电刺激生物反馈对产后盆底功能障碍患者盆底肌力、盆底肌电位及MMP-2、TIMP-2、TGF-β1水平的影响

Effects of electrical stimulation biofeedback on pelvic floor muscle strength,pelvic floor muscle potential and levels of MMP-2,TIMP-2 and TGF-β1 in patients with postpartum pelvic floor dysfunction

目的:探究电刺激生物反馈对产后盆底功能障碍(pelvic floor dysfunctional disease,PFD)患者盆底肌力、盆底肌电位及基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)、基质金属蛋白酶组织抑制因子-2(tissue inhibitor of metalloproteinase-2,TIMP-2)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)水平的影响。方法:选取2019年9月至2020年9月海南省妇女儿童医学中心收治的150例产后PFD患者,随机分为3组,每组各50例。其中A组给予Kegel盆底肌训练,B组给予电刺激生物反馈治疗,C组给予Kegel盆底肌训练联合电刺激生物反馈治疗,时间为3个月。对比3组临床疗效及治疗前后的盆底肌力、盆底肌电位、盆腔器官脱垂(pelvic organ prolapse,POP)-Q分期、性生活质量,并检测盆腔壁组织中MMP-2、TIMP-2、TGF-β1表达水平。结果:C组治疗总有效率为92.00%,高于A组(70.00%)和B组(76.00%),差异有统计学意义(P<0.05)。治疗后,C组盆底手测肌力及I类、II类纤维肌最大电位值均显著高于A组、B组(P<0.05),且B组显著高于A组(P<0.05)。治疗后,C组POP-Q分期等级与A组、B组相比明显降低(P<0.05),B组POP-Q分期等级与A组相比,差异无统计学意义(P>0.05)。治疗后,A组、B组、C组盆腔器官脱垂-尿失禁性功能问卷(Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-12,PISQ-12)评分分别为26.34±5.67、28.96±5.31、32.88±5.29,差异有统计学意义(P<0.05)。治疗后,C组MMP-2水平显著低于A组、B组(P<0.05),TIMP-2、TGF-β1水平显著高于A组、B组(P<0.05),且B组各指标变化优于A组(P<0.05)。结论:电刺激生物反馈治疗产后PFD疗效显著,能够增强患者盆底肌力,改善患者性生活质量。

Objective:To explore the effects of electrical stimulation biofeedback on pelvic floor muscle strength,pelvic floor muscle potential,matrix metalloproteinase-2(MMP-2),tissue inhibitor of matrix metalloproteinase-2(TIMP-2)and transforming growth factor-β1(TGF-β1)in patients with postpartum pelvic floor dysfunction(PFD).Methods:A total of 150 postpartum PFD patients admitted to Hainan Women and Children’s Medical Center from September 2019 to September 2020 were randomly divided into 3 groups with 50 patients in each group.The A group was given Kegel pelvic floor muscle training,the B group was given electrical stimulation biofeedback therapy,and the C group was given Kegel pelvic floor muscle training combined with electrical stimulation biofeedback therapy for 3 months.The clinical efficacy,pelvic floor muscle strength,pelvic floor muscle potential,pelvic organ prolapses(POP)-Q stage,quality of sexual life,and the expression levels of MMP-2,TIMP-2 and TGF-β1 in pelvic wall tissue were compared between the two groups before and after treatment.Results:The total effective rate of the C group was 92.00%,higher than that of group A(70.00%)and group B(76.00%),and the difference was statistically significant(P<0.05).After treatment,the pelvic floor muscle strength measured by hand and the maximum potential values of class I and class II fibromuscular in the C group were significantly higher than those in the A and B group(P<0.05),and that in B group was significantly higher than that in A group(P<0.05).After treatment,the POP-Q staging grade of the C group was significantly lower than that of the A group and B group(P<0.05),and there was no difference in POP-Q staging grade between B group and A group(P>0.05).After treatment,the scores of Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-12(PISQ-12)in the A group,B group and C group were 26.34±5.67,28.96±5.31,32.88±5.29,respectively,and the difference was statistically significant(P<0.05).After treatment,the level of MMP-2 in the C group was significantly lower than that in the A group and B group(P<0.05),and the levels of TIMP-2 and TGF-β1 in the C group were significantly higher than those in the A group and B group(P<0.05),and the changes of indexes in B group were better than those in A group(P<0.05).Conclusion:Electrical stimulation biofeedback is effective in the treatment of postpartum PFD,which can enhance the pelvic floor muscle strength and improve the quality of sexual life.