Application Analysis of Ultrasonic Evaluation in the Determination of Endometrial Receptivity
-
摘要:
目的 探讨经阴道三维超声在子宫内膜容受性判定中的应用价值。 方法 回顾性选取昆明市妇幼保健院2022 年4 月至2023 年6 月106 例拟行辅助生殖者,所有辅助生殖者在妊娠前均接受经阴道三维超声检测,根据临床妊娠与否分为妊娠组(n = 48)和未妊娠组(n = 58 ),运用经阴道三维容积探头,记录2 组子宫内膜类型、子宫内膜血流分型、子宫内膜容积、妊娠率、子宫内膜及内膜下血流参数[血流指数(flow index,FI)、血管化指数(vascularization index,VI)、及血管-血流指数(vascular fiow index,VFI)]情况。 结果 2 组在子宫内膜类型、子宫内膜血流分型、子宫内膜容积方面比较,差异有统计学意义(P < 0.05);子宫内膜形态A型妊娠率高于C型,子宫内膜血流分型Ⅲ级妊娠率高于型Ⅰ级,差异有统计学意义(P < 0.05);2组在子宫内膜及内膜下FI、VI以及VFI方面比较,差异有统计学意义(P < 0.05)。 结论 经阴道三维超声技术能够有效评估子宫内膜容受性,预测妊娠结局,为临床治疗方案提供重要依据。 Abstract:Objective To investigate the application value of transvaginal three-dimensional ultrasound in the determination of endometrial receptivity. Methods A retrospective study was conducted on 106 patients who were scheduled to undergo assisted reproductive treatment at Kunming Maternal and Child Health Hospital from April 2022 to June 2023. All patients underwent transvaginal three-dimensional ultrasound examination before pregnancy. They were divided into a pregnant group (n = 48) and a non-pregnant group (n = 58) based on whether they achieved clinical pregnancy. The transvaginal three-dimensional volume probe was used to record the endometrial type, endometrial blood flow classification, endometrial volume, pregnancy rate, and endometrial and subendometrial blood flow parameters [Flow Index (FI), Vascularization Index (VI), and Vascular Flow Index (VFI)]. Results When comparing the endometrial type, endometrial blood flow classification, and endometrial volume between the two groups, statistically significant differences were observed (P < 0.05). The pregnancy rate of endometrial morphology type A was higher than that of type C, and the pregnancy rate of endometrial blood flow classification III was higher than that of type I, with statistically significant differences (P < 0.05). There were statistically significant differences in endometrial and subendometrial FI, VI and VFI between the two groups (P < 0.05). Conclusion Transvaginal three-dimensional ultrasound technology not only enables effective evaluation of endometrial receptivity, accurate prediction of pregnancy outcomes, but also provides an important basis for clinical treatment plans. -
