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Акушерство и Гинекология Санкт-Петербурга

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Синдром поликистозных яичников и дефицит витамина D

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Аннотация

XXI век стал веком экологического и, соответственно, репродуктивного нездоровья, поскольку любые неблагополучные факторы внешней среды негативно влияют на гормональный гомеостаз. Увеличение количества бесплодных пар и возрастающая потребность в ВРТ - реалии современного мира, причем эффективность ЭКО не возросла. В структуре причин бесплодия пальму первенства сейчас-держат эндокринные, и при этом в структуре причин женского бесплодия порядка 20-40 % отводится бесплодию, связанному с отсутствием овуляции. Причиной 75 % всех ановуляторныхнарушений является синдром поликистозных яичников (СПКЯ). Вместе с тем патогенез ановуляции и методы ее эффективного преодоления при СПКЯ по-прежнему до конца не изучены, что вызывает многочисленные версии и контраверсии в терапии данного заболевания,отраженные в данном литературном обзоре.

Согласно заключениям современных исследований, СПКЯ очень часто сочетается с дефицитом витамина D (у 67-85% женщин с СПКЯ отмечается разной степени выраженности дефицит витамина D) [1]. В данной статье рассмотрены как вопросы патогенеза СПКЯ, так и связи низкого уровня витамина D при СПКЯ с нарушением репродуктивной функции, проведен обзор мировых исследований по определению эффективности терапии СПКЯ с помощью витамина D, целесообразности его включения в алгоритм лечения ановуляторно-го бесплодия, что позволит расширить представление о патогенезе развития ановуляции при СПКЯ, повысить эффективность преодоления бесплодия, связанного с ановуляцией при СПКЯ.

Об авторах

А. Т. Сафи
Российский университет дружбы народов
Россия

Сафи Айгуль Тахтаровна - аспирант кафедры акушерства и гинекологии перинатологии РУДН; врач акушер-гинеколог отдела гинекологии РДЦ КФ «UMC».

Ул. Миклухо-Маклая, д. 6, Москва, 117198; ул. Сыганак, 2, Астана, Казахстан



М. Р. Оразов
Российский университет дружбы народов
Россия

Оразов Мекан Рахимбердыевич - доктор медицинских наук, профессор кафедры акушерства и гинекологии с курсом перинатологии.

Ул. Миклухо-Маклая, д. 6, Москва, 117198



С. Ю. Калинченко
Российский университет дружбы народов
Россия

Калинченко Светлана Юрьевна – доктор медицинских наук,профессор кафедры эндокринологии.

ул. Миклухо-Маклая, д. 6, Москва, 117198



Список литературы

1. MerhiZ., DoswellA., Krebs К, Cipolla M. Vitamin D alters genesinvolved in follicular development and steroidogenesis in humancumulusgranulosa cells. J ClinEndocrinolMetab. 2014; 99(6):E1137-E1145.

2. Wanderley M.D.S., Pereira L.C.R., Santos C.B., Cunha V.S.D., Neves M.V.J. Association between insulinresistance and cardiovascular risk factors in Polycystic Ovary Syndrome patients.Rev Bras Ginecol Obstet. 2018; 40(4):188-195.

3. Leiviska J., Sundvall J., JauhiainenM., Laatikainen T. Apolipoprotein A-I and B in laboratory diagnostics of dyslipidemia- what benefits do we gain compared with cholesterol measurements? Duodecim. 2014; 130(22-23):2331 -2337.

4. Ng D.S. Diabetic dyslipidemia: from evolving pathophysiologicalinsight to emerging therapeutic targets .Can. J.Diabetes. 2013; 37(5):319-326.

5. Escobar-Morreale H.F. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment.Nat Rev Endocrinol. 2018;14(5):270-284.

6. . VinkJ.M., Sadrzadeh S., Lambalk C.B., Boomsma D.I. Heritability of polycystic ovary syndrome in a Dutch twinfamilystudy. J. Clin. Endocrinol. Metab. 2006; 91(6):2100-2104.

