种植窗口期宫腔镜检查对原因不明不孕症患者子宫内膜容受性及妊娠结局的预测价值
충식창구기궁강경검사대원인불명불잉증환자자궁내막용수성급임신결국적예측개치
Predictive value of endometrial receptivity and pregnancy outcome by hysteroscopy examination at the phase of implantation window in unexplained infertile women
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2010年 3期 184-190 ,共7页

    李素春%冯苗%聂琼英%潘萍%吴穗妹%伍洁华%程少霞%康举龄%郭祖文

    리소춘%풍묘%섭경영%반평%오수매%오길화%정소하%강거령%곽조문

    不育%女(雌)性%黄体期%子宫内膜%宫腔镜检查%妊娠结局 不育%女(雌)性%黃體期%子宮內膜%宮腔鏡檢查%妊娠結跼
    불육%녀(자)성%황체기%자궁내막%궁강경검사%임신결국
    Infertility,female%Luteal phase%Endometrium%Hysteroscopy%Pregnancy outcome
    目的 探讨种植窗口期官腔镜检查用于预测原因不明不孕症患者子宫内膜容受性及妊娠结局的价值.方法 选择2007年10月-2009年3月在广东省计划生育专科医院就诊的原因不明不孕症患者93例,在排卵后7～9 d(即种植窗口期)行宫腔镜检查,将其中未发现官腔病变的79例患者根据宫腔镜下子宫内膜腺体开口和血管的形态分为佳型内膜组19例、差型内膜组60例.比较两组患者子宫内膜的形态、厚度、分泌情况、胞饮突形态及数量、血管分布等,以及两组患者的血性激素水平、宫腔冲洗液中白血病抑制因子(LlF)及妊娠相关子宫内膜蛋白glycodelin水平、妊娠结局等.结果 (1)佳型内膜组患者种植窗口期血雌二醇、孕酮水平分别为(518±176)pmol/L、(40±20)nmol/L,分别与差型内膜组[分别为(513±244)pmoL/L、(37±19)nmol/L]比较,差异均无统计学意义(P>0.05).B超检查显示,佳型内膜组排卵日、种植窗口期子宫内膜厚度分别为(1.06±0.10)cm和(1.16±0.08)cm,分别与差型内膜组[分别为(0.93±0.12)cm和(1.02±0.10)cm]比较,差异均无统计学意义(P>0.05);佳型内膜组患者排卵日内膜形态为A、B、C型者分别占63%(12/19)、37%(7/19)和0(0/19),差型内膜组分别占23%(14/60)、77%(46/60)和0(0/60),两组A、B型内膜百分率分别比较,差异均有统计学意义(P<0.05);两组患者种植窗口期内膜形态均为B型.(2)佳型内膜组患者中89%(17/19)子宫内膜分泌正常,差型内膜组患者中仅7%(4/60)子宫内膜分泌正常,两组比较,差异有统计学意义(P<0.01).(3)佳型内膜组患者中,胞饮突形态为成熟期者占84%(16/19),胞饮突数量丰富者占89%(17/19),均明显高于差型内膜组[分别为42%(25/60)和57%(34/60),P<0.05].(4)佳型内膜组内膜中CD_(34)表达水平及微血管密度(MVD)分别为(40.1±1.2)阳性单位(PU)和(21.7±4.0)条/高倍视野(HP),均明显高于差型内膜组[分别为(18.1±1.3)PU和(8.5±1.3)条/HP,P均<0.01].(5)佳型内膜组宫腔冲洗液中LIF、glycodelin水平分别为(72±54)ng/L和(196±20)μg/L,均明显高于差型内膜组[分别为(15±16)ng/L和(116±26)μg/L,P均<0.05].(6)佳型内膜组患者临床妊娠率、自然流产率、足月分娩率分别为74%(14/19)、0(0/14)和100%(14/14),差型内膜组分别为23%(14/60)、14%(2/14)和86%(12/14),佳型内膜组的临床妊娠率及足月分娩率均明显高于差型内膜组(P<0.01).结论 种植窗口期宫腔镜检查能反映子宫内膜血管及腺体的发育水平,是一种较好的评估子宫内膜容受性的方法,对预测妊娠结局有一定的价值.
    목적 탐토충식창구기관강경검사용우예측원인불명불잉증환자자궁내막용수성급임신결국적개치.방법 선택2007년10월-2009년3월재광동성계화생육전과의원취진적원인불명불잉증환자93례,재배란후7～9 d(즉충식창구기)행궁강경검사,장기중미발현관강병변적79례환자근거궁강경하자궁내막선체개구화혈관적형태분위가형내막조19례、차형내막조60례.비교량조환자자궁내막적형태、후도、분비정황、포음돌형태급수량、혈관분포등,이급량조환자적혈성격소수평、궁강충세액중백혈병억제인자(LlF)급임신상관자궁내막단백glycodelin수평、임신결국등.결과 (1)가형내막조환자충식창구기혈자이순、잉동수평분별위(518±176)pmol/L、(40±20)nmol/L,분별여차형내막조[분별위(513±244)pmoL/L、(37±19)nmol/L]비교,차이균무통계학의의(P>0.05).B초검사현시,가형내막조배란일、충식창구기자궁내막후도분별위(1.06±0.10)cm화(1.16±0.08)cm,분별여차형내막조[분별위(0.93±0.12)cm화(1.02±0.10)cm]비교,차이균무통계학의의(P>0.05);가형내막조환자배란일내막형태위A、B、C형자분별점63%(12/19)、37%(7/19)화0(0/19),차형내막조분별점23%(14/60)、77%(46/60)화0(0/60),량조A、B형내막백분솔분별비교,차이균유통계학의의(P<0.05);량조환자충식창구기내막형태균위B형.(2)가형내막조환자중89%(17/19)자궁내막분비정상,차형내막조환자중부7%(4/60)자궁내막분비정상,량조비교,차이유통계학의의(P<0.01).(3)가형내막조환자중,포음돌형태위성숙기자점84%(16/19),포음돌수량봉부자점89%(17/19),균명현고우차형내막조[분별위42%(25/60)화57%(34/60),P<0.05].(4)가형내막조내막중CD_(34)표체수평급미혈관밀도(MVD)분별위(40.1±1.2)양성단위(PU)화(21.7±4.0)조/고배시야(HP),균명현고우차형내막조[분별위(18.1±1.3)PU화(8.5±1.3)조/HP,P균<0.01].(5)가형내막조궁강충세액중LIF、glycodelin수평분별위(72±54)ng/L화(196±20)μg/L,균명현고우차형내막조[분별위(15±16)ng/L화(116±26)μg/L,P균<0.05].(6)가형내막조환자림상임신솔、자연유산솔、족월분면솔분별위74%(14/19)、0(0/14)화100%(14/14),차형내막조분별위23%(14/60)、14%(2/14)화86%(12/14),가형내막조적림상임신솔급족월분면솔균명현고우차형내막조(P<0.01).결론 충식창구기궁강경검사능반영자궁내막혈관급선체적발육수평,시일충교호적평고자궁내막용수성적방법,대예측임신결국유일정적개치.
