三维能量彩色多普勒监测子宫及内膜血流参数与冻融胚胎移植周期妊娠结局的关系
发布时间：2018-09-08 13:43
【摘要】：背景 在常规体外受精-胚胎移植（IVF）治疗中，子宫内膜的超声检查是一种常用的非侵入性检查方法，用来评估子宫内膜的容受性。子宫内膜良好的血液供应通常被认为是着床的必要条件，因此，近年来，在IVF中对子宫内膜血流的评估受到越来越广泛的关注。有学者认为子宫内膜的多普勒研究并不能反映实际流向子宫内膜的血流情况，但三维能量多普勒超声下子宫内膜和内膜下血流相关参数可以更客观和更可靠的评价子宫内膜血流情况。然而，就其对IVF妊娠结局的预测作用，报道的结果存在争议。究其原因可能是因为实验设计本身的不同以及超声数据采集日期的不同。三维能量多普勒超声以一种新的成像方式被引入到临床实践中。虽然这种技术可能不会取代二维超声，但它正在越来越广泛的被使用，并且它是一个非常好的可重复性技术。三维能量多普勒超声能评估特定容积内或整个器官的血管化程度，例如子宫或卵巢，它在一个特定容积内的血流信号比二维超声更能反映容积内的血管化程度。使用三维能量多普勒超声技术，我们既可以评估动脉血流，也可以评估静脉血流，并且计算机技术使评估结果更客观。因此，三维能量多普勒是评估血液循环的很好的工具。 越来越多的研究证明，仅用子宫内膜厚度和类型来评价子宫内膜的容受性是不全面的，子宫相关血流参数才是决定IVF-ET中子宫内膜容受性的重要因素。而对于FET周期中子宫动脉及内膜血流的研究相对较少，故本实验主要在FET周期中，通过不同时段监测子宫相关血流参数来评价子宫内膜的容受性，以期为临床工作提供参考。 目的 通过脉冲多普勒技术（PW）及彩色多普勒超声技术（PDI），从影像学角度监测子宫及子宫内膜血流动力学变化，探讨其对FET周期妊娠结局的影响。 方法 选择2013年11月-2014年2月于郑州大学第一附属医院生殖医学中心行FET患者共310例，对这些患者于内膜转化日及移植前一天，通过彩色多普勒超声诊断仪（GE公司生产的GEVOLUSON E8），监测子宫内膜厚度、子宫内膜容积（V）、子宫内膜血管指数（VI）、血流指数（FI）、血管血流指数（VFI）、子宫动脉收缩期峰流速（PSV）、舒张末期流速（EDV）、收缩期峰值流速/舒张末期流速（S/D）、搏动指数（PI）、阻力指数（RI）等参数，分别进行分组比较，并进行统计学分析。 结果 1.三维能量多普勒超声测量子宫动脉及内膜相关指标与妊娠结局关系：转化日妊娠组子宫动脉搏动指数（PI）显著低于非妊娠组，两组比较有统计学差异（P＜0.05）；移植前日妊娠组子宫动脉搏动指数（PI）、阻力指数（RI）显著低于非妊娠组，且差异有统计学意义（P＜0.05），移植前日妊娠组子宫内膜血管指数（VI）、血流指数（FI）、血管化血流指数（VFI）及子宫内膜容积（V）显著高于非妊娠组，差异有统计学意义（P＜0.05）。子宫内膜容积（V）及子宫内膜血管化血流指数（VFI）对妊娠结局有一定的预测价值，两者的ROC曲线下面积分别为0.637、0.620。 2.转化日与移植前日三维能量多普勒超声测量相关指标比较：所有病例转化日数据与移植前日数据比较发现，移植前日子宫动脉搏动指数（PI）虽低于转化日，但无统计学差异（P＞0.05）。而移植前日子宫动脉阻力指数（RI）、子宫动脉收缩期峰值流速（PSV）、子宫动脉舒张末期流速（EDV）较转化日降低，，且差异有统计学意义（P＜0.05）；移植前日子宫内膜容积（V）、子宫内膜血流指数（FI）较转化日升高，且差异有统计学意义（P＜0.05）。 3.不同内膜准备方式三维多普勒超声测量参数的比较：自然周期组和激素替代周期（E-P周期）组在子宫动脉及内膜相关血流参数方面无统计学差异（P＞0.05）。 4.不同内膜厚度三维多普勒超声测量参数的比较：内膜厚度≥15mm组及8-14mm组子宫动脉PI、RI与≤7mm组相比较显著降低，且差异均有明显统计学意义（P＜0.05），≤7mm组子宫内膜容积（V）与8-14mm、≥15mm组比较显著较低，且差异有统计学意义（P＜0.05）。 5.不同指标与子宫内膜厚度的相关性：子宫动脉RI、PI及子宫内膜容积与子宫内膜厚度的相关系数分别为-0.431、-0.775及0.796（P＜0.01）。 6.不同子宫动脉阻力指数（RI）妊娠率比较：子宫动脉阻力指数（RI）为0.70-0.85和0.86-0.95时，两组妊娠率分别为53.18%、40.00%，且有统计学差异（P＜0.05）。 结论 1.子宫动脉阻力指数（RI）较低者较易获得妊娠。子宫动脉阻力指数（RI）、子宫内膜容积（V）及子宫内膜血管化血流指数（VFI）是预测冻融胚胎解冻移植周期（FET）结局较好的指标，借助超声监测具有简单、准确、快速的优点。 2.子宫内膜较厚者子宫动脉搏动指数（PI）、子宫动脉阻力指数（RI）较低。 3.不同内膜准备方式子宫动脉及内膜相关血流参数无明显差异。
[Abstract]:background
In conventional in vitro fertilization-embryo transfer (IVF) treatment, endometrial ultrasonography is a commonly used noninvasive method for evaluating endometrial receptivity. Good blood supply to the endometrium is often considered a necessary condition for implantation. Therefore, the evaluation of endometrial blood flow in IVF has been increasing in recent years. Some