三维阴道超声子宫内膜-肌层交界区指标预测子宫腺肌病辅助生殖妊娠结局效果

Predictive value of endometrial-myometrial junction index measured by three-dimensional vaginal ultrasound for the pregnancy outcomes of women with adenomyosis after assisted reproduction

目的:探讨三维阴道超声(3D-TVUS)测定子宫内膜-肌层交界区指标对子宫腺肌病行辅助生殖患者妊娠结局的预测价值。方法:选择医院2020年6月-2022年2月收治的子宫腺肌病患者292例,均行辅助生殖助孕,依据妊娠结局情况分为妊娠组和未妊娠组。比较两组一般资料、人绒毛膜促性腺激素(HCG)注射日3D-TVUS测定的子宫内膜-肌层交界区指标(厚度、形态)情况;应用二元logistic回归分析妊娠失败影响因素;受试者工作特征(ROC)曲线分析子宫内膜-肌层交界区指标对辅助生殖妊娠结局的预测效力。结果:292例行IVF/ICSI-ET助孕后获得临床妊娠122例(41.8%)为妊娠组;未临床妊娠170例(58.2%)为未妊娠组。未妊娠组3D-TVUS测定的子宫内膜-肌层交界区厚度(8.6±2.2 mm)、形态异常率(55.3%)均高于妊娠组(5.2±1.8 mm、24.6%)(均P<0.05);回归分析显示,年龄大、子宫内膜-肌层交界区厚度增高、形态异常均为子宫腺肌病患者妊娠失败的独立影响因素(P<0.05);子宫内膜-肌层交界区厚度、形态均对辅助生殖后妊娠结局有一定预测价值,二者联合预测时曲线下面积为0.896,敏感度81.8%、特异度84.4%,预测效力最大。结论:3D-TVUS测定子宫内膜-肌层交界区指标可较好预测行辅助生殖后妊娠结局情况,且厚度增加、形态异常可增加辅助生殖助孕妊娠失败率。

Objective:To investigate the predictive value of endometrial-myometrial junction index measured by threedimensional transvaginal ultrasound(3D-TVUS)for the pregnancy outcomes of women with adenomyosis after assisted reproduction.Methods:292women with adenomyosis who had been assisted reproduction were selected and were divided into group A(women with pregnancy)and group B(women without pregnancy)acceding to the pregnant situation from June 2020to February 2022.The general data,the endometrial-myometrial junction indexes,such as the endometrial thickness and morphology measured by 3D-TVUS on the day of HCG injection of the women were compared between the two groups.Binary logistic regression analysis was used to explore the influencing factors of pregnancy failure of the women with adenomyosis.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of the endometrial-myometrial junction indexes measured by 3D-TVUS of the women with adenomyosis on their pregnancy outcomes after assisted reproduction.Results:In 292women who had been given IVF/ICSIET,there were 122(41.8%)women with clinical pregnancy in group A,and 170(58.2%)women without clinical pregnancy in group B.The thickness(8.6±2.2mm)of endometrium-myometrial junction measured by 3D-TVUS and the abnormal rate of endometrial shape(55.3%)of the women in group B were significantly higher than those(5.2±1.8mm and 24.6%)of the women in group A(all P<0.05).Regression analysis showed that the advanced age,the increased thickness of endometrio-myometrial junction area,and the abnormal endometrial shape were the independent factors of the pregnancy failure of the women with adenomyosis(P<0.05).Both the thickness and shape of the endometrium-myometrial junction area of the women with adenomyosis had certain predictive values for their pregnancy outcomes after assisted reproduction.The area under the curve,the sensitivity,and the specificity of the combined of the thickness and shape of the endometrium-myometrium junction area of the women with adenomyosis for their pregnancy outcomes were 0.896,81.8%,and 84.4%,respectively.Conclusion:The endometrial-myometrial junction indexes measured by 3D-TVUS of the women with adenomyosis can well predict their pregnancy outcomes.The increases thickness and the abnormal shape of the endometrial-myometrial junction area of the women with adenomyosis can increase their pregnancy failure rate after assisted reproductive.