维生素D与男性不育关系的研究进展

维生素D(vitamin D,VD)作为一类常见的营养元素,不仅在调节钙稳态和骨骼健康方面具有明确的作用,近年来有研究表明其与男性生殖可能存在密切关系。本文通过阐述VD的代谢、VD与男性性激素、精子质量以及妊娠结局的关系,以进一步说明VD对男性生育力的重要影响。了解VD对男性生殖的影响及其机制可为临床诊疗提供新的思路和方法。     

维生素D与女性生殖疾病的关系

维生素D调节钙和磷吸收,促进骨骼的生长和重构。越来越多的研究证实,维生素D在高血压、肿瘤、自身免疫性疾病、2型糖尿病等疾病的发生和发展中起重要作用。研究发现,维生素D受体(VDR)广泛分布于卵巢、子宫、输卵管、宫颈、乳腺、睾丸、精子等生殖器官、组织与细胞中。关于维生素D的活性代谢产物的生理作用已进行了广泛研究,但其在人类生殖中的报道较少。现本文就维生素D缺乏对女性生殖系统功能的影响做一综述。     

生殖健康与男性保健

1　男性的生物学特征和性别角色　　男性的生物学特征 :在生殖生动中 ,男性的作用是原发的 ,女性的作用是继发的。男性的生殖活动没有类似女性的周期性 ,一旦发育成熟 ,就持续不断地产生精子 ,成年男子每天约可产生 1 6× 10 8个精子。男性生殖功能的衰退是一个渐进性漫长的退行演变过程 ,个体差异很大。年龄对精子数量和精子受精能力没有明显影响。男子一生中需要生育干预的时间几乎是女性的两倍。男性的性行为是一种主动行为 ,具有攻击性 ,同时也容易受各种因素的干扰而发生障碍。　　男性的性别角色 :几乎在每一个社会单位都有性别的角色…     

子宫肌瘤与维生素D关系的研究进展

子宫肌瘤是妇科常见的良性肿瘤,严重影响女性的生活质量。目前临床治疗子宫肌瘤的思路是根据个体差异制定不同的保守治疗方案或手术治疗方案,但这些治疗方案都存在弊端。多年来,医学界一直在寻找更佳的治疗子宫肌瘤的方案,维生素D与子宫肌瘤之间的关系也因此被发现。作为一种类固醇类化合物,维生素D在人体各器官组织中起到重要作用。已证实的与维生素D有关的妇产科疾病包括不孕症、多囊卵巢综合征和早产等。近十年的研究证实,人体内维生素D水平降低是子宫肌瘤发生、发展的危险因素之一,目前也有研究发现补充维生素D及其类似物可以起到治疗子宫肌瘤的作用。     

青岛地区男性肿瘤患者生殖损伤保护意识现状调查及分析

目的 调查并分析青岛地区医患双方对男性肿瘤患者生殖损伤保护意识.方法 随机对肿瘤科、血液科医生及15～40岁男性肿瘤患者进行关于生殖保护的问卷调查;对在本院行精子冷冻保存的患者的资料进行分析.结果 医生关于生殖损伤的告知率较高,患者对生殖保护具体方法的认知度偏低;冻存者主要为恶性肿瘤及血液病患者,精液总利用率偏低.结论 生殖损伤保护应用的人群及方法较少,医患双方对其临床应用有待进一步提高.     

成年男性血清生殖激素水平与精液量以及精子密度的关系

目的:探索普通成年男性血清生殖激素水平与精液量以及精子密度的关系。方法:资料来源于对5个研究现场(河北省石家庄市、山西省太原市、贵州省贵阳市、浙江省杭州市及山东省青岛市)的普通成年男性的横断面调查。同时收集研究对象的血样和精液样本,分析黄体生成素(LH)、卵泡刺激素(FSH)、睾酮(T)以及雌二醇(E2)与精液量、精子密度之间的关系。结果:共招收研究对象978名,通过相关分析及方差分析表明,高水平T对象的精子密度较低;高水平E2对象精液量较少。Logistic回归分析发现,高水平T发生低精子密度的危险性大,低水平的LH发生低精子密度的危险性小。结论:普通成年男性血清中生殖激素水平与精液数量指标有关,但表现出的某些关联性用已知的下丘脑-垂体-睾丸轴调节机制尚无法完全解释。     

