盆底超声测量提肌板角度评估产后盆腔器官脱垂

Levator plate angle measured with pelvic floor ultrasound for evaluating postpartum pelvic organ prolapse

目的观察盆底超声测量提肌板角度(LPA)评估产后盆腔器官脱垂(POP)的价值。方法87名产后女性接受盆底超声检查,根据存在POP与否将其分为POP组(n=49)和正常组(n=38),分别测量静息状态(LPA_(静息))、最大缩肛动作(LPA_(缩肛))及最大瓦尔萨尔瓦动作下(LPA_(瓦))的LPA,计算最大缩肛动作(△LPA_(缩肛))和最大瓦尔萨尔瓦动作下LPA变化值(△LPA_(瓦));比较2组LPA参数差异,并观察其与POP的相关性。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各LPA参数诊断POP的效能。结果POP组LPA_(瓦)小于正常组(U=330.00,P<0.001)、△LPA_(瓦)大于正常组(t=-4.357,P<0.001),而LPA_(静息)、LPA_(缩肛)及△LPA_(缩肛)差异均无统计学意义(P均>0.05)。POP严重程度与LPA_(瓦)呈中度负相关(r=-0.570,P<0.001),与△LPA_(瓦)呈低度正相关(r=0.475,P<0.001),而与LPA_(静息)(r=-0.130,P=0.231)、LPA_(缩肛)(r=-0.036,P=0.741)和△LPA_(缩肛)(r=-0.029,P=0.793)均无明显相关。以LPA_(瓦)=2.70°为截断值,其诊断POP的敏感度可达81.63%,特异度达83.67%;以△LPA_(瓦)=21.10°为截断值,其诊断POP的敏感度为67.35%,特异度为81.57%(Z=1.832,P=0.067)。结论采用盆底超声测量LPA可诊断产后POP,以LPA_(瓦)和△LPA_(瓦)的诊断效能最佳。

Objective To observe the value of levator plate angle(LPA)measured with pelvic floor ultrasound for evaluating postpartum pelvic organ prolapse(POP).Methods Totally 87 postpartum women who underwent pelvic floor ultrasonography were enrolled and divided into POP group(n=49)and normal group(n=38).LPA was measured at resting-state(LPA_(rest)),under the maximum pelvic floor contraction(LPA_(contraction))and the maximum Valsalva maneuver(LPA_(Va)),and the changes of LPA under the maximum pelvic floor contraction(△LPA_(contraction))and the maximum Valsalva maneuver(△LPA_(Va))were calculated and compared between groups,and the correlations of LPA parameters and POP were observed.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to assess the efficacies of LPA parameters for diagnosing POP.Results LPA_(Va) of POP group was lower than that of normal group(U=330.00,P<0.001),and△LPA_(Va) of POP group was higher than that of normal group(t=-4.357,P<0.001),while there was no significant difference of LPA_(rest),LPA_(contraction) nor △LPA_(contraction) between groups(all P>0.05).The severity of POP was moderately negatively correlated with LPA_(Va)(r=-0.570,P<0.001),lowly positively correlated with△LPA_(Va)(r=0.475,P<0.001),but not significantly correlated with LPA_(rest)(r=-0.130,P=0.231),LPA_(contraction)(r=-0.036,P=0.741)nor △LPA_(contraction)(r=-0.029,P=0.793).Taken 2.70°as the cutoff value of LPA_(Va),the sensitivity for diagnosing POP was 81.63%,and the specificity was 83.67%.Taken 21.10°as the cutoff value of △LPA_(Va),the sensitivity for diagnosing POP was 67.35%,and specificity was 81.57%.There was no significant difference of diagnostic efficacies between LPA_(Va) and △LPA_(Va).Conclusion LPA measured with pelvic floor ultrasound could be used to diagnose postpartum POP.LPA_(Va) and △LPA_(Va) had the best efficacies.