宋瑞芳，苏迎春，王芳

子宫及内膜血流参数与冻融胚胎移植妊娠结局的关系

宋瑞芳，苏迎春，王芳

目的：探讨子宫及子宫内膜血流动力学变化对冻融胚胎移植（frozen-thawed embryo transfer，FET）妊娠结局的影响。方法：310例FET患者按照临床妊娠结局分为妊娠组（153例）和非妊娠组（157例）。所有患者均于内膜转化日及移植前1 d，通过彩色多普勒超声诊断仪监测子宫内膜厚度、子宫内膜容积（V）、子宫内膜及内膜下血流相关参数。结果：转化日妊娠组子宫动脉搏动指数（PI）、收缩期峰值流速（PSV）与舒张末期流速（EDV）比值（S/D）低于非妊娠组，子宫内膜容积高于非妊娠组（P＜0.05）；移植前日妊娠组PI、阻力指数（RI）均低于非妊娠组，血流指数（FI）、子宫内膜容积均高于非妊娠组（P＜0.05）；子宫内膜容积的ROC曲线下面积为0.637，显著大于参考下面积（P＜0.01）。移植前日子宫动脉PSV、EDV、RI较转化日低，而子宫内膜FI、子宫内膜容积较转化日高（P＜0.05）。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）。据RI值分为0.70～0.85组和0.86～0.95组，妊娠率分别为53.18%、40.00%，0.70～0.85组妊娠率较高（P＜0.05）。结论：移植前日PI、RI较低者易获得妊娠。子宫内膜容积对子宫内膜容受性有一定的预测价值。PI、RI可能通过改变子宫内膜厚度而影响子宫内膜容受性。

超声检查，多普勒，彩色；胚胎移植；妊娠结局；血流动力学；子宫内膜

【Abstract】Objective:To investigate the relationship between the uterine and endometrial blood flow index and the pregnancy outcomes of frozen-thawed embryo transfer（FET）cycles.M ethods:Three hundred and ten women who had undergone FET were grouped into two groups，the pregnancy group（n=153）and the nonpregnancy group（n=157），according to the clinical outcomes.All patients were asked tomonitor the endometrial thickness，endometrial volume（V），endometrial and subendometrial blood flow on the endometrial transformation days and before transplantation day.Resu lts:The uterine artery pulsatility index（PI），the peak systolic velocity（PSV）/end diastolic velocity（EDV）on the endometrial transformation day in the pregnant group were significantly lower than those in the non-pregnant group（P＜0.05）.The PIand resistance index（RI）on the transplantation day in the pregnantgroup was significantly lower than those in the non-pregnant group，while the flow index（FI）and V value in the pregnant group were significantly higher（P＜0.05）.The area under the ROC curve of endometrial volume in the pregnancy group was significantly higher（0.637，P＜0.01）.The uterine artery PSV，EDV and RIon the pre-transplant day were lower than those on the transformation day，while FI and V value on the pretransplant day were higher than those on the transformation day（P＜0.05）.The correlation coefficient between the uterine artery RI，PI，V and endometrial thicknesswere-0.431，-0.775 and 0.796（P＜0.01）.The pregnancy rate in those women with the uterine RI 0.70-0.85 was significantly higher than that in those women with the uterine RI 0.86-0.95（53.18%vs.40.00%，P＜0.05）.Conclusions:Those women with lower RIand PIon the transplantation day aremore likely to get pregnancy.The V value is helpful for predictiving the endometrial receptivity.The PI and RImay affect the endometrial receptivity.

【Keyw ords】Ultrasonography，Doppler，color；Embryo transfer；Pregnancyoutcome；Hemodynamics；Endometrium

（JIntReprod Health/Fam Plan，2016，35：365-368）

自人类冻融胚胎移植（frozen-thawed embryo transfer，FET）临床妊娠成功以来，其作为常规体外受精-胚胎移植（IVF-ET）技术重要的补充，已成为辅助生殖技术（ART）不可或缺的组成部分；尤其是在提升累积临床妊娠率、降低多胎妊娠率、减少治疗费用、预防卵巢过度刺激综合征发生等方面发挥着重要作用［1］。……