超声评估内膜区血管指数和子宫内膜蠕动性与宫腔粘连程度的关系

Associations of ultrasound-assessed endometrial vascular index and peristalsis with the severity of intrauterine adhesions

摘要:

目的 探讨三维超声内膜区血管指数和二维超声子宫内膜蠕动性与宫腔粘连（IUA）程度的关系，为非侵入性评估IUA严重程度提供超声学依据。方法 回顾性选取2022年5月—2024年5月在绵阳市中心医院妇科及生殖医学中心就诊的128例女性患者，根据宫腔镜检查结果分为正常组（62例）和IUA组（66例，其中轻度18例、中度25例、重度23例）。患者均在月经干净后第3～5天接受常规二维超声、彩色多普勒超声和三维能量多普勒超声检查。测量并记录内膜动脉血流参数［搏动指数（PI）、阻力指数（RI）、收缩期峰值流速（PSV）和收缩期/舒张期流速比值（S/D）］、子宫动脉血流参数、内膜厚度、内膜容积、内膜血管化指数（VI）、内膜血流指数（FI）、内膜血管化血流指数（VFI）以及子宫内膜蠕动情况。结果 IUA组患者的内膜厚度薄于正常组（P 0.05），内膜容积小于正常组（P 0.05），VI、FI及VFI均低于正常组（P 0.05）。IUA组内膜动脉PI、RI及S/D均高于正常组（P 0.05）。重度粘连组内膜厚度均薄于轻度粘连组、中度粘连组（P 0.05），内膜容积均小于轻度粘连组、中度粘连组（P 0.05）。轻度粘连组、中度粘连组、重度粘连组PSV、PI、RI及S/D比较，差异无统计学意义（P 0.05）。IUA组中0型高于正常组（P 0.05），Ⅱ、Ⅲ型低于正常组（P 0.05）。轻度粘连组、中度粘连组、重度粘连组子宫内膜波动幅度比较，差异有统计学意义（P 0.05）。Spearman相关性分析结果显示，IUA程度与子宫内膜蠕动级别、VFI、内膜容积、内膜厚度、VI、FI均呈负相关（r_s =-0.508、-0.498、-0.488、-0.447、-0.430、-0.374，均P 0.05），与内膜动脉S/D、内膜动脉RI、内膜动脉PI均呈正相关（r_s =0.258、0.219、0.203，均P 0.05）。结论 三维超声内膜区血管指数和二维超声子宫内膜蠕动性在IUA患者中显著异常，且与粘连严重程度相关，两者联合可作为评估IUA的辅助无创指标，为临床诊治提供重要参考。

Abstract:

Objective To investigate the associations of the endometrial vascular index measured by three-dimensional ultrasound and the endometrial peristalsis measured by two-dimensional ultrasound with the severity of intrauterine adhesions (IUA), providing an ultrasonographic basis for the non-invasive assessment of IUA severity.Methods A retrospective analysis was conducted on 128 female patients who visited the Department of Gynecology and the Reproductive Medicine Center of Mianyang Central Hospital between May 2022 and May 2024. Based on hysteroscopic findings, they were divided into a normal group (62 cases) and an IUA group (66 cases, including 18 mild, 25 moderate, and 23 severe cases). All patients underwent conventional two-dimensional ultrasound, color Doppler ultrasound, and three-dimensional power Doppler ultrasound examinations on days 3-5 after menstruation. The endometrial arterial blood flow parameters [pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), systolic/diastolic velocity ratio (S/D) ], uterine artery blood flow parameters, endometrial thickness, endometrial volume, endometrial vascularization index (VI), endometrial flow index (FI), endometrial vascularization flow index (VFI), and endometrial peristalsis were measured and recorded.Results Patients in the IUA group had thinner endometrial thickness (P 0.05), smaller endometrial volume (P 0.05), and lower VI, FI, and VFI compared with the normal group (all P 0.05). The endometrial arterial PI, RI, and S/D in the IUA group were all higher than those in the normal group (P 0.05). In the severe IUA group, endometrial thickness was thinner than in both the mild and moderate IUA groups (P 0.05), and endometrial volume was smaller than in both the mild and moderate IUA groups (P 0.05). There were no statistically significant differences in PSV, PI, RI, or S/D among the mild, moderate, and severe IUA groups (P 0.05). The proportion of type 0 endometrial peristalsis in the IUA group was higher than that in the normal group (P 0.05), whereas the proportions of type II and type III endometrial peristalsis were lower than those in the normal group (P 0.05). There were statistically significant differences in endometrial peristaltic amplitude among the mild, moderate, and severe IUA groups (P 0.05). Spearman correlation analysis showed that the severity of IUA was negatively correlated with endometrial peristaltic grade, VFI, endometrial volume, endometrial thickness, VI, and FI (r_s = -0.508, -0.498, -0.488, -0.447, -0.430, and -0.374, respectively; all P 0.05), and positively correlated with endometrial arterial S/D, RI, and PI (r_s = 0.258, 0.219, and 0.203, respectively; all P 0.05).Conclusion The endometrial vascular index measured by three-dimensional ultrasound and endometrial peristalsis measured by two-dimensional ultrasound show significant differences between the normal and IUA groups and are correlated with the severity of IUA. They can serve as auxiliary non-invasive indicators for assessing IUA, providing important references for clinical diagnosis and treatment.