三维能量多普勒超声检测黄体血流对高龄女性妊娠的作用
Effect of corpus luteum blood flow measured by three-dimensional power Doppler ultrasound on pregnancy in elderly women

摘要：目的 探索三维能量多普勒超声检测黄体血流对高龄女性妊娠的作用。方法 选择2016年1月至2017年7月在西安交通大学第一附属医院就诊的排卵正常高龄女性464例为研究组，选择同期计划妊娠<35岁的女性436例为对照组，比较两组患者的临床资料。结果 两组患者各监测时间点优势卵泡平均直径和子宫内膜厚度均无统计学差异(P>0.05)，排卵后第1天黄体血流分级亦无统计学差异(P>0.05)，但研究组排卵后第7～9天黄体血流分级较对照组显著降低(P<0.05)。两组患者排卵后第1天黄体体积(V)、血管参数及排卵后第7～9天黄体体积(V)比较无统计学差异(P>0.05)，研究组排卵后第7～9天黄体血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)均显著低于对照组(P<0.05)。研究组生化妊娠率和临床妊娠率分别为16.38%、9.05%，显著低于对照组的23.17%、19.04%(P<0.05)。研究组生化妊娠流产率为7.33%，显著高于对照组的4.13%(P<0.05)。两组患者中生化妊娠流产组黄体V、VI、FI、VFI均显著低于临床妊娠组(P<0.05)。结论 高龄女性胚胎着床窗口期黄体血供减少，可能与子宫内膜容受性和妊娠率降低有关。无论高龄与否，生化妊娠流产者易出现黄体血供减少，进而导致妊娠失败。
ABSTRACT: Objective To explore the effect of corpus luteum blood flow measured by three-dimensional power Doppler ultrasound on pregnancy in elderly women. Methods We selected 464 elderly women with normal ovulation who came to the First Affiliated Hospital of Xi’an Jiaotong University from January 2016 to July 2017 as study group. Another 436 women aged less than 35 years old who planned pregnancy in the same period were selected as control group. The clinical data were compared between the two groups. Results There was no significant difference in average diameter of dominant follicles and endometrial thickness at each monitoring point between the two groups (P>0.05). There was no significant difference in corpus luteum blood flow grade 1 day after ovulation (P>0.05), but corpus luteum blood flow grade 7 to 9 days after ovulation in study group was significantly reduced as compared with control group (P<0.05). The two groups did not differ significantly in corpus luteum volume (V) or vascular parameters 1 day after ovulation, corpus luteum V 7-9 days after ovulation (P>0.05). However, luteum vascularization index (VI), flow index (FI) and vascularization flow index (VFI) significantly decreased in study group compared with control group (P<0.05). Biochemical pregnancy rate and clinical pregnancy rate were 16.38% and 9.05% in study group, which were significantly lower than 23.17% and 19.04% in control group, respectively (P<0.05). Miscarriage rate of biochemical pregnancy in study group was 7.33%, significantly higher than 4.13% in control group (P<0.05). Corpus luteum V and vascular parameters in women with biochemical pregnancy abortion in both groups were significantly lower than those with clinical pregnancy (P<0.05). Conclusion The decreased of blood supply of the corpus luteum in embryo implantation window of elderly women may be related to the reduction of endometrial receptivity and pregnancy rate. Regardless of old age,