基于临床资料及盆底超声参数的列线图预测产后压力性尿失禁的临床价值  

Clinical value of nomogram based on clinical data and pelvic floor ultrasound parameters in predicting postpartum stress urinary incontinence

作　　者：练为芳 黄晓民 LIAN Weifang;HUANG Xiaomin(Department of Ultrasound Medicine,Ningde Municipal Hospital of Ningde Normal University,Fujian 352100,China)

机构地区：[1]宁德师范学院附属宁德市医院超声医学科,福建省宁德市352100

出　　处：《临床超声医学杂志》2024年第6期485-490,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的基于临床资料及盆底超声参数建立列线图模型,探讨其预测产后压力性尿失禁(SUI)的临床价值。方法选取于我院就诊的78例产后SUI患者(研究组)及同期就诊的非SUI患者80例(对照组),获取两组一般资料、二维及三维盆底超声参数,并比较其差异。采用Logistic回归分析筛选预测产后SUI的独立影响因素,并建立列线图模型。绘制受试者工作特征(ROC)曲线和校准曲线分别评价列线图模型的区分度和校准度;决策曲线评价列线图模型的临床适用性。结果两组年龄、体质量指数(BMI)、末次分娩时间、分娩方式及久坐、侧切、绝经占比比较差异均有统计学意义(均P<0.05)。盆底超声检查结果显示,两组Valsalva状态下膀胱后壁最低点位于耻骨联合下缘水平线上方、膀胱颈位于耻骨联合下缘水平线上方占比及膀胱尿道后角、尿道旋转角、膀胱颈移动度、肛提肌裂孔面积比较差异均有统计学意义(均P<0.05)。Logistic回归分析显示,年龄、BMI、分娩方式、膀胱尿道后角、膀胱颈移动度和肛提肌裂孔面积均为预测产后SUI的独立危险因素(均P<0.05)。依据上述因素建立列线图模型,ROC曲线分析显示列线图模型预测产后SUI的曲线下面积为0.969(95%可信区间:0.947~0.991);校准曲线显示列线图模型的预测概率与实际概率拟合度较好,具有良好的校准度;决策曲线显示列线图模型具有良好的临床适用性。结论基于临床资料及盆底超声参数的列线图模型在预测产后SUI中具有较高的临床价值。Objective To establish nomogram model based on clinical data and pelvic floor ultrasound parameters,and to explore its clinical value in predicting postpartum stress urinary incontinence(SUI).Methods A total of 78 cases of postpartum SUI patients(study group)and 80 cases of non SUI patients(control group)who visited our hospital during the same period were selected.The general information,two-dimensional and three-dimensional pelvic floor ultrasound parameters of the two groups were obtained,and the differences were compared.Logistic regression analysis was used to screen the independent influencing factors for predicting postpartum SUI,and a nomogram model was established.Receiver operating characteristic(ROC)curve and calibration curve were drawn to evaluate the discrimination and calibration of the nomogram model,and the decision curve was used to analyze the clinical applicability of the nomogram model.Results There were statistically significant differences in age,body mass index(BMI),last delivery time,mode of delivery and the proportion of sedentary,episiotomy and menopause between the two groups(all P<0.05).The pelvic floor ultrasound showed that the proportion of the lowest point of the posterior bladder wall was above the horizontal line of the lower margin of the pubic symphysis and the bladder neck above the horizontal line of the lower margin of the pubic symphysis and the bladder urethral posterior angle,the urethral rotation angle,the mobility of the bladder neck,and the area of levator ani hiatus were significantly different between the two groups under Valsalva state(all P<0.05).Logistic regression analysis showed that age,BMI,mode of delivery,the bladder urethral posterior angle,the mobility of the bladder neck and the area of levator ani hiatus were all independent risk factors for predicting postpartum SUI(all P<0.05).According to the above factors,the nomogram model was established.ROC curve analysis showed that the area under the curve of the nomogram model for predicting postpartum SUI was

关 键 词：超声检查 盆底 压力性尿失禁 产后 列线图 

分 类 号：R445.1[医药卫生—影像医学与核医学]