阴道三维超声对子宫腺肌症合并不孕患者妊娠结局的评估价值  

The application value of transvaginal three-dimensional ultrasound on predicting pregnancy outcomes in patients with adenomyosis combined with infertility

作　　者：杨藜 徐少蓉 安银华 黄兴华 漆家高 YANG Li;XU Shao-rong;AN Yin-hua;HUANG Xing-hua;QI Jia-gao(Mianyang Hospital Affiliated to the School of Medicine,University of Electronic Science and Technology of China,Mianyang Central Hospital,Mianyang Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院绵阳市中心医院,四川绵阳621000

出　　处：《中国临床医学影像杂志》2025年第4期279-284,共6页Journal of China Clinic Medical Imaging

基　　金：四川省卫生健康委员会科研课题(编号:19PJ111)。

摘　　要：目的:探讨经阴道三维超声预测子宫腺肌症合并不孕患者妊娠结局的应用价值。方法:选取2021年1月—2023年12月在本院接受体外受精-胚胎移植的115例子宫腺肌症合并不孕患者为研究对象,均在入院时接受经阴道三维超声检查。根据115例子宫腺肌症合并不孕患者的妊娠结局分为妊娠组(n=67)与未妊娠组(n=48),比较两组的经阴道三维超声检查指标。采用多因素Logistic回归分析探讨子宫腺肌症合并不孕患者妊娠结局的独立影响因素。结果:妊娠组与未妊娠组患者子宫内膜厚度、内膜容积以及子宫内膜形态类型比较差异无统计学意义(均P>0.05)。妊娠组患者内膜及内膜下血流搏动指数(PI)、阻力指数(RI)、收缩峰速度与舒张末期速度之比(S/D)均低于未妊娠组患者,血流指数(FI)高于未妊娠组患者(均P<0.05)。未妊娠组结合带体积/子宫内膜体积(JZV/EV)显著增高(P<0.05),妊娠组与未妊娠组子宫结合带平均厚度无显著差异(P>0.05)。经阴道三维超声检查指标PI、RI、S/D、FI预测子宫腺肌症合并不孕患者妊娠结局的曲线下面积及95%CI分别为0.532(0.489~0.582)、0.749(0.705~0.799)、0.607(0.562~0.653)、0.634(0.584~0.684),FI预测价值最高。未妊娠组患者年龄≥35岁比例高于妊娠组(P<0.05)。多因素Logistic回归分析显示,年龄≥35岁,PI≥1.15,RI≥0.81,S/D≥3.18,FI≤26.65,JZV/EV≥0.52是子宫腺肌症合并不孕患者妊娠结局的危险因素(P<0.05)。结论:经阴道三维超声可以通过评估子宫内膜容受性,有效预测子宫腺肌症合并不孕患者体外受精-胚胎移植的妊娠结局,具有一定的临床应用价值。Objective:To explore the application value of transvaginal three-dimensional ultrasound on predicting pregnancy outcomes in patients with adenomyosis combined with infertility.Methods:A total of 115 patients with adenomyosis combined with infertility who underwent in vitro fertilization and embryo transfer in our hospital from January 2021 to December 2023 were selected,all of whom underwent transvaginal three-dimensional ultrasound examination at admission.According to the pregnancy outcomes of 115 patients with adenomyosis combined with infertility,they were divided into pregnant group(n=67)and non-pregnant group(n=48),and the transvaginal three-dimensional ultrasound examination indicators of the two groups were compared.Using multiple Logistic regression analysis to explore the independent influencing factors of pregnancy outcomes in patients with adenomyosis combined with infertility.Results:There was no statistically significant difference in endometrial thickness,endometrial volume,and endometrial morphology between the pregnant group and non-pregnant group(all P>0.05).The PI,RI,and S/D of endometrial and subendometrial blood flow in the pregnant group were lower than those in the non-pregnant group,while the FI was higher than those in the non-pregnant group(all P<0.05).The JZV/EV value significantly increased in the non-pregnant group(P<0.05),and there was no significant difference in the average junction zone thickness between two groups(P>0.05).The AUC(95%CI)of PI,RI,S/D,and FI in predicting pregnancy outcomes in patients with adenomyosis combined with infertility through transvaginal three-dimensional ultrasound examination were 0.532(0.489~0.582),0.749(0.705~0.799),0.607(0.562~0.653),and 0.634(0.584~0.684),respectively.FI had the highest predictive value.The proportion of patients aged≥35 years in the non pregnant group was higher than that in the pregnant group(P<0.05).Multivariate Logistic regression analysis showed that age≥35 years old,PI≥1.15,RI≥0.81,S/D≥3.18,FI≤26.65,JZV/EV≥0.52 w

关 键 词：子宫腺肌病 不育 女性 超声检查 

分 类 号：R711.74[医药卫生—妇产科学] R445.1[医药卫生—临床医学]