scholars believe that the endometrial Doppler study does not reflect the actual flow of blood to the endometrium, but the parameters related to endometrial and subendometrial blood flow under three-dimensional power Doppler ultrasound can more objectively and reliably evaluate the endometrial blood flow. However, their predictions of IVF pregnancy outcome Three-dimensional power Doppler ultrasound has been introduced into clinical practice as a new imaging method. Although this technique may not replace two-dimensional ultrasound, it is being used more and more widely. And it's a very reproducible technique. Three-dimensional power Doppler ultrasound can assess the degree of vascularization in a particular volume or in an entire organ, such as the uterus or ovary. Its blood flow signals in a specific volume can better reflect the degree of vascularization in a specific volume than two-dimensional ultrasound. Using three-dimensional power Doppler ultrasound, we Both arterial and venous blood flow can be assessed, and computer technology makes the assessment more objective. Therefore, three-dimensional power Doppler is a good tool for assessing blood circulation.
More and more studies have proved that it is incomplete to evaluate endometrial receptivity only by endometrial thickness and type, and the parameters of uterine related blood flow are the important factors determining the endometrial receptivity of IVF-ET. To evaluate endometrial receptivity by monitoring uterine blood flow parameters at different time intervals, so as to provide reference for clinical work.
objective
The changes of uterine and endometrial hemodynamics were monitored by pulse Doppler (PW) and color Doppler ultrasound (PDI) in order to explore the effects of PW and PDI on the outcome of FET cycle pregnancy.
Method
A total of 310 FET patients were selected from the Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University from November 2013 to February 2014. The endometrial thickness, endometrial volume (V) and endometrial vascular index (VI) were monitored by color Doppler ultrasonography (GEVOLUSON E8) on the day of endometrial transformation and the day before transplantation. Blood flow index (FI), vascular flow index (VFI), uterine artery peak systolic velocity (PSV), end-diastolic velocity (EDV), peak systolic velocity/end-diastolic velocity (S/D), pulsatile index (PI), resistance index (RI) and other parameters were compared and statistically analyzed.