儿童维生素D缺乏症的研究进展

近年来,随着医疗卫生水平的发展,维生素D缺乏(VDD)在儿童生长发育过程中越来越受到重视,且发病率较高。维生素D主要来源于皮肤暴露在阳光下转化的维生素D₃,VDD主要表现为佝偻病、手足搐搦症,目前VDD的诊断标准仍存在争议,治疗方案一般分为每日和每周治疗方案,VDD的预防也很重要。本文从流行病学、代谢机制与病因、临床表现、诊断、治疗、预防六个方面就儿童VDD的研究进展作一综述,为儿童VDD提供一定的临床参考。     

维生素D骨骼外研究进展

维生素D（vitamin D）是大家熟知的脂溶性维生素,维生素D对人类健康特别是儿童健康具有重要意义。维生素D缺乏性佝偻病是由于缺乏维生素D引起体内钙磷代谢异常,钙盐不能正常沉着在骨骼生长部分,骨骼钙化不良而致骨骼病变,多见于婴幼儿,影响小儿生长发育,是我国儿科重点防治的四病之一。临床发现维生素D缺乏性佝偻病除导致骨骼病变外,同时也可影响神经、肌肉、造血及免疫等组织器官的功能,此引起了人们对维生素D生理作用及临床意义的极大兴趣,近年来对维生素D的研究取得了重大进展［     

维生素D及其受体与妇科肿瘤

化疗是治疗妇科肿瘤的主要手段之一.但是,目前临床所应用的化疗药物存在较严重的毒性,限制了其在临床上的应用.近年研究发现维生素D(VD)和维生素D受体(VDR)除了已熟知的维持血清钙离子平衡和骨结构的生理功能外,还与肿瘤有密切关系.体内外试验证明VD有抑制肿瘤细胞增殖和诱导分化的作用.VD和VDR与妇科肿瘤关系的研究.     

生殖健康与围生期保健中的男性参与

生殖健康与围生期保健中的男性参与是 2 1世纪面临的富有挑战性的焦点问题。在著名的 1994年埃及开罗国际人口与发展大会 (ＩＣＰＤ)的行动纲领中曾首次提出“应促进男子参与生殖健康和分担责任” ,同时强调指出“妇女和男子需要在生产和生育方面充分地参与和建立真正的伙伴关系 ,包括照料和扶养子女及家庭的稳定[1] 。”男性参与和分担责任是一个极其重要的问题 ,它不仅关系到人口与发展 ,也关系到生殖健康与妇女地位。同时 ,男性参与的现实意义还在于改进男女之间在性和生殖健康方面的沟通 ,增进对共同责任的理解 ,使男子和妇女在公共和私…     

Iron and copper in male reproduction: a double-edged sword

Iron and copper are essential trace nutrients playing important roles in general health and fertility. However, both elements are highly toxic when accumulating in large quantities. Their direct or indirect impact on the structure and function of male gonads and gametes is not completely understood yet. Excess or deficiency of either element may lead to defective spermatogenesis, reduced libido, and oxidative damage to the testicular tissue and spermatozoa, ultimately leading to fertility impairment. This review will detail the complex information currently available on the dual roles iron and copper play in male reproduction.     

