经阴道分娩女性产后盆底肌筋膜疼痛风险列线图的建立

Establishment of risk prediction nomogram model for postpartum myofascial pelvic pain in women with vaginal delivery

目的筛选影响经阴道分娩女性产后盆腔肌筋膜疼痛(myofascial pelvic pain,MFPP)发生的高危因素并构建预测模型。方法选取2020年7月至2021年9月在温州市人民医院单胎顺产并在产后6~12周内进行随访的女性200例,根据诊断情况分为MFPP组和非MFPP组,每组各100例。对两组的人口学资料变量和产科相关资料变量行单因素分析,并采用LASSO回归进行多因素分析,然后以筛选变量为依据构建产后MFPP风险预测列线图模型,绘制校准图及采用一致性指数(concordance index,C-index)评估列线图模型的稳定性及预测效能。结果产次、分娩方式、引产方式、阴道内操作(包括产程中的人工破膜、阴道内诊)、是否妊娠糖尿病、新生儿体质量、喂养方式(母乳喂养、混合喂养、人工喂养)、孕期白蛋白、会阴情况(会阴裂伤或会阴侧切)9个预测变量可能是经阴道分娩女性产后MFPP发生的相关因素。以多因素分析结果构建列线图模型,C-index指数为0.789(95%置信区间:0.724~0.854),说明本研究所建立的列线图模型的精确度及区分度较好。结论本研究分析了经阴道分娩女性产后MFPP发生的影响因素,建立了针对经阴道分娩产妇产后发生MFPP的风险预测模型,为临床评估工作提供有效指导。

Objective To screen out the high-risk factors affecting the occurrence of postpartum myofascial pelvic pain(MFPP)in women who delivered vaginally and to construct a predictive model.Methods A total of 200 women who had a singleton normal delivery at Wenzhou People's Hospital from July 2020 to September 2021 and were followed up within 6-12 weeks after delivery were selected and divided into the MFPP group and the non-MFPP group according to the diagnostic criteria of MFPP,with 100 cases in each group.Univariate analysis was performed on demographic data variables and obstetric-related data variables in the two groups,and Lasso regression was used for multivariate analysis.Then,based on the screening variables,a nomogram model for postpartum MFPP risk prediction was constructed,a calibration chart was drawn,and concordance index(C-index)was used to evaluate the stability and predictive performance of the nomogram model.Results Parity,delivery mode,labor induction method,intravaginal operation(including artificial rupture of membranes during labor,intravaginal examination),whether gestational diabetes mellitus,neonatal weight,feeding method(breastfeeding,mixed feeding,artificial feeding),albumin during pregnancy,perineal condition(perineal laceration or episiotomy)9 predictors may be associated with the occurrence of postpartum MFPP in women who delivered vaginally.A nomogram model was constructed based on the results of multivariate analysis,and the C-index was 0.789(95%confidence interval:0.724-0.854),which indicated that the nomogram model established in this study had good accuracy and discrimination.Conclusion This study analyzed the influencing factors of postpartum MFPP in vaginal delivery women,established a risk prediction model for postpartum MFPP in vaginal delivery women,and provided effective guidance for clinical evaluation.