Correlation Between Serum 25-OH-D3 Level And Different Clinical Subtypes Of Polycystic Ovary Syndrome

Background:Polycystic ovary syndrome(PCOS)is a complex gynecological endocrine and metabolic disorder.Its worldwide incidence is about 6-16% of women of childbearing age,and it tends to increase year by year.The main manifestations are polycystic ovarian changes,menstrual cycle disorders,infertility,abnormal biochemical indicators of high androgen or clinical manifestations of high androgen,such as hypertrichosis,acne,hair loss,etc.Due to the high heterogeneity of PCOS,its pathophysiological changes and prognosis vary greatly.In China,the concept of classification diagnosis is proposed in the diagnostic criteria,and PCOS is classified according to the following criteria: whether there is abnormal glucose and lipid metabolism,whether there is obesity or centripetal obesity,whether there is hyperandrogenemia or the expression of androgen.Metabolic factors interact with polycystic ovary syndrome in recent years more and more attention,it is thought the occurrence of PCOS is the complex of the hypothalamus-pituitary-ovarian or hypothalamus-pituitary-adrenal axis and the interaction of metabolic diseases,such as obesity,insulin resistance,hyperinsulinemia,hyperlipidemia and other metabolic factors may affect the androgen to estrogen conversion process,produce or plays a role in the pathogenesis of PCOS,is the main cause of glucoseand lipid metabolism disorders and reproductive disorders.Disorders of glucose and lipid metabolism increase the risk of cardiovascular and cerebrovascular complications such as type 2 diabetes and atherosclerosis,as well as endometrial cancer.Due to the complexity of PCOS etiology and the diversity of clinical manifestations,there is no ideal prevention and treatment method at present.Numerous studies have shown that serum vitamin D levels are generally low in PCOS patients,and vitamin D receptors are expressed in female reproductive organs and tissues such as ovary,follicular epithelium,endometrium,placenta and demembration,etc.Vitamin D deficiency is correlated with the occurrence of female reproductive dysfunction,which has a negative impact on PCOS infertility patients.Vitamin D deficiency can also aggravate the metabolic disorder symptoms of polycystic ovary syndrome,which is related to PCOS ’abnormal glucose and lipid metabolism,obesity,ovulation disorder,reduced pregnancy success rate,and increased risk of cardiovascular and cerebrovascular diseases.Vitamin D supplementation has some beneficial effects on menstrual changes and insulin resistance in women with PCOS,but the clinical evidence is limited.Objective:To study the correlation between serum vitamin D level of PCOS patients and other indicators such as insulin resistance(IR)status,obesity and high androgen,and to further explore the significance of vitamin D in PCOS of different clinical subtypes,and to expand new thinking for the diagnosis and treatment of PCOS.Methods: Choose 2018.05-2018.09 seeing in the department of obstetrics and gynecology of our hospital 82 cases of PCOS patients as the research object,measuring height,body mass,and since morning fasting blood samples,measured the serum level of 25-OH-D3,follicle-stimulating hormone(FSH),testosterone(T),luteinizing hormone(LH),estradiol(E2),prolactin(PRL),thyroid-stimulating hormone(TSH),fasting blood glucose(FGP),fasting insulin(FINS).SPSS 24.0 was used for analysis and processing of all the data finally obtained.The measurement data were represented by mean standard deviation(?x±s).Single sample t test was used to detect whether there were significant differences between 25-OH-D3,HOMA-IR,T,LH/FSH and the overall average level of the subjects.Pearson correlation coefficient was used to analyze the correlation between25-OH-D3 and BMI,HOMA-IR,T and other biochemical indexes.Multiple linear regression was used to analyze the quantitative relationship between multiple factors and 25-OH-D3 in PCOS patients.The rank-sum test was used to further compare the 25-OH-D3 levels of the normal BMI group and the obese group.P<0.05 was considered statistically significant,while P<0.01 was considered statistically significant.Results:1.Serum levels of 25-OH-D3 in PCOS patients were lower than normal,while HOMA-IR,T,LH/FSH were all higher than normal,P<0.05 was statistically significant.2.The serum 25-OH-D3 of PCOS patients has a negative correlation with HOMA-IR,T,FINS and has no correlation with other indexes.3.In the linear regression analysis,the "collinear diagnosis" was used to screen the factors with collinear in the PCOS group.Finally,25-OH-D3 was used as the dependent variable,and BMI,HOMA-IR,LH/FSH,T,E2,PRL and TSH were used as independent variables for the multiple linear regression analysis.The results showed that the change of serum 25-OH-D3 level had a linear regression relationship with T and presented a negative correlation(P=0.044).It can be seen from the standardized regression coefficient that T had the greatest influence on the level of 25-OH-D3.4.Among the 82 samples in this study,33 were in the normal BMI group(18.5≤BMI<24kg/m2)and 18 were in the obese BMI group(BMI≥28kg/m2).The rank-sum test showed no significant difference in 25-OH-D3 levels between the two groups.Conclusions:1.Vitamin D deficiency is common in PCOS patients.2.Insulin resistance and hyperandrogen expression in PCOS patients may be related to the insufficient content of vitamin D in serum,that is,vitamin D deficiency is more obvious in PCOS patients with abnormal metabolism and androgen elevated subtype,suggesting that vitamin D deficiency may affect the hyperandrogenemia and glucose metabolism disorders in PCOS patients.3.Serum vitamin D level may be an auxiliary indicator to assess the severity of PCOS.4.Exogenously added vitamin D may be able to prevent the occurrence of polycystic ovary syndrome and play an important role in improving and delaying the metabolic disorder and hyperandrogenemia associated with PCOS.