盆底超声参数预测剖宫产术后压力性尿失禁的效能及其与盆底组织E-cadherin和Vimentin表达的关系研究

Efficacy of Pelvic Floor Ultrasound Parameters in Predicting Stress Urinary Incontinence after Cesarean Section and its Relationship with E-cadherin and Vimentin Expression in Pelvic Floor Tissues

目的:研究盆底超声参数预测剖宫产术后压力性尿失禁(SUI)的效能及其与盆底组织钙粘附蛋白E(E-cadherin)和波形蛋白(Vimentin)表达的关系。方法:选取2020年1月~2021年1月湖南省妇幼保健院收治的124例剖宫产患者。将其按照是否发生SUI分为SUI组18例以及无SUI组106例。对所有患者均进行盆底超声检查,比较两组静息期(R)、张力期Valsalva动作(V)的膀胱尿道后角(PUA)以及膀胱颈到耻骨联合下缘水平垂直距离(BNS),膀胱颈移动度(BND)、尿道旋转角度(UR)。通过受试者工作特征(ROC)曲线分析盆底超声参数预测剖宫产术后SUI的效能。另外,对比两组盆底组织E-cadherin和Vimentin mRNA水平,采用Pearson相关性分析各项盆底超声参数和盆底组织E-cadherin、Vimentin mRNA表达的相关性。结果:SUI组R-PUA、V-PUA、BND以及UR均高于无SUI组,而R-BNS以及V-BNS均低于无SUI组(均P<0.05)。ROC曲线分析结果:各项盆底超声参数联合预测剖宫产术后SUI的效能均优于各项参数单独预测。SUI组盆底组织E-cadherin mRNA水平低于无SUI组,而Vimentin mRNA水平高于无SUI组(均P<0.05)。经Pearson相关性分析发现,R-PUA、V-PUA、BND、UR均和盆底组织E-cadherin mRNA水平呈负相关关系,与Vimentin mRNA水平呈正相关关系;而R-BNS、V-BNS均和盆底组织E-cadherin mRNA水平呈正相关关系,与Vimentin mRNA水平呈负相关关系(均P<0.05)。结论:盆底超声参数预测剖宫产术后SUI的效能较高,且和盆底组织E-cadherin、Vimentin表达有关。

Objective: To study the efficacy of pelvic floor ultrasound parameters in predicting stress urinary incontinence(SUI)after cesarean section and analyze its relationship with the E-cadherin and Vimentin expression in pelvic floor tissue. Methods: 124 patients with cesarean section who were admitted to Hunan Maternal and Child Health Hospital from January 2020 to January 2021 were selected. According to the occurrence of SUI, they were divided into SUI group with 18 cases and non-SUI group with 106 cases. Pelvic floor ultrasonography was performed in all patients, and the posterior Angle of bladder and urethra(PUA), the horizontal and vertical distance from bladder neck to the lower margin of pubic symphysis(BNS), bladder neck mobility(BND) and urethra rotation Angle(UR)were compared between the two groups during rest(R) and tension(V) Valsalva movements. The efficacy of pelvic floor ultrasound parameters in predicting SUI after cesarean section was analyzed by receiver operating characteristic(ROC) curve analysis. In addition,the mRNA levels of E-cadherin and Vimentin in pelvic floor tissues were compared between the two groups, and the correlation between various pelvic floor ultrasound parameters and the E-cadherin and Vimentin expression in pelvic floor tissues was analyzed by Pearson correlation. Results: R-PUA, V-PUA, BND and UR in SUI group were higher than those in non-SUI group, while R-BNS and V-BNS were lower than those in non-SUI group(all P<0.05). ROC curve analysis results: the combined efficacy of various pelvic floor ultrasound parameters in predicting SUI after cesarean section was better than that of various parameters alone. The mRNA level of E-cadherin in the pelvic floor tissues of SUI group was lower than that of the non-SUI group, while the mRNA level of Vimentin was higher than that of the non-SUI group(all P<0.05). Pearson correlation analysis showed that R-PUA, V-PUA, BND, UR were negatively correlated with E-cadherin mRNA levels in pelvic floor tissues, and positively correlated with Vimentin mRNA levels. While R-BNS and V-BNS were positively correlated with E-cadherin mRNA level in pelvic floor tissue, and negatively correlated with Vimentin mRNA level(all P<0.05). Conclusions: Pelvic floor ultrasound parameters are highly effective in predicting SUI after cesarean section, and are related to the E-cadherin and Vimentin expression in pelvic floor tissues.