【摘要】 目的 分析三维能量多普勒超声（3D-PDU）联合超微血管成像（SMI）评估多囊卵巢综合征（PCOS）不孕患者子宫内膜容受性（ER）的价值。方法 纳入105例PCOS不孕患者，患者于月经干净后第5～7天接受3D-PDU、SMI检查；同时根据子宫内膜容积检查结果将患者分为ER良好组和ER不良组。比较两组3D-PDU、SMI检查相关指标，分析3D-PDU联合SMI评估PCOS不孕患者ER的价值。结果 105例PCOS不孕患者中ER不良占68.57%。ER不良组血管指数（VI）值、血管血流指数（VFI）值均低于ER良好组，螺旋动脉的阻力指数（RI）值、搏动指数（PI）值、收缩期/舒张期速度比（S/D）值、睾酮（T）均高于ER良好组，子宫内膜厚度（EMT）小于ER良好组（t分别=-3.61、-4.70、3.10、3.70、4.85、3.48,Z=2.92,P均<0.05）;logistic回归分析显示，EMT、VI、VFI、螺旋动脉RI、PI、S/D及T均是影响PCOS不孕患者ER不良的相关因素（OR分别=0.49、0.46、0.34、20.15、5.50、6.00、2.03,P均<0.05）；绘制受试者工作特征（ROC）曲线，VI、VFI、螺旋动脉RI、PI、S/D单独及联合评估PCOS不孕患者ER不良的曲线下面积分别为0.70、0.79、0.69、0.69、0.74、0.92；限制性立方样条结果显示，当螺旋动脉RI≥0.77、PI≥1.99、S/D≥3.62、VI<3.06%、VFI<2.32时，其对PCOS不孕患者ER具有负影响风险；绘制决策曲线，当阈值为0.00～0.06、0.30～1.00时，VI、VFI、螺旋动脉RI、螺旋动脉PI、螺旋动脉S/D联合预测模型预测PCOS不孕患者ER不良的净收益率优于单个指标预测。结论 3D-PDU联合SMI可为PCOS不孕患者ER的评估提供更精准的参考信息。更多还原

【Abstract】 Objective To analyze the value of three-dimensional power doppler ultrasonography(3D-PDU)combined with superb micro-vascular imaging(SMI)in evaluating endometrial receptivity(ER)in infertile patients with polycystic ovary syndrome(PCOS). Methods A total of 105 infertility patients with PCOS were included in the study. The patients underwent 3D-PDU and SMI examinations on the 5th to 7th day post menstrual cycle. At the same time,according to the results of endometrial volume examination,the patients were divided into good ER group and poor ER group. The related indexes of 3D-PDU and SMI were compared between the two groups,and the value of 3D-PDU combined with SMI in evaluating ER in infertile patients with PCOS was analyzed. Results ER was found to be poor in 68.57% of 105infertile patients with PCOS. The vascular index(VI)and vascular blood flow index(VFI)in the poor ER group were lower than those in the good ER group. The resistance index(RI),pulsatility index(PI),systolic/diastolic velocity ratio(S/D)and testosterone(T)of the spiral artery were higher than those in the good ER group. The endometrial thickness(EMT)was thinner than those in the good ER group(t=-3.61,-4.70,3.10,3.70,4.85,3.48,Z=2.92,P<0.05). Logistic regression analysis showed that EMT,VI,VFI,spiral artery RI,PI,S/D and T were risk factors affecting poor ER in infertile patients with PCOS(OR=0.49,0.46,0.34,20.15,5.50,6.00,2.03,P<0.05). The areas under the curve(AUC)of VI,VFI,spiral artery RI,PI,S/D alone and combination to evaluate the poor ER in infertile patients with PCOS were 0.70,0.79,0.69,0.69,0.74,and0.92,respectively. The results of the restricted cubic spline showed that when the spiral artery RI≥0.77,PI≥1.99,S/D≥3.62,VI<3.06%,VFI<2.32,it had a negative impact on the risk of ER in infertile patients with PCOS. The decision curve was drawn. When the threshold was 0.00-0.06and 0.30-1.00,the VI,VFI,spiral artery RI,spiral artery PI,spiral artery S/D combined prediction model was superior to single index prediction in predicting the net rate of return of poor ER in PCOS infertile patients. Conclusion The combination of 3D-PDU and SMI can provide more accurate reference information for the evaluation of ER in PCOS infertility patients.更多还原