经阴道彩色多普勒超声检查对卵巢储备功能下降患者卵巢基础状态的评价

目的采用经阴道彩色多普勒超声检查探讨卵巢基础状态与卵巢储备功能的关系,评价其对卵巢储备功能的预测价值。方法 74例不孕患者于自然月经周期第2～3天测定基础性激素水平,同时经阴道彩色多普勒超声检测卵巢最大平面平均直径(MOD)、窦卵泡数(AFC)、卵巢间质动脉峰值流速(PSV)、阻力指数(RI)、搏动指数(PI),并于同一周期行克罗米芬刺激实验(CCCT),应用人绒毛膜促性腺激素(hCG)诱导成熟卵泡排卵,指导同房或行宫腔内人工受精(IUI)。超声监测卵泡发育,同时计数注射hCG日优势卵泡数。结果依据基础性激素测定及CCCT结果将患者分为卵巢储备功能正常组和下降组。卵巢储备功能下降组AFC和PSV值均显著低于正常组(P<0.001),卵巢储备功能下降组MOD低于正常组,但二者差异无统计学意义(P>0.05);卵巢储备功能下降组注射hCG日所获优势卵泡数少,妊娠率低于正常组,二者差异有统计学意义(P=0.021)。卵巢间质动脉PSV与注射hCG日优势卵泡数呈正相关(r=0.432,P=0.014)。结论卵巢基础窦卵泡数和PSV值与卵巢储备功能密切相关,可作为临床预测卵巢储备功能的有效指标。

Transvaginal color Doppler ultrasonography in evaluation of patients with ovarian reserve decline under ovarian basic state

Objective To explore the relationship between ovarian basic state and ovarian reserve function by transvaginal color Doppler ultrasonography Inspection, and to evaluate the value of the ovarian reserve function. Methods Totally 74 cases of infertile women during the second and third day of their natural menstrual period were chosen as the hormone baseline, and the maximum ovarian diameter（ MOD）, antral follicle count（AFC）, peak systolic velocity （PSV）, resistive index（ RI ）and pulsatility index （PI ）were detected by transvaginal color Doppler ultrasonography, and the clomiphene citrate challenge test（CCCT） at the same time was run to accelerate ovulation,to induce mature follicle ovulation by employing human chorionic gonadotrophin（hCG）and to instruct sexual intercourse and intrauterine insemination（IUI）. Monitoring follicular development with ultrasound and while counting the number of dominant follicle on hCG injectione. Results The evidence base to stimulate sex hormone determination and CCCT results were divided into normal ovarian reserve and fall groups. The number decreases of antral follicles and the PSV group were lower than those in normal group （P0.001）, the mean diameter was less than normal ovaries, and both were not significantly different （P0.05）; The fall group received injection of hCG at dominant follicle small number, the pregnancy rate was significantly lower than the normal group （P=0.021）. PSV was positively correlated with the number of dominant follicles on the day of HCG injection（r=0.432,P=0.014）.Conclusion The AFC and PSV are positively correlated with the ovarian reserve function, therefore they can be taken as an effective index for evaluation of the ovarian reserve function.