子宫内膜及内膜下血流参数对冷冻胚胎移植周期妊娠结局的影响

Role of endometrial and subendometrial blood flow index assessment in predicting pregnancy outcome of freezing embryo transfer cycles

目的 探讨冷冻胚胎移植周期（FET）子宫内膜厚度、内膜及内膜下血流分型及相关参数对妊娠结局的影响.方法 回顾性分析468个冷冻胚胎移植周期,采用经阴道彩色多普勒超声测量内膜转化日内膜厚度、内膜及内膜下血流分型、搏动指数（PI）、阻力指数（RI）、收缩期与舒张期血流速度比值（S/D）.按照妊娠结局分为妊娠组和未妊娠组,比较上述指标在两组之间的差异.结果 妊娠组与未妊娠组子宫内膜血流分型比较差异有统计学意义（P＜0.05）,子宫内膜及内膜下血流分型为Ⅰ、Ⅱ、Ⅲ型的妊娠率分别为31.0％、62.5％、79.0％.在内膜转化日妊娠组子宫内膜的S/D、PI、RI明显低于未妊娠组（P＜0.05）,两组之间的子宫内膜厚度差异无统计学意义（P＞0.05）.结论 经阴道彩色多普勒超声测定子宫内膜及内膜下血流分型及内膜血流动力学参数可以反映子宫内膜容受性,可以指导FET胚胎移植时机的选择.

Objective To evaluate the role of transvaginal color Doppler ultrasound measurements of endometrial thickness,endometrium and subendometrial blood distribution patterns and flow index in predicting endometrial receptivity and pregnancy outcome of freezing embryo transfer（FET）.Methods 468 cycles FET were analysed retrospectively.Endometrial thickness,endometrium and subendometrial blood distribution patterns,pulsatility index （PI）,resistance index （RI）,systolic /diastolic ratio （S/D） of endometrial and subendometrial blood flows with transvaginal ultrasonography were measured on the day of progesterone initiation.Based on the clinical pregnancy or not,patients were divided into two groups.The comparison of these indicators were carried out between pregnant group and non pregnant group.Results The endometrium and subendometrial blood distribution patterns had statistical difference between the two groups（P 〈0.05）,the clinical pregnancy rate of Ⅰ,Ⅱ,Ⅲ blood distribution patterns were 31.0%,62.5%,79.0% respectively.In the pregnancy group,the S/D,PI,and RI of endometrium were significantly lower than those in the nonpregnant group （P 〈 0.05）,and there was no significant difference between the pregnant group and nonpregnant group in endometrial thickness（P 〉0.05）.Conclusions Endometrium and subendometrial blood distribution patterns and flow index measured with transvaginal color Doppler ultrasound could assess endometrial receptivity and guide the time selecting of FET transplantation.