摘要
目的 基于盆底超声参数及血清学指标建立列线图模型,探讨其预测初产妇压力性尿失禁(SUI)的临床应用价值.方法 选取我院148例初产妇,根据产后3个月是否发生SUI分为SUI组(37例)及非SUI组(111例),获取两组一般资料,包括分娩方式及妊娠期是否进行盆底肌锻炼、是否运动、是否存在SUI;均行盆底超声检查和实验室检查,获取尿道旋转角(URA)、尿道倾斜角(UTA)、膀胱颈移动度(BND)、膀胱尿道后角(PUA)、肛提肌裂孔面积(LHA)及血清基质金属蛋白酶-1(MMP-1)、骨桥蛋白(OPN)、结缔组织生长因子(CTGF),比较两组上述检查结果的差异.采用多因素Logistic回归分析筛选初产妇SUI的独立影响因素,并据此建立预测初产妇SUI的列线图模型.绘制受试者工作特征(ROC)曲线分析模型的区分度;采用Hosmer-Lemeshow检验并绘制校准曲线评估模型的校准度;绘制临床决策曲线分析模型的临床适用性.结果 两组分娩方式及妊娠期是否进行盆底肌锻炼、是否运动、是否存在SUI,以及URA、UTA、BND、PUA、LHA和血清MMP-1、OPN、CTGF比较差异均有统计学意义(均P<0.05).多因素Logistic回归分析显示,URA、UTA、BND、PUA、LHA和血清MMP-1、OPN、CTGF均为初产妇SUI的独立影响因素(均P<0.05);基于以上独立影响因素构建列线图模型.ROC曲线分析显示,列线图模型预测初产妇SUI的曲线下面积为0.841(95%可信区间:0.756～0.926);Hosmer-Lemeshow检验显示,列线图模型预测概率与实际概率比较差异无统计学意义(χ2=82.349,P=0.642);校准曲线显示,预测曲线与校准曲线的校准度较高;临床决策曲线显示,列线图模型具有较好的临床适用性.结论 基于盆底超声参数及血清学指标建立的列线图模型对初产妇SUI具有较高的预测价值,能为临床防治初产妇SUI提供参考依据.
Abstract
Objective To establish a nomogram model based on pelvic floor ultrasound parameters and serological indicators,and to explore the clinical application value of the model in predicting stress urinary incontinence(SUI)in primiparas.Methods A total of 148 primiparas in our hospital were enrolled,according to whether SUI occurred 3 months postpartum,they were divided into SUI group(37 cases)and non-SUI group(111 cases).General data of two groups were obtained,including delivery mode,whether pelvic floor muscle exercise,the presence of SUl during pregnancy.Pelvic floor ultrasound and laboratory examination were performed to obtain the urethral rotation angle(URA),urethral tilt angle(UTA),bladder neck descend(BND),posterior angle of urethra(PUA),hole area(LHA)and serum matrix metalloproteinase-1(MMP-1),osteopontin(OPN),connective tissue growth factor(CTGF),the differences of above results between the two groups were compared.Multivariate Logistic regression analysis was used to screen the independent influencing factors of SUI in primiparas.A nomogram model was established based on above independent influencing factors.Receiver operating characteristic(ROC)curve was drawn to analyze the discrimination of the model.The calibration of the model was evaluated by Hosmer-Lemeshow test and calibration curve.The clinical decision curve was used to assess the clinical utility of the model.Results There were significant differences in the delivery mode,whether pelvic floor muscle exercise,the presence of SUl during pregnancy,and URA,UTA,BND,PUA,LHA and serum MMP-1,OPN,CTCF between two groups(all P<0.05).Multivariate Logistic regression analysis showed that URA,UTA,BND,PUA,LHA and serum MMP-1,OPN,CTGF were independent influencing factors for SUI in primiparas(all P<0.05).The nomogram was established based on above independent influencing factors.ROC analysis showed that the area under the curve of the nomogram model for predicting SUI in primiparas was 0.841(95%confidence interval:0.756～0.926).Hosmer-Lemeshow test showed no statistically significant difference between the predicted probability and the actual probability(χ2=82.349,P=0.642).The calibration curve showed a strong correlation between the prediction curve and the calibration curve.The clinical decision curve showed that the model had a higher clinical benefit.Conclusion The nomogram model based on pelvic floor ultrasound parameters and serological indicators has high predictive value for SUI in primiparas,which can provide reference for the prevention and treatment of SUI in clinic.
NETL
NSTL
万方数据