孕晚期血清松弛素水平与产后盆底功能障碍性疾病及盆底超声参数的相关性研究

Correlation between serum relaxin level in the late trimester and postpartum pelvic floor dysfunction and pelvic ultrasound parameters

目的探讨孕晚期血清松弛素水平与产后盆底功能障碍性疾病(pelvic floor dysfunction,PFD)和盆底超声参数的相关性。方法采用病例对照研究,收集2017年2月至2018年7月期间在郑州大学第二附属医院产检的孕妇348例,按照产后是否出现PFD将产妇分为病例组(自然分娩68例,剖宫产44例)和对照组(自然分娩134例,剖宫产102例),收集同期健康未孕女性100例为健康未育组。检测产妇妊娠37~40周的血清松弛素水平和产后42 d的盆底超声参数——膀胱尿道后角(posterior vesicourethral angle,PVA)、膀胱颈移动度(bladder neck mobility,BNM)、尿道旋转角(urethral rotation angle,URA)、逼尿肌厚度(detrusor wall thickness,DWT)及肛提肌裂口面积(levator ani hiatus area,LHA);分别于不同分娩方式下比较病例组和对照组的松弛素差异,利用logistic回归、受试者工作特征(receiver operator characteristic,ROC)曲线分析松弛素水平与PFD的相关性;分析松弛素水平与各盆底超声参数之间的相关性。结果自然分娩方式及剖宫产方式的病例组松弛素水平[(664.23±69.26)ng/L,(640.10±153.18)ng/L]均显著高于其对照组[(443.62±58.79)ng/L,(440.49±87.82)ng/L,均P<0.001],且均高于健康未育组[(64.86±17.36)ng/L,均P<0.001]。logistic多因素分析显示松弛素水平是PFD发生的独立危险因素(OR=3.931,95%CI=2.330~6.628,P<0.001);ROC曲线分析提示松弛素诊断总体、自然分娩组及剖宫产组的曲线下面积分别为0.947、0.876和0.861;松弛素水平与超声参数Valsalva动作下的PVA、BNM、URA、静息状态及Valsalva动作下的LHA之间存在显著正相关性(分别r=0.134,P=0.013;r=0.108,P=0.045;r=0.190,P=0.001;r=0.343,P=0.001;r=0.261,P=0.001)。结论妊娠晚期松弛素水平与产后PFD发病及超声表现下的严重程度密切相关,对于产后PFD的发病发展有一定提示意义。

Objective To explore the relationship between serum relaxin level in the late pregnancy and the postpartum pelvic floor dysfunction(PFD)and ultrasound parameters of pelvic floor.Methods A total of 348 pregnant women who underwent antenatal examination in the Second Affiliated Hospital of Zhengzhou University from February 2017 to July 2018 were collected and divided into case group(68 cases of natural delivery,44 cases of cesarean section)and control group(134 cases of natural delivery,102 cases of cesarean section)according to whether PFD occurred after delivery.Totally 100 healthy nulliparous women in the same period were collected as health nulliparous group.The serum relaxin level of pregnant women at 37-40 weeks and the pelvic ultrasound parameters of 42 d postpartum,such as posterior vesicourethral angle(PVA),bladder neck mobility(BNM),urethral rotation angle(URA),detrusor wall thickness(DWT),levator ani hiatus area(LHA)were measured.The relaxin levels between case group and control group were compared under different delivery modes.The correlation between relaxin level and PFD was analyzed by receiver operator characteristic curve(ROC)and logistic regression.The correlation between relaxin level and each ultrasonic parameter was analyzed by correlation analysis.Results The relaxin levels of case group under natural delivery and cesarean section[(664.23±69.26)ng/L,(640.10±153.18)ng/L]were both higher than those of control group[(443.62±58.79)ng/L,(440.49±87.82)ng/L,all P<0.001],all of which was significantly higher than that of the healthy nulliparous group[(64.85±17.36)ng/L,all P<0.001].Logistic analysis showed that high relaxin level was an independent risk factor for PFD(OR=3.931,95%CI=2.330-6.628,P<0.001).ROC curve analysis indicated that the area under curve of relaxin diagnosed of PFD in total,natural delivery group and cesarean section were 0.867,0.876 and 0.861,respectively.There were significant positive correlations between relaxin level and ultrasound parameters PVA under the Valsalva action,BNM,URA,LHA at rest and Valsalva action(r=0.134,P=0.013;r=0.108,P=0.045;r=0.190,P=0.001;r=0.343,P=0.001;r=0.261,P=0.001;respectively).Conclusion The level of relaxin in the third trimester of pregnancy is closely related to the incidence and severity of postpartum PFD,which has some implications for the incidence and progression of PFD.