Result
1. The relationship between uterine artery and endometrial related parameters and pregnancy outcome measured by three-dimensional power Doppler ultrasound: The uterine artery pulsatility index (PI) of pregnancy group on the day of transformation was significantly lower than that of non-pregnancy group, the difference between the two groups was statistically significant (P < 0.05); the uterine artery pulsatility index (PI) and resistance index (RI) of pregnancy group on the day before transplantation were significantly lower than that of non-pregnancy group. The endometrial vascularization index (VI), blood flow index (FI), vascularized blood flow index (VFI) and endometrial volume (V) were significantly higher in the pregnant group than in the non-pregnant group on the day before transplantation (P < 0.05). The predicted area of the ROC curve is 0.637,0.620.
2. Comparing the data of conversion day and pre-transplantation day by three-dimensional power Doppler ultrasound, it was found that the PI of uterine artery on the day before transplantation was lower than that on the day before transplantation, but there was no significant difference (P > 0.05). Peak flow velocity (PSV) and end-diastolic flow velocity (EDV) of uterine artery were significantly lower than those on the day of transformation (P < 0.05), and endometrial volume (V) and endometrial blood flow index (FI) were significantly higher on the day before transplantation (P < 0.05).
3. Comparison of three-dimensional Doppler ultrasound parameters in different endometrial preparation methods: There was no significant difference in uterine artery and endometrial related blood flow parameters between natural cycle group and hormone replacement cycle group (E-P cycle) (P > 0.05).
4. Comparison of three-dimensional Doppler ultrasonographic parameters of different endometrial thickness: PI and RI of uterine artery in group (> 15mm) and group (> 7mm) were significantly lower than those in group (> 7mm) (P < 0.05). Endometrial volume (V) in group (> 7mm) was significantly lower than that in group (> 15mm), and the difference was statistically significant (P < 0.05). .05).
5. Correlation between different parameters and endometrial thickness: the correlation coefficients of RI, PI and endometrial volume with endometrial thickness were - 0.431, - 0.775 and 0.796 respectively (P < 0.01).
6. Comparing the pregnancy rates of different uterine artery resistance index (RI): when the RI was 0.70-0.85 and 0.86-0.95, the pregnancy rates of the two groups were 53.18% and 40.00% respectively, and there was significant difference (P < 0.05).
conclusion
1. Pregnancy is more likely to occur if the uterine artery resistance index (RI) is low. The uterine artery resistance index (RI), endometrial volume (V) and endometrial vascularization blood flow index (VFI) are good indicators for predicting the outcome of frozen-thawed embryo transfer cycle (FET).
2. the uterine artery pulsatility index (PI) and uterine artery resistance index (RI) were thicker in the endometrium.
3. there was no significant difference in blood flow parameters between endometrium and endometrium.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8
[Abstract]:background
In conventional in vitro fertilization-embryo transfer (IVF) treatment, endometrial ultrasonography is a commonly used noninvasive method for evaluating endometrial receptivity. Good blood supply to the endometrium is often considered a necessary condition for implantation. Therefore, the evaluation of endometrial blood flow in IVF has been increasing in recent years. Some scholars believe that the endometrial Doppler study does not reflect the actual flow of blood to the endometrium, but the parameters related to endometrial and subendometrial blood flow under three-dimensional power Doppler ultrasound can more objectively and reliably evaluate the endometrial blood flow. However, their predictions of IVF pregnancy outcome Three-dimensional power Doppler ultrasound has been introduced into clinical practice as a new imaging method. Although this technique may not replace two-dimensional ultrasound, it is being used more and more widely. And it's a very reproducible technique. Three-dimensional power Doppler ultrasound can assess the degree of vascularization in a particular volume or in an entire organ, such as the uterus or ovary. Its blood flow signals in a specific volume can better reflect the degree of vascularization in a specific volume than two-dimensional ultrasound. Using three-dimensional power Doppler ultrasound, we Both arterial and venous blood flow can be assessed, and computer technology makes the assessment more objective. Therefore, three-dimensional power Doppler is a good tool for assessing blood circulation.
