声触诊组织定量剪切波弹性成像联合盆底超声对阴道分娩者产后盆底功能障碍的诊断价值

Diagnostic value of virtual touch tissue imaging quantification shear wave elastography combined with pelvic ultrasound in pelvic floor dysfunction after vaginal delivery

目的探讨声触诊组织成像定量(VTIQ)剪切波弹性成像联合盆底超声对阴道分娩者产后盆底功能障碍(PFD)的诊断价值。方法选取2019年1月至12月海南医学院附属海南医院收治的经阴道分娩的42例PFD患者为PFD组,选择同期52名经阴道分娩的健康志愿者为正常对照组,均进行盆底超声和VTIQ剪切波弹性成像检查。记录并比较2组受检者的临床资料,包括年龄、体质量指数、产次及新生儿体质量以及盆底超声检查参数[膀胱颈移动度(BND)、膀胱尿道后角(PUVA)、尿道旋转角度(URA)、子宫颈外口移动度(COD)、直肠壶腹部移动度(RAD)、盆膈裂孔面积(LHA)]和弹性超声参数(静息状态和最大缩肛状态下杨氏模量值)。单因素分析采用秩和检验及t检验,筛选出对PFD有诊断价值的指标,并建立二分类Logistic回归模型,明确阴道分娩者产后PFD的独立影响因素。采用受试者操作特征(ROC)曲线分析单个参数及回归模型的诊断价值,并进行曲线下面积(AUC)的比较。结果单因素分析正常对照组和PFD组产次、新生儿体质量、BND、PUVA、URA、COD、RAD、LHA、最大缩肛状态杨氏模量值及杨氏模量值差值比较,差异均有统计学意义(P均<0.05)。杨氏模量值差值区分正常对照组与PFD组AUC大于最大缩肛状态杨氏模量值(0.865 vs 0.750),差异具有统计学意义(Z=2.844,P<0.001)。二分类Logistic回归分析结果显示新生儿体质量(X_(4))、BND(X_(5))及LHA(X_(10))是阴道分娩后PFD的独立危险因素,杨氏模量值差值(X13)是阴道分娩后PFD的独立保护因素,构建的Logistic回归模型为:Logit(P)=-60.011+0.010X_(4)+0.599X_(5)+1.202X_(10)-0.416X_(13)。ROC曲线结果显示新生儿体质量、BND及LHA、杨氏模量值差值以及回归模型预测阴道分娩后PFD的AUC分别为0.779、0.836、0.876、865、0.996,其中回归模型预测的AUC明显高于各指标单独预测的结果(P<0.001、<0.001、=0.006、=0.013),其余单个指标AUC比较,差异均无统计学意义(P均>0.05)。当回归模型预测概率为0.5454时,其敏感度与特异度分别为88.10%和94.23%。结论VTIQ技术联合盆底超声建立的回归模型对阴道分娩者产后PFD有较高的诊断价值。

Objective To assess the value of virtual touch tissue imaging quantification(VTIQ)shear wave elastography combined with pelvic ultrasound in the diagnosis of pelvic floor dysfunction(PFD)after vaginal delivery.Methods From January 2019 to December 2019,42 patients with PFD treated at Hainan Affiliated Hospital of Hainan Medical University Hospital after vaginal delivery were selected as a PFD group,and 52 healthy volunteers without PFD were included in a control group.All patients underwent pelvic ultrasound and VTIQ shear wave elastography.The clinical data of the two groups were recorded and compared,including age,body mass index,parity,the mean of birth weight,pelvic floor ultrasound parameters[bladder neck descent(BND),posterior urethrovesical angle(PUVA),urethral rotation angle(URA),cervical orifice descent(COD),rectal ampulla descent(RAD),and levator hiatus area(LHA)],and elastic ultrasound parameters[Young's modulus of the puborectalis(PR)at resting and maximum anal contraction state].Rank sum test and t-test were used to screen out indicators with diagnostic value for PFD,and a binary logistic regression model was developed to identify the independent factors for postpartum PFD.Receiver-operating characteristic curve(ROC)analysis was performed to analyze the diagnostic value of single parameter and regression model,and the area under curve(AUC)was compared.Results There were significant differences in parity,the mean of birth weight,BND,PUVA,URA,COD,RAD,LHA,Young's modulus of PR at maximum anal contraction state,and Young's modulus difference between the two groups(P<0.05).The AUC of Young's modulus difference was higher than that of Young's modulus at maximum anal contraction state between the two groups(0.865 vs 0.750;Z=2.844,P<0.001).Binary logistic regression analysis showed that the mean of birth weight(X_(4)),BND(X_(5)),and LHA(X_(10))were identified as independent risk factors,and Young's modulus difference(X_(13))was identified as an independent protective factor for PFD after vaginal delivery.The developed logistic regression equation was:Logit(P)=-60.011+0.010X_(4)+0.599X_(5)+1.202X_(10)-0.416X_(13).ROC curves analysis indicated that the AUCs of the mean of birth weight,BND,LHA,Young's modulus difference,and the regression model for predicting PFD after vaginal delivery were 0.779,0.836,0.876,0.865,and 0.996,respectively.The AUC of the regression model was significantly higher than those of other indexes(P<0.001,<0.001,=0.006,and=0.013,respectively),but the AUCs of the other indexes did not differ significantly(P>0.05).When the prediction probability of the regression model was 0.5454,the sensitivity and specificity were 88.10%and 94.23%,respectively.Conclusion The regression model established by VTIQ technology combined with pelvic ultrasound has high diagnostic value for PFD after vaginal delivery.