摘要
目的 探讨鲜胚移植周期超声参数预测体外受精-胚胎移植(IVF-ET)患者妊娠结局的临床价值.方法 选取在我院就诊的98例IVF-ET患者,根据患者IVF-ET术后12～14 d是否妊娠将其分为妊娠组59例和非妊娠组39例,比较两组IVF-ET术当天经阴道超声检查所测子宫内膜厚度、容积、血管指数(VI)、血流指数(FI)、血管血流指数(VFI)、子宫内膜形态及子宫内膜下血流参数[动脉收缩期峰值血流速度与舒张末期血流速度比值(S/D)、搏动指数(PI)、阻力指数(RI)]的差异.应用Logistic回归分析预测IVF-ET患者妊娠结局的独立影响因素,并建立联合应用模型;绘制受试者工作特征(ROC)曲线分析各超声参数单独及联合应用预测IVF-ET患者妊娠结局的诊断效能.结果 妊娠组患者子宫内膜下S/D、PI、RI均低于非妊娠组,子宫内膜和子宫内膜下FI、VI、VFI均高于非妊娠组,差异均有统计学意义(均P<0.05);两组患者子宫内膜厚度、容积及形态比较差异均无统计学意义.Logistic回归分析显示,子宫内膜下S/D、PI、VI和子宫内膜VI、VFI为预测IVF-ET患者妊娠结局的独立影响因素,基于此建立联合应用模型为:Logit(P)=-6.013+1.025×子宫内膜下S/D+3.428×子宫内膜下PI+0.831×子宫内膜下VI+0.633×子宫内膜VI+5.934×子宫内膜VFI.ROC曲线分析显示,子宫内膜下S/D、PI、VI和子宫内膜VI、VFI单独及联合应用预测IVF-ET患者妊娠结局的曲线下面积分别为0.796、0.736、0.735、0.780、0.725、0.978,其中联合应用模型预测妊娠结局的曲线下面积最高,与各超声参数单独应用预测的曲线下面积比较差异均有统计学意义(均P<0.05).结论 子宫内膜下S/D、PI、VI和子宫内膜VI、VFI均可预测IVF-ET患者妊娠结局,且多参数联合应用的预测价值更高.
Abstract
Objective To explore the clinical value of ultrasound parameters during fresh embryo transfer cycle in predicting pregnancy outcomes in patients undergoing in vitro fertilization embryo transfer(IVF-ET).Methods A total of 98 patients underwent IVF-ET in our hospital were selected and divided into pregnant group(59 cases)and non-pregnant group(39 cases)according to whether they were pregnant 12～14 d after IVF-ET.The endometrial thickness,volume,vascularization index(VI),flow index(FI),vascularization flow index(VFI),endometrial morphology and sub-endometrial blood flow parameters[ratio of peak systolic velocity and end diastolic velocity(S/D),pulpability index(PI),resistance index(RI)]measured by transvaginal ultrasonography were compared between the two groups on the day of IVF-ET.Logistic regression analysis was used to analyze the independent influencing factors in predicting pregnancy outcomes in patients underwent IVF-ET,and the combined diagnostic model was established.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of ultrasound parameters alone and in combination for predicting pregnancy outcomes in patients underwent IVF-ET.Results The sub-endometrial S/D,PI,and RI in the pregnancy group were lower than those in the non-pregnancy group,while endometrial and sub-endometrial VI,FI,and VFI in the pregnancy group were higher than those in the non-pregnancy group,and the differences were statistically significant(all P<0.05).There were no significant differences of the endometrial thickness,volume,endometrial morphology between two groups.Logistic regression analysis showed that sub-endometrial S/D,PI,VI,and endometrial VI and VFI were independent influencing factors for predicting pregnancy outcomes of patients underwent IVF-ET.Based on these factors,the combined diagnostic model was established as follows:Logit(P)=-6.013+1.025×sub-endometrial S/D+3.428×sub-endometrial PI+0.831×sub-endometrial VI+0.633×endometrial VI+ 5.934×endometrial VFI.ROC curve analysis showed that the area under curve(AUC)of sub-endometrial S/D,PI and VI,as well as endometrial VI and VFI alone or in combination for predicting pregnancy outcomes of IVF-ET patients were 0.796,0.736,0.735,0.780,0.725 and 0.978,respectively.The AUC of the combined diagnostic model for predicting pregnancy outcomes was the highest,and the differences were statistically significant compared with that of each parameter alone(all P<0.05).Conclusion The sub-endometrial S/D,PI,VI,and endometrial VI,VFI can predict pregnancy outcomes in patients undergoing IVF-ET,and multi-parameter combined detection has higher predictive value.
基金项目
河北省2021年度医学科学研究课题计划项目(20211501)
NETL
NSTL
维普
万方数据