不同超声参数在评估IVF-ET患者子宫内膜容受性中的价值

The value of different ultrasound parameters in evaluation of endometrial receptivity in IVF-ET patients

目的探究彩色超声多普勒(CDFI)和超声造影技术(CEUS)参数在评估体外受精及胚胎移植(IVF-ET)患者子宫内膜容受性中的价值。方法对2016年6月—2018年6月间进行IVF-ET的86例患者进行分析,根据是否达到临床妊娠,分为妊娠组(32例)和未成功组(54例),比较2组患者子宫内膜CDFI的搏动指数(PI)和阻力指数(RI)以及上升时间(RT)、达峰时间(TTP)、峰值强度(PI)和曲线下面积(AUC)等CEUS指标间的差异,分析探究不同超声参数与子宫内膜微血管密度(MVD)的相关性,比较不同超声参数对于妊娠成功的预测效能。结果妊娠组患者子宫内膜的CDFI-PI和RI以及CEUS-RT和TTP显著低于未成功组,而CEUS-PI显著高于未成功组,差异均有统计学意义(均P<0.05);2组的CEUS-AUC间差异无统计学意义(P>0.05)。妊娠组的MVD显著高于未成功组(P<0.05)。相关性分析显示,CDFI的PI和RI,CEUS的RT和TTP与子宫内膜MVD呈负相关,与CEUS的PI呈正相关。在预测妊娠结局时,CEUS-PI的曲线下面积最高,CDFI-PI和RT次之,TTP和RI较低。CEUS-PI预测临床妊娠的最佳截点值为≥4.75 dB,其预测敏感度为68.75%,特异度为92.59%。结论子宫内膜超声造影峰值强度与微血管密度呈正相关;应用CEUS-PI预测IVF-ET妊娠结局具有较高的诊断特异性。

Objective To investigate the value of color ultrasound Doppler(CDFI)and contrast-enhanced ultrasound(CEUS)parameters in assessing endometrial receptivity in patients undergoing in vitro fertilization and embryo transfer(IVF-ET).Methods Eighty-six patients with IVF-ET in our hospital from June 2016 to June 2018 were analyzed.According to whether they reached clinical pregnancy,they were divided into pregnancy group(32 cases)and unsuccessful group(54 cases).The pulsatility index(PI)and resistance index(RI)of the endometrial CDFI and the CEUS index between the rise time(RT),peak time(TTP),peak intensity(PI),and area under the curve(AUC)were compared between the two groups.Differences were analyzed to investigate the correlation between different ultrasound parameters and endometrial micro-vessel density(MVD),and to compare the predictive power of different ultrasound parameters for pregnancy success.Results The CDFI-PI and RI and CEUS-RT and TTP in the endometrium of the pregnant group were significantly lower than those in the unsuccessful group,while CEUS-PI was significantly higher than the unsuccessful group(all P<0.05).There was no statistical difference between the groups of CEUS-AUC(P>0.05).The MVD of the pregnant group was significantly higher than that of the unsuccessful group(P<0.05).Correlation analysis showed that PI and RI of CDFI,CEUS RT and TTP were negatively correlated with endometrial MVD and positively correlated with CEUS PI.In predicting pregnancy outcomes,CEUS-PI has the highest area under the curve,followed by CDFI-PI and RT,and lower TTP and RI.The optimal cut-off value of CEUS-PI for predicting clinical pregnancy is≥4.75 dB,with a predictive sensitivity of 68.75%and a specificity of 92.59%.Conclusion The peak intensity of endometrial contrast-enhanced ultrasound is positively correlated with the micro-vessel density.The use of CEUS-PI to predict IVF-ET pregnancy outcome has a high diagnostic specificity.