7. Barker DJ. The fetal and infant origins of adult disease. BrMed J 1990;301:1111.

8. AbbottD.H., Dumesic D.A., FranksS. Developmental origin of polycystic ovary syndrome—a hypothesis. J Endocrinol 2002;174:1 -5.

9. Joseph S. et al. PCOSKB: A KnowledgeBase on genes, diseases, ontology terms and biochemical pathways associated with PolyCystic Ovary Syndrome. Nucleic. Acids. Res. 2015; 44 (D1 ):d1032-d1035.

10. Tu X., Yu C., Gao M., Zhang Y., Zhang Z. et al. LEPR gene polymorphism and plasma soluble leptin receptor levels are associated with polycystic ovary syndrome in Han Chinese women.Per Med. 2017; 14(4):299-307.

11. Ebrahimi S.O., Reiisi S., Parchami Barjui S. Increased risk of polycystic ovary syndrome (PCOS) associated with CC genotype of miR-146agene variation. GynecolEndocrinol. 2018; 11:1 -5.

12. Paltoglou G., Tavernarakis G., Christopoulos P., VlassiM., GazouliM., Deligeoro-glou E. et al. PON1-108 TT and PON1-192 RR genotypes are more frequently encountered in Greek PCOS than non-PCOS women, and are associated with hyperandrogenaemia.ClinEndocrinol (Oxf). 2013; 79(2):259-266.

13. Kaur R., Kaur T., Kaur A.Genetic association study from North India to analyze association of CYP19A1 and CYP17A1 with polycystic ovary syndrome. J Assist Reprod Genet. 2018; 22. doi: 10.1007/s10815-018-1162-0.

14. Nestler J. et al. Role of obesity and insulin in development of anovulation. In Ovulation induction/ Ed by Filicori and C. Flamigni. Elsevier Science B, 1994.

15. Калинченко С.Ю. Транссексуализм. 2006.

16. Chan K.J., Liang J.J., Jolly D, Weinand J.D.., Safer J.D. Exogenus testosterone does not induce or exacerbate the metabolicfeatures associated with pcos among transgender men.Endocrpract. 2018; 6. doi: 10.4158/EP-2017-0247.

17. ThathapudiS., Kodati V., Erukkambattu J., Addepally U., QurratulainH. Association of luteinizing hormone chorionic gonadotropin receptor gene polymorphism (rs2293275) with polycystic ovarian syndrome.Genet Test Mol Biomarkers. 2015;19(3):128-132.

18. Huang C.C., Tien Y.J., Chen M.J., Chen C.H., Ho H.N., Yang Y.S. Symptom patterns and phenotypic subgrouping of women with polycystic ovary syndrome: association between endocrine characteristics and metabolic aberrations. Hum Reprod. 2015;30(4):937-946.

19. Pepinsky R.B., Sincalir L.K., Chow E.P., Mattaliano R.J., ManganaroT.F., Donahoe P.K. et al. Proteolytic processing of Mullerianinhibitingsubstance produces a transforming growth factor beta like fragment.JBiolChem 1988; 263:18961-18964.

20. Durlinger A.L., Gruijters M.J., Kramer P., Karels B., Ingraham H.A., Nachtigal M.W. et al. Anti-Mullerian hormone inhibits initiation of primordial follicle growth in the mouse ovary. Endocrinology 2002;143:1076.

21. Andersen C.Y., Byskov A.G. Estradiol and regulation of anti-Mullerian hormone, inhibin-A, and inhibin-B secretion: analysis of small antral and preovulatory human follicles' fluid. J ClinEndocrinolMetab 2006; 91:4064.

22. Fanchin R., Schonauer L.M., Righini C., Guibourdenche J., Frydman R., Taieb J. Serum anti-Mullerian hormone is more strongly related to ovarianfollicu-lar status than serum inhibin B, estradiol, FSH and LH on day 3. HumReprod 2003; 18:323-327.

