influenced by hormones, physical activity, inflammatory factors, minerals, dietary components, and body weight. Bone fractures are a major cause of decreased quality of life and mortality in humans. Polycystic ovary syndrome (PCOS), is one of the most common endocrine disorders in women of reproductive age worldwide. PCOS is associated with disturbances in androgen and estrogen levels, insulin resistance (IR), obesity, as well as low-grade chronic inflammation, and gut microbiota (GM) dysbiosis, all of which may negatively or positively affect bone metabolism. However, it has not yet been well clarified whether PCOS is bone-protective or bone-destructive. This study aimed to review the association between bone health and PCOS, and summarize its related factors. PubMed, Scopus, and Web of Science databases were searched to retrieve relevant English publications investigating the relationship between bone health and PCOS. Several disorders associated with PCOS can negatively or positively affect bone metabolism. Despite some positive effects of insulin, androgens, estrogens, and obesity on bone, IR, estrogen deficiency, low-grade chronic inflammation, and GM dysbiosis may adversely affect the bone metabolism in PCOS women. Studies comparing bone mineral density or bone metabolism and the risk of bone fractures in women with PCOS have controversial results. Further studies are required to understand the mechanisms underlying bone metabolism in PCOS subjects. Moreover, prospective studies are needed to estimate the risk of bone fractures and osteoporosis in PCOS subjects.     

Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women

Summary

The various factors that may contribute to vitamin D deficiency or insufficiency were examined among healthy Saudi pre- and postmenopausal women. Vitamin D deficiency was highly prevalent among studied Saudi women with obesity, poor sunlight exposure, poor dietary vitamin D supplementation and age as the main risk factors.

Introduction

The various factors that may contribute to vitamin D deficiency or insufficiency in relation to bone health among Saudi women are not known. The main objectives of the present study were to determine the factors influencing vitamin D status in relation to serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (PTH), bone turnover markers (BTMs), bone mineral density (BMD), and vitamin D receptor genotype (VDR) in healthy Saudi pre- and postmenopausal women.

Methods

A total number of 1,172 healthy Saudi women living in the Jeddah area were randomly selected and studied. Anthropometric parameters, socioeconomic status, sun exposure index together with serum levels of 25(OH)D, calcitriol, intact PTH, Ca, PO4, Mg, creatinine, albumin, and biochemical BTMs were measured. BMD was measured by a dual energy X-ray absorptiometry and VDR genotypes were also determined.

Results

About 80.0% of Saudi women studied exhibited vitamin D deficiency (serum 25(OH)D?<?50.0?nmol/L) with only 11.8% of all women were considered with adequate vitamin D status (serum 25(OH)D?>?75?nmol/L). Secondary hyperparathyroidism was evident in 18.5% and 24.6% in pre- and postmenopausal women with 25(OH)D?<?50?nmol/L. Serum 25(OH)D was lower (P?<?0.001) and intact PTH higher (P?<?0.001) in the upper quintiles of body mass index (BMI) and waist-to-hip ratio (WHR). Multiple linear regression analysis showed that BMI, sun exposure index, poor dietary vitamin D supplementation, WHR, and age were independent positive predictors of serum 25(OH)D values.

Conclusions

Vitamin D deficiency is highly prevalent among healthy Saudi pre-and postmenopausal women and largely attributed to obesity, poor exposure to sunlight, poor dietary vitamin D supplementation, and age.     

Vitamin D as a novel nontraditional risk factor for mortality in hemodialysis patients: the need for randomized trials

Vitamin D has been used in the context of secondary hyperparathyroidism in patients with end-stage renal disease. A wave of recent studies suggests that vitamin D treatment may be associated with decreased mortality risk in these patients. The article by Wolf et al. further supports these studies by identifying vitamin D deficiency as a risk factor for early mortality in incident hemodialysis patients.     

High prevalence of vitamin D deficiency in African American kidney transplant recipients

Kidney transplant patients are at high risk for developing Vitamin D(3) deficiency. The prevalence rates of 25(OH) Vitamin D(3) deficiency and its association with parathyroid hormone (PTH) levels in African American kidney transplant recipients have not been examined. We measured 25(OH) Vitamin D(3) and intact PTH concentrations in 38 African American transplant patients at our center in October 2006. We collected various laboratory data including serum creatinine, calcium, phosphate, alkaline phosphatase, and glomerular filtration rate. Vitamin D(3) deficiency was present in 57.8% of the patients and 94.7% had insufficiency. Ten of 22 (45%) patients with chronic kidney disease stage 3 had intact PTH more than or equal to 70 pg/mL. On multivariate analysis, 25(OH) Vitamin D(3) level was negatively correlated with intact PTH (P<0.01) and alkaline phosphatase level was positively associated with intact PTH levels (P<0.002). Vitamin D(3) deficiency and insufficiency is present in most of the African American kidney transplant patients.     

