三维超声评价女性盆底肌功能与胰岛素抵抗的关系  

Relationship between insulin resistance and pelvic floor muscle function evaluated by three-dimensional ultra⁃sound

作　　者：王磊 毛笑园 何萍 陈萍 任敏 WANG Lei;MAO Xiao-yuan;HE Ping;CHEN Ping;REN Min(Departments of Ultrasound Diagnostics,International Peace Maternity and Child Health Hospital of China Welfare Institution,Shanghai Jiao Tong University,Shanghai 200030,China;不详)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院超声科,上海200030 [2]同济大学附属第一妇婴保健院,产科、上海市母胎医学重点实验室,上海200040 [3]同济大学附属第一妇婴保健院,超声科,上海200040

出　　处：《中国实用妇科与产科杂志》2023年第8期833-836,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：上海市科委医学引导类课题(16411969000)。

摘　　要：目的三维超声评估胰岛素抵抗(IR)妇女的盆底功能,探讨盆底肌功能与胰岛素水平之间的关系。方法前瞻性分析2020年5月至2021年5月期间同济大学附属第一妇婴保健院产科门诊患者的临床资料,通过详细的病史记录、体格检查和生化分析收集数据,通过测量空腹和口服葡萄糖后血糖水平及胰岛素水平来判断是否有胰岛素抵抗。51例胰岛素抵抗的女性纳入IR组,另设置对照组35例。采用三维超声观察两组对象的静息态及Valsalva运动下的肛提肌裂孔各径线、周长和面积,采用t检验和线性回归模型分析数据。结果IR组年龄(29.3±4.5)岁,对照组年龄(27.2±4.0)岁。IR组和对照组体重分别为(60.6±7.6)kg和(49.8±4.9)kg。IR组和对照组体重指数(BMI)分别为29.2±5.1和20.3±4.8,IR组和对照组腰围分别为(89.2±15.1)cm和(70.3±5.8)cm,IR组和对照组空腹血糖分别为(5.0±0.4)mmol/L和(3.8±0.2)mmol/L,空腹胰岛素IR组为(16.7±4.6)mU/L,对照组为(5.4±1.8)m U/L(P<0.05)。两组间静息态裂孔面积IR组(14.8±5.8)cm^(2),对照组(11.6±2.7)cm^(2)(P<0.05);Valsalva动作下的肛提肌裂孔面积IR组(18.2±6.3)cm^(2),对照组(13.4±3.4)cm^(2)(P<0.001)差异均有统计学意义,Valsalva动作下IR组裂孔前后径(AP)较对照组明显增大[(40.0±4.7)mm vs.(33.0±4.4)mm,P<0.05]。以胰岛素水平为因变量的多因素回归分析显示,裂孔面积的影响系数r^(2)为0.7;体重和腰围的影响系数为0.1和0.2(P均<0.05)。IR组前中Valsalva动作下膀胱颈、子宫颈和直肠壶腹部位置较对照组显著降低(P<0.05)。结论静息态及Valsalva动作状态下IR组肛提肌裂孔面积较对照组明显增大,Valsalva状态下IR组盆腔前中后腔室的器官位置显著降低。胰岛素水平与盆底肌功能存在相关性。Objective To use three-dimensional ultrasound to assess pelvic floor function in women with insulin resistance(IR)and to explore its relationship with insulin levels.Methods This is a prospective analysis.The clinical data of patients from the Departmentof Premature Abortion and Cervical-Related Abortion and the Department of Reproductive Immunology in Shanghai First Maternal and Infant Health Hospital from May 2020 to May 2021 were analyzed.Data were collected through detailed history records,physical examination and biochemical analysis of collected data.Insulin resistance is determined by measuring fasting and post-oral glucose insulin levels and glucose levels respectively.Fifty-one insulin-resistant women were enrolled in the IR group and 35 normal controls were included.Three-dimensional ultrasound was used to observe the diameter lines,perimeters and areas of the levator hiatus in the two groups at rest and under Valsalva movement,and t-test and linear regression model were used to analyze the data.Results The mean age of IR group was(29.3±4.5)years old,and that of control group was(27.2±4.0)years old.The average body weight of IR group and control group was(60.6±7.6)kg and(49.8±4.9)kg,respectively.Body mass index(BMI)of IR group and control group was 29.2±5.1 and 20.3±4.8,and waist circumference of IR group and control group was(89.2±15.1)cm and(70.3±5.8)cm,respectively.Fasting blood glucose in IR group and control group was(5.0±0.4)mmol/L and(3.8±0.2)mmol/L,respectively.Fasting insulin of IR group was(16.7±4.6)mU/L and that of control group was(5.4±1.8)mU/L(P<0.05).There were statistically significant differences in the area of levator hiatus between the two groups in the resting state[(14.8±5.8)cm2 and(11.6±2.7)cm2,P<0.05]and Valsalva movement[(18.2±6.3)cm2 and(13.4±3.4)cm2,P<0.05],and the anterior-posterior(AP)diameters of hiatus under Valsalva movement were significant ly increased in the IR group,and the difference between the two groups was statistically significant[(40.0±4.7)mm and

关 键 词：盆底 三维超声 肛提肌裂孔 胰岛素抵抗 

分 类 号：R711.2[医药卫生—妇产科学]