经阴道三维超声评价冻融胚胎移植周期子宫内膜容受性的研究

发布时间：2018-01-04 08:41

本文关键词：经阴道三维超声评价冻融胚胎移植周期子宫内膜容受性的研究　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景近年来,人口老龄化问题日益严重,伴随着二胎政策的放开,高龄不孕问题成为当今社会面临的重大问题,由于现代生活节奏加快、生活方式的改变、环境污染等因素,不孕患者人数急剧增加,解决不孕患者的生育问题逐渐被提上日程,辅助生殖技术(assisted reproductive technology,ART)的迅速发展,使许多不孕症患者成功怀孕成为可能。良好的子宫内膜容受性(endometrial receptivity)和高质量胚胎的协同作用是成功妊娠的关键因素,也是成功植入的必要条件。随着科学技术的快速发展,胚胎实验室技术也日新月异,因此带来了体外受精-胚胎移植(invitro fertilization and embryo transfer,IVF-ET)技术中临床妊娠率的提高。子宫内膜容受性成为影响临床妊娠率进一步提高的瓶颈,它也成为生殖医学研究的重点和难点。目前评价子宫内膜容受性的方式中最重要、最准确的是进行子宫内膜活检,由于它为有创检查,并且行活检后当周期不能移植,限制了其在临床中的应用。而超声检查是一种直观、简便、无创、可重复的检查,在临床中的应用越来越多,三维超声及其能量多普勒的发展,使观察微小血流分布及定量检测血流多少成为可能,越来越多的相关专业人员利用经阴道三维能量多普勒超声研究、评价子宫内膜容受性。目的利用经阴道三维超声检测冻融胚胎移植(frozen-thawed embryo transfer,FET)女性内膜转化日和胚胎移植日的子宫内膜厚度、容积、内膜及内膜下容积、内膜以及内膜下血流参数,探索其容积、血流参数与妊娠结局的关系,评价冻融胚胎移植周期中不同时间点的子宫内膜容受性。资料与方法选择山东中医药大学附属医院生殖与遗传中心接受FET周期助孕治疗的患者,应用经阴道三维超声分别于内膜转化日和胚胎移植日检测子宫内膜厚度、内膜容积、内膜及内膜下容积、内膜以及内膜下区域的血流参数包括血管化指数(vascularization index VI)、血流指数(flow index FI)、血管化血流指数(vascularization-flow index VFI),根据临床妊娠结局分为两组,即妊娠组与未妊娠组,对两组之间各参数的差异进行分析比较。结果内膜转化日组:56例患者中有32例获得临床妊娠,妊娠率为57.14%。两组间子宫内膜厚度、内膜容积(V0)、内膜及内膜下1-3 mm容积(V1-V3)、内膜血流指数(FI)、内膜下1 mm血流指数(FI1)差异无统计学意义(P0.05);妊娠组内膜和内膜下1mm的血管化指数(VI、VI1)、血管化血流指数(VFI、VFI1)、内膜下2mm和内膜下3mm的血管化指数(VI2、VI3)、血流指数(FI2、FI3)、血管化血流指数(VFI2、VFI3)均低于未妊娠组,两组间进行比较,差异有显著统计学意义(P0.05)。VI、VFI、VI1、VFI1、VI2、FI2、VFI2、VI3、FI3、VFI3预测妊娠的ROC曲线下面积分别为0.757、0.736、0.749、0.749、0.749、0.686、0.744、0.738、0.706、0.736。子宫内膜及内膜下血流参数中预测妊娠的敏感性和特异性均较高的指标为内膜血管化指数(VI)、内膜血管化血流指数(VFI)、内膜下3mm血流指数(FI3)。子宫内膜血管化指数(VI)预测妊娠的最佳临界值标准为≤3.176,敏感性为75%,特异性为79.17%;子宫内膜血管化血流指数(VFI)预测妊娠的最佳临界值标准为≤0.711,敏感性为75%,特异性为79.17%;子宫内膜下3mm血流指数(FI3)预测妊娠的最佳临界值标准为≤25.814,敏感性为75.00%,特异性为70.83%。胚胎移植日组:53例患者中24例获得临床妊娠,29例未妊娠(包括5例生化妊娠、24例未妊娠),临床妊娠率为45.28%。两组间子宫内膜厚度、内膜容积(V0)、内膜及内膜下1-3mm容积(V1-V3)、内膜以及内膜下血流参数包括内膜以及内膜下1-3 mm血管化指数(VI、VI1-VI3)、内膜以及内膜下1-3 mm血流指数(FI、FI1-FI3)、内膜以及内膜下1-3mm血管化血流指数(VFI、VF1-VFI3)差异均无统计学意义(P0.05)。结论可以用经阴道三维超声评价子宫内膜容受性、预测冻融胚胎移植的妊娠结局,内膜转化日:三维血流参数中内膜和内膜下1mm的血管化指数(VI、VI1)、血管化血流指数(VFI、VFI1)、内膜下2mm和内膜下3mm的血管化指数(VI2、VI3)、血流指数(FI2、FI3)、血管化血流指数(VFI2、VFI3)对临床妊娠结局有一定的评估预测价值;胚胎移植日:内膜以及内膜下区域的三维血流参数对判断妊娠结局没有预测价值。将内膜下区域设定为内膜下3 mm,研究内膜下3 mm区域处的血流参数对评价内膜容受性更有意义。
[Abstract]:Background: in recent years, the problem of population aging is becoming increasingly serious, accompanied by the release of two-child policy, the elderly infertility has become a major problem facing society today, due to the accelerated pace of modern life, lifestyle changes, environmental pollution and other factors, a sharp increase in the number of patients with infertility, child infertility is gradually put on the agenda assisted reproductive technology (assisted reproductive, technology, ART) is developing rapidly, many infertile patients with successful pregnancy possible. Endometrial receptivity (endometrial receptivity) good synergistic effect and high quality embryo is a key factor in successful pregnancy, and it is a necessary condition for successful implantation. With the rapid development of science and technology, the embryo laboratory technology change rapidly, thus bringing about in vitro fertilization and embryo transfer (invitro fertilization and embryo transfer, IVF-ET) technology The pregnancy rate in clinical improvement. Endometrial receptivity become the bottleneck to further improve the clinical pregnancy rate, it has become the focus and difficulty in the research of reproductive medicine. The most important evaluation of endometrial receptivity in the way at present, is the most accurate endometrial biopsy, which is due to the invasive examination, when the cycle is not transplantation and biopsy, limiting its clinical application. The ultrasonography is an intuitive, simple, noninvasive and repeatable inspection, used more and more in clinical practice, the development of 3D ultrasound and energy Doppler, to observe the micro flow distribution and quantitative detection of blood flow how many possible related majors more and more people using the Doppler ultrasound study of three-dimensional energy vagina, evaluation of endometrial receptivity. The purpose of the use of transvaginal three-dimensional ultrasound detection of frozen thawed embryo transfer (frozen-thawed embryo transfer FET), endometrial thickness, endometrial transformation and female embryo transplantation on volume, endometrial and endometrial volume, endometrial and subendometrial