子宫及内膜血流参数与冻融胚胎移植妊娠结局的关系

The Uterine and Endometrial Blood Flow Index and Pregnancy Outcome of Frozen-thawed Embryo Transfer Cycles

目的：探讨子宫及子宫内膜血流动力学变化对冻融胚胎移植（frozen-thawed embryo transfer,FET）妊娠结局的影响。方法：310例FET患者按照临床妊娠结局分为妊娠组（153例）和非妊娠组（157例）。所有患者均于内膜转化日及移植前1 d,通过彩色多普勒超声诊断仪监测子宫内膜厚度、子宫内膜容积（V）、子宫内膜及内膜下血流相关参数。结果：转化日妊娠组子宫动脉搏动指数（PI）、收缩期峰值流速（PSV）与舒张末期流速（EDV）比值（S/D）低于非妊娠组,子宫内膜容积高于非妊娠组（P〈0.05）;移植前日妊娠组PI、阻力指数（RI）均低于非妊娠组,血流指数（FI）、子宫内膜容积均高于非妊娠组（P〈0.05）;子宫内膜容积的ROC曲线下面积为0.637,显著大于参考下面积（P〈0.01）。移植前日子宫动脉PSV、EDV、RI较转化日低,而子宫内膜FI、子宫内膜容积较转化日高（P〈0.05）。子宫动脉RI、PI及子宫内膜容积与子宫内膜厚度的相关系数分别为-0.431、-0.775及0.796（P〈0.01）。据RI值分为0.70-0.85组和0.86-0.95组,妊娠率分别为53.18%、40.00%,0.70-0.85组妊娠率较高（P〈0.05）。结论：移植前日PI、RI较低者易获得妊娠。子宫内膜容积对子宫内膜容受性有一定的预测价值。PI、RI可能通过改变子宫内膜厚度而影响子宫内膜容受性。

Objective： To investigate the relationship between the uterine and endometrial blood flow index and the pregnancy outcomes of frozen-thawed embryo transfer （FET） cycles. Methods： Three hundred and ten women who had undergone FET were grouped into two groups, the pregnancy group （n =153） and the non - pregnancy group （n=157）, according to the clinical outcomes. All patients were asked to monitor the endometrial thickness, endometrial volume （V）, endometrial and subendometrial blood flow on the endometrial transformation days and before transplantation day. Results： The uterine artery pulsatility index （PI）, the peak systolic velocity （PSV）/end diastolic velocity （EDV） on the endometrial transformation day in the pregnant group were significantly lower than those in the non-pregnant group（P〈0.05）. The PI and resistance index （RI） on the transplantation day in the pregnant group was significantly lower than those in the non-pregnant group, while the flow index（FI） and V value in the pregnant group were significantly higher （P〈 0.05）. The area under the ROC curve of endometrial volume in the pregnancy group was significantly higher （0.637, P〈0.01）. The uterine artery PSV, EDV and RI on the pre -transplant day were lower than those on the transformation day, while FI and V value on the pre -transplant day were higher than those on the transformation day （P〈 0.05）. The correlation coefficient between the uterine artery RI, PI, V and endometrial thickness were -0.431, -0.775 and 0.796（P〈0.01）. The pregnancy rate in those women with the uterine RI 0.70-0.85 was significantly higher than that in those women with the uterine RI 0.86-0.95 （53.18% vs. 40.00%, P〈0.05）. Conclusions：Those women with lower RI and PI on the transplantation day are more likely to get pregnancy. The V value is helpful for predictiving the endometrial receptivity. The PI and RI may affect the endometrial receptivity.