Preovulatory changes of blood flow in different regions of the human follicle
Preovulatory changes of blood flow in different regions of the human follicle
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DOI：
10.1016/s0015-0282(97)00544-x
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发表时间：
1998-03-01
影响因子：
6.7
通讯作者：
Bourne, T
中科院分区：
文献类型：
--
作者：
Brännström, M;Zackrisson, U;Bourne, T
目的：探讨血浆LH激增后优势卵泡血流超声指标的区域变化。设计：横断面前瞻性研究。地点：一所大学的生殖医学单位。患者：在自然周期内到辅助受孕诊所确定移植先前冷冻胚胎的合适时间的妇女。干预措施：采用经阴道超声彩色多普勒成像和脉冲多普勒频谱分析，获得10-12天（月经第1天）、黄体生成素激增后、破裂前优势卵泡基部、外侧和尖端血管的血流和速度指标。从第10个周期开始，每天两次（上午8-10点和下午4-6点）采用免疫分析法测定血LH浓度。主要观察指标：子宫动脉和优势卵泡三个区域（根尖、外侧和基底）的脉搏指数（PI）、阻力指数（OU）、峰值收缩速度（PSV）和时间平均最大速度（TAMXV）；卵泡体积;LH激增开始的日期和时间（定义为LH第一次浓度bbb22 Un）和每次扫描的次数。结果：研究了22名女性（28-39岁），其中7名在第10-12天进行了扫描。对其余数据的回顾性检查显示，8名患者在LH激增发生20小时后进行了扫描。促黄体生成素激增后卵泡体积显著增加。周期第10-12天，基部血管PI（0.86 +/- 0.11，平均值+/- SEM）、外侧血管PI（0.72 +/- 0.51）和先端血管PI（0.67 +/- 0.09）相似，然后先端血管PI逐渐降低。国际扶轮也有类似的变化。10-12天时，卵泡底部（10.1 +/- 1.64）、侧面（8.2 +/- 1.43）和顶端（9.2 +/- 1.91）血管的PSV（平均+/- SEM； cm/s）相似。在LH激增发生的20小时内，基底血管的PSV升高（23.4 +/- 4.10），外侧血管的PSV保持不变（1.64 +/- 3.18），8个卵泡中有6个的尖端血管未检测到PSV。LH激增20小时后，卵泡顶部未见搏动性血流量，但基部（15.73 +/- 3.42）和外侧（9.02 +/- 1.5）持续高PSV。TAMXV也有相应的变化。结论：在排卵过程中，卵泡局部血流量变化明显，卵泡底部血流量明显增加，卵泡顶部血流量明显减少。这些变化可能对成熟卵母细胞的释放至关重要。(C) 1998年，美国生殖医学学会。
Objective: To assess regional changes in ultrasound-derived indices of blood flow in the dominant human follicle after the plasma LH surge.Design: A cross-sectional, prospective study.Setting: Reproductive medicine unit at a university.Patient(s): Women attending an assisted conception clinic to determine the appropriate time to transfer previously frozen embryos during a natural cycle.Intervention(s): Transvaginal ultrasonography with color Doppler imaging and pulsed Doppler spectral analysis was used to obtain indices of blood flow and velocity from vessels in the base, lateral part, and apex of the dominant follicle on days 10-12 (from day 1 of menses) and after the LH surge, bur before rupture. Immunoassays were used to measure the blood concentrations of LH twice daily (at 8-10 A.M. and 4-6 P.M.) from cycle day 10.Main Outcome Measure(s): The pulsatility index (PI), resistance index OU), peak systolic velocity (PSV), and time-averaged maximum velocity (TAMXV) in the uterine arteries and three regions of the dominant follicle (apical, lateral, and basal parts); follicular volume; the day and time of the onset of the LH surge (defined as first concentration of LH >22 Un) and the times of each scan.Result(s): Twenty-two women (aged 28-39 years) were studied and seven were scanned on days 10-12. A retrospective examination of the data from the remainder showed that eight were scanned 20 hours after the onset of the LH surge. There was a significant increase in follicular volume after the LH surge. The PI was similar in vessels from the base (0.86 +/- 0.11; mean +/- SEM), lateral part (0.72 +/- 0.51) and apex (0.67 +/- 0.09) at cycle days 10-12 and then gradually decreased in the apex. There were similar changes in the RI. The PSV (mean +/- SEM; cm/s) was similar in vessels from the base (10.1 +/- 1.64), lateral side (8.2 +/- 1.43), and apex (9.2 +/- 1.91) in follicles of days 10-12. Within 20 hours of the onset of the LH surge, the PSV had increased in basal vessels (23.4 +/- 4.10), remained similar in lateral vessels (1 1.64 +/- 3.18), and was undetectable in apex vessels from six of eight follicles. Twenty hours after the LH surge, there was no pulsatile blood flow observed in the apical parr of the follicle, but there was a sustained high PSV in the base (15.73 +/- 3.42) and lateral side (9.02 +/- 1.5). There were corresponding changes in the TAMXV.Conclusion(s): During the ovulatory process there are prominent changes in the regional blood flow of the follicle with a marked increase of the flow to the base of the follicle and a concomitant decrease of blood flow to the apex. These changes may be essential for the release of a mature oocyte. (C) 1998 by American Society for Reproductive Medicine.