经阴道三维超声对体外受精-胚胎移植患者子宫内膜容受性的评估及对妊娠结局的预测价值  

Evaluation of endometrial receptivity in patients undergoing in vitro fertilization and embryo transfer by transvaginal three-dimensional ultrasound and its predictive value for pregnancy outcome

作　　者：刘耘利[1] 许伟标[1] 刘琼珠 暴络宁 成方霞 刘彦红[1] LIU Yun-li;XU Wei-biao;LIU Qiong-zhu;BAO Luo-ning;CHENG Fang-xia;LIU Yan-hong(Zhuhai Maternal and Child Health Hospital,Zhuhai Guangdong 519000,China)

机构地区：[1]珠海市妇幼保健院,广东珠海519000

出　　处：《中国临床医学影像杂志》2021年第6期426-431,共6页Journal of China Clinic Medical Imaging

基　　金：珠海市科技计划项目(项目编号:20171009E030046)。

摘　　要：目的:探讨经阴道三维超声评估体外受精-胚胎移植(IVF-ET)患者子宫内膜容受性及对妊娠结局的预测价值。方法:选取2017年2月—2019年9月于本院就诊的134例不孕患者(观察组),均采取IVF-ET进行治疗,采用个体化长方案进行控制性超促排卵。根据患者妊娠结局分为妊娠组(临床妊娠和生化妊娠,88例)和未妊娠组(未妊娠,46例)。比较两组一般情况、实验室指标(基础FSH、LH、E_(2)和HCG日FSH、LH、E_(2))、子宫情况(子宫位置、子宫内膜形态、子宫内膜厚度)、血流动力学参数(S/D、PI、RI、VI、FI、VFI)。采用多因素Logistic回归分析确定IVF-ET患者妊娠结局的影响因素。绘制ROC曲线分析经阴道二维和三维超声参数对妊娠结局的预测价值。以2019年10月—2020年4月收治的84例不孕患者验证研究结果,验证组患者经阴道三维超声检查方法及治疗方案与观察组相同,根据观察组分析结果预测患者妊娠结局并与实际妊娠结局进行对照。结果:妊娠组和未妊娠组年龄、体质量指数、不孕年限、促卵泡激素用量、不孕类型、基础FSH、LH、E_(2)和HCG日FSH、LH、E_(2)、子宫位置、子宫内膜形态、子宫内膜厚度、子宫内膜容积的差异无统计学意义(P>0.05)。妊娠组基础FSH、S/D、PI、RI明显低于未妊娠组,VI、FI、VFI均明显高于未妊娠组(均P<0.05)。多因素Logistic回归分析显示,PI (OR=0.295,95%CI:0.111-0.784)、RI (OR=0.352,95%CI:0.144-0.860)、VI (OR=1.372,95%CI:1.028-1.831)、FI (OR=1.897,95%CI:1.115-3.227)、VFI (OR=2.241,95%CI:1.285-3.908)是IVF-ET妊娠结局的影响因素(P<0.05)。ROC曲线显示,VFI预测妊娠结局的曲线下面积为0.932 (95%CI:0.872-0.992),当截断值为6.12时,敏感度与特异度为0.896和0.724;FI预测妊娠结局的曲线下面积为0.823(95%CI:0.716-0.929),当截断值为31.08时,敏感度与特异度分别为0.836和0.709。二者对IVF-ET患者妊娠结局有较高预测价值。84例验证组患�Objective: To explore the value of transvaginal three-dimensional ultrasound in evaluating the endometrial receptivity of patients with in vitro fertilization-embryo transfer(IVF-ET) and predicting pregnancy outcome. Methods: A total of134 infertile patients who were treated in our hospital from February 2017 to September 2019 were selected(observation group), all were treated with IVF-ET, and an individualized long-term plan was used for controlled ovarian hyperstimulation.According to the pregnancy outcome of patients, they were divided into pregnancy group(clinical pregnancy and biochemical pregnancy, 88 cases) and non-pregnant group(non-pregnant, 46 cases). The general conditions, laboratory indicators(basic FSH,LH, E_(2) and HCG day FSH, LH, E_(2)), uterine conditions(uterine position, endometrial shape, endometrial thickness), hemodynamic parameters(S/D, PI, RI, VI, FI, VFI) were compared between the two groups. Multivariate Logistic regression analysis was used to determine the influencing factors of pregnancy outcome in IVF-ET patients. Draw the ROC curve to analyze the predictive value of transvaginal two-dimensional and three-dimensional ultrasound parameters for pregnancy outcome. Based on the verification study results of 84 infertile patients admitted from October 2019 to April 2020, the method and treatment plan of transvaginal three-dimensional ultrasound examination in the verification group were the same as those in the observation group. According to the analysis results of the observation group, the pregnancy outcome of the patients was predicted and compared with the actual. The pregnancy outcome was compared. Results: There were no significant difference in age, body mass index, years of infertility, follicle-stimulating hormone dosage, type of infertility, basic and HCG day FSH, LH, E_(2), uterine position, endometrial shape, endometrial thickness, and endometrial volume between pregnant and non-pregnant groups(P>0.05). The basic FSH, S/D, PI and RI of the pregnant group were significantly l

关 键 词：妊娠结局 子宫内膜 超声检查 产前 

分 类 号：R714.1[医药卫生—妇产科学] R445.1[医药卫生—临床医学]