经阴道高帧率剪切波弹性成像技术评估卵巢功能不全的价值  

Transvaginal high frame rate sound touch elastography in assessing ovarian insufficiency

作　　者：张永超 范晓蓓 陈然 肖彬 郑东平 蒲悦磊 朱圆圆 ZHANG Yongchao;FAN Xiaobei;CHEN Ran;XIAO Bin;ZHENG Dongping;PU Yuelei;ZHU Yuanyuan(Department of Ultrasound,Shiyan Renmin Hospital,Renmin Hospital of Hubei University of Medicine,Shiyan,Hubei 442000,China;Department of Medical Laboratory,Shiyan Renmin Hospital,Renmin Hospital of Hubei Universityof Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]十堰市人民医院湖北医药学院附属人民医院超声科,湖北十堰442000 [2]十堰市人民医院湖北医药学院附属人民医院医学检验科,湖北十堰442000

出　　处：《中华实用诊断与治疗杂志》2025年第2期159-163,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：十堰市科学技术局引导性科研项目(22Y70)。

摘　　要：目的 比较经阴道高帧率剪切波弹性成像(HiFR STE)技术及血浆抗苗勒管激素(AMH)评估卵巢储备功能的效果,探讨经阴道HiFR STE对卵巢功能不全的评估价值。方法 2022年8月—2024年2月十堰市人民医院诊治早发性卵巢功能不全(POI)患者46例为POI组,卵巢早衰(POF)患者50例为POF组,同期健康育龄女性50例为对照组。3组均行经阴道超声HiFR STE检查,比较双侧卵巢杨氏模量Emean、Emax、Emin值;采用电化学发光法检测血浆AMH水平,采用Pearson相关法分析卵巢功能不全(POI+POF)患者双侧卵巢Emean值与血浆AMH水平的相关性。绘制ROC曲线,评估左侧卵巢Emean值及血浆AMH诊断卵巢功能不全的效能。结果 3组血浆AMH水平比较差异有统计学意义(F=135.043,P<0.001),对照组、POI组、POF组血浆AMH水平[(3.72±1.59)、(0.87±0.37)、(0.33±0.24)μg/L]依次降低(P<0.05)。3组左、右侧卵巢Emean、Emax、Emin值比较差异均有统计学意义(F=175.888~306.242,P均<0.001),对照组、POI组、POF组左、右侧卵巢Emean值[(15.69±3.44)、(22.40±4.42)、(30.10±3.65)kPa,(15.71±3.27)、(22.47±3.73)、(29.84±2.97)kPa]、Emax值[(21.29±3.25)、(27.36±3.83)、(35.54±3.22)kPa,(21.11±3.48)、(30.21±3.21)、(34.99±2.68)kPa]、Emin值[(11.30±2.76)、(15.63±3.36)、(25.36±2.99)kPa,(11.23±2.19)、(14.81±2.93)、(23.94±2.78)kPa]均依次增高(P<0.05),左侧卵巢与右侧卵巢比较差异均无统计学意义(P>0.05)。卵巢功能不全患者左、右侧卵巢Emean值与血浆AMH水平均呈负相关(r=-0.712,P<0.001;r=-0.742,P<0.001)。左侧卵巢Emean值、血浆AMH分别以20.12 kPa、1.49μg/L为最佳截断值,单独及联合诊断POI的AUC分别为0.875(95%CI:0.792~0.934,P<0.001)、0.982(95%CI:0.932~0.998,P<0.001)、0.993(95%CI:0.948~1.000,P<0.001),灵敏度分别为72%、95%、91%,特异度分别为90%、94%、100%。左侧卵巢Emean值、血浆AMH分别以27.65 kPa、0.52μg/L为最佳截断值,单独及联合诊断POF的AUC分别为0.920(95%CI:0.847Objective To compare the effects of transvaginal high frame rate sound touch elastography(HiFR STE)and plasma anti-Mullerian hormone(AMH)on assessing ovarian reserve function,and to explore the value of transvaginal HiFR STE to the assessment of ovarian insufficiency.Methods Forty-six premature ovarian insufficiency(POI)patients(the POI group)and 5O premature ovarian failure(POF)patients(the POF group)were diagnosed and treated in Shiyan Renmin Hospital from August 2022 to February 2024,and another 50 healthy women of childbearing age at the same period were included as the control group.Transvaginal ultrasound HiFR STE examination was conducted in three groups,and the Emean,Emax and Emin values of Young's modulus of both ovaries were compared.Plasma AMH level was measured using electrochemiluminescence.Pearson correlation coefficient was used to analyze the correlation between Emean values of left and right ovaries and plasma AMH level in patients with ovarian insufficiency(POI+POF).ROC curves were plotted to evaluate the diagnostic efficiencies of left ovarian Emean value and plasma AMH on ovarian insufficiency.Results The plasma AMH level showed significant difference among three groups(F=135.043,P<0.001),and decreased successively in the control group,POI group and POF group[(3.72±1.59),(0.87±0.37),(0.33±0.24)μg/L](P<0.05).The Emean,Emax and Emin values of left and right ovaries showed significant differences among three groups(F=175.888-306.242,all P values<0.001).The left and right ovarian Emean value[(15.69±3.44),(22.40±4.42),(30.10±3.65)kPa;(15.71±3.27),(22.47±3.73),(29.84±2.97)kPa],Emax value[(21.29±3.25),(27.36±3.83),(35.54±3.22)kPa;(21.11±3.48),(30.21±3.21),(34.99±2.68)kPa],andEminvalue[(11.30±2.76),(15.63±3.36),(25.36±2.99)kPa;(11.23±2.19),(14.81±2.93),(23.94±2.78)kPa] increased successively in the control group,POI group and POF group(P<0.05),and showed no significant differences between left ovary and right ovary(P>0.05).The Emean values of left and right ovaries were negativel

关 键 词：早发性卵巢功能不全 卵巢早衰 高帧率剪切波弹性成像 抗苗勒管激素 卵巢储备功能 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.75[医药卫生—诊断学]