多囊卵巢综合征患者血清25-羟维生素D水平对代谢综合征的初筛价值

Preliminary Screening Value of 25-Hydroxyvitamin D Levels in Patients with Polycystic Ovary Syndrome for Metabolic Syndrome

摘要: 目的：分析多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者血清25-羟维生素D水平与代谢综合征(metabolic syndrome, MS)的相关性及对MS的初筛价值。方法：连续纳入2023年9月至2024年9月于重庆医科大学附属第二医院妇科就诊，符合入组标准的PCOS患者161例，按照血清25-羟维生素D水平分为严重缺乏组(n = 40)、缺乏组(n = 96)和不缺乏组(n = 25)，收集所有患者的临床资料，比较三组患者的腰围、血清甘油三酯及高密度脂蛋白胆固醇水平等MS相关指标。应用Logistic回归模型分析血清25-羟维生素D水平与MS的相关性。以漏诊率 < 10%确定血清25-羟维生素D在PCOS患者中筛查MS的截断值，并采用混淆矩阵评价其筛查效能。结果：血清25-羟维生素D严重缺乏组的MS患病率(75.0%)显著高于缺乏组(15.6%)和不缺乏组(0.0%)，差异有统计学意义(P = 0.000)。血清25-羟维生素D (OR = 0.006, 95% CI 0.001~0.045, P = 0.000)及血清黄体生成素(OR = 0.231, 95% CI 0.084~0.635, P = 0.004)是PCOS患者发生MS的保护因素，体质量指数(OR = 3.619, 95% CI 1.433~9.141, P = 0.007)是PCOS患者发生MS的危险因素。在PCOS患者中应用血清25-羟维生素D (<32.25 nmol/L)初筛MS的召回率为91.11%，准确率为73.91%。结论：低血清25-羟维生素D水平可能增加PCOS患者合并MS的风险，血清25-羟维生素D对MS具有良好的初筛价值。

Abstract: Objective: To analyze the correlation between serum 25-hydroxyvitamin D level and metabolic syndrome (MS) in patients with polycystic ovary syndrome (PCOS) and its screening value for MS. Methods: A total of 161 patients with PCOS who met the inclusion criteria and were admitted to the Second Affiliated Hospital of Chongqing Medical University from September 2023 to September 2024 were enrolled. According to the degree of serum 25-hydroxyvitamin D deficiency, they were divided into severe deficiency group (n = 40), deficiency group (n = 96) and non-deficiency group (n = 25). Clinical data of all patients were collected and waist circumference, triglyceride and high density lipoprotein cholesterol were compared among the three groups. Logistic regression model was established to analyze the correlation between serum 25-hydroxyvitamin D level and MS. A missed diagnosis rate of <10% was used to determine the cut-off value of serum 25-hydroxyvitamin D for MS screening in patients with PCOS. Confounding matrix evaluation of screening efficacy of serum 25-hydroxyvitamin D for PCOS with MS. Results: Prevalence of MS in severe serum 25-hydroxyvitamin D deficiency group (75.0%) significantly higher than the deficiency group (15.6%) and non-deficiency group (0.0%), statistically significant difference(P = 0.000); Serum 25-hydroxyvitamin D (OR = 0.006, 95% CI 0.001~0.045, P = 0.000) and serum luteinizing hormone (OR = 0.231, 95% CI 0.084~0.635, P = 0.004) was a protective factor for MS in PCOS patients, body mass index(OR = 3.619, 95% CI 1.433~9.141, P = 0.007) was a risk factor for MS in PCOS patients. The recall rate and accuracy rate of MS screening in PCOS patients using serum 25-hydroxyvitamin D cut-off value of 32.25 nmol/L were 91.11% and 73.91%, respectively. Conclusion: Low serum 25-hydroxyvitamin D levels may increase the risk of MS in PCOS patients, and serum 25-hydroxyvitamin D may be of some screening value for MS.