卵泡周围血流参数与IVF-ET卵泡发育、胚胎质量和妊娠结局的相关性分析

Correlation analysis of perifollicular blood flow parameters with IVF-ET follicular development,embryo quality and pregnancy outcome

目的分析卵泡周围血流参数与体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)卵泡发育、胚胎质量和妊娠结局的相关性。方法回顾性病例对照研究分析2020年10月至2022年10月期间驻马店市中心医院生殖医学科收治的112例接受IVF-ET的不孕患者资料。使用阴道彩色多普勒超声测量卵泡周围血流参数,即动脉收缩期峰值流速/舒张末期血流速度比值(peak systolic velocity/end diastolic velocity,S/D)、阻力指数(resistance index,RI)、搏动指数(pulsatility index,PI)、收缩期最大血流速度(peak systolic velocity,PSV)。共提取1156个卵泡,依照卵泡发育情况划分为优质卵泡组(n=208)和非优质卵泡组(n=948),依照胚胎质量划分为优质胚胎组(n=161)和非优质胚胎组(n=995),依照妊娠结局划分为妊娠组(n=37)和未妊娠组(n=75),比较不同组间的S/D、RI、PI、PSV。对比不同卵泡周围血流PSV峰速间相关指标,以Pearson法分析非优质卵泡组、非优质胚胎组、未妊娠组中PSV与卵泡发育、胚胎质量、妊娠结局的相关性。结果优质卵泡组PSV[(11.26±0.94)cm/s]明显较非优质卵泡组高[(10.31±0.78)cm/s,P<0.001],两组间S/D、RI、PI差异均无统计学意义(均P>0.05)。优质胚胎组PSV[(13.38±1.19)cm/s]明显较非优质胚胎组高[(12.02±0.85)cm/s,P<0.001],优质胚胎组、非优质胚胎组间S/D、RI、PI比较,差异均无统计学意义(均P>0.05)。妊娠组PSV[(15.14±1.25)cm/s]明显较未妊娠组[(8.27±0.75)cm/s,P<0.001]高,妊娠组、未妊娠组间S/D、RI、PI比较,差异均无统计学意义(均P>0.05)。不同卵泡周围血流PSV峰速间年龄、不孕年限、体质量指数、基础卵泡刺激素水平、促性腺激素(gonadotropin,Gn)用量、Gn使用时间对比差异均无统计学意义(均P>0.05),而优质卵泡数、优质胚胎数、血β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)水平组间比较差异有统计学意义[PSV<9 cm/s:(1.05±0.23)个、(0.73±0.14)个、(3.05±0.61)U/L;PSV 9~10 cm/s:(1.35±0.35)个、(0.85±0.16)个、(22.14±5.78)U/L;PSV>10 cm/s:(2.01±0.41)个、(1.12±0.20)个、(71.33±8.63)U/L;均P<0.001];采用Pearson进行相关性分析,结果显示非优质卵泡组、非优质胚胎组、未妊娠组中PSV与卵泡直径、胚胎质量评分、血β-hCG水平呈正相关(r=0.767,P<0.001;r=0.750,P<0.001;r=0.700,P<0.001)。结论卵泡周围血流参数PSV与IVF-ET卵泡发育、胚胎质量、妊娠结局具有相关性,可为临床评定卵泡发育、胚胎质量、妊娠结局提供重要参考。

Objective To analyze the correlation of perifollicular blood flow parameters with follicle development,embryo quality and pregnancy outcome in in vitro fertilization and embryo transfer(IVF-ET).Methods A retrospective case-control study was conducted to analyze the data of 112 infertile patients who underwent IVF-ET admitted to the Department of Reproductive Medicine of Zhumadian Central Hospital from October 2020 to October 2022.Perifollicular blood flow parameters[peak systolic velocity/end diastolic velocity(S/D),resistance index(RI),pulsatility index(PI)and peak systolic velocity(PSV)]were measured by vaginal color doppler ultrasound.A total of 1156 follicles were extracted,they were divided into high-quality follicle group(n=208),and non-high-quality follicle group(n=948)according to follicle development,high-quality embryo group(n=161)and non-high-quality embryo group(n=995)according to embryo quality,pregnant group(n=37)and non-pregnant group(n=75)according to pregnancy outcome.The S/D,RI,PI and PSV of the groups were compared.The correlation indexes of PSV peak velocity among different perifollicular blood flow were compared,and the correlation between PSV and follicle development and embryo quality in non-high-quality follicle group,non-high-quality embryo group and non-pregnant group was analyzed by Pearson method.Results PSV in high-quality follicle group[(11.26±0.94)cm/s]was significantly higher than that in non-high-quality follicle group[(10.31±0.78)cm/s,P<0.001],but there were no significant differences in S/D,RI and PI between high-quality follicle group and non-high-quality follicle group(all P>0.05).PSV was significantly higher in the high-quality embryo group[(13.38±1.19)cm/s]than in the non-high-quality embryo group[(12.02±0.85)cm/s,P<0.001],but there were no significant differences in S/D,RI and PI between high-quality embryo group and non-high-quality embryo group(all P>0.05).PSV of pregnant group[(15.14±1.25)cm/s]was significantly higher than that of non-pregnant group[(8.27±0.75)cm/s,P<0.001],and there were no significant differences in S/D,RI and PI between pregnant group and non-pregnant group(all P>0.05).There were no statistically significant differences in age,infertility duration,body mass index,basal follicle-stimulating hormone level,total dosage and duration of gonadotropin used among different perifollicular blood flow PSV peak velocity(all P>0.05),but there were statistically significant differences in the number of high-quality follicles,the number of high-quality embryos and the level ofβ-human chorionic gonadotropin(β-hCG)[<9 cm/s:1.05±0.23,0.73±0.14,(3.05±0.61)U/L;9-10 cm/s:1.35±0.35,0.85±0.16,(22.14±5.78)U/L;>10 cm/s:2.01±0.41,1.12±0.20,(71.33±8.63)U/L;all P<0.001].Pearson correlation analysis showed that PSV was positively correlated with follicle diameter,embryo quality score and bloodβ-hCG level(r=0.767,P<0.001;r=0.750,P<0.001;r=0.700,P<0.001)in non-high-quality follicle group,non-high-quality embryo group,non-pregnant group.Conclusion Perifollicular blood flow parameter PSV is correlated with IVF-ET follicle development,embryo quality and pregnancy outcome,which can provide an important reference for clinical evaluation of follicle development,embryo quality and pregnancy outcome.