经阴道超声评价二次妊娠期女性盆底结构的变化及受试者操作特征曲线

The pelvic floor structure change and receiver operating characteristic curve based on transperineal ultrasound during the second pregnancy

目的经阴道超声评价二次妊娠期女性盆底结构的变化,寻找二次妊娠期压力性尿失禁(SUI)的诊断界值。方法选取我院产检孕妇(120例),分为首次妊娠组(60例)与二次妊娠组(60例),依据有无SUI将二次妊娠组分为SUI组(33例)与非SUI组(27例),均行经阴道超声检查,比较2组间超声参数的差异;构建各超声指标诊断二次妊娠期女性SUI的受试者操作特征曲线(ROC)。结果首次妊娠组与二次妊娠组比较,张力状态下膀胱颈位置(D2)、膀胱颈移动度(BND)、尿道旋转角度(URA)、张力状态下膀胱尿道后角(PUVA2)、静息状态下肛提肌裂孔面积(LHA1)、张力状态下肛提肌裂孔面积(LHA2)、尿道内口漏斗化差异有统计学意义(P<0.05);二次妊娠期SUI与非SUI组比较,D2、BND、URA、LHA1、LHA2、尿道内口漏斗化差异有统计学意义(P<0.05);ROC曲线分析结果显示,D2、BND、LHA1、尿道内口漏斗化及四者联合曲线下面积均>0.70。结论二次妊娠期女性较首次妊娠期女性盆底结构支持力弱;D2、BND、LHA1、尿道内口漏斗化及四者联合指标均可作为二次妊娠期女性SUI的诊断指标,且联合指标诊断效能最高,诊断界值为0.432。

Objective To evaluate the changes in the pelvic floor structure in women for assessing the diagnostic threshold of stress urinary incontinence(SUI)during second pregnancy using transperineal ultrasound.Methods A total of 120 pregnant women receiving obstetric examinations in our hospital were categorized into the first(60 cases)and second(60 cases)pregnancy groups.Based on SUI,pregnant women in the second pregnancy group were further sub-divided into the SUI(33 cases)and non-SUI(27 cases)groups.All participants underwent transperineal ultrasound examinations to compare the ultrasonic parameters between the first and second pregnancy groups.The ROC curves of various ultrasonic indicators were constructed for diagnosing SUI in women during the second pregnancy.Results The difference in the ultrasonic parameters of D2,BND,URA,PUVA2,LHA1,LHA2,and funnelation of the urethral orifice were statistically significant(P<0.05)between the first pregnancy group and the second pregnancy group.Additionally,the difference in the above-mentioned ultrasonic parameters was statistically significant(P<0.05)between the SUI and non-SUI groups during the second pregnancy.The ROC curve analysis showed that the area under the curve of each of D2,BND,LHA1,funnelation of the urethral orifice,and the combination of all four were>0.70.Conclusion The pelvic floor structural support of women is weaker in the second trimester than that in the first.The D2,BND,LHA1,funnelation of the urethral orifice,or the combination of all four could be used as a diagnostic index for assessing SUI in women during the second pregnancy.The combined indices revealed the highest diagnostic efficacy,with a diagnostic cut-off value of 0.432.