23. Muttukrishna S., McGarrigle H., Wakim R., Khadum I., Ranieri D.M., Serhal P. Antral follicle count, anti-Mullerian hormone and inhibin B: predictorsofo-varian response in assisted reproductive technology? Br J ObstetGynaecol. 2005; 112:1384-1390.

24. Van Rooij I.A., Baroekmans F.J., Scheffer G.J., Looman C.W., Habbema J.D., De Jong F.H. et al. Serumanti-Mullerian hormone levels best reflect the reproductive decline withage in normal women with proven fertility: a longitudinal study. FertilSteril. 2005; 83:979.

25. Pierre A., Peigne M., Gynberg M., Arouche N., Taieb J., Hesters L. et al. Fanchin loss of LH-induced down-regulation ofanti-Mullerian hormone receptor expression may contribute toanovulation in women with polycystic ovarian syndrome. Hum Reprod. 2013; 28:762-769.

26. Carlsen S., VankyE., Fleming R. Anti-Mullerian hormone concentrations inan-drogen-supressed women with polycystic ovary syndrome. HumReprod. 2009; 24:1732-1738.

27. Homburg R., Ray A., Bhide P., Gudi A., Shah A., Timms P., Grayson K. Therelation-ship of serum anti-Mullerian hormone with polycystic ovarianmorphology and polycystic ovary syndrome: a prospective cohort study.Hum Reprod. 2013; 28:1077-1080.

28. Pellatt L., Hanna L., Brincat M., Galea R., Brain H., Whitehead S. et al. Granulosa cell production of anti-MuЁllerian hormone is increased inpolycystic ovaries. J ClinEndocrinolMetab. 2007; 92:240-245.

29. Pellatt L., Rice S., Mason H.D. Anti-MuЁllerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction 2010; 139:825-833.

30. PellattL., RiceS., DilaverN., HeshriA., Galea R., BrincatM. et al. Anti-MuЁllerian hormone reduces folliclesensitivity to follicle-stimulating hormone human granulosa cells. FertilSteril. 2011; 96:1246-1251.

31. Di Clemente N., Goxe B., Remmy J., Cate R., Josso N., Vigier B., Salesse R. Inhibitory effect of MAH upon the expression of aromatase and LHreceptors by cultured granulose cells of rat and porcine immatureovaries. Endocrine. 1994; 2:553-558.

32. Laven J.S., Mulders A.G., Visser J.A., Themmen A.P., De Jong F.H., Fauser B.C. Anti-MuЁllerian hormone serum concentrations in normo-ovulatory andanovula-tory women of reproductive age. J ClinEndocrinolMetab. 2004; 89:318-323.

33. Pigny P., Merlen E., Robert Y., Cortet-Rudelli C., Decanter C., Jonard S. et al. Elevated serum level of anti-MuЁllerian hormone in patientswith polycystic ovary syndrome: relationship to the ovarian follicleexcess and to the follicular arrest. J ClinEndocrinolMetab. 2003; 88:5957-5962.

34. Piouka A. Famakiotis D. Ka tsikis I. Macut D. Gerou S. Panidis D. Anti-Mu Ё llerian hormone levels reflect severity of PCOS but arenegatively influenced by obesity: relationship with increased luteinizing hormone levels. Am J PhysiolEn-docrinolMetab. 2009; 296:E238-E243.

35. Elting M.W, Kwee J, Korsen TJ, Rekers-Mombarg L.T, Schoemaker J. Agingwomen with polycystic ovary syndrome who achieve regular menstrualcycles have a smaller follicle cohort than those who continue to haveirregular cycles. FertilSteril. 2003; 79:1154-1160.

36. Moran L.J., Noakes M., Clifton P.M., Norman R.J. The use of anti-Mullerianhor-mone in predicting menstrual response after weight loss inoverweight women with polycystic ovary syndrome. J ClinEndocrinolMetab. 2007; 92:3796-3802.

