子宫内膜血流灌注在评价子宫内膜容受性中的作用

目的 探讨超声检测的子宫及内膜血流指标在评价子宫内膜容受性中的价值.资料与方法 不孕组21例,对照组18例.自然月经周期中,黄体生成素峰出现日(LH d),超声观察子宫内膜回声类型,检测双层子宫内膜厚度、子宫动脉收缩期峰值血流速度(PSV)、阻力指数(RI);能量多普勒超声检测子宫内膜血流灌注情况并分为A、B、C型；扫描电镜观察(LH+3)～(LH+9)d子宫内膜胞饮突的发育.结果 不孕组与对照组子宫内膜厚度(t=-0.768,P=0.447)、回声类型分布(Z=-0.203,P=0.839)以及子宫动脉PSV(t=-0.947,P=0.349)、RI(t=0.591,P=0.557)差异均无统计学意义；能量多普勒超声检测两组子宫内膜血流灌注分型差异有统计学意义(Z=-2.272,P=0.023)；完全发育的胞饮突出现在“种植窗”期,A、B、C型内膜血流灌注组完全发育的胞饮突数量差异有统计学意义(x2=6.785,P=0.034),两者呈负相关(r=-0.672,P=0.004).结论 临近“种植窗”期,子宫内膜从血流灌注水平、超微结构的胞饮突数量上呈相关性变化,提示能量多普勒超声检测的子宫内膜血流灌注状态指标可作为胞饮突的替代性指标,用以评价子宫内膜容受性.

Endometrial Blood Flow Perfusion in Evaluating Endometrial Receptivity

Purpose To investigate uterine and endometrial blood flow index detected by ultrasound in evaluating endometrial receptivity.Materials and Methods There were 21 women in infertility group and 18 women in control group.On luteinizing hormone(LH) day during natural cycles,endometria was detected in echo pattern to measure endometrial thickness,peak systolic velocity(PSV) and resistance index(RI) of uterine artery with ultrasonography.Endometrial blood flow perfusion was graded as type A,type B and type C with energy Doppler ultrasonography.Endometrial biopsic samples were collected for electron microscope(SEM) observation from(LH+3) d to(LH+9) d sequentially.Endometrial pinopodes growing processes were investigated.Results There was no statistical difference in endometrial thickness(t =-0.768,P = 0.447),echo pattern(Z =-0.203,P = 0.839),PSV(t =-0.947,P = 0.349) and RI(t = 0.591,P = 0.557) of uterine artery between infertility group and control group.But grades of visible blood flow of the endometria detected by energy Doppler ultrasound was significantly different between the two groups(Z =-2.272,P = 0.023).There was statistical significance in number of fully developed pinopodes which formed in the implantation window in the groups with different endometrial blood flow perfusion type(χ2 = 6.785,P = 0.034),which related with pinopodes developing(r =-0.672,P = 0.004).Conclusion Around the implantation window,endometria appears relative changes from ultrastructure and blood perfusion.It demonstrates that grade of visible color flow of endometria detected with energy Doppler ultrasonography may be alternate indices for pinopodes to reflect endometrial receptivity.