阴道三维超声评估宫腔粘连患者的子宫内膜容受性及其对妊娠的影响

Clinical value of three-dimensional transvaginal ultrasound for evaluating endometrial receptivity and predicting pregnancy outcome in patients with intrauterine adhesions

目的探讨经阴道三维超声评估宫腔粘连患者子宫内膜容受性的临床价值及其对妊娠的影响。方法选取2019年1月—2020年8月华中科技大学协和深圳医院经宫腔镜确诊宫腔粘连的116例女性患者作为观察组,选取同期该院行妇科检查的健康女性60例作为对照组。研究对象在排卵日和行宫腔镜下宫腔粘连分离术后,均进行经阴道三维超声检查。测量子宫内膜厚度(ET)、子宫动脉搏动指数(PI)、阻力指数(RI)、子宫内膜容积(EV)、内膜血管指数(VI)、血流指数(FI)和血管血流指数(VFI)等,分析超声参数对患者妊娠结局的预测价值。结果观察组ET薄于对照组,EV、VI、FI、VFI小于对照组(P<0.05),RI、PI大于对照组(P<0.05)。中度组和重度组ET薄于轻度组(P<0.05),EV、VI、FI、VFI小于轻度组(P<0.05),RI、PI高于轻度组(P<0.05)。重度组ET薄于中度组、EV、VI、FI、VFI小于中度组(P<0.05),RI、PI大于中度组(P<0.05)。未妊娠组ET薄于未妊娠组,EV、RI、PI、VI、FI、VFI小于妊娠组(P<0.05)。VFI对妊娠结局的敏感性最高,其次为FI;FI对妊娠结局的特异性最高,其次为RI;AUC最大为VFI,为0.737(95%CI:0.626,0.847),其次为FI,为0.708(95%CI:0.592,0.825)。结论经阴道三维超声可通过测量EV和内膜血流等超声指标对宫腔粘连子宫内膜容受性进行评价,且可对妊娠结局进行预测。

Objective To investigate the clinical value of three-dimensional transvaginal ultrasound for evaluating endometrial receptivity and predicting pregnancy outcome in patients with intrauterine adhesions.Methods A total of 116 patients with intrauterine adhesions diagnosed by hysteroscopy in our hospital from January2019 to August 2020 were selected as the observation group.Sixty healthy women who underwent gynecological examination during the same period were selected as control group.Three-dimensional transvaginal ultrasound was performed on the day of ovulation and after hysteroscopic management of intrauterine adhesions.The endometrial thickness(ET),uterine artery pulsatility index(PI),resistance index(RI),endometrial volume(EV),vascularization index(VI),flow index(FI)and vascularization flow index(VFI)were measured,and predictive values of these parameters for pregnancy outcome were analyzed.Results Compared with the control group,ET,EV,VI,FI and VFI were lower,while RI and PI were higher in the observation group(P<0.05).The ET,EV,VI,FI and VFI were lower,but RI and PI were higher in patients with moderate and severe intrauterine adhesions than those in the patients with mild intrauterine adhesions(P<0.05).Moreover,ET,EV,VI,FI and VFI in patients with severe intrauterine adhesions were even lower than those in patients with moderate intrauterine adhesions,while RI and PI were even higher in patients with severe intrauterine adhesions than those in patients with moderate intrauterine adhesions(P<0.05).In non-pregnant patients,ET,EV,VI,FI and VFI were lower relative to those in pregnant patients(P<0.05).The VFI,followed by FI,exhibits the highest sensitivity for predicting pregnancy outcome.However,FI,followed by RI,shows the highest specificity for predicting pregnancy outcome.The area under the receiver operating characteristic(ROC)curve(AUC)of VFI was the highest[0.737(95%CI:0.626,0.847)],followed by that of FI[0.708(95%CI:0.592,0.825)].Conclusions Three-dimensional transvaginal ultrasound can evaluate the endometrial receptivity of patients with intrauterine adhesions by measuring parameters including endometrial volume and endometrial blood flow,and is of predictive value for the pregnancy outcome in these patients.