37. Amer S.A., Li T.C., Ledger W.L.The value of measuring anti-Mullerianhormo-nein women with anovulatory polycystic ovary syndrome undergoinglap-aroscopic ovarian diathermy. Hum Reprod. 2009; 24:2760-2766.

38. HolickM.F. Vitamin D deficiency. New Eng J Med. 2007; 357:266-281.

39. Kinuta K., Tanaka H., Moriwake T., Aya K., Kato S., Seino Y. Vitamin D is an important factor in estrogen biosynthesis of both female and male gonads. Endocrinol. 2000; 141:1317-1324.

40. Castro L.C. The vitamin D endocrine system. Arq Bras EndocrinolMetabol. 2011; 55(8):566-575.

41. Jones G., StrugnellS.A., DeLuca H.F. Current understanding of themolecular actions of vitamin D. Physiological Reviews.1998; 78:1193-1231.

42. Jenster G., Spencer T.E., Burcin M.M., Tsai S.Y., Tsai M.J. et al. Steroid receptor induction of gene transcription: a two-stepmodel. PNAS. 1997; 94:7879-7884.

43. Bouillon R., Carmeliet G., Verlinden L., van Etten E., Verstuyf A., Luderer H.F. et al. Vitamin D and humanhealth: lessons from vitamin D receptor null mice. EndocrineReviews. 2008; 29:720-726.

44. AutierP., BoniolM., PizotC.,MullieP. Vitamin D status and ill health:a systematic review. Lancet Diabetes Endocrinol. 2014; 2:76-89.

45. Buggio L., Roncella E., Somigliana E., Vercellini P. Vitamin D andbenigngynae-cological diseases: A critical analysis of the currentevidence. GynecolEndo-crinol. 2015; 16:1-5.

46. Lerchbaum E., Rabe T. Vitamin D and female fertility. CurrOpinObstet Gynecol. 2014; 26(3):145-150.

47. Lerchbaum E., Obermayer-Pietsch B. Vitamin D and fertility: a systematic review. Eur J Endocrinol. 2012; 166(5):765-778.

48. Aquila S., Guido C., Middea E., et al. Human male gamete endocrinology:1 alpha, 25-dihydroxyvitamin D3 (1,25(OH)2D3) regulatesdifferent aspects of human sperm biology and metabolism. ReprodBiolEndocrinol. 2009; 7:140.

49. Anagnostis P., KarrasS., GoulisD.G. Vitamin D in human reproduction:a narrative review. Int J ClinPract. 2013; 67(3):225-235.

50. Mathieu C., Gysemans C. Vitamin D and diabetes. Av Diabetol. 2006; 22(3): 187-193.

51. Maestro B., Campion J., Davila N., Calle C. Stimulation by 1,25-dihydroxyvita-min D3 of insulin receptor expression and insulin responsivenessfor glucose transport in U-937 human promonocytic cells. Endocr J. 2000; 47(4):383-391.

52. Pittas A.G., Lau J., Hu F.B, Dawson-Hughes B. The role of vitaminD and calcium in type 2 diabetes. A systematic review and metaanalysis. JClinEndocrinol-Metab. 2007; 92:2017-2029.

53. Nimptsch K., Platz E.A., Willett W.C., Giovannucci E. Associationbetween plasma 25-OH vitamin D and testosterone levels in men.ClinEndocrinol (Oxf). 2012; 77(1):106-112.

54. Wortsman J., Matsuoka L.Y., Chen T.C., Lu Z., Holick M.F. Decreasedbioavailabil-ity of vitamin D in obesity. Amer J ClinNutr. 2000; 72:690-693.

55. Compston J.E., Vedi S., Ledger J.E., Webb A., Gazet J.C., PilkingtonT.R. Vitamin D status and bone histomorphometry in gross obesity.Amer J Clinical Nutr. 1981; 34:2359-2363.

