基于经会阴三维超声联合剪切波弹性成像的肛提肌形态及弹性对女性压力性尿失禁诊断模型的构建及效果评价  

Construction and evaluation of a diagnostic model for female stress urinary incontinence based on the mor-phology and elasticity of the levator ani muscle by transperineal three-dimensional ultrasound combined with shear wave elastography

作　　者：郭二芳 冯蕾[2] 石超会 李宁 林伟群 张树华 GUO Erfang;FENG Lei;SHI Chaohui;LI Ning;LIN Weiqun;ZHANG Shuhua(Department of Ultrasound,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,Hebei,China;不详)

机构地区：[1]华北理工大学附属医院超声科,河北唐山063000 [2]解放军总医院第四医学中心超声科,北京100142

出　　处：《实用医学杂志》2025年第8期1224-1231,共8页The Journal of Practical Medicine

基　　金：河北省省级科技计划项目(编号:20377735D);河北省医学科学研究课题项目(编号:20231265)。

摘　　要：目的探讨肛提肌形态及弹性与压力性尿失禁(SUI)之间的关系;同时建立基于肛提肌形态及弹性指标的SUI多模态诊断模型并评价模型的诊断效果。方法选取2020年9月至2022年9月于华北理工大学附属医院就诊的SUI女性患者147例为SUI组(病例组),同期选取排除SUI的女性144例为非SUI组(对照组),行经会阴超声检查,测量静息状态下肛提裂孔前后径(LH-A1)、肛提裂孔横径(LH-D1)、肛提裂孔面积(LA1);最大瓦式动作下肛提裂孔前后径(LH-A2)、肛提裂孔横径(LH-D2)、肛提裂孔面积(LA2);记录缩肛状态下肛提肌损伤情况(LA-MI);经会阴SWE检查并记录:静息及缩肛状态下耻骨直肠肌弹性模量值(E1、E3)。比较各组超声参数的差异,应用logistic回归模型进行多因素分析,并以此建立SUI的诊断模型。通过Hosmer-Lemeshow统计量对logistic回归模型的拟合优度进行检验,ROC曲线评价各单独指标及诊断模型对压力性尿失禁的诊断效能,决策曲线评价模型的临床效用。结果两组比较,年龄、BMI、LH-A1、LH-D1、LA1、LH-A2、LH-D2、LA2、LA-MI、E1及E3差异有统计学意义(P<0.05)。多因素logistic回归分析表明,年龄、BMI、LH-A1、LA2、LA-MI、E1及E3与SUI有关联(P<0.05)。据此构建SUI的诊断模型:PRESUI=0.261×年龄+0.904×BMI-4.300×LH-A1+1.166×LA2-2.815×LA-MI+0.587×E1-0.631×E3-1.258。该模型拟合优度好(P=0.983)。ROC曲线结果显示,年龄、BMI、LH-A1、LA2、LA-MI、E1及E3均具有诊断SUI的效能(AUC>0.500,P<0.05);构建的诊断模型诊断SUI的AUC为0.996(95%CI:0.992~1.000),诊断效能大于各单独指标。当诊断模型的截断值为0.437时,灵敏度为98.0%、特异度为97.2%。决策曲线显示在阈值0.1~1.0的范围内,诊断模型的临床净获益良好。结论SUI女性的肛提肌形态与弹性均有所改变;SWE技术具有潜在的应用价值,可用于定量评估尿道周围肌肉(LAM)的弹性;以年龄、BMI、LH-A1、LA2、LA-MI、E1及E3构建的�Objective To investigate the relationship between the morphology and elasticity of the levator ani muscle(LAM)and stress urinary incontinence(SUI),and to develop a multimodal diagnostic model for SUI based on LAM morphology and elasticity parameters,while evaluating the diagnostic performance of this model.Methods From September 2020 to September 2022,147 female patients with SUI from the Affiliated Hospital of North China University of Science and Technology were enrolled as the SUI group(case group),while 144 women without SUI during the same period were selected as the non-SUI group(control group).Transperineal ultrasonography was conducted to measure the anteroposterior diameter(LH-A1)and transverse diameter(LH-D1)of the levator hiatus at rest,the resting area of the levator hiatus(LA1),as well as the anteroposterior diameter(LH-A2),transverse diameter(LH-D2),and area(LA2)of the levator hiatus during the maximum Valsalva maneuver.Addi-tionally,ultrasonography was used to observe LAM injury(LA-MI)during pelvic muscle contraction.Shear wave elastography(SWE)was also performed transperineally to record the elastic modulus values of the puborectalis muscle at rest(E1)and during pelvic muscle contraction(E3).The differences in ultrasound parameters between the two groups were compared,and a logistic regression model was constructed for multivariate analysis to establish a diagnostic model for SUI.The goodness of fit of the logistic regression model was assessed using the Hosmer-Lemeshow test.The diagnostic performance of individual indicators and the diagnostic model for SUI was evaluated using the receiver operating characteristic(ROC)curve.Finally,the clinical utility of the model was assessed using decision curve analysis.Results There were statistically significant differences in age,BMI,LH-A1,LH-D1,LA1,LH-A2,LH-D2,LA2,LA-MI,E1,and E3 between the two groups(P<0.05).Multivariate logistic regression analysis revealed that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 were significantly associated with SUI(P<0.05).Based on t

关 键 词：三维超声 剪切波弹性成像 肛提肌 压力性尿失禁 

分 类 号：R445.1[医药卫生—影像医学与核医学]