孕晚期血清松弛素、分娩方式对初产妇产后早期盆底功能障碍影响的交互作用分析

Analysis of the Interaction between Serum RLX in the Third Trimester,Delivery Mode and Pelvic Floor Dysfunction in Primipara

目的分析孕晚期血清松弛素、分娩方式对初产妇产后早期盆底功能障碍(PFD)影响的交互作用。方法选取2019年3月—2022年12月收治的203例初产妇,根据产后42 d有无PFD分为PFD组(43例)和无PFD组(160例)2组,比较2组基线资料、孕晚期血清松弛素;采用Logistic回归分析探讨初产妇产后早期PFD的相关危险因素,交互作用系数γ、比值比(OR)分析孕晚期血清松弛素、分娩方式对初产妇产后早期PFD影响的交互作用,受试者工作特征曲线(ROC)分析孕晚期血清松弛素、分娩方式及二者联合预测初产妇产后早期PFD的价值。结果PFD组自然分娩产妇占比高于无PFD组(P<0.05)。PFD组孕晚期血清松弛素为(657.33±178.56)ng/L高于无PFD组(460.81±142.35)ng/L(P<0.05)。Logistic回归分析显示,自然分娩、血清松弛素均是初产妇产后早期PFD的相关危险因素(P<0.01)。自然分娩产妇血清松弛素高于剖宫产初产妇(P<0.05)。单独孕晚期血清松弛素所致OR为132.000,单独自然分娩所致OR为6.919,孕晚期血清松弛素与自然分娩联合所致OR为198.000,交互作用OR小于单独孕晚期血清松弛素与单独自然分娩OR的乘积,为次相乘模型,孕晚期血清松弛素对自然分娩的效应具有正向交互作用。孕晚期血清松弛素联合分娩方式预测PFD的ROC曲线下面积大于单独血清松弛素、分娩方式(P<0.05),预测敏感度为86.05%,特异度为86.87%。结论孕晚期血清松弛素、分娩方式对初产妇产后早期PFD的影响符合次相乘模型,孕晚期血清松弛素对自然分娩的效应具有正向交互作用,联合孕晚期血清松弛素、分娩方式可提高对初产妇产后早期PFD的预测能力。

Objective To analyze the interaction between serum relaxin(RLX)in the third trimester,delivery mode and pelvic floor dysfunction(PFD)in primipara.Methods A total of 203 primipara treated in our hospital from March 2019 to December 2022 were selected and divided into PFD group(n=43)and non-PFD group(n=160)according to presence of PFD in 42 d postpartum.The baseline data of the two groups and serum RLX in the third trimester were compared,and the related risk factors of PFD in the early postpartum period were analyzed by Logistic regression analysis.Interaction coefficient γ and odds ratio(OR)were used to analyze the interaction between serum RLX in the third trimester,mode of delivery and PFD of primipara in the early postpartum period.Receiver operating characteristic(ROC)curve was used to analyze the value of serum RLX and mode of delivery alone and in combination in prediction of PFD of primipara in the early postpartum period.Results The proportion of natural delivery in PFD group was higher than that in non-PFD group(P<0.05).The serum RLX in the PFD group was(657.33±178.56)ng/L,which was higher than that in the non-PFD group[(460.81±142.35)ng/L](P<0.05).Logistic regression analysis showed that natural delivery and serum RLX were the risk factors for PFD in the early postpartum period(P<0.01).The serum RLX of puerpera undergoing natural delivery was higher than that of primipara undergoing cesarean section(P<0.05).OR caused by serum RLX alone in the third trimester was 132.000,OR caused by natural delivery alone was 6.919,OR caused by the coexistence of serum RLX and natural delivery in the third trimester was 198.000,and the OR of interaction was smaller than that product of OR of serum RLX alone in the third trimester and OR of natural delivery alone,which was the submultiplication model.Serum RLX in the third trimester had a positive interaction on the effect of natural delivery.The area under the curve(AUC)of serum RLX combined with delivery mode in predicting PFD was greater than that of serum RLX alone and delivery mode alone(P<0.05)with the sensitivity and specificity of 86.05%and 86.87% respectively.Conclusion The effects of serum RLX in the third trimester and mode of delivery on PFD of primipara in the early postpartum period are consistent with the sub-multiplication model,and serum RLX in the third trimester play a positive interaction effect on natural delivery.The combination of serum RLX in the third trimester and mode of delivery can improve the ability to predict PFD of primipara in the early postpartum period.