经阴道3D-PDI联合2D-SWE定量参数评估备孕女性ER及预测受孕结局的价值

目的 探讨经阴道三维能量多普勒血流显像超声(3D-PDI)联合二维实时剪切波弹性成像(2D-SWE)评估备孕女性子宫内膜容受性(ER)及预测受孕结局的价值。方法 选取2020年1月~2022年3月本院接受卵泡检测的87例备孕女性,均于排卵第7~8天(种植窗期)进行经阴道3D-PDI、2D-SWE检查和生殖激素水平检测。随访6周,根据受孕结局将其分为受孕组31例和未受孕组56例,比较两组种植窗期的血清雌二醇(E₂)、睾酮(T)、孕酮(P)、促黄体生成素(LH)、促卵泡生成素(FSH)水平和子宫内膜厚度、容积、内膜回声类型、内膜血流分型及子宫螺旋动脉搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张末期流速(S/D)值、血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)及增殖期弹性模量值等参数；受试者操作特征曲线(ROC)分析经阴道3D-PDI联合2D-SWE定量参数对备孕女性受孕结局的预测价值。结果 受孕组和未受孕组年龄、BMI、生育史、备孕时间和E₂、P、T、LH、FSH水平无显著差异(P＞0.05)；受孕组子宫内膜厚度显著高于未受孕组(P＜0.05)；两组子宫容积、子宫内膜回声类型和子宫内膜血流分型无显著差异(P＞0.05)；受孕组S/D和增殖期弹性模量值均显著低于未受孕组,FI显著高于未受孕组(P＜0.05)；两组PI、RI、VI和VFI无显著差异(P＞0.05)；ROC分析,子宫内膜厚度、S/D、FI和增殖期弹性模量值预测备孕女性受孕结局的ROC分别为0.789、0.851、0.853和0.840,联合检测预测备孕女性受孕结局的ROC为0.895(P＜0.05)。结论 经阴道3D-PDI联合2D-SWE定量参数可客观全面的评估备孕女性ER,临床可用于预测备孕女性受孕结局。

Value of transvaginal 3D-PDI combined with 2D-SWE quantitative parameters in evaluating ER and predicting conception outcomes in planning pregnancy women

Objective To explore the value of transvaginal three-dimensional power Doppler imaging (3D-PDI) combined with two-dimensional real-time shear wave elastography (2D-SWE) in evaluating endometrial receptivity (ER) and predicting conception outcomes in planning pregnancy women. Methods A total of 87 planning pregnancy women undergoing follicular test in the hospital were enrolled between January 2020 and march 2022. All underwent 3D-PDI and 2D-SWE, and were tested for reproductive hormone on the 7_th^-8_th day after ovulation (implantation window period). All were followed up for 3 month. According to conception outcomes, they were divided into conception group (31 cases) and non-conception group (56 cases). The levels of serum estradiol (E₂), testosterone (T), progesterone (P), luteinizing hormone (LH) and follicle stimulating hormone (FSH) during implantation window period, endometrial thickness, volume, types of endometrial echoes, classifications of endometrial blood flow, spiral artery pulsatility index (PI), resistance index (RI), peak systolic velocity/end-diastolic velocity (S/D), vascularization index (VI), flow index (FI), vascularization flow index (VFI) and elasticity modulus during proliferation period were compared between the two groups. The predictive value of transvaginal 3D-PDI combined with 2D-SWE quantitative parameters for conception outcomes was analyzed by receiver operating characteristic (ROC) curves. Results There was no significant difference in age, BMI, reproductive history, planning pregnancy time, E₂, P, T, LH or FSH between the two groups (P>0.05). The endometrial thickness in conception group was significantly thicker than that in non-conception group (P<0.05). There was no significant difference in uterine volume, types of endometrial echoes or classifications of endometrial blood flow between the two groups (P>0.05). S/D and elasticity modulus during proliferation period in conception group were significantly lower than those in non-conception group, while FI was significantly higher than that in non-conception group (P<0.05). There was no significant difference in PI, RI, VI or VFI between the two groups (P>0.05). ROC curves analysis showed that area under ROC curve (AUC) values of endometrial thickness, S/D, FI, elasticity modulus during proliferation period and combined detection for predicting conception outcomes were 0.789, 0.851, 0.853, 0.840 and 0.895, respectively (P<0.05). Conclusion Transvaginal 3D-PDI combined with 2D-SWE quantitative parameters can evaluate ER in planning pregnancy women objectively and comprehensively, which can be applied to predict conception outcomes in clinical practice.