3D-PDI评估IVF-ET中HCG日孕酮升高对子宫内膜的影响

目的：探讨体外受精-胚胎移植（IVF-ET）中人绒毛膜促腺性激素注射日（HCG日）血清孕酮水平升高对子宫内膜的影响及其与妊娠结局的相关性。方法：通过经阴道三维能量多普勒血流显像超声（3D-PDI）检测于2018年2月至9月间在温州医科大学附属第二医院生殖中心接受IVF-ET的180例不孕患者的子宫内膜厚度、内膜回声、内膜血流分型、内膜容积、内膜血管化指数（Ⅵ）、血流指数（FI）及血管化血流指数（VFI）。检测患者HCG日血清孕酮水平，根据ROC曲线分析获得的孕酮升高截断值分为孕酮升高组和孕酮正常组，分析各参数的差异性及其与妊娠结局的相关性。结果：180 例中有84 例妊娠成功为妊娠组，5 例生化妊娠，2例宫外孕，89 例未妊娠为未妊娠组，临床妊娠率约46.6%。ROC曲线分析结果显示HCG日孕酮升高截断值为1.29 ng/mL，孕酮升高组59例，孕酮正常组121例。孕酮升高组和孕酮正常组年龄、内膜FI值差异无统计学 意义（P ＞0.05）；与孕酮正常组相比，孕酮升高组C型内膜占比和I型血流占比增高（P ＜0.05），Ⅲ型血流占比减少（P ＜0.05）；孕酮升高组内膜厚度、内膜容积、内膜VI、VFI小于孕酮正常组（P ＜0.05）。妊娠组和未妊娠组的年龄、内膜厚度、内膜容积、内膜FI差异无统计学意义（P ＞0.05）；妊娠组内膜VI、VFI高于未妊娠组（P ＜0.05）；A型、B型、C型内膜回声患者的妊娠率依次减低，I型、II型、III型内膜血流患者的妊娠率依次增高，差异有统计学意义（P ＜0.05）。结论：IVF-ET中HCG日孕酮升高导致子宫C型内膜占比增高，内膜血流灌注减少，内膜血管化程度减低，不利于妊娠成功。

Elevated progesterone on HCG day and its effect on the endometrium evaluated by three-dimensional power Doppler flow imaging

Objective: To study the elevated progesterone on the day of HCG injection in in vitro fertilization and embryo transfer (IVF-ET) treatment and its effect on the endometrium and its correlation with pregnancy outcome. Methods: Transvaginal three-dimensional power Doppler flow imaging ultrasound (3D-PDI) was used to examine 180 patients who were treated with IVE-ET at the Reproductive Center of the Second Affiliated Hospital of Wenzhou Medical University from February to September 2018. Data of their endometrial thickness, echo, endometrial blood flow classification and endometrial volume, endometrial vascularization index (VI), blood flow index (FI) and vascularized blood flow index (VFI) were obtained, and the serum progesterone value on HCG day elevation. According to ROC curve analysis, the cut-off value of HCG day progesterone measured was divided as the elevated progesterone group followed by an analysis of parameters and its correlation with pregnancy outcomes. Results: Of 180 cases, 84 were successful and became pregnant group, 5 biochemical pregnancy, 2 ectopic pregnancy, 89 cases were not pregnant and became non-pregnant group. The clinical pregnancy rate was about 46.6%. ROC curve analysis showed the cut-off value of elevated progesterone was 1.29 ng/mL. There were 59 cases in the elevated progesterone group and 121 cases in the normal progesterone group, showing no significant difference in age and endometrial FI between the two groups (P>0.05). In the elevated progesterone group, the proportion of type C endometrium and the type I blood flow were higher than the normal progesterone group, while the proportion of type III blood flow was lower than the normal progesterone group, with statistical difference (P<0.05). The endometrial thickness, endometrial volume, endometrial VI and VFI in the elevated progesterone group were lower than those in the normal progesterone group (P<0.05). There was no significant difference in age, endometrial thickness, endometrial volume and endometrial FI between the pregnant group and the non-pregnant group (P>0.05). The endometrial VI and VFI of the pregnant group were higher than those of the non-pregnant group (P<0.05). The pregnancy rate of type A, type B and type C endometrial echo decreased sequentially, while the pregnancy rate of type I, type II and type III endometrial blood flow increased sequentially, with significant difference (P<0.05). Conclusion: Elevated progesterone on HCG day in IVF-ET will lead to an increased proportion of type C endometrium, decreased endometrial blood perfusion and endometrial vascularization, which is not conducive to successful pregnancy.