应用彩色多普勒能量图检测子宫内膜血流评价IVF-ET结局

Endometrial blood flow distribution measured by color Doppler energy imaging in the prediction of pregnancy outcomes during in vitro fertilization and embryos transfer cycles

目的探讨彩色多普勒能量超声子宫内膜血流检测在预测IVF-ET结局中的作用。方法前瞻性研究2005年11月～12月于我中心行IVF-ET，年龄在38岁以下的患者182例，测定hCG注射日（注射hCG前8h）子宫内膜厚度、形态及血流状态，按子宫内膜血流显示情况分为3组：A组，不能检测到子宫内膜血流；B组，仅可检测到子宫内膜下血流；C组，可检测到子宫内膜内及子宫内膜下血流。随访IVF—ET结局，组1为未妊娠组，组2为宫内孕活胎组（移植后30d超声检查宫内可见妊娠囊及有原始胎心管搏动），组3为其他（包括生化妊娠、异位妊娠、胚胎停育和自然流产）。结果c组的宫内活胎率为62，2％（59／90）、胚胎种植率为65．6％（59／90），明显高于A组（0、0）及B组[17．1％（14／82）、20．7％（17／82）]，差异有高度显著性（P〈0．001）。组2（宫内孕活胎组）子宫内膜PI、RI及S／D分别为1，0±0．2、0，6±0．1及2，5±0．4，明显低于组1的1．1±0．2、0．6±0，0、2．8±0．4及组3的1，0±0．1、0．6±0，0、2．8±0．4（P1-2〈0．001，P2-3〈0，05）。妊娠组hCG日子宫内膜厚度、形态、容积及子宫、卵巢动脉血流与其他两组相比差异无显著性。结论hCG日子宫内膜内血流存在与否与胚胎种植及继续发育明显相关；存在子宫内膜内血流及子宫内膜血流阻力低者，显示了较高的临床妊娠率及胚胎种植率；彩色多普勒能量图检测子宫内膜血流预测子宫内膜容受性，是一种较好的无创检查方法。

Objective To discuss the role of endometrial blood flow screening measured by color Doppler energy （CDE） in the prediction of outcomes in patients receiving in vitro fertilization and embryos transfer （IVF-ET）. Methods A total of 182 women below the age of 38 years old undergoing IVF-ET in this center from November 2005 to December 2005 were recruited in this prospective study. The endometrial thickness, echo pattern, and blood flow status were detected by transvaginal ultrasonography on the day of hCG injection （8 hours before injection）. The patients were divided into three groups： Group A, the endometrial blood flow could not be detected; Group B, only sub-endometrial blood flow could be detected; and Group C, both endometrial and subendometrial blood flow could be detected. All the patients were re-divided into three groups according to their outcomes of IVF-ET： Group 1, no pregnancy; Group 2, intrauterine pregnancy with live fetus and Group 3, other conditions （including biochemical pregnancy, embryonic diapause, ectopic pregnancy, and spontaneous abortion） were encountered. Results The clinical pregnancy rate with live fetus and the implantation rate were significantly higher in the Group C （62.2% and 65.6% ） than in the Group A （0 and 0） and the Group B （ 17.1% and 20.7% ）, respectively （P 〈0.001 ）. The pulsatility index （ PI）, resistance index （ RI）, and S/D ratio of the endometrial spiral arteries were 1.0±0.2, 0. 6 ± 0.1, and 2.5 ±0.4 in the Group 2, which were significantly lower than those in the Group 1 （ 1.1 ±0.2, 0.6 ±0.0, and 2.8 ±0.4） and the Group 3 （ 1.0 ±0.1, 0.6 ±0.0, and 2.8 ±0.4） （ Pl -2 〈 0. 001, P2-3 〈 0.05）. The endometrial thickness, echo pattern, endometrial volume, and blood flow status of the uterus artery and the ovary artery showed no significant differences between the Group 2 and the other two groups. Conclusions The status of endometrial blood flow on the day of hCG injection is closely associated with the ability of embryo implantation and developmental potential. Those whose endometrial blood flow can be detected show higher clinical pregnancy rate and implantation rate. The clinical application of color Doppler energy for detecting the endometrial blood flow is a non-invasive method in the prediction of endometrial receptivity.