绝经期女性发生盆底肌功能障碍的影响因素分析及预测模型的构建

Influencing factors of pelvic floor muscle dysfunction in postmenopausal women and construction of prediction model

目的 探讨绝经期女性发生盆底肌功能障碍(pelvic floor dysfunction, PFD)的影响因素并构建预测模型。方法 回顾性分析2020年3月至2021年5月在苏州大学附属苏州九院和南京医科大学附属江苏盛泽医院妇产科就诊的343例绝经期女性患者资料。以患者的盆底肌功能检查结果分为PFD组(71例)和非PFD组(272例)。对两组各项指标进行单因素分析,再行Logistic多因素回归分析并构建预测模型,应用受试者工作特征(receiver operating characteristic, ROC)曲线检测其区分度,应用拟合优度检验评价其校准度。另选苏州大学附属苏州九院74例绝经期女性患者作该模型的临床验证。结果 多因素Logistic回归分析发现年龄≥50岁、体质量指数(body mass index, BMI)≥24 kg/m2、雌二醇(estrodiol, E2)、分娩次数、25-羟维生素D3[25-hydroxy-vitamin D3,25-(OH)D3]、血钙指标均是绝经期女性发生PFD的影响因素(P<0.05)。根据影响因素得出预测模型方程:Prob=1/(e^-Y),Y=31.784-0.475×年龄+0.241×BMI+0.562×E2+0.749×分娩次数+0.505×25-(OH)D3+0.318×血钙。该模型的ROC曲线下面积为0.895(95%CI:0.850-0.939),最大约登指数(0.645)对应的灵敏度和特异度分为0.902、0.837。经拟合优度检验χ2=3.178,P=0.326。临床验证模型的灵敏度为88.24%、特异度为84.21%、准确率为85.14%。结论 年龄≥50岁、BMI≥24 kg/m2、E2低表达、分娩次数多、25-(OH)D3低表达、血钙低表达与绝经期女性发生PFD有关,存在以上指标异常的绝经期女性,应警惕PFD风险。

Objective To explore the influencing factors of pelvic floor dysfunction(PFD) in postmenopausal women and build a predictive model.Methods The data of 343 postmenopausal female patients who visited the Department of Obstetrics and Gynecology of the Suzhou Ninth Hospital Affiliated to Soochow University and the Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from March 2020 to May 2021 were retrospectively analyzed.The patients were divided into PFD group(71 cases) and non-PFD group(272 cases) according to the pelvic floor muscle function test results.Single factor screening was performed for each index of the two groups.Logistic multivariate regression analysis was performed again, and a prediction model was established.The receiver operating characteristic(ROC) curve was used to detect its discrimination, a goodness-of-fit test was used to evaluate the degree of calibration.Another 74 menopausal female patients in Suzhou Ninth Hospital Affiliated to Soochow University were selected for clinical validation of the model.Results Multivariate Logistic regression analysis showed that age≥50 years old, BMI≥24 kg/m~2,E2,delivery times, 25-(OH)D3,and serum calcium were all influencing factors of PFD in postmenopausal women(P<0.05).According to the influencing factors, the prediction model equation is obtained: Prob=1/(e^-Y),Y=31.784-0.475×age+0.241×BMI+0.562×E2+0.749×delivery times+0.505×25-(OH)D3+0.318 × blood calcium.The area under the ROC curve of this model was 0.895(95% CI:0.850-0.939),the sensitivity and specificity corresponding to the maximum Youden index(0.645) were divided into 0.902,0.837.After the goodness of fit test, χ~2=3.178,P=0.326.The sensitivity of the clinically validated model was 88.24%,the specificity was 84.21%,and the correct rate was 85.14%.Conclusions Age≥50 years old, BMI≥24 kg/m~2,low expression of E2,multiple deliveries, low expression of 25-(OH)D3,and low expression of blood calcium are related to the occurrence of PFD in menopausal women.The menopausal women with abnormal above indicators should be alert to the risk of PFD.