摘要
目的 应用盆底超声定量分析高龄孕妇盆底结构及功能的变化,确立高龄孕妇压力性尿失禁(SUI)的超声诊断指标及界值。方法 选取2015年1月至2021年2月在华北理工大学附属医院就诊的高龄孕妇140例为高龄组(其中SUI组66例,非SUI组74例),同时选取适龄孕妇145例为适龄组,两组均接受盆底超声检查并记录以下指标:静息状态、张力状态膀胱颈的位置(H_(1)、H_(2))、尿道倾斜角(UIA_(1)、UIA_(2))、膀胱尿道后角(PVUA_(1)、PVUA_(2))、膀胱颈移动度(BND)、尿道旋转角度(URA)、肛提肌裂孔面积(LHA_(1)、LHA_(2))。比较高龄组与适龄组各超声参数及SUI检出率的差异;高龄孕妇SUI组与非SUI组各超声参数的差异;构建各超声参数及联合指标诊断高龄孕妇SUI的ROC曲线,确立最佳诊断指标及界值。结果 (1)高龄组H_(1)、H_(2)均低于适龄孕妇,BND、URA、PVUA_(1)、LHA_(2)均高于适龄组,差异均有统计学意义(t值分别为-3.844、-3.608、2.272、3.469、4.326、2.233,P<0.05);高龄组SUI检出率为47.5%,明显高于适龄组,差异有统计学意义(χ^(2)=4.439,P<0.05)。(2)高龄孕妇SUI组H_(2)低于非SUI组,BND、UIA_(2)、URA_(2)、PVUA_(2)、LHA_(1)、LHA_(2)高于非SUI组,差异均有统计学意义(t值分别为9.059、-11.504、-4.529、-8.515、-4.162、-10.352、-10.466,P<0.05)。(3)以临床诊断SUI为“金标准”,构建各超声参数及联合指标诊断高龄孕妇SUI的ROC曲线,其中H_(2)、BND、UIA_(2)、URA、PVUA_(2)、LHA_(1)、LHA_(2)及联合指标曲线下面积均>0.7;联合指标曲线下面积最大,为0.976;诊断界值为0.368时,敏感度及特异度最高,分别为97.0%、90.5%。结论 高龄孕妇盆底结构支持力较适龄孕妇明显减弱,其中患有SUI的高龄孕妇尤为明显,多超声指标联合可以作为高龄孕妇SUI的最佳诊断指标,诊断界值为0.368。
Objective To quantitatively analyze the changes of pelvic floor structure and function in pregnant women with advanced maternal age by pelvic floor ultrasound, and establish the ultrasonic diagnosis index and boundary value of stress urinary incontinence(SUI) for pregnant women with advanced maternal age.Methods A total of 140 pregnant women with advanced maternal age, who visited in the North China University of Science and Technology Affiliated Hospital between January, 2015 to February, 2021 were selected as the advanced maternal age group(including 66 cases of the SUI group and 74 cases of the non-SUI group).At the same time, 145 cases of the age-appropriate pregnant were selected as the age-appropriate pregnant group.Pelvic floor ultrasound examination was conducted in both two groups and the following parameters were recorded: the position of bladder neck in resting and tension state(H_(1),H_(2)),inclination angle of urethra(UIA_(1),UIA_(2)),posterior horn of bladder and urethra(PVUA_(1),PVUA_(2)),moving distance of bladder neck(BND),urethral rotation angle(URA),area of levator ani hiatus(LHA_(1),LHA_(2)).The differences of ultrasound parameters and SUI detection rate between the advanced maternal age group and the age-appropriate pregnant group were compared.The differences of ultrasound parameters between the SUI group and the non-SUI group were compared.The ROC curve of single ultrasound parameter and combined index in the diagnosis of SUI in pregnant women with advanced maternal age was constructed, and the best diagnostic index and cut-off value were figured out.Results(1)Compared with the age-appropriate pregnant group, the value of H_(1) and H_(2) were lower, and BND,URA,PVUA_(1),LHA_(2) were higher in the advanced maternal age group, and the differences were statistically significant(t=-3.844,-3.608,2.272,3.469,4.326 and 2.233,respectively, P<0.05).The detection rate of SUI in the advanced maternal age group was 47.5%,which was significantly higher than that in the age-appropriate pregnant group, an
作者
李宁
郭二芳
王艺桦
张曼
张树华
龚娥
郭艳娟
LI Ning;GUO Erfang;WANG Yihua;ZHANG Man;ZHANG Shuhua;GONG E;GUO Yanjuan(Department of Ultrasound,the North China University of Scienceand Technology Affiliated Hospital,Hebei Tangshan 063000,China;Department of Obstetrics and Gynecology,the North China University of Scienceand Technology Affiliated Hospital,Hebei Tangshan 063000,China)
出处
《中国妇幼健康研究》
2022年第11期119-126,共8页
Chinese Journal of Woman and Child Health Research
基金
河北省省级科技计划项目(20377735D)
河北省省属高校基本科研业务费项目(JQN2019014)。
关键词
高龄孕妇
盆底超声
压力性尿失禁
诊断指标及界值
pregnant women with advanced maternal age
pelvic floor ultrasound
stress urinary incontinence
diagnostic index and cut-off value