维生素D与多囊卵巢综合征相关性的初步研究

目的:研究多囊卵巢综合征(PCOS)患者血清维生素D的浓度与内分泌紊乱的相互关系。方法:收集55例初诊PCOS患者(PCOS组)和20例健康育龄期妇女(对照组),计算体重指数(BMI),测定血清睾酮(T)、雌二醇(E2)、LH、FSH及血清25-(OH)D3浓度,并行OGTT和胰岛素释放试验,计算QUICKI指数。结果:PCOS组25-(OH)D3浓度显著低于对照组(P0.01)。将PCOS组患者分为肥胖、超重及正常体重者分析,发现肥胖和超重者25-(OH)D3浓度显著低于正常体重者。PCOS组中,25-(OH)D3浓度与BMI、T、LH/FSH呈显著负相关(r=-0.446、-0.390、-0.411,P0.01),与QUICKI值呈正相关(r=0.423,P0.01)。结论:维生素D缺乏与PCOS内分泌紊乱密切相关。     

The effect of vitamin D3 on improving lipid profile,fasting glucose and insulin resistance in polycystic ovary syndrome women with vitamin D deficiency

Introduction

Metabolic disturbances are common in women with PCOS. Some studies have suggested that vitamin D deficiency may play a role in metabolic disorders and insulin resistance, although limited clinical trials on this subject have been published with contradictory findings. Therefore, the aim of this study was to investigate the effects of vitamin D on metabolic disorders in women with PCOS and vitamin D deficiency.

1型糖尿病患儿血清维生素A和维生素D水平及其临床意义

目的分析1型糖尿病(T1DM)患儿血清维生素A和维生素D水平变化及其临床意义。方法 2012年2月至2015年1月南阳市中心医院儿科收治住院的T1DM患儿45例,为T1DM组,其中27例合并酮症酸中毒(DKA)。同期选取本院健康体检儿童38例,为对照组。采用酶联免疫吸附法测定血清维生素A和维生素D水平。结果 T1DM患儿血清维生素A和维生素D水平均低于对照组,差异有统计学意义(P0.05)。单纯T1DM患儿血清维生素A和维生素D与T1DM合并DKA患儿比较差异均无统计学意义(P0.05)。结论及时、足量补充维生素A和维生素D可能降低或延迟儿童T1DM发病。     

Association of vitamin D level and vitamin D deficiency with risk of preeclampsia: A systematic review and updated meta-analysis

Objectives

Because of the immune modulatory effects of vitamin D3 in preeclampsia, we intend to have a systematic review and meta-analysis on association of both 25-hydroxy vitamin D (25-OHD) level (parametric approach) and 25-OHD deficiency (non-parametric approach) with preeclampsia. As well, for the parametric part, we used receiver operating characteristic (ROC) curve model.

Placental genetic variations in vitamin D metabolism and birthweight

IntroductionVitamin D has pleiotropic functions that regulate fetal growth and development. We investigated associations of common placental genetic variations in vitamin D metabolism with birthweight.MethodsThe study was conducted among participants (506 maternal-infant pairs) of a pregnancy cohort study. Data were collected using interviewer-administered questionnaires and post-delivery medical record abstraction. DNA, extracted from placental samples collected at delivery, was genotyped for eight single nucleotide polymorphisms (SNPs) in five vitamin D metabolism genes (CUBN, LRP2, VDR, GC, and CYP2R1). Linear and logistic regression models were used to evaluate associations of SNPs with birthweight and risk of low birthweight, respectively. Effect modification of associations by infant sex was examined using stratified analyses and interaction terms in regression models.ResultsMean (standard-deviation) birthweight among all, male, and female infants was 3482.1 (549.9), 3544.6 (579.0) and 3419.2 (512.5) grams, respectively. Each copy of the minor allele of rs2282679 (GC) was associated with a 68.6 g (95%CI:3.1134.7 g) increase in birthweight overall. Sex-specific associations were observed for SNP rs4667591 (LRP2) (p-value for interaction < 0.001). Each copy of the minor allele of rs4667591 was associated with a 124.7 g (95%CI:20.1229.0 g) increase in birthweight among female infants, and a suggested 81.6 g decrease in birthweight among male infants (95%CI:−183.7,20.5 g).DiscussionOur study identified overall and sex-specific associations between placental genetic variations in vitamin D metabolism and birthweight. If confirmed by larger replication studies, observed associations may provide insight into mechanistic underpinnings of the relationships between placental vitamin D metabolism and birth size.     

