经阴道二维及三维超声对体外受精-胚胎移植子宫内膜容受性的评估价值

目的应用经阴道二维及三维超声检测子宫内膜厚度、容积和内膜及内膜下血流，比较各参数对体外受精-胚胎移植（IVF-ET）中子宫内膜容受性的评估价值。 方法应用经阴道二维及三维超声，对120例接受IVF-ET的不孕症患者于控制性超排卵（COH）周期人绒毛膜促性腺激素（HCG）注射日进行子宫内膜厚度、内膜容积、内膜及内膜下血流搏动指数（pulse index，PI）、阻力指数（resistance index，RI）、收缩期与舒张期比值（S/D）、内膜及内膜下区域的血管化指数（VI）、血流指数（FI）、血管化血流指数（VFI）测定，根据妊娠结果分为妊娠组与未妊娠组，比较两组之间各参数的差异。 结果120例患者临床妊娠39例，妊娠率为32.5%。两组间子宫内膜厚度、内膜容积差异无统计学意义（P>0.05），子宫内膜厚度与内膜容积预测妊娠的ROC曲线下面积分别为0.584和0.557；妊娠组内膜及内膜下血流的PI、RI、S/D均明显低于非妊娠组，两组间比较差异均具有统计学意义（Z?＝?-3.811、-3.097、-2.071，P?＝?0.001、0.001、0.038）；内膜及内膜下血流PI、RI、S/D预测妊娠的ROC曲线下面积分别为0.652、0.611、0.612；妊娠组内膜及内膜下VI、FI、VFI参数均高于非妊娠组，两组间比较差异有统计学意义（Z?＝?-1.970、-2.698、-1.981，P?＝?0.490、0.007、0.048；Z?＝?-2.098、-2.090、-2.115，P?＝?0.036、0.037、0.034）。内膜及内膜下VI、FI、VFI预测妊娠的ROC曲线下面积分别为0.729、0.670、0.655及0.720、0.715、0.617。 结论经阴道二维及三维超声可用于评价子宫内膜容受性、预测IVF-ET结局，二维及三维血流参数比较，内膜及内膜下容积血流参数VI对妊娠结果有一定的预测价值。

Study on transvaginal two-dimensional and three-dimensional ultrasound in the eveluation of endometrial receptivity during in vitro fertilization-embryo transfer treatment

ObjectiveTo determine endometrial thickness, endometrial volumeand, endometrial and subendometrial blood flows, by using transvaginal two-dimensional (2D) and three-dimensional (3D) ultrasound examination and to compare the value of all the parameters in the prediction of endometrial receptivity during in vitro fertilization-embryo transfer (IVF-ET) cycles. MethodsOne hundred and twenty patients undergoing IVF cycles were recruited for this study. Transvaginal 2D and 3D ultrasound examination was performed to determine endometrial thickness, endometrial volume, pulsatility index (PI), resisitance index (RI) , systolic/diastolic ratio (S/D) of endometrial, subendometrial blood flows , vascularization index (VI), flow index (FI) and vascularization flow index (VFI) of endometrial and subendometrial regions by experienced sonographers on the day of human chorionic gonadotropin (HCG) injection. Statistical comparison was carried out by Mann-Whitney test. The receiver operator characteristic (ROC) curve analysis was applied and the area under the curve (AUC) was calculated. Statistic analyses were performed using SPSS 13.0. The two-tailed value of was considered statistically significant. ResultsThere were no significant differences between the pregnant group and non-pregnant group in endometrial thickness, endometrial volume (P>0.05). Patients in the pregnant group had lower PI, RI and S/D of endometrial and subendometrial blood flows than those in the non-pregnant group (Z=-3.811, -3.097, -2.071, P=0.001, 0.001, 0.038), with statisticalsignificant difference. Patients in the pregnant group had higher VI, FI and VFI of endometrial and subendometrial regions than those in the non-pregnant group (Z=-1.970, -2.698, -1.981, P=0.490, 0.007, 0.048; Z=-2.098, -2.090, -2.115, P=0.036, 0.037, 0.034), with statistical significant difference. ConclusionsEndometrial and subendometria blood flows measured by transvaginal 2D and 3D ultrasound can be as a reliable indicator to assess endometrial receptivity and predict the pregnancy outcome. Among all the endometrial and subendometrial blood flow parameters, VI of endometrial and subendometrial are better predicators.