探讨经阴道三维超声联合抗苗勒管激素（AMH）检测在卵巢储备功能评估中的应用价值。

选取121例备孕女性，均在月经期第3天行经阴道三维超声检查，采用超声自动容积测量（SonoAVC）技术获取窦卵泡计数（AFC）、卵巢体积（OV）及卵巢基质动脉收缩期峰值流速（PSV），并同时检测与卵巢储备功能相关的基础性激素及AMH的绝对值水平。根据基础性激素水平正常与否，将备孕女性分为A组（正常组）与B组（异常组），再依据年龄进一步将A组分为A₁组（年龄<40岁）和A₂组（年龄≥40岁），将B组分为B₁组（年龄<40岁）和B₂组（年龄≥40岁）。研究分析4组间上述各项超声测量值、血液AMH值以及临床妊娠率和妊娠结局的差异性；分析AFC、OV及卵巢基质动脉PSV三者之间的相关性，以及三者与AMH的相关性；同时根据妊娠结局，将所有成功受孕女性分为妊娠结局良好组与不良组，比较2组间上述各项超声测量值及AMH之间的差异性。

4组备孕女性的AFC、OV及AMH差异均有统计学意义（F=12.572、5.862、15.194，P均≤0.001），A₁组的AFC、OV、AMH显著高于B₁和B₂组，差异具有统计学意义（P均<0.05）。A₁组的AFC显著大于A₂组，差异具有统计学意义（P<0.05）；A₂组的AFC大于B₂组，差异具有统计学意义（P<0.05）；B₁组的AFC显著大于B₂组，差异具有统计学意义（P<0.05）。A₂组的AMH显著高于B₂组，差异具有统计学意义（P<0.05）。4组备孕女性卵巢基质动脉PSV差异无统计学意义（P>0.05）。AFC与OV，AFC与AMH，OV与AMH均呈正相关（r=0.488、0.498、0.462，P均<0.001）。A₁组临床妊娠率最高（22/51，43.14%），不良妊娠结局发生率最低（5/22，22.73%）；B₂组临床妊娠率最低（1/17，5.88%），且受孕女性妊娠结局不良。妊娠结局良好组的AFC、OV及AMH显著高于不良组（t=2.079、2.885、2.164，P均<0.05）。

经阴道三维SonoAVC技术可简便、准确地获取AFC、OV等超声指标，联合血清AMH水平可为临床提供精准、可靠的量化指标，从而为卵巢储备功能的评估以及妊娠结局的预测提供重要的参考依据。

To assess the value of transvaginal three-dimensional (3D) ultrasound combined with anti-Müllerian hormone (AMH) in the assessment of ovarian reserve function.

One hundred and twenty-one women who were ready for pregnancy were selected, all of whom underwent transvaginal 3D ultrasound on the third day of menstruation. The data of antral follicle count (AFC), ovarian volume (OV), and peak systolic velocity of the ovarian stromal artery (PSV) were collected by sonography-based automated volume calculation (Sono AVC). The levels of basic sex hormone and AMH, which are related to ovarian reserve function, were also detected. According to the level of basic sex hormone, the patients were divided into either group A (having a normal level of basic sex hormone) or group B (having an abnormal level of basic sex hormone). The two groups were further divided into two subgroups based on the age: <40 yrs (subgroups A₁ and B₁) and ≥40 yrs (subgroups A₂ and B₂). The data of ultrasound, AMH, and pregnancy outcome among the subgroups were compared. The correlations among AFC, OV, and ovarian stromal artery PSV as well as their correlation with AMH were also analyzed. According to the pregnancy outcome, all the pregnant women were divided into a good pregnancy outcome group and a poor pregnancy outcome group, and the differences in the above ultrasound measurements and AMH between the two groups were compared.

The four subgroups of women showed a statistical difference in AFC, OV, and AMH (F=12.572, 5.862, and 15.194, respectively; P≤0.001 for all). The AFC, OV, and AMH in subgroup A₁ were significantly higher than the those in subgroups B₁ and B₂ (P<0.05). The AFC was significantly higher in subgroup A₁ than in subgroup A₂ (P<0.05), in subgroup A₂ than in subgroup B₂ (P<0.05), and in subgroup B₁ than in subgroup B₂ (P<0.05). There was a positive correlation between AFC and OV, between AFC and AMH, and between OV and AMH (r=0.488, 0.498, and 0.462, respectively; P<0.001 for all). Subgroup A₁ had the highest pregnancy rate [22/51 (43.14%)] and lowest poor pregnancy outcome [5/22 (22.73%)]. Subgroup B₂ had the lowest pregnancy rate [1/17 (5.88%)] and a poor pregnancy outcome. The AFC, OV, and AMH in the good pregnancy outcome group were significantly higher than those in the poor pregnancy outcome group (t=2.079, 2.885, and 2.164, respectively; P<0.05 for all).

Transvaginal 3D ultrasound-based AVC can obtain AFC and OV easily and precisely. Combined with AMH, transvaginal 3D ultrasound can provide objective, precise, and reliable data for ovarian reserve function assessment and pregnancy outcome prediction.