Current osteoporosis treatment: reasons for adding vitamin D to alendronate

Recently, many studies showed need to administer vitamin D in treatment of osteoporosis. Vitamin D deficiency was proved in postmenopausal women with osteoporosis. Effects of vitamin D resulted in lower risk of fractures and falls, as well as improvement of neuromuscular performances. In more than ten years of practice and several short- and long-term clinical studies alendronate lowered the risk of vertebral and extravertebral fractures, improved BMD of all measured sites in postmenopausal women and men with osteoporosis. Positive results of alendronate were demonstrated in different entities like persons of various ages and grades of lower BMD or patients with glucocorticoid-induced osteoporosis. Combination of vitamin D with efficacious antiresorptive drug alendronate maintains all pharmacological features and proves clinical effects of lx weekly alendronate, partly eliminating need for vitamin D supplementation.     

Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism

Summary

This study evaluated the parameters of bone mineral homeostasis including 25(OH)D and PTH in 90 Indian patients with hip fracture and 90 controls. Hypovitaminosis D, secondary hyperparathyroidism, and biochemical osteomalacia was present in 77, 69, and 50 % patients, respectively, significantly higher compared to controls. Vitamin D deficiency is an important risk factor for hip fracture.

Introduction

The prevalence of vitamin D deficiency is not well known in hip fracture patients from India. Therefore, the present study was conducted to evaluate the parameters of bone mineral homeostasis including 25(OH)D and intact PTH in hip fracture from North India.

Methods

Ninety consecutive patients with hip fracture and similar number of age- and sex-matched controls were enrolled in the study. The fasting venous samples were analyzed for 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. Vitamin D deficiency was defined as serum 25-OHD of <20 ng/dl.

Results

The mean age of hip fracture subjects was 65.9?±?12.6 which was comparable in men and women. Majority of study subjects were women (70 women and 20 men). The serum 25(OH)D and calcium levels were significantly lower, whereas the intact PTH and ALP levels were significantly higher in patients compared to controls. There was significant negative correlation between serum 25(OH)D and PTH. In the hip fracture group, 76.7 % of the subjects had vitamin D deficiency, and 68.9 % had secondary hyperparathyroidism. In the control group, vitamin D deficiency and elevated PTH levels were seen in 32.3 and 42.2 %, respectively.

Conclusion

About three fourths of hip fracture patients have vitamin D deficiency, and two thirds have secondary hyperparathyroidism. Therefore, the serum 25-OHD level may be a useful index for the assessment of risk of hip fracture in India.     

The role of vitamin D for bone health and fracture prevention

Vitamin D inadequacy is pandemic in adults. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures. Vitamin D deficiency can be prevented by sensible sun exposure and adequate supplementation. Monitoring serum 25-hydroxyvitamin D is the only way to determine vitamin D status. Recent recommendations suggest that in the absence of sun exposure, adults should ingest 1000 IU of vitamin D₃ per day. The ideal healthy blood level of 25-hydroxyvitamin D should be 30 to 60 ng/mL. Vitamin D intoxication occurs when 25-hydroxyvitamin D levels are greater than 150 ng/mL. Three recent reports suggesting that vitamin D and calcium supplementation does not decrease the risk of fracture will be put into perspective in light of the vast literature supporting increasing vitamin D and calcium intake as an effective method for decreasing risk of vertebral and nonvertebral fractures.     

不孕女性的维生素D营养状况对IUI临床妊娠率的影响

目的调查不孕女性体内维生素D的营养状况,以及探讨维生素D水平对宫腔内人工授精(IUI)临床妊娠率的影响。方法收集2014年10月到2015年10月在本中心行IUI助孕的288名不孕女性患者的血清,化学发光免疫分析法检测血清中25(OH)D水平。结果不孕女性维生素D严重缺乏[25(OH)D30nmol/L]比例为27.4%,缺乏[25(OH)D30~49.9nmol/L]比例为52.5%;体重超重与体重正常女性之间维生素D营养状况有显著性差异(P=0.007),超重女性维生素D充足[25(OH)D≥50nmol/L]比例仅为2.4%,明显低于正常女性(23.2%);不同季节维生素D营养状况有显著性差异(P=0.001),春季和冬季是维生素D严重缺乏的高发季节;调整混杂因素年龄和体重指数(BMI)后,Logistics回归模型分析显示血清25(OH)D水平50nmol/L的女性获得IUI临床妊娠的几率显著低于血清25(OH)D水平≥50nmol/L的女性(aOR=0.427,P=0.032)。结论不孕女性维生素D缺乏较为普遍,尤其是春季和冬季易发生维生素D严重缺乏,缺乏维生素D可能会对IUI临床妊娠产生负面影响,因此不孕女性需要注意维生素D的适量补充。