产后早期盆腔器官脱垂发生的预测模型构建及验证  

Establishment and validation of prediction model of new-onset pelvic organ prolapse in early postpartum period

作　　者：王青 于晓杰[1] 刘慧鑫[2] 汪海波[3] 孙秀丽[1] 王建六[1] Wang Qing;Yu Xiaojie;Liu Huixin;Wang Haibo;Sun Xiuli;Wang Jianliu(Department of Obstetrics and Gynecology,Peking University People′s Hospital,Key Laboratory of Female Pelvic Floor Disorders of Beijing,Beijing 100044,China;Office of Academic Research,Peking University People′s Hospital,Beijing 100044,China;Peking University Clinical Research Institute,Beijing 100191,China)

机构地区：[1]北京大学人民医院妇产科北京市女性盆底疾病研究重点实验室,北京100044 [2]北京大学人民医院科研处,北京100044 [3]北京大学临床研究所,北京100191

出　　处：《中华妇产科杂志》2022年第1期32-38,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2018YFC2002204)。

摘　　要：目的分析产后早期发生盆腔器官脱垂(POP)的高危因素并构建预测模型。方法横断面调查北京大学人民医院2018年12月至2019年10月期间产后6周妇女(2247例)的临床资料和POP现状并采用logistic回归分析产后POP发生的相关影响因素,构建产后早期POP发生的预测模型并进行内部验证;另采集2019年11—12月间的数据(403例产妇)用作预测模型的外部验证。进一步探讨影响阴道分娩初产妇(2019年1月至2019年11月期间的阴道分娩初产妇885例)产后早期POP发生的产科因素。结果发生POP者占24.3%(545/2247),年龄、产次、孕前体质指数、阴道分娩及新生儿出生体重与产后早期新发POP相关(P均<0.05)。据此构建了产后早期POP发生的风险预测模型,经内部验证和外部验证提示模型的区分度良好[代表区分度的C指数(C-index)分别为0.759和0.760]。在阴道分娩初产妇中,年龄和新生儿出生体重是其产后早期发生POP的主要高危因素(P=0.044、P=0.004)。结论产后早期POP发生率高,本研究构建的产后早期POP发生的风险预测模型,可在一定程度指导临床实际工作,给予孕产妇相应的诊疗建议,为POP的一级预防提供了理论支持。Objective To analyze the risk factors of pelvic organ prolapse(POP)and to establish the prediction model.Methods A study was conducted on the prevalence of POP among 2247 parturient women at 6 weeks postpartum in Peking University People′s Hospital from December 2018 to October 2019,and relevant influencing factors were analyzed to construct a prediction model of early postpartum POP using logsitic regression,which was validated internally.Data from November 2019 to December 2019(403 parturient women)were collected for external validation of the prediction model.In addition,the obstetrical factors affecting the occurrence of early postpartum POP in 885 primiparas with vaginal delivery(from January 2019 to November 2019)were further discussed.Results A total of 2247 cases were included in the modeling group,and 403 cases were included in the external validation data set.POP accounted for 24.3%(545/2247).Age,parity,body mass index before pregnancy,vaginal delivery and newborn birth weight were negative factors for early postpartum POP(all P<0.05).The nomogram was established based on the above factors,and internal and external verification indicated that the model had a good discrimination(C-index were 0.759 and 0.760,respectively).In addition,this study found that age and newborn birth weight were the main causes of early postpartum POP in primiparas with vaginal delivery(P=0.044,P=0.004).Conclusions The incidence of early postpartum POP is high.The prediction model of POP constructed in this study could be used to guide clinical practice to a certain extent and give corresponding treatment suggestions to pregnant women scientifically,so as to provide theoretical support for primary prevention.

关 键 词：盆腔器官脱垂 产后期 危险因素 预测 

分 类 号：R714.6[医药卫生—妇产科学]