摘要
目的基于肛提肌剪切波弹性成像(SWE)参数构建列线图模型,探讨其预测初产妇发生盆腔脏器脱垂(POP)的临床应用价值。方法选取我院产后42 d经阴道分娩的初产妇107例,以盆腔脏器脱垂定量分期法(POP-Q)评分作为POP诊断依据,将其分为POP阳性组65例和POP阴性组42例,应用SWE测量两组静息状态下右侧和左侧耻骨直肠肌杨氏模量值(rE1和rE2)、右侧和左侧髂尾肌杨氏模量值(rE3和rE4),以及缩肛状态下右侧和左侧耻骨直肠肌杨氏模量值(cE1和cE2)、右侧和左侧髂尾肌杨氏模量值(cE3和cE4),并计算两种状态下右侧和左侧耻骨直肠肌杨氏模量差值(ΔE1和ΔE2)、右侧和左侧髂尾肌杨氏模量差值(ΔE3和ΔE4),比较两组上述各参数的差异。应用二元Logistic回归分析筛选预测初产妇发生POP的独立影响因素;绘制受试者工作特征(ROC)曲线分析各独立影响因素预测初产妇发生POP的诊断效能,选取其中曲线下面积(AUC)>0.850的参数作为优选参数,并基于优选参数构建预测初产妇发生POP的列线图模型。绘制ROC曲线分析列线图模型预测初产妇发生POP的诊断效能,并采用Bootstrap法对该模型进行内部验证;采用C-index评价模型的区分度;校准曲线评价模型的校准度。结果POP阳性组rE1、rE2、rE3、rE4、cE1、cE2、cE3、cE4、ΔE1、ΔE2、ΔE3、ΔE4均小于POP阴性组,差异均有统计学意义(均P<0.05)。二元Logistic回归分析显示,rE3、cE1、cE4、ΔE1、ΔE2、ΔE4均为预测初产妇发生POP的独立影响因素(OR=0.855、0.796、0.797、0.845、0.682、0.669,均P<0.05)。ROC曲线分析显示,当rE3、cE1、cE4、ΔE1、ΔE2、ΔE4截断值分别为26.35 kPa、51.70 kPa、47.10 kPa、25.65 kPa、24.35 kPa、22.30 kPa时,预测初产妇发生POP的灵敏度分别为61.5%、89.2%、83.1%、83.1%、90.8%、72.3%,特异度分别为81.0%、73.8%、81.0%、61.9%、71.4%、92.9%,曲线下面积分别为0.764(95%可信区间:0.671~0.857)、0.864(95%可信�
Objective To explore the clinical application value of nomogram model based on shear wave elastography(SWE)parameters of levator ani muscle in predicting pelvic organ prolapse(POP)in primipara.Methods A total of 107 primipara who delivered vaginally in 42 d postpartum period in our hospital were selected and divided into two groups according to the quantitative evaluation of pelvic organ prolapse(POP-Q)as the diagnostic criterion for POP,with 65 cases in the POPpositive group and 42 cases in the POP-negative group.SWE was used to measure the Young’s modulus values of the right and left puborectalis muscle(rE1 and rE2)and piriformis muscle(rE3 and rE4)under the resting state.The Young’s modulus values of the right and left puborectalis muscles(cE1 and cE2)and piriformis muscles(cE3 and cE4)were measured under the contracted state.The differences value in Young’s modulus of the right and left puborectalis muscle(ΔE1 and ΔE2)and the differences value in Young’s modulus of the right and left piriformis muscle(ΔE3 and ΔE4)were calculated under two states.All the above parameters were compared between the two groups.Binary Logistic regression analysis was used to screen the independent influencing factors for predicting the occurrence of POP in primipara.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficiency of each independent influencing factor for predicting the occurrence of POP in primipara.The parameters with an area under the curve(AUC)higher than 0.850 were selected as the preferred parameters,and a nomogram model was established based on multiple preferred parameters for predicting the occurrence of POP in primipara.ROC curve was drawn to analyze the diagnostic efficacy of the nomogram model in predicting the occurrence of POP in primipara,and the nomogram model was internally validated by Bootstrap method,and the discriminatory ability was evaluated by C-index.The calibration curve was used to evaluate the calibration degree of the nomogram model.Results In the
作者
赵津艺
张玉玲
胥卉苹
刘婷
李蔚
周江英
ZHAO Jinyi;ZHANG Yuling;XU Huiping;LIU Ting;LI Wei;ZHOU Jiangying(Department of Ultrasound Medicine,the Wenjiang Hospital of Sichuan Provincial People’s Hospital,Chengdu 610000,China)
出处
《临床超声医学杂志》
CSCD
2024年第8期623-629,共7页
Journal of Clinical Ultrasound in Medicine
基金
2023年成都市卫健委医学科研课题资助项目(2023442)
2022年成都市卫健委医学科研课题资助项目(2022446)。
关键词
剪切波弹性成像
盆腔脏器脱垂
肛提肌
经阴道分娩
初产妇
Shear wave elastography
Pelvic organ prolapse
Levator ani muscle
Vaginal delivery
Primipara
