宫腔镜检查在C型子宫内膜患者首次冻融胚胎移植中的应用  

Application of hysteroscopy in the first freeze-thaw embryo transfer in patients with C-type endometrium

作　　者：沈晶晶 李欣[1] 赵纯[1] 凌秀凤[1] SHEN Jingjing;LI Xin;ZHAO Chun;LING Xiufeng(Nanjing Women and Children's Healthcare Hospital,Nanjing Medical University,Nanjing 210004,CHINA)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)生殖医学中心,江苏210004

出　　处：《江苏医药》2025年第3期229-233,共5页Jiangsu Medical Journal

基　　金：国家自然科学基金项目(81971386)。

摘　　要：目的探讨宫腔镜检查在C型子宫内膜患者首次冻融胚胎移植中的应用。方法回顾性分析移植前阴道超声监测人绒毛膜促性腺激素(hCG)日C型子宫内膜且行宫腔镜检查的197例患者首次冻融胚胎移植周期的临床资料,根据宫腔镜镜下诊断及子宫内膜病理结果,将患者分为宫腔正常组(81例)和宫腔异常组(116例)。宫腔异常组患者接受相应的治疗后,均接受冻融胚胎移植。比较两组患者胚胎移植的妊娠结局。采用ROC曲线评估子宫内膜厚度对C型子宫内膜患者宫腔异常的预测价值。结果阴道超声监测hCG日C型子宫内膜患者中,宫腔异常的发生率为58.9%。宫腔异常组子宫内膜厚度高于宫腔正常组(P<0.05)。两组患者生化妊娠率、临床妊娠率、流产率、活产率比较差异均无统计学意义(P>0.05)。单因素logistic回归分析结果显示,子宫内膜厚度增厚是C型子宫内膜患者宫腔异常的独立危险因素[OR=1.17,95%CI(1.05~1.31),P<0.05]。ROC曲线结果显示,子宫内膜厚度预测C型子宫内膜患者宫腔异常的AUC为0.634[95%CI(0.555~0.714),P<0.05],取子宫内膜厚度11.50mm为最佳诊断界值,其对应的预测灵敏度为75.9%,特异度为54.3%。结论宫腔镜检查在C型子宫内膜患者首次冻融胚胎移植周期中具有一定的诊断价值,有助于发现潜在宫腔异常问题的C型子宫内膜患者。对于阴道超声检查发现子宫内膜厚度大于11.50mm的C型子宫内膜患者,可考虑行宫腔镜检查,以提高对宫腔异常的诊断率。Objective To investigate the application of hysteroscopy in the first freeze-thaw embryo transfer in the patients with C-type endometrium.Methods The clinical data of 197 patients with C-type endometrium monitored on hCG day before transplantation and underwent hysteroscopy during the first freeze-thaw embryo transfer cycle were retrospectively analyzed.According to hysteroscopic diagnosis and endometrial pathology,the patients were divided into two groups of A(with normal uterine cavity,81 cases)and B(with abnormal uterine cavity,116 cases).After receiving corresponding treatment,all patients in group B received freeze-thaw embryo transfer.The pregnancy outcomes of embryo transfer between the two groups were compared.The ROC curve was used to evaluate the predictive value of endometrial thickness for uterine abnormalities in the patients with type C endometrium.Results The incidence of uterine abnormalities was 58.9%in the patients with type C endometrium monitored by vaginal ultrasound on hCG day.The endometrial thickness of group B was higher than that of group A(P<0.05).There were no significant differences in the biochemical pregnancy rate,clinical pregnancy rate,abortion rate and live birth rate between the two groups(P>0.05).Univariate logistic regression analysis showed that the endometrial thickness was an independent risk factor for uterine abnormalities in the patients with type C endometrium[OR=1.17,95%CI(1.05-1.31),P<0.05].ROC curve results showed that the AUC of endometrial thickness in predicting uterine abnormalities of the patients with type C endometrium was 0.634[95%CI(0.555-0.714),P<0.05].Taking endometrial thickness 11.50mm as the best diagnostic threshold,the corresponding prediction sensitivity and specificity were 75.9%and 54.3%,respectively.Conclusion Hysteroscopy has a certain diagnostic value in the first freeze-thaw embryo transfer cycle for C-type endometrial patients,and can help identify C-type endometrial patients with potential uterine abnormalities.Hysteroscopy may be considered

关 键 词：宫腔镜 子宫内膜类型 子宫内膜厚度 辅助生殖 宫腔异常 胚胎移植 

分 类 号：R714[医药卫生—妇产科学]