More and more studies have proved that it is incomplete to evaluate endometrial receptivity only by endometrial thickness and type, and the parameters of uterine related blood flow are the important factors determining the endometrial receptivity of IVF-ET. To evaluate endometrial receptivity by monitoring uterine blood flow parameters at different time intervals, so as to provide reference for clinical work.
objective
The changes of uterine and endometrial hemodynamics were monitored by pulse Doppler (PW) and color Doppler ultrasound (PDI) in order to explore the effects of PW and PDI on the outcome of FET cycle pregnancy.
Method
A total of 310 FET patients were selected from the Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University from November 2013 to February 2014. The endometrial thickness, endometrial volume (V) and endometrial vascular index (VI) were monitored by color Doppler ultrasonography (GEVOLUSON E8) on the day of endometrial transformation and the day before transplantation. Blood flow index (FI), vascular flow index (VFI), uterine artery peak systolic velocity (PSV), end-diastolic velocity (EDV), peak systolic velocity/end-diastolic velocity (S/D), pulsatile index (PI), resistance index (RI) and other parameters were compared and statistically analyzed.
Result
1. The relationship between uterine artery and endometrial related parameters and pregnancy outcome measured by three-dimensional power Doppler ultrasound: The uterine artery pulsatility index (PI) of pregnancy group on the day of transformation was significantly lower than that of non-pregnancy group, the difference between the two groups was statistically significant (P < 0.05); the uterine artery pulsatility index (PI) and resistance index (RI) of pregnancy group on the day before transplantation were significantly lower than that of non-pregnancy group. The endometrial vascularization index (VI), blood flow index (FI), vascularized blood flow index (VFI) and endometrial volume (V) were significantly higher in the pregnant group than in the non-pregnant group on the day before transplantation (P < 0.05). The predicted area of the ROC curve is 0.637,0.620.
2. Comparing the data of conversion day and pre-transplantation day by three-dimensional power Doppler ultrasound, it was found that the PI of uterine artery on the day before transplantation was lower than that on the day before transplantation, but there was no significant difference (P > 0.05). Peak flow velocity (PSV) and end-diastolic flow velocity (EDV) of uterine artery were significantly lower than those on the day of transformation (P < 0.05), and endometrial volume (V) and endometrial blood flow index (FI) were significantly higher on the day before transplantation (P < 0.05).
3. Comparison of three-dimensional Doppler ultrasound parameters in different endometrial preparation methods: There was no significant difference in uterine artery and endometrial related blood flow parameters between natural cycle group and hormone replacement cycle group (E-P cycle) (P > 0.05).
4. Comparison of three-dimensional Doppler ultrasonographic parameters of different endometrial thickness: PI and RI of uterine artery in group (> 15mm) and group (> 7mm) were significantly lower than those in group (> 7mm) (P < 0.05). Endometrial volume (V) in group (> 7mm) was significantly lower than that in group (> 15mm), and the difference was statistically significant (P < 0.05). .05).
5. Correlation between different parameters and endometrial thickness: the correlation coefficients of RI, PI and endometrial volume with endometrial thickness were - 0.431, - 0.775 and 0.796 respectively (P < 0.01).
6. Comparing the pregnancy rates of different uterine artery resistance index (RI): when the RI was 0.70-0.85 and 0.86-0.95, the pregnancy rates of the two groups were 53.18% and 40.00% respectively, and there was significant difference (P < 0.05).
conclusion
1. Pregnancy is more likely to occur if the uterine artery resistance index (RI) is low. The uterine artery resistance index (RI), endometrial volume (V) and endometrial vascularization blood flow index (VFI) are good indicators for predicting the outcome of frozen-thawed embryo transfer cycle (FET).
2. the uterine artery pulsatility index (PI) and uterine artery resistance index (RI) were thicker in the endometrium.
3. there was no significant difference in blood flow parameters between endometrium and endometrium.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8
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