不同程度宫腔粘连患者子宫内膜参数对妊娠结局的预测价值

Predictive value of endometrial parameters on pregnancy outcome in patients with different degrees of intrauterine adhesion

目的:探讨不同程度宫腔粘连患者子宫内膜参数对妊娠结局的预测价值。方法:选取90例宫腔粘连患者为研究对象,根据宫腔镜检查结果分为轻度组(n=36)、中度组(n=32)、重度组(n=22)。患者均行宫腔粘连分离术治疗并经阴道容积能量超声检查,根据术后随访1~2年不同妊娠结局分为妊娠组(n=27)和非妊娠组(n=63)。比较不同病情程度术前及不同妊娠结局患者术前术后子宫内膜超声参数[厚度(ED)、内膜体积(EV)、内膜区血管指数(VI)、血流指数(FI)、血管血流指数(VFI)]及妊娠情况,受试工作者特征(ROC)曲线分析子宫内膜超声参数对妊娠结局的预测价值。结果:术前,不同宫腔粘连程度组患者ED、EV、VI、FI、VFI比较,差异有统计学意义(P<0.05),且重度组<中度组<轻度组(P<0.05)。轻度组患者活产率高于中、重度组(P<0.05)。妊娠组和非妊娠组患者术前、术后ED比较,差异无统计学意义(P>0.05);妊娠组患者术前术后EV、VI、FI、VFI高于非妊娠组(P<0.05)。ROC曲线分析显示,内膜VFI预测妊娠结局的效能最高,曲线下面积(AUC)为0.884,其次为FI、VI、EV。结论:经阴道容积能量超声检查可较好地评估宫腔粘连患者的子宫内膜容受性,且EV、VI、FI、VFI对患者妊娠结局有较好的预测价值。

Objective:To investigate the evaluation value of endometrial receptivity on pregnancy outcome in patients with different degrees of intrauterine adhesion.Methods:90 patients with intrauterine adhesions were selected and divided into mild group(n=36),moderate group(n=32)and severe group(n=22)according to the results of hysteroscopy.All patients were treated with intrauterine adhesions separation and underwent transvaginal volume ultrasonography after operation.All patients were followed up for 1-2 years,and the clinical pregnancy outcomes of the three groups were compared.According to the clinical pregnancy results,the patients were divided into pregnancy group(n=27)and non-pregnancy group(n=63).The endometrial ultrasound parameters[endometrial thickness(ED),endometrial volume(EV),endometrial vascular index(VI),blood flow index(FI)and vascular blood flow index(VFI)]and pregnancy before and after operation of patients with different disease levels and different pregnancy outcomes were compared.The efficacy of endometrial ultrasound parameters in predicting pregnancy outcome was evaluated by ROC curve.Results:Before operation,there were significant difference in ED,EV,VI,FI and VFI in patients with different degrees of intrauterine adhesions(P<0.05).The ED,EV,VI,FI and VFI in the severe group were lower than those in the moderate group and the mild group(P<0.05).The ED,EV,VI,FI and VFI in the moderate group were lower than those in the mild group(P<0.05).The live birth rate in mild group was significantly higher than that in moderate group and severe group(P<0.05).There was no significant difference in preoperative and postoperative ED values between the pregnant group and the non-pregnant group(P>0.05).The preoperative and postoperative EV,VI,FI and VFI in the pregnant group were significantly higher than those in the non-pregnant group(P<0.05).ROC curve analysis showed that endometrial VFI had the highest efficacy in predicting pregnancy outcomes,with AUC of 0.884,followed by FI,VI and EV.Conclusion:Transvaginal volume ultrasonography can better evaluate endometrial receptivity in patients with intrauterine adhesions,and EV,VI,FI and VFI have certain reference value for predicting pregnancy outcome.