超声子宫动脉及子宫内膜血流参数对不明原因复发性流产患者妊娠结局的影响

Application of ultrasonic uterine artery and endometrial blood flow parameters in predicting pregnancy outcome in patients with unexplained recurrent spontaneous abortion

目的探讨超声子宫动脉及子宫内膜血流参数对不明原因复发性流产(URSA)患者妊娠结局的影响。方法回顾性收集杭州市中医院(浙江中医药大学附属杭州市中医院)2020年1月至2021年12月收治的112例URSA患者作为研究对象,根据妊娠结局的不同分为已孕组(n=55)与未孕组(n=57),采集备孕期子宫内膜容受性指标(超声子宫动脉、子宫内膜形态和血流参数),并采用χ2检验或Fisher精确概率法或独立样本t检验比较2组间差异,采用多因素条件Logistic回归分析超声参数与妊娠结局的关系。结果已孕组的子宫动脉搏动指数(PI)水平低于未孕组[(2.06±0.42)vs(2.41±0.69)],差异具有统计学意义(t=4.669,P<0.001)。已孕组子宫内膜厚度高于未孕组组[(8.56±1.42)mm vs(8.19±2.41)mm],已孕组的子宫内膜回声B型、内膜血流Ⅱ级和内膜连续者占比高于未孕组(67.27%vs 47.37%、74.55%vs 50.88%和90.91%vs 0),差异均具有统计学意义(χ2=12.151、7.408、93.607,P均<0.001)。多因素条件Logistic回归分析显示,子宫动脉PI升高是URSA患者妊娠的高危因素(β=-0.922,OR=0.924,P=0.004),内膜厚度(β=0.514,OR=1.147,P=0.007)、内膜回声B型(β=0.425,OR=1.502,P=0.001)、内膜血流Ⅱ级(β=0.337,OR=1.655,P=0.002)和内膜连续(β=0.437,OR=2.715,P=0.022)是URSA患者妊娠成功的保护性因素。结论彩色多普勒超声检测子宫动脉血流参数、子宫内膜形态和血流参数可较为准确地评估URSA患者的子宫内膜容受性。

Objective To evaluate the predictive value of ultrasound uterine artery and endometrial blood flow parameters for pregnancy outcome in patients with unexplained recurrent spontaneous abortion(URSA).Methods One hundred and twelve patients with URSA were collected retrospectively at Hangzhou Hospital of Traditional Chinese Medicine from January 2020 to December 2021 as the study subjects.According to different pregnancy outcomes,they were divided into a pregnant group(n=55)and a non-pregnant group(n=57).Comparative analysis was conducted on endometrial receptivity indicators(ultrasound uterine artery and endometrial blood flow parameters)of the two groups of patients during pregnancy preparation,using theχ2 test or Fisher's exact test or independent sample t-test,and multivariate conditional Logistic regression was used to analyze the relationship between ultrasound parameters and pregnancy outcome.Results The pulsatility index of the uterine artery in the pregnant group was significantly lower than that of the non-pregnant group[(2.06±0.42)vs(2.41±0.69),t=4.669,P<0.001].The endometrial thickness of the pregnant group was significantly higher than that of the non-pregnant group[(8.56±1.42)mm vs(8.19±2.41)mm].The proportions of patients with endometrial echo type B,endometrial blood flow grade II,and endometrial continuity in the pregnant group were 67.27%,74.55%,and 90.91%,respectively,which were significantly higher than those of the non-pregnant group(47.37%,50.88%,and 0,respectively;χ2=12.151,7.408,and 93.607,respectively;P<0.001 for all).Multivariate conditional Logistic regression analysis showed that elevated uterine artery PI was a high risk factor for pregnancy failure in URSA patients(β=-0.922,odds ratio[OR]=0.924,P=0.004),while endometrial thickness(β=0.514,OR=1.147,P=0.007),endometrial echo type B(β=0.425,OR=1.502,P=0.001),endometrial blood flow grade II(β=0.337,OR=1.655,P=0.002),and endometrial continuity(β=0.437,OR=2.715,P=0.022)were protective factors for successful pregnancy in URSA patients.Conclusion The detection of uterine artery blood flow parameters,endometrial morphology,and blood flow parameters by color Doppler ultrasound can accurately evaluate the endometrial receptivity of URSA patients to provide a basis for clinical prediction of successful pregnancy.