基于多参数超声特征的中老年女性压力性尿失禁诊断模型研究  

Multi-parameter ultrasound-based diagnostic model for stress urinary incontinence in middle-aged and elderly women

作　　者：胡可[1] 鲁蓉[2] Hu Ke;Lu Rong(Department of Ultrasonography,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Gynecology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院超声影像科,长沙410008 [2]中南大学湘雅医院妇科,长沙410008

出　　处：《中华医学超声杂志（电子版）》2024年第5期477-483,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：湖南省自然科学基金面上项目(2023JJ30920)。

摘　　要：目的构建基于多参数超声特征对中老年女性压力性尿失禁(SUI)的诊断模型,探讨其应用价值。方法回顾性分析2021年3月至2023年5月期间,中南大学湘雅医院盆底诊治中心的197例中老年女性的临床信息及超声检查资料,其中SUI患者127例,非SUI患者70例。按7∶3的比例将全部资料随机分为训练集(n=137)和验证集(n=60),在训练集中先进行单因素差异比较,再采取多因素Logistic回归分析筛选变量,并构建诊断中老年女性SUI的列线图模型。分别在训练集、验证集中计算受试者操作特征曲线下面积(AUC)评价模型区分度,采用Hosmer-Lemeshow检验和校准曲线评价模型校准度,利用临床决策曲线分析(DCA)评价模型的临床适用性。结果纳入诊断模型的变量包括:阴道分娩史(OR=11.256,95%CI:1.275~99.405,P=0.029)、尿道内口漏斗形成(OR=10.552,95%CI:2.427~45.886,P=0.002)、膀胱颈下降距离增大(OR=1.072,95%CI:1.010~1.138,P=0.022)和膀胱尿道后角增大(OR=1.042,95%CI:1.014~1.070,P=0.003)。列线图在训练集和验证集中的AUC分别为0.952(95%CI:0.921~0.983)、0.897(95%CI:0.813~0.982),Hosmer-Lemeshow检验的结果(χ^(2)=4.282,P=0.892;χ^(2)=10.556,P=0.307)和校准曲线均显示模型的校准较好,DCA显示模型具有较好的净获益。结论基于多参数超声特征建立的列线图模型对中老年女性SUI具有较好的诊断效能,能为临床提供更客观的诊断依据。Objective To develop a diagnostic model based on multi-parameter ultrasound for stress urinary incontinence(SUI)in middle-aged and elderly women and assess its application value.Methods The clinical and ultrasonographic data of 197 middle-aged and elderly women,including 127 SUI patients and 70 non-SUI patients,from the Pelvic Floor Diagnostic and Treatment Center of Xiangya Hospital of Central South University from March 2021 to May 2023,were retrospectively analyzed in this study.All the subjects were randomly divided into a training group(n=137)anda validation group(n=60)at a ratio of 7∶3.In the training group,univariable analysis and multivariable logistic regression analysis were used to select the indicators.Then,a nomogram diagnostic model was established.The discrimination,calibration,and clinical applicability of the model were evaluated by the area under the curve(AUC),Hosmer-Lemeshow test,calibration curve,and decision curve analysis.Results Vaginal delivery(odds ratio[OR]=11.256,95%confidence interval[CI]:1.275-99.405,P=0.029),internal urethral orifice funnel(OR=10.552,95%CI:2.427-45.886,P=0.002),increased bladder neck mobility(OR=1.072,95%CI:1.010-1.138,P=0.022),and increased posterior retrovesical angle(OR=1.042,95%CI:1.014-1.070,P=0.003)were included in the diagnostic model.The AUC values of the model in the training group and validation group were 0.952(95%CI:0.921-0.983)and 0.897(95%CI:0.813-0.982),respectively.The results of the Hosmer-Lemeshow test(χ^(2)=4.282,P=0.892,χ^(2)=10.556,P=0.307)and calibration curve analysis exhibited good calibration.The clinical decision curve indicated good net gain.Conclusion The nomogram model developed based on multi-parameter ultrasound has good diagnostic performance for SUI in middle-aged and elderly women,providing a more objective basis for clinical diagnosis.

关 键 词：压力性尿失禁 超声检查 列线图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.59[医药卫生—诊断学]