基于分类树模型的产后盆底肌筋膜疼痛的危险因素分析

Analysis of risk factors for postpartum pelvic floor myofascial pain based on the classification tree model

目的 构建产后盆底肌筋膜疼痛(MFPP)发病影响因素的分类树模型,寻找产后MFPP发生的危险因素。方法 选取2017年1—12月在南京市妇幼保健院常规产后检查的975例产妇,进行流行病学调查。205例产妇患有MFPP分为病例组,229例产妇无盆底功能障碍性疾病(PFD)情况分为对照组。结果 病例组中轻、中、重度疼痛人数分别为27例、173例、5例。我们对病例组研究发现产后MFPP发病影响因素的分类树模型共有5层,筛选出4个解释变量:快肌最大值,慢肌平均值,产妇体质量指数(BMI),新生儿出生体质量。其中快肌最大值≤41.20μv且慢肌平均值≤6.85μv时,产后MFPP发生率为76.0%,分类树模型预测的受试者操作特征(ROC)曲线下面积(AUC)为69.1%,95%CI:(0.64,0.74)。结论 快肌最大值、慢肌平均值、产妇BMI及新生儿出生体质量为影响产后MFPP发生的危险因素,盆底肌电筛查中快肌最大值≤41.20μv和慢肌平均值≤6.85μv可作为筛查指标,对于这部分的产妇,需联合盆底肌疼痛检查是否存在产后MFPP。

Objective To construct a classification tree model of influencing factors for the onset of postpartum pelvic floor myofascial pain(MFPP)and to identify risk factors for the occurrence of postpartum MFPP.Methods A total of 975 women who underwent routine postpartum examinations in Nanjing Maternity and Child Health Care Hospital from January to December 2017 were selected for epidemiological investigation.The 205 women with MFPP were divided into case groups and 229 women without pelvic floor dysfunctional disease(PFD)conditions were divided into control groups.Results The number of mild,moderate and severe pain in the case group was 27,173,and 5,respectively.Our study of the case group found a five-level classification tree model of factors influencing the onset of postpartum MFPP,and four explanatory variables were screened:fast muscle maximum,slow muscle mean,maternal body mass index(BMI),and neonatal birth mass.The incidence of postpartum MFPP was 76.0%for fast muscle maximum≤41.20μv and slow muscle mean≤6.85μv,and the area under the operating characteristic(ROC)curve(AUC)predicted by the classification tree model was 69.1%,95%CI:(0.64,0.74).Conclusions Fast muscle maximum,slow muscle mean,maternal BMI and neonatal birth mass are risk factors affecting the occurrence of postpartum MFPP.A pelvic floor electromyographic screen with a fast muscle maximum≤41.20μv and a slow muscle mean≤6.85μv can be used as a screening indicator,and for this group,the presence of postpartum MFPP needs to be examined in combination with pelvic floor muscle pain.