不同促排卵方案对子宫内膜血流、厚度、类型的影响

The effects of different ovulation induction schemes on endometrial blood flow,thickness and types

目的探讨多囊卵巢综合征(PCOS)患者促排卵中子宫内膜血流、厚度、类型与妊娠的相关性。方法对119例4组[克罗米芬(CC)、克罗米芬+补佳乐组(CC+PGV)、克罗米芬+人绝经期促性腺激素组(CC+HMG)、来曲唑(LE)]PCOS不孕患者进行145个周期促排卵对照研究,比较各组卵泡中、晚期子宫内膜血流参数值PI(搏动指数)、RI(阻力指数)、S/D(收缩期与舒张期速度比值),内膜厚度,类型,妊娠率。结果 (1)CC+HMG及LE组卵泡中、晚期:子宫内膜血流值小于CC及CC+PGV组(P<0.05);子宫内膜厚度大于CC、CC+PGV组(P<0.05),两者间均有统计学差异。(2)CC+PGV组卵泡中期子宫内膜血流值小于CC组(P<0.05);两组间子宫内膜厚度无统计学差异。(3)各组间子宫内膜类型无统计学差异,CC+HMG组妊娠率较其它三组高(32.3%,P<0.05)。(4)妊娠者卵泡晚期子宫内膜血流值小于非妊娠者(P<0.05);内膜类型A型率(70%)大于非妊娠者(22%)(P<0.05),两者间内膜厚度无统计学差异。结论 CC+HMG和LE治疗PCOS不孕者子宫内膜血流灌注、子宫内膜厚度优于CC及CC+PGV,CC+HMG有显著的妊娠率,加用PGV后可改善CC对子宫内膜血流灌注的影响。子宫内膜血流参数值PI、RI、S/D,厚度和类型与妊娠率相关,是评价子宫内膜容受性较好的手段。

Objective To investigate the correlation between endometrial blood flow,thickness,types and pregnancy in patients of PCOS after using different ovulation drugs.Methods A study involved 119 infertile women with PCOS（4 groups） as observation group,which were treated with different circles of different ovulation drugs：Clomifene（CC）,Clomifene ＋ Estradiol Valerate（CC ＋ PGV）,Clomifene ＋ Menotrophin（CC ＋ HMG）,letrozole（LE）.Compare endometrial the blood flow parameters value PI（pulsations index）,RI（resistance index）,S/D（systolic and diastolic speed ratio）,endometrial thickness,type,pregnancy rate among these groups in mid and late follicular.Results（1）In middle and late follicles comparing with CC group and CC ＋ PGV group,endometrial blood flow value in CC HMG group and LE group was significantly lower（P 0.05）,while endometrial thickness was significantly greater.No significances were found between CC＋ HMG and LE group.（2）Compared with CC group in mid follicles,endometrial blood flow value in CC ＋PGV group was lower,（P〈0.05）.Endometrial thickness between two groups was not statistically significant.（3）Endometrial type had no difference among each group（P〈0.05）,the pregnancy rate in CC＋ HMG group was significantly higher than other three groups（32.3%,P〈0.05）.4.In late follicles,compared with cases with no pregnancy,endometrial thickness in cases with pregnancy was not statistically significant,endometrial blood flow value was lower（P〈0.05） and endometrial type A rate（70%） in cases with pregnancy was higher than the rate in cases with non-pregnancy（22%）（P〈0.05）.Conclusion When treating infertile women with PCOS,CC ＋ HMG and LE,endometrial thickness and endometrial blood perfusion was superior to groups treating with CC and CC ＋ PGV.pregnancy rates of CC ＋HMG group was the highest;when adding PGV to CC,the influence of endometrial blood perfusion caused by CC could be improved.Endometrial blood flow parameters value PI,RI,S/D,thickness and types were correlated with pregnancy rates,which may be good means to evaluate endometrial let.