不同超声参数在评估IVF-ET患者子宫内膜容受性中的价值
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摘要
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.
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.
引文
[1] 张奕文,李蓉.评估和改善子宫内膜容受性治疗反复种植失败的研究进展[J].中华生殖与避孕杂志,2017,37(9):754-758.
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[3] 张玲玲,郭瑞君.子宫血流超声参数在评估体外受精-胚胎移植患者子宫内膜容受性中的应用[J].临床超声医学杂志,2017,19(6):404-407.
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[10] 陈敏霞,何燕妮,刘红梅,等.子宫内膜及内膜下血流灌注与不明原因不孕的关系[J].中国妇幼保健,2015,30(33):5817-5819.
[11] 谢梦,王文平.评估不孕症患者子宫内膜容受性的超声研究进展[J].实用妇产科杂志,2013,29(8):583-585.
[12] MA X,ZHAO Y,ZHANG B,et al.Contrast-enhanced ultrasound for differential diagnosis of benign and malignant ovarian tumors:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2015,46(3):277-283.
[13] WEI X,LI Y,ZHANG S,et al.Prediction of thyroid extracapsular extension with cervical lymph node metastases (ECE-LN) by CEUS and BRAF expression in papillary thyroid carcinoma[J].Tumour Biol,2014,35(9):8559-8564.
[14] FERRAIOLI G,MELONI M F.Contrast-enhanced ultrasonography of the liver using SonoVue[J].Ultrasonography,2018,37(1):25-35.
[15] BAROZZI L,CAPANNELLI D,IMBRIANI M.Contrast enhanced ultrasound in the assessment of urogenital pathology[J].Arch Ital Urol Androl,2014,86(4):319-324.
[16] RAN L,ZHAO W,ZHAO Y,et al.Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP):A systematic review and a meta-analysis[J].Medicine(Baltimore),2017,96(28):e7463.
[17] CHEN M,HE Y,ZHANG P,et al.Comparison of Uterine Receptivity between Fertile and Unexplained Infertile Women by Assessment of Endometrial and Subendometrial Perfusion Using Contrast-Enhanced Ultrasound:Which Index is Better--Peak Intensity or Area under the Curve?[J].Ultrasound Med Biol,2016,42(3):654-663.
[18] POP C M,MIHU D,BADEA R.Role of contrast-enhanced ultrasound (CEUS) in the diagnosis of endometrial pathology[J].Clujul Med,2015,88(4):433-437.
[2] 吴燕虹,赵军招.冻融胚胎移植内膜准备的研究进展[J].温州医科大学学报,2016,46(2):149-153.
[3] 张玲玲,郭瑞君.子宫血流超声参数在评估体外受精-胚胎移植患者子宫内膜容受性中的应用[J].临床超声医学杂志,2017,19(6):404-407.
[4] COELHO NETO M A,RONCATO P,NASTRI C O,et al.True Reproducibility of UltraSound Techniques (TRUST):systematic review of reliability studies in obstetrics and gynecology[J].Ultrasound Obstet Gynecol,2015,46(1):14-20.
[5] 王楠,张坪,赵永玲,等.内皮型一氧化氮合酶表达及微血管密度评估体外受精患者子宫内膜容受性的价值[J].实用妇产科杂志,2017,33(3):185-188.
[6] 中华医学会生殖医学分会第一届实验室学组.人类体外受精-胚胎移植实验室操作专家共识(2016)[J].生殖医学杂志,2017,26(1):1-8.
[7] XIANG H,HUANG R,CHENG J,et al.Value of three-dimensional contrast-enhanced ultrasound in the diagnosis of small adnexal masses[J].Ultrasound Med Biol,2013,39(5):761-768.
[8] D’ONOFRIO M,CROSARA S,DE ROBERTIS R,et al.Contrast-Enhanced Ultrasound of Focal Liver Lesions[J].AJR Am J Roentgenol,2015,205(1):W56-66.
[9] 田密苏,郑波,吕芳杰.彩色多普勒能量超声评估子宫内膜容受性预测胚胎解冻移植妊娠结局的价值[J].宁夏医科大学学报,2016,38(9):1058-1060.
[10] 陈敏霞,何燕妮,刘红梅,等.子宫内膜及内膜下血流灌注与不明原因不孕的关系[J].中国妇幼保健,2015,30(33):5817-5819.
[11] 谢梦,王文平.评估不孕症患者子宫内膜容受性的超声研究进展[J].实用妇产科杂志,2013,29(8):583-585.
[12] MA X,ZHAO Y,ZHANG B,et al.Contrast-enhanced ultrasound for differential diagnosis of benign and malignant ovarian tumors:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2015,46(3):277-283.
[13] WEI X,LI Y,ZHANG S,et al.Prediction of thyroid extracapsular extension with cervical lymph node metastases (ECE-LN) by CEUS and BRAF expression in papillary thyroid carcinoma[J].Tumour Biol,2014,35(9):8559-8564.
[14] FERRAIOLI G,MELONI M F.Contrast-enhanced ultrasonography of the liver using SonoVue[J].Ultrasonography,2018,37(1):25-35.
[15] BAROZZI L,CAPANNELLI D,IMBRIANI M.Contrast enhanced ultrasound in the assessment of urogenital pathology[J].Arch Ital Urol Androl,2014,86(4):319-324.
[16] RAN L,ZHAO W,ZHAO Y,et al.Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP):A systematic review and a meta-analysis[J].Medicine(Baltimore),2017,96(28):e7463.
[17] CHEN M,HE Y,ZHANG P,et al.Comparison of Uterine Receptivity between Fertile and Unexplained Infertile Women by Assessment of Endometrial and Subendometrial Perfusion Using Contrast-Enhanced Ultrasound:Which Index is Better--Peak Intensity or Area under the Curve?[J].Ultrasound Med Biol,2016,42(3):654-663.
[18] POP C M,MIHU D,BADEA R.Role of contrast-enhanced ultrasound (CEUS) in the diagnosis of endometrial pathology[J].Clujul Med,2015,88(4):433-437.