表 1 2组一般资料比较[($\bar x \pm s $)/n(%)]
Table 1. Comparison of general data between the two groups[($\bar x \pm s $)/n(%)]
组别 n 平均年龄(岁) BMI(kg/m2) 不孕类型 原发性不孕 继发性不孕 不明原因不孕 妊娠组 48 30.7±6.1 21.65±2.56 33(68.75) 13(27.08) 2(4.17) 未妊娠组 58 32.5±5.6 22.07±2.35 41(70.69%) 14(24.14) 3(5.17) t/χ2 / 1.387 1.194 1.176 P / 0.170 0.235 0.915 表 2 2 组子宫内膜类型、血流分型分布及容积情况比较[($\bar x \pm s $)/n(%)]
Table 2. Comparison of endometrial types,blood flow classification distribution and volume between the two groups[($\bar x \pm s $)/n(%)]
组别 n 子宫内膜类型 子宫内膜血流分型 子宫内膜容积(mL) A型 B型 C型 Ⅰ级 Ⅱ级 Ⅲ级 妊娠组 48 28(58.33) 11(22.92) 9(18.75) 5(10.42) 14(29.17) 29(60.42) 3.52±1.31 未妊娠组 58 19(32.76) 18(31.03) 21(36.21) 27(46.55) 16(27.59) 15(25.86) 0.86±1.12 χ2/t / 6.265 6.457 4.962 P / 0.043* 0.039* 0.001* *P < 0.05。 表 3 2 组子宫内膜及内膜下血流的血流参数和血管化程度比较($\bar x \pm s $)(1)
Table 3. Comparison of blood flow parameters and degree of vascularization of endometrial and subendometrial blood flow between the two groups($\bar x \pm s $)(1)
组别 n 子宫内膜 VI FI VFI 妊娠组 48 22.41±3.12 32.15±2.63 6.59±1.09 未妊娠组 58 16.54±2.56 28.66±2.60 4.89±0.88 t / 6.973 4.475 4.254 P / 0.001* 0.001* 0.001* *P < 0.05。 表 3 2 组子宫内膜及内膜下血流的血流参数和血管化程度比较($\bar x \pm s $)(2)
Table 3. Comparison of blood flow parameters and degree of vascularization of endometrial and subendometrial blood flow between the two groups($\bar x \pm s $)(2)
组别 n 子宫内膜下 VI FI VFI 妊娠组 48 44.23±3.79 33.27±3.07 15.62±2.27 未妊娠组 58 36.15±3.55 30.79±3.17 11.16±2.07 t / 7.606 3.573 7.552 P / 0.001* 0.001* 0.001* *P < 0.05。 -
[1] 白云,李蕾,吴月蓉,等. 子宫内膜容受性检测对于反复种植失败的有效性研究及影响种植窗的临床因素分析[J]. 昆明医科大学学报,2022,43(5):71-75. doi: 10.12259/j.issn.2095-610X.S20220501 [2] 张晶晶,孙虹. 子宫内膜容受性的评估方法[J]. 中国计划生育学杂志,2023,31(3):732-736. [3] Liao J,Yang S,Chen K,et al. A predictive model for first-trimester pregnancy inception after IVF-ET based on multimodal ultrasound evaluation of endometrial receptivity[J]. BMC Medical Imaging,2022,22(1):1-7. doi: 10.1186/s12880-021-00730-0 [4] 徐少蓉,张耀,王亮. 子宫内膜容受性评估方法的研究进展[J]. 实用妇产科杂志,2022,38(8):593-596. doi: 10.3969/j.issn.1003-6946.2022.8.syfckzz202208009 [5] 段霞,王治鸿. 评估子宫内膜容受性的研究进展[J]. 