blood flow parameters, explore the relationship between blood volume parameters and pregnancy outcome evaluation, frozen endometrial receptivity and thawing at different time points of embryo transfer cycle in materials and methods. Reproductive and genetic Hospital Affiliated to the Shandong University of Traditional Chinese Medicine Center for treatment period FET help pregnant patients, application of transvaginal three-dimensional ultrasound in endometrial transformation and embryo transplantation on detection of endometrial thickness, endometrial volume, endometrial and endometrial volume, endometrial and endometrial blood flow parameters of the area including the vascularization index (vascularization index VI), flow index (flow index FI), vascular blood flow index (vascularization-flow index VFI), according to the clinical outcome of pregnancy were divided into two groups, namely pregnancy group and non pregnancy group, two groups of The difference between the parameters are analyzed and compared. Results: 56 cases of endometrial transformation on the group of patients with 32 cases of clinical pregnancy, the pregnancy rate was 57.14%. between the two groups of endometrial thickness, endometrial volume (V0), 1-3 mm volume (V1-V3) endometrial and endometrial, endometrial blood flow index (FI), 1 endometrial mm blood flow index (FI1) showed no significant difference (P0.05); vascularization index 1mm of endometrial and subendometrial pregnancy group (VI, VI1), blood vessels and blood flow index (VFI, VFI1), vascularization index 2mm and 3mm endometrial subendometrial (VI2, VI3), flow index (FI2, FI3), vascular blood flow index (VFI2, VFI3) were lower than those in non pregnant group, were compared between the two groups, the difference was statistically significant (P0.05).VI, VFI, VI1, VFI1, VI2, FI2, VFI2, VI3, FI3, VFI3, ROC curve area of forecasting pregnancy were 0.757,0.736,0.749,0.749,0.749,0.686,0.744,0.738,0.706,0.736. of endometrium and endometrium blood flow The parameters were higher in pregnancy prediction sensitivity and specificity index for endometrial vascularization index (VI), vascular intima and blood flow index (VFI), endometrial 3mm blood flow index (FI3). Endometrial vascularization index (VI) to predict pregnancy best critical value standard is less than or equal to 3.176, the sensitivity was 75%, specificity is 79.17%; endometrial vascular blood flow index (VFI) to predict pregnancy best critical value standard is less than or equal to 0.711, the sensitivity was 75%, specificity was 79.17%; endometrial 3mm blood flow index (FI3) to predict pregnancy best critical value standard is less than or equal to 25.814, the sensitivity was 75%, specificity was 70.83%. on the day of embryo transfer group: 53 patients in 24 cases of clinical pregnancy, 29 cases of non pregnancy (including 5 cases of biochemical pregnancy, 24 cases without pregnancy), the clinical pregnancy rate of 45.28%. between the two groups of endometrial thickness, endometrial volume (V0), 1-3mm volume (V1-V3) membrane and endometrial, endometrial and endometrial Blood flow parameters including endometrial and subendometrial 1-3 mm vascularization index (VI, VI1-VI3), 1-3 mm and endometrial endometrial blood flow index (FI, FI1-FI3), and 1-3mm endometrial endometrial blood vessels and blood flow index (VFI, VF1-VFI3) showed no significant difference (P0.05). The use of transvaginal three-dimensional ultrasound evaluation of endometrial receptivity and pregnancy outcome prediction of frozen thawed embryo transfer, endometrial transformation: endometrial and subendometrial 1mm vascular index in 3D flow parameters (VI, VI1), blood vessels and blood flow index (VFI, VFI1), vascularization index 2mm and 3mm endometrial subendometrial (VI2, VI3) and the blood flow index (FI2, FI3), blood vessels and blood flow index (VFI2, VFI3) have some predictive value for assessment of the clinical outcome of pregnancy; embryo transfer: three-dimensional blood flow parameters of endometrial and subendometrial regions to determine the pregnancy outcome had no predictive value. The subendocardial region is set to 3 m under intima M, the hemodynamic parameters of 3 mm area at the research on Evaluation of endometrial receptivity is more meaningful.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8;R445.1

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