| 摘要: |
| 目的：本研究通过剪切波弹性成像（shear wave elastography，SWE）技术定量评估经阴道分娩对初产妇肛提肌弹性的影响，探讨肛提肌弹性参数在早期诊断产后POP的价值并构建临床预测列线图模型。方法：收集于我院行盆底超声检查的产后42天经阴道分娩的107名初产妇，以临床盆腔脏器脱垂定量评价（pelvic organ prolapse quantification,POP-Q）作为诊断POP金标准，将初产妇分为产妇POP阳性组及产妇POP阴性组，应用SWE测量两组初产妇在静息、缩肛状态下耻骨直肠肌的弹性值rE1、cE1、rE2、cE2、髂尾肌的弹性值rE3、cE3、rE4、cE4，计算缩肛前后差值ΔE1、ΔE2、ΔE3、ΔE4，首先对测量参数进行组内及组间比较，计算单参数诊断初产妇发生POP的效能，再建立多个优选参数诊断初产妇发生POP的列线图临床预测模型，采用Bootstrap法对模型进行内部验证，并通过校准曲线评估模型的诊断效能。结果：1.POP阳性组、POP阴性组在静息、缩肛状态下耻骨直肠肌、髂尾肌弹性值及缩肛前后差值均有差异（P＜0.05）。2. 以 cE1、cE4、ΔE2作为最优弹性参数建立多参数诊断初产妇发生POP的预测模型，当截断值为0.48（对应总分数为108分），诊断的敏感度及特异度分别为93.8%、90.5%，AUC为0.952（95%CI=0.910-0.993)，内部验证（AUC=0.952）及校准曲线显示该模型具有较高的预测能力。结论：1.经阴道分娩对初产妇肛提肌弹性造成的损伤在一定程度上会导致POP。2.SWE能够定量评估初产妇产后早期肛提肌弹性的损伤情况。3.基于肛提肌多个最优弹性参数诊断初产妇发生POP的列线图预测模型，有助于POP的早期诊断，多参数诊断效能优于单一参数。 |
| 关键词: 剪切波弹性成像 盆腔脏器脱垂 肛提肌 经阴道分娩 |
| DOI： |
| 投稿时间：2023-08-14修订日期：2023-10-10 |
| 基金项目:经阴道盆底超声多参数在诊断老年女性压力性尿失禁的价值研究 |
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| Value Analysis of Levator ANI Muscle Shear Wave Elasticity Parameters in the Diagnosis of POP in Primiparas with Vaginal Delivery and Construction of a Nomogram Prediction Model |
| Zhao Jin Yi |
| () |
| Abstract: |
| 【Abstract】Objective: To quantitatively evaluate the effect of vaginal delivery on the elasticity of levator ani muscle in primiparas by shear wave elastography (SWE), and to explore the value of levator ani muscle elasticity parameters in the early diagnosis of postpartum POP and to construct a clinical prediction nomogram model. Methods :A total of 107 primiparas who had vaginal delivery 42 days after delivery and underwent pelvic floor ultrasound examination in our hospital were enrolled. pelvic organ prolapse quantification (POP-Q) was used as the gold standard for the diagnosis of POP. Primiparas were divided into maternal POP positive group and maternal POP negative group. SWE was used to measure the elasticity values of the puborectal musclerE1, cE1, rE2, cE2, and the elasticity values of the iliococcygeus muscle rE3, cE3, rE4, cE4 at rest and in the state of anal contraction, and the differences of ΔE1, ΔE2, ΔE3, ΔE4 before and after anal contraction were calculated. First, the measurement parameters were compared within and between groups. Then, a nomogram clinical prediction model with multiple preferred parameters for the diagnosis of POP was established, the Bootstrap method was used for internal validation of the model, and the calibration curve was used to evaluate the diagnostic efficiency of the model. Results: 1. There were significant differences in the elasticity values of puborectalis and iliococcygeal muscles and the difference before and after anal contraction among the POP-positive group, POP-negative group at rest and during anal contraction (P < 0.05). 2. Taking cE1, cE4 and ΔE2 as the optimal elasticity parameters to establish a multi-parameter prediction model for the diagnosis of POP in primiparas. When the cut-off value was 0.48 (corresponding to a total score of 108 points), the sensitivity and specificity were 93.8% and 90.5%, respectively, and the AUC was 0.952 (95%CI=0.910-0.993). Internal validation (AUC=0.952) and calibration curve showed that the model had high predictive ability. Conclusion: 1. The damage to the elasticity of levator ani muscle caused by vaginal delivery in primiparas can lead to POP to some extent. 2.SWE can quantitatively evaluate the change of levator ani muscle elasticity in the early postpartum period. 3. The nomogram prediction model based on multiple optimal elasticity parameters of levator ani muscle is helpful for the early diagnosis of POP in primiparas, and the diagnostic efficiency of multiple parameters is better than that of single parameter. |
| Key words: SWE Pelvic organ prolapse Levator ani muscle Vaginal delivery |