56. Hahm S., Haselhorst U., Tan S., Quadbeck B., Schmidt M., Roesler S. et al. Low serum 25-hydroxy vitaminD concentrations are associated with insulin resistance and obesityin women with polycystic ovary syndrome. ExperClinEn-docrinolDiab. 2006; 114:577-583.

57. Chunla He,Zhoumeng Lin, Sara WagnerRobbandAmara E. Ezeamama. Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis. Nutrients. 2015; 7:4555-4577.

58. Velija-AsimiZ. Evaluation of the association of vitamin D deficiency with gonadotropins and sex hormone in obese and non-obese women with polycystic ovary syndrome. Med. Glas. 2014; 11:170-176.

59. Tsakova AD., Gateva AT., KamenovZ.A. 25(OH) vitamin D levels in premenopausal women with polycystic ovary syndrome and/or obesity. Int. J. Vitam. Nutr. Res. 2012; 82:399-404.

60. Bonakdaran S., Khorasani Z.M., Davachi B., Khorasani J.M. The effects of cal-citriol on improvement of insulin resistance, ovulation and comparison with metformin therapy in pcos patients: A randomized placebo-controlled clinical trial. Iran. J.Reprod. Med. 2012; 10:465-472.

61. Kotsa K., Yavropoulou M.P., Anastasiou O., Yovos J.G. Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome. Fertil. Steril. 2009; 92:1053-1058.

62. Rahimi-Ardabili H., PourghassemGargari B., Farzadi L. Effects of vitamin D on cardiovascular disease risk factors in polycystic ovary syndrome women with vitamin D deficiency. J. Endocrinol. Investig. 2013; 36:28-32.

63. Raja-Khan N., Shah J., Stetter C.M., Lott M.E., Kunselman A.R., Dodson W.C., Legro R.S. High-dose vitamin D supplementation and measures of insulin sensitivity in polycystic ovary syndrome: A randomized, controlled pilot trial. Fertil. Steril. 2014; 101:1740-1746.

64. SeydehZ.S, Firouzeh G.,FaranakK. Role of vitamin D in female Reproduction. ClinicaChimicaActa. 2016; 455:33-38.

65. WehrE.,PieberT.R,Obermayer-PietschB. Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in PCOS women - a pilot study. Journal of Endocrinological Investigation. 2011; 34:757-763.

66. Rashidi B., Haghollahi F., Shariat M.,Zayerii F. The effects of calcium-vitamin D and metformin on polycystic ovary syndrome: a pilot study. Taiwanese Journal of Obstetrics and Gynecology. 2009; 48:142-147.

67. BerkovitzS., Ambler G., JenkinsM., ThurgoodS. Serum 25-hydroxy vitamin D levels in chronic fatigue syndrome: a retrospective survey. International journal for vitamin and nutrition research. 2009; 79:250-254.

68. HarlowB.L, Signorello L.B, Hall J.E, Dailey C, Komaroff A.L. Reproductive correlates of chronic fatigue syndrome. The American journal of medicine. 1998; 105:94S-99S.

69. Hoeck A.D, PallM.L. Will vitamin D supplementation ameliorate diseases characterized by chronic inflammation and fatigue? Medical hypotheses. 2011; 76:208-213.

70. FangF.,NiK.,Cai Y., Shang J.,ZhangX.,XiongC. Effect of vitamin D supplementation on polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Complement TherClinPract. 2017; 26:53-60.


Для цитирования:


Сафи А.Т., Оразов М.Р., Калинченко С.Ю. Синдром поликистозных яичников и дефицит витамина D. Акушерство и Гинекология Санкт-Петербурга. 2018;(2):55-61.

For citation:


Safi A.A., Orazov M.R., Kalinchenko S.Yu. Polycystic ovary syndrome and vitamin D deficiency. Obstetrics and Gynaecology of Saint-Petersburg. 2018;(2):55-61. (In Russ.)

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