经阴道三维容积超声在高龄生育女性卵巢储备功能减退评估中的应用价值  

Application Value of Transvaginal Three-Dimensional Volume Ultrasound in the Evaluation of Ovarian Reserve Decline in Older Reproductive Women

作　　者：陈飞[1] 徐扬 沈倩云 黄鲜梅 CHEN Fei;XU Yang;SHEN Qianyun;HUANG Xianmei(Department of Ultrasonography,Yangzhou Maternal and Child Care Service Centre/Yangzhou Maternal and Child Care Service Centre Affiliated to Yangzhou University Medical College,Yangzhou 225002,China;Department of Obsterics and Gynecology,Yangzhou Maternal and Child Care Service Centre/Yangzhou Maternal and Child Care Service Centre Affiliated to Yangzhou University Medical College,Yangzhou 225002,China;Department of Clinical Laboratory,Yangzhou Maternal and Child Care Service Centre/Yangzhou Maternal and Child Care Service Centre Affiliated to Yangzhou University Medical College,Yangzhou 225002,China)

机构地区：[1]扬州市妇幼保健院、扬州大学医学院附属扬州妇幼保健院超声科,江苏扬州225002 [2]扬州市妇幼保健院、扬州大学医学院附属扬州妇幼保健院妇产科,江苏扬州225002 [3]扬州市妇幼保健院、扬州大学医学院附属扬州妇幼保健院检验科,江苏扬州225002

出　　处：《医学综述》2025年第5期636-640,共5页Medical Recapitulate

基　　金：扬州市科技计划--社会发展项目(YZ2023093)。

摘　　要：目的探讨经阴道三维容积超声对高龄生育女性卵巢储备功能减退的评估价值。方法选取2021年1月至2023年12月于扬州市妇幼保健院就诊的500名35~45岁备孕女性作为研究对象,依据血清抗米勒管激素(AMH)水平(AMH≤2μg/L)及临床表现(月经改变、生育力降低或不孕等)分为卵巢储备功能下降组和卵巢储备功能正常组,各250例。两组均行经阴道三维容积超声[窦卵泡计数(AFC)、卵巢体积(OV)、卵巢基质动脉峰值流速(PSV)]检查。采用受试者工作特征曲线(ROC曲线)分析AFC、OV、PSV及三者联合检测对卵巢储备功能减退的诊断价值。结果卵巢储备功能下降组的AFC、OV、PSV均小于卵巢储备正常组[3.0(2.0,5.0)个比14.0(10.0,19.0)个、2.6(1.9,3.6)cm^(3)比6.0(4.5,7.8)cm 3;6.7(5.2,8.7)cm/s比10.6(9.0,12.6)cm/s](均P<0.01)。Spearman相关性分析结果显示,AFC、OV、PSV与血清AMH水平均呈正相关(r_(s)=0.905,P<0.001;r_(s)=0.787,P<0.001;r_(s)=0.661,P<0.001)。AFC、OV、PSV评估卵巢储备功能下降的ROC曲线下面积分别为0.973、0.915、0.862,均低于三者联合诊断的0.986;AFC、OV、PSV评估卵巢储备功能下降的灵敏度分别为94.00%、80.00%、80.00%,低于三者联合诊断的95.60%;AFC、OV、PSV评估卵巢储备功能下降的特异度分别为88.80%、87.60%、77.20%,低于三者联合诊断的92.00%。结论经阴道三维容积超声能够有效地评估卵巢储备功能,AFC、OV、PSV联合检测的灵敏度和特异度高于单一指标。Objective To explore the value of transvaginal three-dimensional volume ultrasound in the evaluation of decreased ovarian reserve function in older reproductive women.Methods A total of 500 pregnant women aged 35 to 45 years who came to Yangzhou Maternal and Child Health Hospital from Jan.2021 to Dec.2023 were selected as the study subjects.By screening serum anti-Müllerian hormone(AMH)levels(AMH≤2μg/L)and clinical symptoms(menstrual changes,decreased fertility,infertility,etc.),the decreased ovarian reserve function group(250 cases)and the normal ovarian reserve function group(250 cases)were selected.Three-dimensional vulvae ultrasonography was conducted to measure antral follicle count(AFC),ovarian volume(OV)and peak systolic blood flow velocity of ovarian stroma(PSV).Receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of AFC,OV,PSV and their combination in ovarian reserve decline.Results The AFC,OV and PSV in the decreased ovarian reserve function group were lower than those in the normal ovarian reserve function group[3.0(2.0,5.0)vs 14.0(10.0,19.0),2.6(1.9,3.6)cm 3 vs 6.0(4.5,7.8)cm^(3),6.7(5.2,8.7)cm/s vs 10.6(9.0,12.6)cm/s](all P<0.01).Spearman correlation analysis showed that AFC,OV,PSV were positively correlated with serum AMH levels(r_(s)=0.905,P<0.001;r_(s)=0.787,P<0.001;r_(s)=0.661,P<0.001).The area under ROC curve(AUC)of AFC,OV and PSV for decreased ovarian reserve was 0.973,0.915 and 0.862 respectively,which was lower than the AUC(0.986)of the combined diagnosis of AFC,OV and PSV.The sensitivity of the three methods for assessing decreased ovarian reserve was 94.00%,80.00%and 80.00%respectively,which was lower than 95.60%of the combined diagnosis of the three methods.The specificity of the three methods for assessing decreased ovarian reserve was 88.80%,87.60%,77.20%respectively,which was lower than the 92.00%of the three methods combined diagnosis.Conclusion Transvaginal three-dimensional volume ultrasound can effectively assess whether the ovarian reserve

关 键 词：卵巢储备功能 容积超声 窦卵泡计数 卵巢体积 卵巢基质动脉峰值流速 

分 类 号：R445.1[医药卫生—影像医学与核医学]