经阴式全子宫切除术后发生盆底功能障碍的危险因素及预测模型构建  

Risk factors and predictive model construction for the occurrence of pelvic floor dysfunction after transvaginal total hysterectomy

作　　者：吴琮璋 刘婷婷[1] 余桂梅[1] 倪茗[1] Wu Congzhang;Liu Tingting;Yu Guimei;Ni Ming(Department of Gynecology,Hanyang Hospital Affiliated of Wuhan University of Science and Technology(Wuhan Hanyang Hospital),Wuhan Hubei 430050,P.R.China)

机构地区：[1]武汉科技大学附属汉阳医院(武汉市汉阳医院)妇科,湖北武汉430050

出　　处：《中国计划生育和妇产科》2024年第1期49-52,63,I0004,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：武汉市医学科研项目(项目编号:WX21D80)。

摘　　要：目的探讨经阴式全子宫切除术后发生盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的危险因素并构建列线图预测模型。方法选取2019年1月至2021年12月在武汉市汉阳医院进行阴式全子宫切除术治疗的139例患者为研究对象,根据术后12个月患者PFD的发生情况,将患者分为PFD组(n=41)与无PFD组(n=98)。对比两组患者的一般资料,分析影响经阴式全子宫切除术后发生PFD的相关指标;经MedCalc软件对差异具有统计学意义的计量指标进行ROC曲线分析,探讨其对经阴式全子宫切除术后发生PFD的预测价值;经Logistic回归分析影响经阴式全子宫切除术后发生PFD的独立危险因素;R语言软件4.0“rms”包构建经阴式全子宫切除术后发生PFD的列线图预测模型,校正及决策曲线对列线图预测模型进行内部验证及临床预测效能评估。结果两组患者年龄、BMI、吸烟、饮酒、孕产次、分娩方式、人工流产史比较,差异有统计学意义(P<0.05)。年龄、BMI的AUC分别为0.674、0.823,最佳截断值分别为49岁、24.4 kg/m2。年龄、BMI、饮酒、孕产次、分娩方式是影响经阴式全子宫切除术后发生PFD的独立危险因素。列线图预测模型的校正曲线与原始曲线及理想曲线接近,C-index为0.675(95%CI:0.633-0.732),模型拟合度高;列线图预测模型的阈值>0.19,可提供临床净收益,且临床净收益均高于年龄、BMI、饮酒、孕产次、分娩方式。结论本研究基于经阴式全子宫切除术后发生PFD的独立危险因素即年龄、BMI、饮酒、孕产次、分娩方式构建了列线图预测模型,对PFD的发生具有较好的预测价值,有助于临床对PFD高风险患者进行干预,降低PFD的发生率。Objective To investigate the risk factors for pelvic floor dysfunction(PFD)after transvaginal total hysterectomy and to construct a nomogram prediction model.Methods 139 patients who underwent transvaginal total hysterectomy in Wuhan Hanyang Hospital from January 2019 to December 2021 were selected,and according to the occurrence of PFD 12 months after surgery,the patients were divided into PFD group(n=41)and non-PFD group(n=98).The general data of the two groups were compared,and the indicators affecting the occurrence of PFD after transvaginal total hysterectomy were analyzed;the ROC curve analysis was performed by MedCalc software for the measures with statistically significant differences to explore their predictive value for the occurrence of PFD after transvaginal total hysterectomy;Logistic regression analysis was used to analyze the independent risk factors affecting PFD after vaginal hysterectomy;the nomogram prediction model for the occurrence of PFD after transvaginal total hysterectomy was constructed with the R language software 4.0"rms"package,and the calibration and decision curves were used to internally validate the nomogram prediction model and evaluate the clinical predictive efficacy.Results The differences between the two groups were statistically significant in terms of age,BMI,smoking,alcohol consumption,number of pregnancies,mode of delivery,and history of abortion(P<0.05).The AUC for age and BMI were 0.674 and 0.823,respectively,and the optimal cutoff values were 49 years old and 24.4 kg/m2,respectively.Age,BMI,alcohol consumption,frequency of pregnancy and delivery methods were independent risk factors for the occurrence of PFD after transvaginal total hysterectomy.The calibration curve of the nomogram prediction model was close to the original curve and the ideal curve with a C-index of 0.675(95%CI:0.633-0.732),and the model fit was good;the threshold of the nomogram prediction model was>0.19,which could provide a net clinical benefit,and the net clinical benefit was higher than that of

关 键 词：阴式全子宫切除术 盆底功能障碍性疾病 危险因素 列线图 预测模型 

分 类 号：R711.23[医药卫生—妇产科学]