阴道二维超声检测子宫内膜基底部血流参数和子宫内膜厚度诊断宫腔粘连价值

Diagnostic values of the endometrial basal blood flow parameters and the endometrial thickness examined by transvaginal two-dimensional ultrasound of women for their intrauterine adhesions

目的:探究经阴道二维超声检测子宫内膜基底部血流参数和子宫内膜厚度诊断宫腔粘连及其程度价值。方法:2019年1月-2022年1月本院进行治疗的宫腔粘连患者100例为宫腔粘连组,依据1998年的欧洲妇科内镜协会的宫腔粘连分类标准分为Ⅰ度15例、Ⅱ度20例、Ⅲ度31例、Ⅳ度19例、Ⅴ度15例,健康体检者100例为对照组,比较两组及宫腔粘连不同严重程度患者的超声检测搏动指数(PI)、阻力指数(RI)、收缩期与舒张期流速比(S/D)以及子宫内膜厚度(EN)并分析各指标联合检测对宫腔粘连及其程度的诊断效能。结果:宫腔粘连组PI、S/D、RI均高于对照组,ET低于对照组;宫腔粘连患者随着疾病程度加重PI、S/D、RI水平升高,ET水平下降(均P<0.05)。通过分析,PI、S/D、RI、ET水平联合检测特异度(97.0%)高于各单独指标检测(89.0%、88.0%、55.0%、74.0%);通过受试者工作特征曲线分析,PI、S/D、RI、ET联合检测诊断宫腔粘连的曲线下面积(0.984)及严重程度曲线下面积(Ⅰ度0.879、Ⅱ度0.896、Ⅲ度0.802、Ⅳ度0.847、Ⅴ度0.862)均提高(均P<0.05)。结论:经阴道二维超声检测子宫内膜基底部血流参数和子宫内膜厚度诊断宫腔粘连及其严重程度具有临床指导价值。

Objective: To investigate the diagnostic values of the endometrial basal blood flow parameters and endometrial thickness of women examined by transvaginal two-dimensional ultrasound for their intrauterine adhesions(IUA) and the degree of IUA. Methods: 100 women with IUA were selected in group A, and were divided into 15 cases with ⅠIUA in group A1, 20 cases with ⅡIUA in group A2, 31 cases with Ⅲ IUA in group A3, 19 cases with ⅣIUA in group A4, and 15 cases with ⅤIUA in group A5 according to the degree of IUA by the classification criteria of the European Society for Gynecological Endoscopy in 1998 from January 2019 to January 2022. Another 100 healthy women were selected in group B. The values of pulse index(PI), the resistance index(RI), systolic to diastolic flow rate ratio(S/D), and the endometrial thickness(EN) of the women were compared between group A and group B, and among group A1, group A2, group A3, group A4, and group A5. The diagnostic efficacy of the combined values of PI, RI, S/D, and ET of the women for their IUA and the degree of IUA was analyzed. Results: The values of PI, S/D, and RI of the women in group A were significantly higher than those of the women in group B, while the ET value of the women in group A was significantly lower. The values of PI, S/D, and RI of the women in group A1, group A2, group A3, group A4, and group A5 had increased gradually, while the ET value of the women had decreased gradually(all P<0.05). Through analysis, the specificity of the combined detections of PI, S/D, RI, and EN of the women for diagnosing their IUA was 97.0%, which was significantly higher than that(89.0%, 88.0%, 55.0%, or 74.0%) of the PI, S/D, RI, or EN detection alone. Based on the results of the analysis of receiver operator characteristic curve, the area under the curve of the combined values of PI, S/D, RI, and EN of the women for diagnosing their IUA, and I IUA, ⅡIUA, Ⅲ IUA, Ⅳ IUA, and Ⅴ IUA were 0.984, 0.879, 0.896, 0.802, 0.847, and 0.862, respectively, which had all increased significantly(all P<0.05).Conclusion:The parameters of endometrial basal blood flow and endometrial thickness examined of the women by transvaginal two-dimensional ultrasound for diagnosing their IUA and the degree of IUA have some clinical guidance values.