Objective

Fibroid treatments that have few side-effects and can preserve fertility are a clinical priority. We studied the association between serum vitamin D and uterine fibroid growth, incidence, and loss.

Design

A prospective community cohort study (enrollment 2010–2012) with 4 study visits over 5 years to conduct standardized ultrasounds, measure 25-hydroxyvitamin D (25(OH)D), and update covariates.

Setting

Detroit, Michigan area.

Patients

Self-identified African American or Black women aged 23–35 at enrollment without previous clinical diagnosis of fibroids.

Intervention(s)

Serum 25(OH)D measured using immunoassay or liquid chromatography-tandem mass spectrometry.

Main Outcome Measure(s)

The primary outcomes were fibroid growth, as measured by change in log volume per 18 months, and fibroid incidence (first detection of fibroid in previously fibroid-free uterus). Adjusted growth estimates from linear mixed models were converted to estimated difference in volume for high vs. low 25(OH)D. Incidence differences were estimated as hazard ratios from age-specific Cox regression. A secondary outcome fibroid loss (reduction in fibroid number between visits), was modeled using Poisson regression. Covariates (reproductive and hormonal variables, demographics, body mass index, current smoking) and 25(OH)D were modeled as time-varying factors.

Result(s)

At enrollment among 1,610 participants with ≥1 follow-up ultrasound, mean age was 29.2 years, 73% had deficient vitamin D (<20ng/mL), and only 7% had sufficient vitamin D (≥30ng/mL). Serum 25(OH)D ≥20ng/mL compared with <20ng/mL was associated with an estimated 9.7% reduction in fibroid growth (95% confidence interval [CI]: -17.3%, -1.3%), similar to the minimally adjusted estimate -8.4% (95% CI: -16.4, 0.3). Serum 25(OH)D ≥30ng/mL compared with <30ng/mL was associated with an imprecise 22% reduction in incidence (adjusted hazard ratio=0.78; 95% CI: 0.47, 1.30), similar to the unadjusted estimate of 0.84 (95% CI: 0.51, 1.39). The >30ng/mL group also had a 32% increase in fibroid loss (adjusted risk ratio=1.32; 95% CI: 0.95, 1.83).

Conclusion(s)

Our data support the hypothesis that high concentrations of vitamin D decrease fibroid development but are limited by the few participants with serum 25(OH)D ≥30ng/mL. Interventional trials that raise and maintain 25(OH)D concentrations >30ng/mL and then prospectively monitor fibroid development are needed to further assess supplemental vitamin D efficacy and determine optimal treatment protocols.

中文翻译：

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维生素 D 与子宫肌瘤的生长、发病率和损失：一项前瞻性超声研究

 客观的

副作用很少且可以保留生育能力的肌瘤治疗是临床优先考虑的事项。我们研究了血清维生素 D 与子宫肌瘤生长、发病率和消失之间的关联。

 设计

一项前瞻性社区队列研究（2010-2012 年入组），在 5 年内进行了 4 次研究访问，以进行标准化超声检查、测量 25-羟基维生素 D (25(OH)D) 并更新协变量。

 环境

 密歇根州底特律地区。

 患者

入组时自我认定年龄为 23-35 岁的非裔美国或黑人女性，之前没有肌瘤的临床诊断。

 干预措施

使用免疫测定法或液相色谱-串联质谱法测量血清 25(OH)D。

 主要观察指标）

主要结局是肌瘤生长（通过每 18 个月的对数体积变化来测量）和肌瘤发病率（在先前无肌瘤的子宫中首次检测到肌瘤）。将线性混合模型调整后的生长估计值转换为高 25(OH)D 与低 25(OH)D 的估计体积差异。发病率差异被估计为年龄特异性 Cox 回归的风险比。使用泊松回归对次要结果肌瘤消失（两次就诊之间肌瘤数量减少）进行建模。协变量（生殖和激素变量、人口统计、体重指数、当前吸烟情况）和 25(OH)D 被建模为时变因素。

 结果）

在 1,610 名接受 ≥1 次超声随访的参与者入组时，平均年龄为 29.2 岁，73% 的人缺乏维生素 D（<20ng id=66>30ng/mL 组的肌瘤丢失也增加了 32%（调整后的风险比= 1.32；95% CI：0.95，1.83）。

 结论

我们的数据支持这样的假设：高浓度维生素 D 可以减少肌瘤的发展，但受到血清 25(OH)D ≥30ng/mL 的少数参与者的限制。需要进行干预性试验，提高并维持 25(OH)D 浓度 >30ng/mL，然后前瞻性监测肌瘤的发展，以进一步评估补充维生素 D 的功效并确定最佳治疗方案。