三维能量多普勒超声评估复发性流产患者子宫内膜容受性及预测妊娠结局的价值分析

Value of three-dimensional power Doppler ultrasound in evaluating endometrial receptivity and predicting pregnancy outcomes in patients with recurrent spontaneous abortion

摘要

目的 探讨三维能量多普勒超声(3D-PDU)评估复发性流产(RSA)患者子宫内膜容受性及预测患者妊娠结局的价值。方法 选取2019年1月至2021年12月期间在唐山市中医医院进行治疗的RSA患者120例,所有患者均在入院后实施3D-PDU及子宫内膜活检,并随访1年。以子宫内膜活检结果+随访结果为金标准,分析3D-PDU对RSA患者子宫内膜容受性的评估价值,使用Kappa进行一致性检验,受试者工作特征(ROC)曲线分析3D-PDU参数[子宫内膜容积、厚度、血管指数(VI)、血流指数(FI)、血管血流指数(VFI)及子宫动脉搏动指数(PI)、阻力指数(RI)]预测RSA患者妊娠结局的价值。结果 经子宫内膜活检结果+随访结果确诊,120例RSA患者中子宫内膜容受性良好者(最终成功妊娠)95例,占79.17%;3D-PDU评估RSA患者子宫内膜容受性的准确性为95.00%、灵敏度为95.79%、特异度为92.00%、阳性预测值为97.85%、阴性预测值为85.19%;经一致性Kappa度量,3D-PDU评估RSA患者子宫内膜容受性结果与子宫内膜活检+随访结果的一致性较好(Kappa=0.853,P<0.001);成功妊娠组子宫动脉PI、RI明显低于未成功妊娠组(t=18.670和12.643,P<0.001);子宫内膜容积、子宫内膜VI、子宫内膜FI、子宫内膜VFI均高于未成功妊娠组(t值介于5.742~34.050,P<0.001);成功妊娠组子宫内膜厚度与未成功妊娠组相比,差异不显著(P>0.05);绘制ROC曲线发现,子宫内膜容积、VI、FI、VFI、子宫动脉PI、RI单独及联合预测RSA患者妊娠结局的曲线下面积(AUC)分别为0.789(95%CI:0.699~0.880)、0.738(95%CI:0.633~0.843)、0.787(95%CI:0.699~0.879)、0.697(95%CI:0.590~0.803)、0.754(95%CI:0.590~0.803)、0.668(95%CI:0.562~0.774)、0.860(95%CI:0.783~0.937),其中联合预测效能最高。结论 3D-PDU对RSA患者子宫内膜容受性有较好的评估价值,与子宫内膜活检结果+随访结果有较高的一致性;子宫内膜容积、VI、FI、VFI与子宫动脉PI、RI联合可有效预测RSA患者的妊娠结局。

Abstract

Objective To investigate the value of three-dimensional power Doppler ultrasound (3D-PDU) in evaluating endometrial receptivity and predicting pregnancy outcomes in patients with recurrent spontaneous abortion (RSA). Methods A total of 120 patients with RSA who received treatment at Tangshan Hospital of Traditional Chinese Medicine between January 2019 and December 2021 were enrolled. All patients underwent 3D-PDU examination and endometrial biopsy after admission and were followed up for 1 year. Endometrial biopsy results combined with follow-up outcomes were used as the gold standard. The diagnostic value of 3D-PDU in evaluating endometrial receptivity in RSA patients was analyzed, and consistency was assessed using the Kappa test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of 3D-PDU parameters, including endometrial volume, thickness, vascularization index (VI), flow index (FI), vascularization flow index (VFI), as well as uterine artery pulsatility index (PI) and resistance index (RI), for pregnancy outcomes in RSA patients. Results According to endometrial biopsy results combined with follow-up outcomes, 95 of the 120 RSA patients were confirmed to have good endometrial receptivity and ultimately achieved successful pregnancy, accounting for 79.17%. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 3D-PDU in evaluating endometrial receptivity were 95.00%, 95.79%, 92.00%, 97.85%, and 85.19%, respectively. Kappa consistency analysis showed good agreement between 3D-PDU assessment and endometrial biopsy combined with follow-up results (Kappa=0.853, P<0.001). The uterine artery PI and RI in the successful pregnancy group were significantly lower than those in the unsuccessful pregnancy group (t=18.670 and 12.643, respectively, P<0.001). Endometrial volume, VI, FI, and VFI were significantly higher in the successful pregnancy group than in the unsuccessful pregnancy group (t values ranged from 5.742 to 34.050, P<0.001). There was no significant difference in endometrial thickness between the two groups (P>0.05). ROC curve analysis revealed that the areas under the curve (AUC) for endometrial volume, VI, FI, VFI, uterine artery PI, RI, and their combined prediction of pregnancy outcomes in RSA patients were 0.789 (95%CI:0.699-0.880), 0.738 (95%CI:0.633-0.843), 0.787 (95%CI:0.699-0.879), 0.697 (95%CI:0.590-0.803), 0.754 (95%CI:0.590-0.803), 0.668 (95%CI:0.562-0.774), and 0.860 (95%CI:0.783-0.937), respectively, with the combined prediction showing the highest predictive efficiency. Conclusion Three-dimensional power Doppler ultrasound demonstrates good value in evaluating endometrial receptivity in patients with RSA and shows high consistency with endometrial biopsy combined with follow-up outcomes. The combination of endometrial volume, VI, FI, VFI, and uterine artery PI and RI can effectively predict pregnancy outcomes in RSA patients.

关键词

复发性流产 / 三维能量多普勒超声 / 子宫内膜容受性 / 妊娠结局 / 预测价值

Key words

recurrent spontaneous abortion / three-dimensional power Doppler ultrasound / endometrial receptivity / pregnancy outcome / predictive value

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基金资助

河北省医学科学研究重点课题计划项目(20240608)