Dysregulation of maternal and placental vitamin D metabolism in preeclampsia

IntroductionEpidemiology has linked preeclampsia (PET) to decreased maternal serum 25-hydroxyvitamin D3 (25(OH)D3). However, alterations in systemic and placental/decidual transport and metabolism of 25(OH)D3 during pregnancy suggest that other forms of vitamin D may also contribute to the pathophysiology of PET.MethodsIn a cross sectional analysis of normal pregnant women at 1st (n = 25) and 3rd trimester (n = 21), pregnant women with PET (n = 22), and non-pregnant female controls (n = 20) vitamin D metabolites were quantified in paired maternal serum, placental, and decidual tissue.ResultsSerum 25(OH)D3 was not significantly different in sera across all four groups. In normal 3rd trimester pregnant women serum active 1,25-dihydroxyvitamin D3 (1,25(OH)₂D3) was significantly higher than non-pregnant, normal 1st trimester pregnant, and PET women. Conversely, PET sera showed highest levels of the catabolites 3-epi-25(OH)D3 and 24,25-dihydroxyvitamin D3 (24,25(OH)₂D3). Serum albumin was significantly lower in normal 3rd trimester pregnant women and PET relative to normal 1st trimester pregnant women, but there was no change in free/bioavailable 25(OH)D3. In PET placental tissue, 25(OH)D3 and 3-epi-25(OH)D3 were lower than normal 3rd trimester tissue, whilst placental 24,25(OH)₂D3 was highest in PET. Tissue 1,25(OH)₂D3 was detectable in 1st trimester decidua, which also showed 10-fold higher 25(OH)D3 relative to paired placentae. 3-epi-25(OH)D3 and 24,25(OH)₂D3 were not different for decidua and placenta. In normal 3rd trimester pregnant women, total, free and bioavailable maternal 25(OH)D3 correlated with placental 25(OH)D3, but this was not conserved for PET.DiscussionThese data indicate that PET is associated with decreased activation, increased catabolism, and impaired placental uptake of 25(OH)D3.     

北京城区健康育龄妇女血清25-羟维生素D水平及胰岛素抵抗的关系

目的了解北京城区正常育龄妇女25-羟维生素D[25-hydroxyvitamin D,25（OH）D]水平及胰岛素抵抗状态,并分析两者的关系。方法于2010年12月1—20日北京妇产医院招募北京市城区23～30岁健康未育妇女170例,采用酶联免疫吸附试验测定其空腹血25（OH）D及甲状旁腺素（parathyroid hormone,PTH）、糖代谢相关指标（空腹血糖、胰岛素和糖化血红蛋白）及血清钙、磷、碱性磷酸酶及血酯水平。结果①170例妇女平均25（OH）D水平为（27.28±6.64）nmol/L,其中25（OH）D缺乏和不足者169例（99.4%）,25（OH）D适宜者1例（0.6%）。②25（OH）D缺乏组PTH[（178.27±78.65）ng/L]与25（OH）D不足组[（172.89±78.52）ng/L]比较,差异无统计学意义（P〉0.05）,但两组PTH均高于正常水平;血清25（OH）D与PTH无线性关系（r=-0.061,P〉0.05）。③血清25（OH）D与血钙、磷、碱性磷酸酶、甘油三酯、总胆固醇、空腹血糖、糖化血红蛋白、体质指数、胰岛素及胰岛素抵抗指数无相关性（P〉0.05）。④170例未育妇女存在胰岛素抵抗者30例（17.6%）,其25（OH）D水平[（24.22±5.44）nmol/L]与无胰岛素抵抗组[（27.93±6.71）nmol/L]比较,差异有统计学意义（P〈0.01）。结论北京城区冬季健康育龄妇女普遍存在维生素D缺乏;其低维生素D水平可能与胰岛素抵抗增加有关,并可能成为妊娠期糖尿病的危险因素。