经阴道超声检测参数对PCOS不孕症患者子宫内膜容受性的评估研究

Evaluation of endometrial receptivity in patients with PCOS infertility by transvaginal ultrasound parameters

目的探讨经阴道超声检测参数对多囊卵巢综合征(PCOS)不孕症患者子宫内膜容受性的评估价值。方法选取2016年10月至2018年9月重庆三峡中心医院收治的162例PCOS不孕症患者作为研究对象。均行子宫内膜胞饮突检查及阴道超声检测,观察子宫内膜胞饮突情况、子宫内膜厚度、容积与子宫螺旋动脉搏动指数(PI)、阻力指数(RI)、S/D(收缩期峰值血流速度/舒张末期血流速度)。根据子宫内膜胞饮突将162例患者分为容受性良好组与不良组,对比两组患者阴道超声检测参数,且采用Logistic回归分析法分析其对子宫内膜容受性的影响。结果162例患者经阴道超声检查,其中子宫内膜厚度(6.42±0.71)mm,子宫内膜容积(1.56±0.38)mL,PI(1.78±0.29),RI(0.79±0.03),S/D(3.84±0.41);子宫内膜容受性良好组患者子宫内膜厚度、子宫内膜容积均大于不良组患者,良好组患者PI、RI、S/D均小于不良组患者,差异均具有统计学意义(均P<0.05);良好组患者子宫内膜厚度≤7.0mm、子宫内膜容积≤2mL、PI≥1.6、RI≥0.72、S/D≥3.6、高雄激素血症、高胰岛素血症构成比占比均明显低于不良组患者,差异均具有统计学意义(均P<0.05),且经Logistic回归分析发现,其均是影响PCOS不孕症患者子宫内膜容受性的危险因素,差异均具有统计学意义(OR=5.223、4.080、2.591、2.998、3.522、2.930、3.684,均P<0.05)。结论经阴道超声检查可观察PCOS不孕症患者子宫内膜及子宫螺旋动脉血流动力学变化情况,且当检测参数显示为子宫内膜厚度≤7.0mm、子宫内膜容积≤2mL、PI≥1.6、RI≥0.72、S/D≥3.6时,此类患者子宫内膜容受性不良的风险增加,可指导临床工作。

Objective To explore the value of transvaginal ultrasound parameters in evaluating endometrial receptivity in infertility patients with polycystic ovary syndrome(PCOS).Methods 162 cases of PCOS infertility treated in our hospital from October 2016 to September 2018 were selected and all underwent endometrial pinocytosis and transvaginal ultrasonography,to observe the endometrial pinocytosis and endometrial thickness,volume and pulsation index(PI),resistance index(RI)and peak systolic flow velocity/end diastolic flow velocity(S/D).According to the endometrial pinocytosis,the patients were divided into good tolerance group and bad tolerance group and the parameters of vaginal ultrasound were compared between the two groups.The influence of vaginal ultrasound parameters on endometrial receptivity was analyzed by Logistic regression analysis.Results 162 patients were examined by transvaginal ultrasonography,and the endometrial thickness was(6.42±0.71)mm,endometrial volume was(1.56±0.38)mL,PI was(1.78±0.29),RI was(0.79±0.03)and S/D was(3.84±0.41).The thickness and volume of endometrium in good tolerance group were larger than those in bad tolerance group,and PI,RI and S/D in good tolerance group were smaller than those in bad tolerance group,all with statistically significant differences(all P<0.05).The proportions of endometrial thickness≤7.0 mm,endometrial volume≤2 mL,PI≥1.6,RI≥0.72,S/D≥3.6,hyperandrogenism and hyperinsulinemia in good tolerance group were significantly lower than those in bad tolerance group,with statistically significant differences(all P<0.05),and the Logistic regression analysis showed that all of them were risk factors for endometrial receptivity in patients with PCOS infertility(OR=5.223,4.080,2.591,2.998,3.522,2.930,3.684,all P<0.05).Conclusions The changes in endometrium and uterine spiral artery hemodynamics in patients with PCOS infertility can be observed by transvaginal ultrasonography,and the risk of endometrial intolerance in such patients increases when the detection parameters show the thickness of endometrium≤7.0 mm,the volume of endometrium≤2 mL,PI≥1.6,RI≥0.72,S/D≥3.6,which can guide clinical work.