孕晚期经会阴超声联合血清弹性蛋白对产后盆底功能障碍的预测价值  

The predictive value of perineal ultrasound combined with serum elastin in late pregnancy for postpartum pelvic floor dysfunction

作　　者：刘盈 刘劲松 吴猛[3] Liu Ying;Liu Jinsong;Wu Meng(Department of Ultrasonography Lab,Huanggang Maternal and Child Health Care Hospital,Huanggang Hubei 438000;Department of Deanery,Macheng City Maternal and Child Health Care Hospital,Macheng Hubei 438300;Department of Comprehensive Ultrasound,Zhongnan Hospital of Wuhan University,Wuhan Hubei 430000,P.R.China)

机构地区：[1]武汉大学中南医院/黄冈市妇幼保健院超声科,湖北黄冈438000 [2]麻城市妇幼保健院行政办公室,湖北麻城438300 [3]武汉大学中南医院综合超声科,湖北武汉430000

出　　处：《中国计划生育和妇产科》2025年第1期78-83,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：2023年湖北省科技计划项目(项目编号:2023BCB024)。

摘　　要：目的探讨孕晚期经会阴超声+血清弹性蛋白(elastin)预测产后盆底功能障碍(pelvic floor dysfunction,PFD)的价值。方法前瞻性选取2022年1月至2023年10月黄冈市妇幼保健院收治的189例孕晚期孕妇,根据产后42 d是否发生PFD分为PFD组、无PFD组。比较两组产前、产后42 d经会阴超声[静息和Valsalva时肛提肌裂孔面积(LHA)、耻骨直肠肌厚度(PMT)、Valsalva时LHA与静息时LHA的差值(△LHA),Valsalva时PMT与静息时PMT的差值(△PMT)]和血清elastin测量值,多因素Logistic回归分析产后PFD的影响因素,受试者工作特征曲线(ROC)分析产前经会阴超声、血清elastin测量值及二者联合预测产后PFD的价值。结果189例孕晚期孕妇,2例失访,余下187例产后42 d发生PFD 48例,PFD发生率25.67%;PFD组孕期增重>15 kg、经产妇、阴道分娩占比高于无PFD组(P<0.05);PFD组产前、产后42 d静息时和Valsalva时LHA、△LHA高于无PFD组,PMT、△PMT、血清elastin低于无PFD组(P<0.05);校正了孕期增重、产史、经阴道分娩后,Logistic回归显示△LHA、△PMT、血清elastin仍是产后PFD的独立影响因素(P<0.05);ROC分析△LHA、△PMT、血清elastin预测产后PFD的ROC下面积(AUC)分别为0.821(95%CI:0.759-0.873)、0.691(95%CI:0.619-0.756)、0.777(95%CI:0.711-0.835);△LHA、△PMT联合血清elastin预测的AUC为0.898(95%CI:0.846-0.938),大于△LHA(Z=2.001,P<0.05),联合预测的灵敏度为81.25%,特异度为87.05%。结论孕晚期经会阴超声测量的△LHA、△PMT以及血清elastin与产后PFD密切相关,联合测量可提高对产后PFD的预测价值,在缺乏有效预测手段时,可作为产后PFD的早期预测手段,为临床提供决策支持。Objective To explore the value of perineal ultrasound+serum elastin in predicting postpartum pelvic floor dysfunction(PFD)in late pregnancy.Methods s A prospective study was conducted on 189 late pregnant women who were admitted to Huanggang Maternal and Child Health Hospital from January 2022 to October 2023.According to whether PFD occurred at 42 days after delivery,they were divided into PFD group and non-PFD group.The transperineal ultrasound measurements[the levator hiatus area(LHA),puborectalis muscle thickness(PMT),and the difference between the LHA at rest and during Valsalva(△LHA),the difference between the PMT at rest and during Valsalva(PMT)Jbefore and after 42 days of pregnancy and the serum elastin measurements were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of postpartum PFD,and receiver operatingcharacteristic(ROC)curve analysis was used to evaluate the predictive value of prenatal transperineal ultrasound,serum elastinmeasurement,and their combined prediction for postpartum PFD.ResultsOf the 189 late pregnant women,2 cases were lost to follow-up,and the remaining 187 developed PFD 48 cases after 42 days of delivery,with a PFD incidence rate of 25.67%.The proportion of pregnantwomen with gained more than 15 kg during pregnancy,multiparous women,and delivered vaginally in the PFD group was higher than that inthe non-PFD group(P<0.05).The LHA and△LHA in the PFD group were higher than those in the non-PFD group at rest and duringValsalva at 42 days before and after delivery,while the PMT,△PMT,and serum elastin were lower than those in the non-PFD group(P<0.05).After adjusting for pregnancy weight gain,birth history,and vaginal delivery,Logistic regression showed that LHA,PMT,andserum elastin were still independent factors affecting postpartum PFD(P<0.05).The ROC area under the curve(AUC)for predictingpostpartum PFD using△LHA,△PMT,and serum elastin were 0.821(95%CI:0.759-0.873),0.691(95%CI:0.619-0.756),and 0.777(95%CI:

关 键 词：孕晚期 经会阴超声 血清弹性蛋白 产后PFD 

分 类 号：R714.46[医药卫生—妇产科学]