子宫内膜超声形态与子宫卵巢血管活性的关系

目的探讨自然排卵周期中子宫内膜超声形态与子宫动脉卵巢基质血流以及血管内皮生长因子(VEGF)的关系。方法30例有正常排卵功能的育龄妇女,于尿黄体生成素(LH)阳性日经阴道超声确定子宫内膜超声形态类型。按Gonen等子宫内膜超声形态的分型标准将研究对象分为A、B、C组。尿LH阳性日和排卵后第6~7天测定子宫动脉和卵巢基质血流收缩期峰值流速(PSV)、舒张末血流速度(EDV)和阻力指数(RI)。于月经周期第3天,尿LH阳性日和排卵后第6~7天放免法测定血清卵泡刺激素(FSH)、LH、雌二醇(E2)及孕酮(P);双抗夹心ELISA法测定血清VEGF浓度。结果①围排卵期子宫动脉和卵巢基质血流PSV为A组>C组(P<0.05)。②黄体中期,子宫动脉EDV为A组>C组,子宫动脉RI为A组C组(P<0.05)。③卵泡早期、围排卵期及黄体中期平均血清VEGF浓度A组>B组>C组,但无显著性差异。结论强回声子宫内膜容受性低可能与黄体功能不足和子宫卵巢血流速减低有关。

Relationship between ultrasonographic appearance of the endometrium and blood flow activitics in the ovarian and uterine arteries

Objective To study the relationship between ultrasonographic appearance of the endometrium and the blood flow of uterine artery,ovarian stroma and VEGF in the spontaneous ovulating cycle.Methods A total of 30 women with normal ovulating function participated in this study.On the day of positive urinary LH,the subjects were divided into three groups(A,B and C) according to Gonen's criterions of endometrial echogenic patterns.The peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI) in uterine arteries and ovarian stromal vessels were measured with transvaginal color Doppler ultrasonography;follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)) and progesterone(P) were assessed by fluoroimmunoassay;and vascular endothelial growth factor(VEGF) was assessed by Enzyme-linked immunosorbent assay on the third day of the cycle,the pre-ovulating phase,and the 6～7 day after ovulation.Results ① During the pre-ovulatory phase uterine arteries and ovarian stromal blood flow PSV in group A was significantly higher than that in group C(P<(0.05)).② During the mid-luteal phase,uterine arteries EDV in group A was significantly higher than that in group C;uterine arteries RI in group A was significantly lower than that in group C(P<0.05).Ovarian stromal blood flow PSV and EDV in group A was significantly higher than that in group C(P<0.05).(③ During) the early follicular phase,the pre-ovulatory phase and the mid-luteal phase,serum VEGF level was highest in group A,then in group B and lowest in group C(P>0.05).Conclusion Lower receptivity in the hyperechogenic endometrium may be related with corpus luteum defection and disorder of the uterine blood vessel activities.