经产妇妊娠间隔时间对盆底功能障碍的影响及其风险模型建立

The Effect of Pregnancy Interval on Pelvic Floor Dysfunction and the Establishment of Risk Prediction Model

目的:探讨妊娠间隔时间对经产妇产后盆底功能障碍(pelvic floor dysfunction,PFD)的影响,建立经产妇PFD预测模型用于指导临床筛查。方法:分析2021年10月—2022年10月我院636例经产妇的临床资料。根据产后是否发生PFD分为PFD组(n=244)和非PFD组(n=392),另选2021年1—9月471例经产妇为验证集。受试者操作特征(receiver operator characteristic,ROC)曲线分析经产妇妊娠间隔时间对产后PFD的预测效能。采用单因素及多因素Logistic回归分析经产妇PFD的影响因素,建立风险预测模型,并验证其检验效能。结果:本研究PFD发生率为38.36%(244/636)。妊娠间隔时间预测PFD的最佳界值为23.5个月。多因素Logistic回归分析发现年龄≥35岁(OR=9.262,95%CI:2.103~40.749)、PFD家族史(OR=6.297,95%CI:1.538~25.789)、妊娠间隔时间≤23.5个月(OR=78.971,95%CI:19.283~323.414)、本次妊娠阴道分娩(OR=5.483,95%CI:1.420~21.170)、新生儿体质量≥4 kg(OR=4.357,95%CI:1.243~15.277)是经产妇PFD发生的危险因素。风险预测模型F=-18.718+9.262×年龄(≥35岁=1、<35岁=0)+6.297×PFD家族史(是=1、否=0)+妊娠间隔时间(≤23.5个月=1、>23.5个月=0)+5.483×本次妊娠阴道分娩(是=1、否=0)+4.357×新生儿体质量(≥4 kg=1、<4 kg=0)。验证风险模型后发现,ROC曲线的曲线下面积为0.878(95%CI:0.852~0.966),敏感度为0.892,特异度为0.820。结论:经产妇妊娠间隔时间≤23.5个月,应警惕产后PFD的发生,建立的PFD风险预测模型有助于对经产妇进行筛查。

Objective:To explore the effect of gestational interval time on postpartum pelvic floor dysfunction(PFD)of multiparas,and to establish a prediction model for PFD of multiparas to guide the clinical screening.Methods:A total of 636 cases of multiparas from October 2021 to October 2022 were retrospectively analyzed.These cases were divided into the PFD group(n=244)and the non-PFD group(n=392)according to whether PFD occurred after delivery.A total of 471 multiparas from January 2021 to September 2021 were selected as the validation set.The predictive power of postpartum PFD was analyzed by receiver operator characteristic(ROC)curve.Univariate and Logistic multivariate analysis were used to analyze the influencing factors of PFD.The PFD risk prediction model was established and the effectiveness of centralized analysis was tested.Results:The incidence of PFD was 38.36%(244/636).The optimal cut-off was 23.5 months.The independent influencing factors of PFD in multiparas were the age≥35 years(OR=9.262,95%CI:2.103-40.749),family history of PFD(OR=6.297,95%CI:1.538-25.789),gestational interval≤23.5 months(OR=78.971,95%CI:19.283-323.414),vaginal delivery of the current pregnancy(OR=5.483,95%CI:1.420-21.170),and neonatal weight≥4 kg(OR=4.357,95%CI:1.243-15.277).Risk prediction model was F=-18.718+9.262×age(≥35 years=1,<35 years=0)+6.297×family history of PFD(yes=1,no=0)+gestational interval(≤23.5 months=1,>23.5 months=0)+5.483×vaginal delivery of this pregnancy(yes=1,no=0)+4.357×newborn weight(≥4 kg=1,<4 kg=0).The area under the curve(AUC)of ROC of risk model was 0.878(95%CI:0.852-0.966),the sensitivity was 0.892,and the specificity was 0.820.Conclusions:Multiparas with gestational interval≤23.5 months should be alert to the postpartum PFD,and the risk prediction model of PFD is helpful for the PFD screening in multiparas.