    Objective To explore predictive value of endometrial receptivity and pregnancy outcome by hysteroscopy examination at the phase of implantation window in unexplained infertile women.Methods From Oct.2007 to Mar.2009,93 unexplained infertile women underwent hysteroscopy examination at 7-9 days after a spontaneous ovulation in Family Planning Research Institute of Guangdong Province.According to the endometrial glandular openings and vascular shape,79 cases without pathological endometrial changes were divided into 60 cases in good endometrium group and 19 cases in poor endometrium group.The following clinical parameters were analyzed and compared between two groups,including endometrial configuration,thickness,secretion,the development and number of pinopodes,vascular distribution,and the level of sex hormone,leukemia inhibitory factor (LIF) and glycodelin in the uterine flushing,and pregnancy outcome.Results (1)There was no statistical difference in the level of serum estrogen and progesterone at the phase of implantation window,which were (518 ± 176)pmol/L,(40 ±20)nmol/L in good group and (513 ±244) ptnol/L,(37 ± 19) nmol/L in poor group (P<0.05).The endometrium thickness at periovulatroy and implantation window days (1.06 ±0.10)cm/(1.16 ± 0.08)cm in good group did not show significant difference with (0.93 ±0.12) cm /(1.02 ±0.10) cm in poor group (P>0.05).The proportion of type A,B and C endometrium at periovulatory days were 63% (12/19),37% (7/19) and 0 (0/19) in good group and 23% (14/60),77% (46/60) and 0 (0/60) in poor group.When compared with those of type A or B between two groups respectively,it all showed statistical difference (P<0.05).However,at phase of implantation window,endometrium configurations were all type B at both groups.(2)90% (17/19)of women in good group and 7% (4/60)of women in poor group showed normal endometrial secretion function,which showed significant differences (P< 0.01).(3)The percentage of fully developed pinopodes and abundant pinopodes [84% (16/19) and 90% (17/19)] in good group were significantly higher than 42% (25/60)and 57% (34/60) in poor group (P<0.05).(4) The level of CD_(34) expression and microvessel density[MVD; (40.1 ± 1.2) positive unit(PU) and(21.7 ±4.0)/high power field (HP)] in good group were significantly higher than(18.1 ± 1.3) PU and (8.5 ± 1.3)/HP in poor group (P< 0.01).(5)The level of LIF and glycodelin in uterine flushing [(72 ± 54)ng/L and (196 ±20)μg/L] in good group were significantly higher than (15±16) ng/L and (116 ±26) μg/L in poor group (P<0.05).(6) The rate of clinical pregnancy,spontaneous abortion and term delivery were 74% (14/19),0 (0/14) and 100% (14/14) in good group and 23% (14/60),14% (2/14) and 86% (12/14) in poor group,the rate of clinical pregnancy and term delivery in good group were significantly increased when compared with those in poor group (P<0.01).Conclusions Hysteroscopy examination at the phase of implantation window could reflect the development of glandular openings and vasculature.It is a preferable method to evaluate the endometrial receptivity and predict pregnancy outcome.
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