未破裂卵泡黄素化综合征患者卵泡与子宫内膜发育同步性的三维能量多普勒超声评价

The application of three-dimensional ultrasound in evaluation of follicle and endometrium growth of infertility patients with luteinized unruptured follicle syndrome

目的对比观察未破裂卵泡黄素化综合征(LUFS)患者与正常女性月经周期各节点卵泡与子宫内膜发育特点,探讨LUFS患者卵泡与子宫内膜发育同步性。方法对比观察LUFS患者(LUFS组)与正常排卵女性共60例(正常组)在卵泡早期、卵泡中期、围排卵期、黄体早期、黄体中期、黄体晚期的卵泡体积、子宫内膜体积、血流动力学参数(VI、FI、VFI),通过两组诸参数差异和生长变化曲线图差异分析LUFS患者卵泡与子宫内膜发育同步性。结果 (1)与正常组比较,LUFS组卵泡早期、卵泡中期卵泡体积、子宫内膜体积差异无统计学意义(P> 0. 05),围排卵期LUFS组卵泡体积、子宫内膜体积偏小(P <0. 05),且增长速度慢;全黄体期LUFS组子宫内膜体积偏小,但差异无统计学意义(P> 0. 05)。(2)正常组优势卵泡周围卵巢VI、FI、VFI随月经周期呈周期性变化。LUFS组的VI变化趋于平缓,自卵泡中期至黄体晚期低于正常组(P <0. 05)。LUFS组FI、VFI整个月经周期变化不明显,整个月经周期LUFS组卵巢FI均数低于正常组(P <0. 05),围排卵期、全黄体期VFI均数低于正常组(P <0. 05)。(3)正常组与LUFS组子宫内膜下VI、FI、VFI血流动力学参数变化曲线相似,且均呈周期性变化。LUFS组卵泡中期、围排卵期、全黄体期VI、FI、VFI低于正常组(P <0. 05)。结论 LUFS患者子宫内膜与卵泡发育不同步。卵泡中期、围排卵期卵泡周围微血管密度低、血流灌注少可能是影响LUFS患者正常排卵的因素。整个月经周期子宫内膜下微血管密度低、血流灌注少可能是子宫内膜容受性低的重要因素。

Objective To serially investigate changes of endometrial and ovary vascularity and the growth synchronism in infertility patients with luteinized unruptured follicle syndrome（ LUFS） throughout the menstrual cycle by three-dimensional ultrasound（ 3 D-US） and 4 D-view software. Methods The follicular volume,endometrium volume and hemodynamic parameters（ VI,FI,VFI） in LUFS group and normal group at the each period of menstrual cycle（ early and mid-term follicular phase,periovulation phase,early period of luteal phase,mid-term period of luteal phase and late period of luteal phase） were compared using 3 D-US. Results There was no significant difference in follicle or endometrium volume between LUFS group and normal group at early or mid-term follicular phase. The follicle and endometrium volumes were significantly smaller in LUFS group at periovulation phase compared with normal group（ P〈0.05）. Normal endometrial volume was larger than LUFS group in luteal phase,but there was no significant difference（ P〉0.05）. The ovary VI,FI and VFI showed a periodical change in normal group. Both the ovary and endometrial VI,FI and VFI were less in women with LUFS from proliferative phase to the late period of luteal phase. The ovary FI was significantly lower in LUFS group. Conclusion The developments of follicular and endometrial are asynchronous in menstrual cycle. The insufficient ovarian and endometrial perfusion may be the risk factors for abnormal ovulation in LUFS patients.