超声评估宫腔粘连患者子宫内膜血流动力学改变及预测妊娠结局的临床价值  

Clinical value of ultrasound in evaluating endometrial hemodynamic changes and predicting pregnancy outcome in patients with intrauterine adhesions

作　　者：陈淑金[1] 邱思花[1] 王志红 CHEN Shujin;QIU Sihua;WANG Zhihong(Department of Ultrasound,Longyan First Hospital,Fujian 364000,China)

机构地区：[1]福建省龙岩市第一医院超声科,364000 [2]龙岩市新罗区妇幼保健院超声科

出　　处：《临床超声医学杂志》2024年第12期1037-1041,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用经阴道三维超声(3D-TVS)评估不同程度宫腔粘连(IUA)患者子宫内膜血流动力学改变,并预测其妊娠结局,探讨其临床应用价值。方法选取于我院就诊的IUA患者90例,其中轻度组10例、中度组43例、重度组37例。应用3D-TVS获取各组子宫内膜容积(EV)及血流动力学参数,包括血管指数(VI)、血流指数(FI)和血管血流指数(VFI),并比较其差异。所有患者均随访2年,其中受孕者64例,根据妊娠结局将其分为妊娠结局不良者42例和妊娠结局良好者22例,比较二者EV和子宫内膜血流动力学参数的差异。采用Logistic回归分析筛选预测IUA患者妊娠结局的独立影响因素。绘制受试者工作特征(ROC)曲线分析EV、VI、FI、VFI单独及联合应用预测IUA患者妊娠结局的诊断效能。结果轻、中、重度组IUA患者EV、VI、FI、VFI比较差异均有统计学意义(均P<0.001),且组间两两比较差异均有统计学意义(均P<0.05)。妊娠结局不良者EV、VI、FI、VFI均低于妊娠结局良好者,差异均有统计学意义(均P<0.001)。Logistic回归分析显示,EV、VI、FI、VFI均为预测IUA患者妊娠结局的独立保护因素(均P<0.05)。ROC曲线分析显示,EV、VI、FI、VFI及其联合应用预测IUA患者妊娠结局的曲线下面积分别为0.808、0.864、0.877、0.852、0.975,联合应用的曲线下面积高于各参数单独应用(Z=2.837、2.403、2.082、2.507,均P<0.05)。结论3D-TVS可较好地评估不同程度IUA患者子宫内膜血流动力学改变,并可用于预测其妊娠结局,具有一定的临床应用价值。Objective To explore the clinical value of transvaginal three-dimensional ultrasound(3D-TVS)in evaluating endometrial hemodynamic changes and predicting pregnancy outcome in patients with intrauterine adhesions(IUA)of different severity.Methods Totally 90 patients with IUA who visited our hospital were included,they were divided into a mild group of 10 cases,a moderate group of 43 cases,and a severe group of 37 cases.The endometrial volume(EV)and hemodynamic parameters in each group were obtained by 3D-TVS,including vascular index(VI),flow index(FI)and vascular flow index(VFI),the differences among the groups were compared.The patients were followed up for two years,there were 42 cases of poor pregnancy and 22 cases of good pregnancy,the differences of EV and hemodynamic parameters between the two were compared.Logistic regression was used to analyze the independent influencing factors for predicting the pregnancy outcome in patients with IUA.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of EV,VI,FI and VFI alone and in combination for predicting pregnancy outcome in patients with IUA.Results The differences in EV,VI,FI and VFI among mild,moderate,severe groups were statistically significant(all P<0.05),there were significant differences in pairwise comparison(all P<0.05).The EV,VI,FI and VFI of the poor pregnancy cases were lower than those of the good pregnancy cases,the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that EV,VI,FI and VFI were independent protective factors for predicting pregnancy outcome in patients with IUA(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of EV,VI,FI,VFI and their combination for predicting pregnancy outcome in patients with IUA were 0.808,0.864,0.877,0.852,0.975,respectively.The AUC of combined applied was higher than that of applied alone(Z=2.837,2.403,2.082,2.507,all P<0.05).Conclusion 3D-TVS can evaluate the endometrial hemodynamic changes and have a

关 键 词：超声检查 经阴道 三维 宫腔粘连 血流动力学 子宫内膜 妊娠结局 

分 类 号：R445.1[医药卫生—影像医学与核医学]