摘要目的 探讨体外受精-胚胎移植(IVF-ET)周期中子宫内膜厚度、子宫动脉和螺旋动脉血流参数以及内膜及内膜下血流分型对妊娠结局的影响,对比超微血流成像(SM I)技术和能量多普勒超声(PDUS)两种血流模式对IVF-ET周期中子宫内膜及内膜下血流分级的差异.方法 收集在2015年9月至2016年6月期间我院进行体外受精-胚胎移植治疗患者41例进行经阴道超声检查,记录人绒毛膜促性腺激素(HCG)注射日子宫内膜厚度、子宫动脉和螺旋动脉收缩期峰值血流速度、舒张期峰值血流速度、搏动指数、阻力指数、收缩期与舒张期血流速度比值,PDUS及SMI两种模式下分别显示内膜及内膜下血流信号,并采用Applehau分型法进行半定量分析.按照妊娠结局分为妊娠组和未妊娠组,比较上述指标在两组之间的差异以及两种血流模式下内膜及内膜下血流分级差异.结果 ①在 HCG注射日妊娠组子宫螺旋动脉阻力指数、搏动指数、收缩期峰值血流速度/舒张期峰值血流速度明显低于未妊娠组,差异均有统计学意义(P <0.05);两组之间子宫内膜厚度、子宫动脉血流参数差异均无统计学意义(P >0.05).②在 HCG注射日SM I模式下妊娠组与未妊娠组子宫内膜及内膜下血流分型比较差异有统计学意义(P =0.005);妊娠组SM I模式中Ⅲ型比例最高(50%).③SM I模式下内膜及内膜血流分型(β=1.085,OR=2.959,95% CI=1.040~8.421,P =0.042)对妊娠有独立预测价值.SMI模式下内膜及内膜下血流分级越高,妊娠可能性越大.SM I模式内膜及内膜下血流分型预测妊娠的曲线下面积为0.746(P =0.008).结论 SMI是一种新型有效的多普勒超声技术,可用于评估IVF-ET周期中子宫内膜及内膜下血流.HCG注射日SMI模式下内膜及内膜下血流分型有望预测 IVF-ET 妊娠结局,指导临床选择最佳的胚胎移植时机.

abstractsObjective To investigate the role of endometrial thickness,uterine artery and spiral artery blood flow parameters,endometrial and subendometrial blood flow on pregnancy outcome in vitro fertilization-embryo transfer (IVF-ET) cycle,compare the difference of the endometrial and subendometrial blood flow typing between the superb micro-vascular imaging (SMI) and power doppler ultrasound (PDUS). Methods Forty-one patients undergoing IVF-ET cycles in our hospital were recruited in this study. Transvaginal color Doppler ultrasound was performed to determine and record endometrial thickness,peak systolic velocity(PSV),end diastolic velocity(EDV),pulse index(PI),resistance index(RI), systolic diastolic ratio(S/D) of uterine artery and spiral artery,and degree endometrial and subendometrial blood flow signals were showed under the two blood flow modes of PDUS and SMI respectively on the day of human chorionic gonadotropin(HCG) injection.The degree of the endometrial and subendometrial blood flow was scored using Applehau classification method.According to the pregnancy outcome,patients were divided into pregnancy group and nonpregnancy group,the difference of the above indicators between the two groups were compared,and the degree of endometrial and subendometrial blood flow under two kinds of blood flow mode were observed.Results ①On the day of HCG injection,patients in pregnancy group had lower RI,PI,S/D of spiral artery than those in the nonpregnancy group (P< 0.05). There were no significant difference between the pregnant group and nonpregnant group in endometrial thickness and the blood flow parameters of uterine artery ( P >0.05). ②On the day of HCG injection,there was significant difference between the pregnant group and nonpregnant group in endometrial and subendometrial blood flow degree with SMI mode ( P =0.005).The patients with type Ⅲ in pregnancy group were most (50% ). ③The endometrial and subendometrial blood flow typing (β= 1.085,OR= 1.085,95% CI=1.040 -8.421, P=0.042) of pregnancy group under SMI mode have an independent predictive value.With increased blood flow typing under endometrial and subendometrial blood flow,the higher the possibility of pregnancy in patients.The ROC curve analysis showed that the area under ROC endometrial and subendometrial blood flow typing SMI mode on the HCG day was 0.746( P =0.008).Conclusions SMI is a new and effective type of Doppler ultrasound technique to evaluate the endometrial and subendometrial blood flow in IVF-ET cycle.On the day of HCG injection,the endometrial and subendometrial blood flow typing in SMI mode may predict pregnancy outcomes in IVF-ET cycles,and guide to choose the best embryo transfer time.