中国计划生育和妇产科,2022,14(11):30-34. doi: 10.3969/j.issn.1674-4020.2022.11.08 [6] Altriagey A,Dawood A S,Babikir G S. Three dimensional ultrasonography and assisted reproductive technology[J]. MOJ Womens Health,2019,8(1):71-76. doi: 10.15406/mojwh.2019.08.00215 [7] 周秀萍,赵雅萍,王启亮,等. 经阴道三维能量多普勒血流显像超声监测IVF-ET中子宫内膜参数评估子宫内膜容受性[J]. 浙江医学,2019,41(10):1053-1056. doi: 10.12056/j.issn.1006-2785.2019.41.10.2018-2637 [8] 寻志杰,高翔,韩静. 经阴道彩超对不孕症患者子宫内膜容受性、血流动力学的评估及对IVF-ET妊娠结局的预测价值[J]. 中国妇幼健康研究,2022,33(2):50-55. doi: 10.3969/j.issn.1673-5293.2022.02.010 [9] 崔雅青,唐慧霞. 不孕症患者子宫内膜容受性评价中经阴道超声的应用及临床价值探讨[J]. 现代医用影像学,2021,30(8):1514-1516. doi: 10.3969/j.issn.1006-7035.2021.08.039 [10] 王夏,苗聪秀,李全喜,等. 子宫内膜异位症对子宫内膜容受性的影响新进展[J]. 中华生殖与避孕杂志,2022,42(7):740-745. [11] 张晶晶,孙虹. 子宫内膜容受性的评估方法[J]. 中国计划生育学杂志,2023,31(3):732-736. [12] 楚琪,张欣,李茂林,等. 薄型子宫内膜与辅助生殖技术妊娠结局的研究进展[J]. 中华生殖与避孕杂志,2020,40(4):325-329. [13] Sun K,Xiu Y,Wang Y,et al. Predictive value of 3D ultrasound assessment of endometrial receptivity for PGD/PGS for transfer pregnancy outcome[J]. BMC Pregnancy and Childbirth,2023,23(1):1-9. doi: 10.1186/s12884-022-05306-6 [14] 芷舒,鲁海鸥,张宇明,等. 不孕患者移植当日子宫内膜容受性评估对临床妊娠率影响研究[J]. 中国实用妇科与产科杂志,2020,36(3):264-266. [15] 李政英,王惠. 经阴道超声评估子宫内膜容受性的应用研究进展[J]. 生殖医学杂志,2023,32(9):1451-1456. doi: 10.3969/j.issn.1004-3845.2023.09.026 [16] 罗美玲,张觇宇. 超声评估子宫内膜容受性在辅助生殖领域应用中的研究进展[J]. 临床超声医学杂志,2021,23(11):856-859. doi: 10.3969/j.issn.1008-6978.2021.11.014 [17] 叶海燕,陈小佩,赵悦子. 三维能量超声子宫内膜容受性检测用于评估体外受精-胚胎移植后妊娠结局的价值[J]. 中国基层医药,2023,30(1):76-80. [18] 谢宛裔,李蓉. 辅助生殖治疗中子宫内膜容受性评估相关临床指标的研究进展[J]. 中华生殖与避孕杂志,2021,41(5):413-418. doi: 10.3760/cma.j.cn101441-20200226-00086 [19] 陈慧佳,吴艺佳,张觇宇,等. 彩色多普勒超声检查预测冻融胚胎解冻移植妊娠结局的价值[J]. 检验医学与临床,2019,16(13):1819-1822. [20] 宋梦洁,徐虹,汪龙霞,等. 子宫内膜容受性的超声评价指标在辅助生殖技术中预测妊娠结局的研究进展[J]. 解放军医学院学报,2021,42(11):1211-1215. doi: 10.3969/j.issn.2095-5227.2021.11.018 [21] 林丹换,覃春容. 辅助生殖技术中子宫内膜容受性指标的评价[J]. 中国计划生育和妇产科,2020,12(7):13-16. doi: 10.3969/j.issn.1674-4020.2020.07.04 [22] 王英华, 鲁海鸥, 李芷舒, 等. 胚胎移植日经阴道三维超声评估子宫内膜容受性对体外受精/卵泡质内单精子显微注射-胚胎移植患者妊娠结局预测价值研究[J]. 临床军医杂志,2020,48(2):191-192. [23] 刘耘利, 许伟标, 刘琼珠, 等. 经阴道三维超声对体外受精-胚胎移植患者子宫内膜容受性的评估及对妊娠结局的预测价值[J]. 中国临床医学影像杂志,2021,32(6):426-431. [24] 杨彬,王薇,苟永贤,等. 阴道三维超声评估子宫内膜容受性预测体外受精-胚胎移植后妊娠结局的临床价值[J]. 临床医学研究与实践,2020,5(29):135-136,139. [25] 周秀萍, 赵雅萍, 王启亮, 等. 经阴道三维能量多普勒血流显像超声监测IVF-ET中子宫内膜参数评估子宫内膜容受性[J]. 浙江医学,2019,41(10):1053-1056. [26] 杨仁祥, 武泽. 子宫内膜容受性的研究进展[J]. 实用妇产科杂志,2019,35(1):19-23.