经阴道彩色多普勒超声对排卵期卵巢动脉血流动力学研究

Study of ovarian artery blood flow in ovulatory phase by transvaginal color Doppler ultrasound

目的探讨排卵期卵巢动脉在卵泡生长成熟和排卵前后的血流动力学变化。方法应用经阴道彩色多普勒超声对30例正常生育期妇女(正常对照组)和30例排卵障碍患者(排卵障碍组)进行检查,观察排卵周期中卵巢动脉血流灌注情况,包括收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)、搏动指数(PI),并予以对比分析。结果整个排卵周期中,正常对照组卵巢动脉血流较丰富且随排卵动态改变;排卵障碍组始终呈现血流纤细、低振幅高阻力表现。在排卵前期,正常对照组PSV、EDV高于排卵障碍组(P<0.01),RI、PI低于排卵障碍组(P<0.05);在排卵期,正常对照组组卵巢动脉血流速度达峰值,PSV、EDV仍高于排卵障碍组(P<0.01),RI、PI远低于排卵障碍组(P<0.01);在黄体早期,正常对照组流速逐渐下降,RI、PI稍上升,其中EDV仍高于排卵障碍组(P<0.01),RI、PI低于排卵障碍组(P<0.01);两组差异在排卵期和黄体早期较为明显(P<0.01),其中排卵期的卵巢动脉RI>0.72、PI>1.50,出现排卵障碍的敏感性及特异性分别为89.5%、83.9%。另外,整个排卵周期正常对照组功能侧卵巢动脉RI、PI分别与对侧卵巢RI、PI相近,差异无统计学意义(P>0.05)。结论应用经阴道彩色多普勒超声可分析卵巢动脉血流动力学指标,评价卵泡发育成熟情况,为临床辅助受孕治疗提供可靠依据。

Objective To explore the changes of ovarian artery blood flow during follicle maturation and ovulation. Methods Thirty normal women and 30 ovulation barrier sterile women were examined by transvaginal ultrasonography, the ovarian artery blood perfusion in ovulatory phase was observed, the parameters including peak systolic velocity （PSV）, end- diastolic velocity （EDV）, resistance index （RI） and pulsatility index （PI） were measured, the results were compared and analyzed. Results In normal women group during ovulatory phase, the ovarian perfusion became more abundant and varied with the follicular development, while in ovulation barrier sterile women group, the ovarian perfusion was always low and RI was obviously high. During the preovulation phase, PSV and EDV in normal group were higher than those in ovulation barrier sterile group （ P〈0.01 ）, RI and PI were lower than those in ovulation barrier sterile group （P〈0.05） ; in the ovulatory phase, the flow velocity was high in the normal group, PSV and EDV were still higher than those in ovulation barrier sterile group（P〈0.01 ）, RI and PI turned to low level, and were much lower than those in ovulation barrier sterile （P〈0.01） ; in the luteal phase, after ovulation, the ovarian artery perfusion was decreased gradually, RI and PI was ascended slightly in the normal group, EDV was still higher, while RI and PI were lower than those of the ovulation barrier sterile group（ P〈0.01 ）, the statistics are different in two groups, especially in the ovulatory phase and luteal phase （ P〈0. 01 ）. In the ovulatory phase, the sensitivity and specificity of RI〉0.72 and PI〉1. 50 for ovulation barrier infertility were 89.5% and 83.9%. In the normal group, RI and PI of the ovarian artery were similar between the functional ovary and opposite side ovary （P〉0.05）. Conclusion Transvaginal color Doppler ultrasonography can analyze the flow indexes of ovarian artery and understand the follicular development and the degree of folliclar maturation, it can provide reliable information for infertility treatment.