本文關鍵詞：經(jīng)陰道三維超聲評價凍融胚胎移植周期子宮內膜容受性的研究　出處：《山東大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 經(jīng)陰道三維超聲 子宮內膜容受性 內膜轉化日 胚胎移植日 內膜及內膜下血流參數(shù)

【摘要】：研究背景近年來,人口老齡化問題日益嚴重,伴隨著二胎政策的放開,高齡不孕問題成為當今社會面臨的重大問題,由于現(xiàn)代生活節(jié)奏加快、生活方式的改變、環(huán)境污染等因素,不孕患者人數(shù)急劇增加,解決不孕患者的生育問題逐漸被提上日程,輔助生殖技術(assisted reproductive technology,ART)的迅速發(fā)展,使許多不孕癥患者成功懷孕成為可能。良好的子宮內膜容受性(endometrial receptivity)和高質量胚胎的協(xié)同作用是成功妊娠的關鍵因素,也是成功植入的必要條件。隨著科學技術的快速發(fā)展,胚胎實驗室技術也日新月異,因此帶來了體外受精-胚胎移植(invitro fertilization and embryo transfer,IVF-ET)技術中臨床妊娠率的提高。子宮內膜容受性成為影響臨床妊娠率進一步提高的瓶頸,它也成為生殖醫(yī)學研究的重點和難點。目前評價子宮內膜容受性的方式中最重要、最準確的是進行子宮內膜活檢,由于它為有創(chuàng)檢查,并且行活檢后當周期不能移植,限制了其在臨床中的應用。而超聲檢查是一種直觀、簡便、無創(chuàng)、可重復的檢查,在臨床中的應用越來越多,三維超聲及其能量多普勒的發(fā)展,使觀察微小血流分布及定量檢測血流多少成為可能,越來越多的相關專業(yè)人員利用經(jīng)陰道三維能量多普勒超聲研究、評價子宮內膜容受性。目的利用經(jīng)陰道三維超聲檢測凍融胚胎移植(frozen-thawed embryo transfer,FET)女性內膜轉化日和胚胎移植日的子宮內膜厚度、容積、內膜及內膜下容積、內膜以及內膜下血流參數(shù),探索其容積、血流參數(shù)與妊娠結局的關系,評價凍融胚胎移植周期中不同時間點的子宮內膜容受性。資料與方法選擇山東中醫(yī)藥大學附屬醫(yī)院生殖與遺傳中心接受FET周期助孕治療的患者,應用經(jīng)陰道三維超聲分別于內膜轉化日和胚胎移植日檢測子宮內膜厚度、內膜容積、內膜及內膜下容積、內膜以及內膜下區(qū)域的血流參數(shù)包括血管化指數(shù)(vascularization index VI)、血流指數(shù)(flow index FI)、血管化血流指數(shù)(vascularization-flow index VFI),根據(jù)臨床妊娠結局分為兩組,即妊娠組與未妊娠組,對兩組之間各參數(shù)的差異進行分析比較。結果內膜轉化日組:56例患者中有32例獲得臨床妊娠,妊娠率為57.14%。兩組間子宮內膜厚度、內膜容積(V0)、內膜及內膜下1-3 mm容積(V1-V3)、內膜血流指數(shù)(FI)、內膜下1 mm血流指數(shù)(FI1)差異無統(tǒng)計學意義(P0.05);妊娠組內膜和內膜下1mm的血管化指數(shù)(VI、VI1)、血管化血流指數(shù)(VFI、VFI1)、內膜下2mm和內膜下3mm的血管化指數(shù)(VI2、VI3)、血流指數(shù)(FI2、FI3)、血管化血流指數(shù)(VFI2、VFI3)均低于未妊娠組,兩組間進行比較,差異有顯著統(tǒng)計學意義(P0.05)。VI、VFI、VI1、VFI1、VI2、FI2、VFI2、VI3、FI3、VFI3預測妊娠的ROC曲線下面積分別為0.757、0.736、0.749、0.749、0.749、0.686、0.744、0.738、0.706、0.736。子宮內膜及內膜下血流參數(shù)中預測妊娠的敏感性和特異性均較高的指標為內膜血管化指數(shù)(VI)、內膜血管化血流指數(shù)(VFI)、內膜下3mm血流指數(shù)(FI3)。子宮內膜血管化指數(shù)(VI)預測妊娠的最佳臨界值標準為≤3.176,敏感性為75%,特異性為79.17%;子宮內膜血管化血流指數(shù)(VFI)預測妊娠的最佳臨界值標準為≤0.711,敏感性為75%,特異性為79.17%;子宮內膜下3mm血流指數(shù)(FI3)預測妊娠的最佳臨界值標準為≤25.814,敏感性為75.00%,特異性為70.83%。胚胎移植日組:53例患者中24例獲得臨床妊娠,29例未妊娠(包括5例生化妊娠、24例未妊娠),臨床妊娠率為45.28%。兩組間子宮內膜厚度、內膜容積(V0)、內膜及內膜下1-3mm容積(V1-V3)、內膜以及內膜下血流參數(shù)包括內膜以及內膜下1-3 mm血管化指數(shù)(VI、VI1-VI3)、內膜以及內膜下1-3 mm血流指數(shù)(FI、FI1-FI3)、內膜以及內膜下1-3mm血管化血流指數(shù)(VFI、VF1-VFI3)差異均無統(tǒng)計學意義(P0.05)。結論可以用經(jīng)陰道三維超聲評價子宮內膜容受性、預測凍融胚胎移植的妊娠結局,內膜轉化日:三維血流參數(shù)中內膜和內膜下1mm的血管化指數(shù)(VI、VI1)、血管化血流指數(shù)(VFI、VFI1)、內膜下2mm和內膜下3mm的血管化指數(shù)(VI2、VI3)、血流指數(shù)(FI2、FI3)、血管化血流指數(shù)(VFI2、VFI3)對臨床妊娠結局有一定的評估預測價值;胚胎移植日:內膜以及內膜下區(qū)域的三維血流參數(shù)對判斷妊娠結局沒有預測價值。將內膜下區(qū)域設定為內膜下3 mm,研究內膜下3 mm區(qū)域處的血流參數(shù)對評價內膜容受性更有意義。
[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.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.8;R445.1

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