Guedes-Martins Luís, Gaio Rita, Saraiva Joaquim, Cerdeira Sofia, Matos Liliana, Silva Elisabete, Macedo Filipe, Almeida Henrique
Department of Experimental Biology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, 4150-180 Porto, Portugal; Centro Hospitalar do Porto EPE, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
Department of Mathematics, Faculty of Sciences, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal; CMUP-Centre of Mathematics, University of Porto, Rua do Campo Alegre, 4169-007 Porto, Portugal.
PLoS One. 2015 Mar 5;10(3):e0119103. doi: 10.1371/journal.pone.0119103. eCollection 2015.
Cyclic endometrial neoangiogenesis contributes to changes in local vascular patterns and is amenable to non-invasive assessment with Doppler sonography. We hypothesize that the uterine artery (UtA) impedance, measured by its pulsatility index (PI), exhibits a regular pattern during the normal menstrual cycle. Therefore, the main study objective was to derive normative new day-cycle-based reference ranges for the UtA-PI during the entire cycle from days 1 to 34 according to the isolated time effect and potential confounders such as age and parity.
From January 2009 to December 2012, a cross-sectional study of 1,821 healthy women undergoing routine gynaecological ultrasound was performed. The Doppler flow of the right and left UtA-PI was studied transvaginally by colour and pulsed Doppler imaging. The mean right and left values and the presence or absence of a bilateral protodiastolic notch were recorded. Reference intervals for the PI according to the cycle day were generated by classical linear regression.
The majority of patients (97.5%) presented unilateral or bilateral UtA notches. The crude 5th, 50th, and 95th reference percentile curves of the UtA-PI at 1-34 days of the normal menstrual cycle were derived. In all curves, a progressive significant decrease occurred during the first 13 days, followed by an increase and recovery in the UtA-PI. The adjusted 5th, 50th, and 95th reference percentile curves for the effects of age and parity were also obtained. These two conditions generated an approximately identical UtA-PI pattern during the cycle, except with small but significant reductions at the temporal extremes.
The median, 5th, and the 95th percentiles of the UtA-PI decrease during the first third of the menstrual cycle and recover to their initial values during the last two thirds of the cycle. The rates of decrease and recovery depend significantly on age and parity.
周期性子宫内膜新生血管形成导致局部血管模式改变，且可用多普勒超声进行无创评估。我们假设，通过搏动指数（PI）测量的子宫动脉（UtA）阻抗在正常月经周期中呈现出规律模式。因此，主要研究目标是根据独立时间效应以及年龄和产次等潜在混杂因素，得出整个月经周期（第1天至第34天）基于新的日周期的UtA-PI规范参考范围。
2009年1月至2012年12月，对1821名接受常规妇科超声检查的健康女性进行了横断面研究。通过彩色和脉冲多普勒成像经阴道研究左右UtA-PI的多普勒血流。记录左右平均值以及双侧舒张早期切迹的有无。根据周期日生成PI的参考区间，采用经典线性回归法。
大多数患者（97.5%）出现单侧或双侧UtA切迹。得出了正常月经周期第1至34天UtA-PI的原始第5、第50和第95参考百分位数曲线。在所有曲线中，UtA-PI在最初13天内呈逐渐显著下降，随后上升并恢复。还获得了针对年龄和产次影响的校正后第5、第50和第95参考百分位数曲线。这两种情况在周期中产生了大致相同的UtA-PI模式，只是在时间极值处有小但显著的降低。
UtA-PI的中位数、第5和第95百分位数在月经周期的前三分之一期间下降，并在周期的后三分之二期间恢复到初始值。下降和恢复速率显著取决于年龄和产次。
