经阴道三维超声定量评估卵巢储备功能减低及卵巢早衰的价值

发布时间：2018-10-07 20:35

【摘要】：目的采用经阴道三维超声观察卵巢储备功能减低和卵巢早衰患者窦卵泡数、卵巢体积及卵巢间质血流灌注变化情况,探讨三维超声定量评估卵巢储备功能减低及卵巢早衰的价值。材料与方法1.选择2014年10月-2016年11月在中国人民解放军总医院门诊进行超声检查的女性患者,按照纳入排除标准筛选出卵巢储备功能正常组100人、卵巢储备功能减低(DOR)组60人、卵巢早衰(POF)组60人。2.记录患者年龄、月经周期、经期等一般情况。3.在月经周期第3-5天抽血化验基础性激素六项,闭经者检查时间不受限制,同时进行阴道三维能量多普勒超声检查。应用三维超声后处理软件VOCAL、Sono AVC对卵巢进行定量分析,得到以下参数:窦卵泡计数(AFC)、卵巢体积(0V)、卵巢血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)。4.比较各组间年龄、月经周期、经期有无差异。比较各组内左、右侧卵巢三维超声参数有是否有差异。比较各组间三维超声参数的差异,绘制ROC曲线,计算各项参数对诊断卵巢功能减低、卵巢早衰的敏感度(SE)、特异度(SP)、曲线下面积(areas under curve, AUC)及临界值。结果1.三组年龄比较,DOR组、POF组年龄大于正常组(P 0. 05),DOR组与POF组无显著差异(P0.05)。2.三组月经周期长度依次延长,即正常组DOR组POF组,差异均有统计学意义(P0. 05)。3.三组经期长度比较,差异无统计学意义(P0. 05)4.各组内左、右侧卵巢三维超声参数比较,均无显著差异(P0. 05)。5.三组间的AFC、OV、VI、FI、VFI依次减低,即正常组DOR组POF组,差异均有统计学意义(P 0.05)。6.正常组与DOR组相比:AFC的ROC曲线下面积为0. 940,灵敏度和特异度分别为0. 933、0. 760; OV的ROC曲线下面积为0. 918,灵敏度和特异度分别为0. 933、0. 735;VI的ROC曲线下面积为0. 883,灵敏度和特异度分别为0. 900、0. 615; FI的ROC曲线下面积为0. 813,灵敏度和特异度分别为0. 917、0. 475; VFI的ROC曲线下面积为0.903,灵敏度和特异度分别为0. 917、0.645。DOR组和POF组相比:AFC的ROC曲线下面积为0. 929,灵敏度和特异度分别为0. 925、0. 783; OV ROC曲线下面积为0. 931,灵敏度和特异度分别为0. 958、0. 750; VI的ROC曲线下面积为0. 934,灵敏度和特异度分别为0. 942、0. 767; FI的ROC曲线下面积为为0. 929,灵敏度和特异度分别为O. 925、0. 733; VFI的ROC曲线下面积为0. 954,灵敏度和特异度分别为 0.942、0.842。结论三维超声定量指标AFC、OV、卵巢血流灌注情况能预测卵巢储备功能。三维超声定量指标中AFC对卵巢储备功能减低的预测价值最高,OV次之,卵巢血流灌注指标最低,其中VFI的价值高于VI、FI。AFC、OV、卵巢血流灌注情况对卵巢早衰均具有较好的预测价值。经阴道三维超声能量多普勒及VOCAL、SonoAVC后处理技术的应用,使AFC、OV、卵巢血流灌注情况的测值更加准确、可靠,对卵巢储备功能的评估具有广泛的研究和应用价值。
[Abstract]:Objective to observe the changes of antral follicle number, ovarian volume and ovarian interstitial blood flow perfusion in patients with decreased ovarian reserve function and premature ovarian failure by transvaginal three-dimensional ultrasound. Objective: to evaluate the value of three-dimensional ultrasound in quantitative evaluation of ovarian reserve function and premature ovarian failure. Materials and methods 1. From October 2014 to November 2016, 100 female patients with normal ovarian reserve function and 60 patients with reduced ovarian reserve function in (DOR) group were selected according to the excluded criteria for ultrasound examination in the outpatient clinic of the Chinese people's Liberation Army General Hospital. Ovarian premature failure (POF) group 60. 2. Record the patient's age, menstrual cycle, menstrual period and other general conditions. During the 3-5 days of menstrual cycle, six basic sex hormones were taken, and the examination time of amenorrhea was not limited. At the same time, the vagina was examined by three dimensional power Doppler ultrasound. The following parameters were obtained by quantitative analysis of ovary by three-dimensional ultrasound post-processing software (VOCAL,Sono AVC): antral follicle count (AFC), ovarian volume (0V), ovarian vascularization index (VI), blood flow index (FI), vascularization index (VFI). 4. The age, menstrual cycle and menstrual period of each group were compared. The three dimensional ultrasound parameters of left and right ovaries in each group were compared. The difference of three dimensional ultrasound parameters was compared, the ROC curve was drawn, and the area (areas under curve, AUC) and critical value under the (SE), specificity (SP), curve were calculated for the diagnosis of ovarian dysfunction and premature ovarian failure. Result 1. The age of DOR group was higher than that of normal group (P 0. 01). There was no significant difference between DOR group and POF group (P0.05). The menstrual cycle length of the three groups was prolonged in turn, that is, normal group, DOR group, POF group, the difference was statistically significant (P 0. 0. (05) .3. There was no significant difference in menstrual length among the three groups (P0. (05) 4. There was no significant difference in three dimensional ultrasound parameters between the left and right ovaries in each group (P 0. 0. (05) .5. The AFC,OV,VI,FI,VFI of the three groups decreased in turn, that is, the normal group, DOR group, POF group, the difference was statistically significant (P 0. 05). 6. The area under the ROC curve of the normal group compared with the DOR group is 0. 5%. The sensitivity and specificity were 0. 933,0. The area under the ROC curve of OV is 0. 0. The sensitivity and specificity were 0. 933,0. The area under the ROC curve of 735 VI is 0. The sensitivity and specificity were 0. 900,0. The area under the ROC curve of FI is 0. The sensitivity and specificity were 0. 917,0. The area under the ROC curve of VFI was 0.903, the sensitivity and specificity were 0.903, respectively. The area under the ROC curve of the 917 AFC 0.645.DOR group compared with the POF group was 0. 5%. The sensitivity and specificity were 0. 925,0. The area under the OV ROC curve is 0. The sensitivity and specificity were 0. 958,0. The area under the ROC curve of VI is 0. 0. The sensitivity and specificity were 0. 942,0. The area under the ROC curve of FI is 0. 7. 929, the sensitivity and specificity were O. 925 and 0, respectively. The area under the ROC curve of VFI is 0. The sensitivity and specificity were 0.942 and 0.842, respectively. Conclusion three-dimensional ultrasound quantitative index AFC,OV, can predict ovarian reserve function. Among the quantitative indexes of three dimensional ultrasound, the predictive value of AFC on ovarian reserve function was the highest and the ovarian perfusion index was the lowest. The value of VFI was higher than that of VI,FI.AFC,OV, in predicting premature ovarian failure. The application of transvaginal three dimensional ultrasound power Doppler and VOCAL,SonoAVC post-processing technology makes the measurement of ovarian perfusion in AFC,OV, more accurate and reliable. It has a wide range of research and application value in the evaluation of ovarian reserve function.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R711.75

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