發(fā)布時(shí)間：2018-12-18 16:44

【摘要】：目的通過(guò)彩色多普勒超聲監(jiān)測(cè)種植窗期子宮動(dòng)脈及子宮內(nèi)膜下血流血流動(dòng)力學(xué)指標(biāo),分析子宮動(dòng)脈及內(nèi)膜下血流血流動(dòng)力學(xué)參數(shù)與體外受精/卵細(xì)胞漿內(nèi)單精子顯微注射-胚胎移植(IVF/ICSI-ET)結(jié)局的關(guān)系,探討其對(duì)子宮內(nèi)膜容受性的預(yù)測(cè)價(jià)值,為反復(fù)種植失敗者提供超聲學(xué)依據(jù),同時(shí)為無(wú)優(yōu)質(zhì)胚胎移植者探索新的治療思路。方法收集2015年8月-2015年12月在寧夏醫(yī)科大學(xué)總醫(yī)院生殖醫(yī)學(xué)中心實(shí)施IVF/ICSI-ET助孕的患者100例。根據(jù)胚胎移植后14天血清HCG結(jié)果分為研究組(HCG≥25IU/ml)共48例,對(duì)照組(HCG25IU/ml)共52例。再由助孕方案分為鮮胚移植組(ET組)47例,凍胚移植組(FET組)53例。應(yīng)用化學(xué)發(fā)光法測(cè)定生殖激素水平,經(jīng)陰道彩色多普勒超聲測(cè)定子宮動(dòng)脈/內(nèi)膜下血流血流指標(biāo):收縮期峰值流速(PSV),舒張期末流速(EDV),收縮期峰值流速/舒張末期流速(S/D),阻力指數(shù)(RI),搏動(dòng)指數(shù)(PI)。SPSS18.0統(tǒng)計(jì)軟件分析,計(jì)量資料用t檢驗(yàn),計(jì)數(shù)資料X2檢驗(yàn),用AUC判斷子宮動(dòng)脈及內(nèi)膜下血流RI臨床預(yù)測(cè)價(jià)值。結(jié)果(1)研究組和對(duì)照組的ET者種植窗期子宮內(nèi)膜厚度明顯高于FET者(12.86±2.48vs.10.81±2.41,12.45±2.26vs.10.74±2.56,均p0.01)。(2)研究組子宮動(dòng)脈及內(nèi)膜下血流RI值均明顯低于對(duì)照組(0.69±0.09vs.0.82±0.33,0.72±0.11vs.0.77±0.15,均p0.05),但二者RI的ROC曲線下面積均小于參考下面積(p0.01)。(3)研究組中優(yōu)質(zhì)胚胎移植者的子宮動(dòng)脈及內(nèi)膜下血流RI值明顯低于對(duì)照組(0.68±0.09vs.0.83±0.36,0.70±0.11vs.0.78±0.16,均p0.05),RI的ROC曲線下面積均小于參考面積(p0.01)。(4)ET中,研究組基礎(chǔ)LH值顯著高于對(duì)照組(4.01±1.64vs.2.70±1.27,p0.05);且ROC曲線下面積大于參考面積(p0.05)。(5)在FET周期中,研究組子宮動(dòng)脈RI顯著低于對(duì)照組(0.69±0.11 vs.0.85±0.41,p0.05)。(6)雙胎妊娠者子宮動(dòng)脈/內(nèi)膜下血流RI略低于單胎妊娠者(p0.05)。結(jié)論(1)子宮動(dòng)脈及內(nèi)膜下血流RI值可做為預(yù)測(cè)胚胎移植結(jié)局的參考指標(biāo)。(2)通過(guò)改善子宮動(dòng)脈及內(nèi)膜下血流血流灌注對(duì)提高非優(yōu)質(zhì)胚胎移植的妊娠率可能存在潛在的臨床應(yīng)用前景。(3)2個(gè)或以上優(yōu)質(zhì)胚胎移植者,移植日子宮動(dòng)脈/內(nèi)膜下血流低RI者也更容易發(fā)生多胎妊娠。(4)超生理劑量的E2水平不是影響子宮內(nèi)膜血流動(dòng)力學(xué)的因素,E2/P為一項(xiàng)調(diào)節(jié)因子。(5)基礎(chǔ)LH是影響鮮胚移植妊娠結(jié)局的因素之一,當(dāng)基礎(chǔ)LH2.58m IU/ml時(shí),妊娠率明顯下降。
[Abstract]:Objective to monitor the uterine artery and subendometrial hemodynamics in the implantation window by color Doppler ultrasound (CDFI). To analyze the relationship between uterine artery and subendometrial hemodynamic parameters and the outcome of in vitro fertilization / intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET), and to explore its predictive value for endometrial receptivity. To provide ultrasonic basis for repeated implantation failure, and to explore a new treatment for those without high quality embryo transfer. Methods from August 2015 to December 2015, 100 cases of IVF/ICSI-ET assisted pregnancy were collected from the Center of Reproductive Medicine, General Hospital of Ningxia Medical University. According to the results of serum HCG 14 days after embryo transfer, 48 cases of study group (HCG 鈮，

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