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目的探讨经阴道三维超声和宫腔镜检查诊断的未改变宫腔形态子宫肌壁间肌瘤助孕患者肌壁间肌瘤及子宫动脉血流参数对体外授精/单精子卵细胞浆内注射-胚胎移植(IVF/ICSI-ET)临床妊娠及围生期结局的影响。方法采用回顾性队列研究,选取2012年1月至2013年12月在郑州大学第三附属医院生殖医学中心超声及宫腔镜检查显示未改变宫腔形态的单发或多发肌壁间子宫肌瘤180例患者作为研究组;并采用随机数字法抽取180例年龄匹配但未合并子宫肌瘤患者作为对照组。比较两组的一般基线资料、人绒毛膜促性腺激素(h CG)日子宫动脉血流参数、临床妊娠结局及围生期结局等相关指标;采用logistic回归分析影响活产率的相关因素。结果两组h CG日子宫动脉搏动指数(pulsat ile i ndex,PI)、子宫动脉收缩期最高血流速度/舒张期最低血流速度(S/D)、着床率、活产率比较,差异有统计学意义(P<0.05),临床妊娠结局及围生期结局等指标比较,差异均无统计学意义(P>0.05)。logistic回归分析显示,年龄(OR=0.849,95%CI:0.796~0.906,P<0.001)、有无肌瘤(OR=0.532,95%CI:1.196~5.359,P<0.05)、子宫动脉PI、S/D(OR=1.3 46,95%CI:0.205~0.586,P<0.001;OR=1.371,95%CI:1.184~1.588;P<0.001)、h CG日内膜厚度(OR=1.732,95%CI:0.639~0.839,P<0.001)是影响IVF/ICSI助孕患者活产率的独立因素;年龄、子宫动脉S/D、h CG日内膜厚度是影响合并肌壁间肌瘤的IVF/ICSI助孕患者活产率的独立因素(OR=0.876,95%CI:0.790~0.970,P<0.05;OR=2.265,95%CI:1.663~3.087,P<0.001;OR=1.751,95%CI:0.595~0.947,P<0.05)。结论 h CG日子宫动脉血流参数及子宫内膜厚度是影响IVF/ICSI助孕患者活产率的独立因素,肌壁间肌瘤对IVF/ICSI助孕有不利影响。
Objective To investigate the relationship between intramuscular myofibroma and uterine arterial blood flow parameters in uterine fibroids and intramuscular injection of embryos Impact of transplantation (IVF / ICSI-ET) on clinical pregnancy and perinatal outcome. Methods A retrospective cohort study was conducted. From January 2012 to December 2013, ultrasound and hysteroscopy in the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from January 2012 to December 2013 were selected to study the single or multiple intramural uterine fibroids One hundred and eighty patients were selected as the study group. 180 patients with age-matched but not combined uterine fibroids were selected as the control group by random number method. General baseline data, uterine arterial blood flow parameters of human chorionic gonadotropin (hCG), clinical pregnancy outcomes and perinatal outcome were compared between the two groups. Logistic regression analysis was used to analyze the factors influencing the live birth rate. Results The differences in h CG day uterine artery pulsatility index (PI), uterine artery systolic peak blood flow / diastolic blood flow velocity (S / D), implantation rate and live birth rate There was statistical significance (P <0.05), clinical pregnancy outcome and perinatal outcome and other indicators, the difference was not statistically significant (P> 0.05). Logistic regression analysis showed that there were no fibroids (OR = 0.532, 95% CI: 1.196-5.359, P <0.05), the age (OR = 0.849,95% CI: 0.796-0.906, P <0.001) ORG was significantly higher in h CG (OR = 1.732, 95% CI: 0.205-0.586, P <0.001; OR = 1.371, 95% CI: 1.184-1.588; % CI: 0.639-0.839, P <0.001) were independent factors influencing the live birth rate in IVF / ICSI-assisted pregnancy. Age, uterine artery S / D, / ICSI were independent factors of live birth rate (OR = 0.876,95% CI: 0.790-0.970, P <0.05; OR = 2.265,95% CI: 1.663-3.087, P <0.001; OR = 1.751, 95% CI: 0.595 ~ 0.947, P <0.05). Conclusion The uterine arterial blood flow parameters and endometrial thickness on h CG day are the independent factors influencing the live birth rate in patients with IVF / ICSI. Intramural fibroids have an adverse effect on IVF / ICSI assisted pregnancy.