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 POP-positive 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 POP-positive group,the rE1,rE2,rE3,rE4,cE1,cE2,cE3,cE4,ΔE1,ΔE2,ΔE3 and ΔE4 were all significantly lower than those in the POP-negative group(all P<0.05).Binary Logistic regression analysis showed that rE3,cE1,cE4,ΔE1,ΔE2 and ΔE4 were independent influencing factors for predicting the occurrence of POP in primipara(OR=0.855,0.796,0.797,0.845,0.682,0.669,all P<0.05).ROC curve analysis showed that when the cut-off values of rE3,cE1,cE4,ΔE1,ΔE2 and ΔE4 were 26.35 kPa,51.70 kPa,47.10 kPa,25.65 kPa,24.35 kPa and 22.30 kPa,respectively,the sensitivity were 61.5%,89.2%,83.1%,83.1%,90.8%,72.3%for predicting the occurrence of POP in primipara,the specificity were 81.0%,73.8%,81.0%,61.9%,71.4%,92.9%,and the AUC were 0.764(95%confidence interval:0.671～0.857),0.864(95%confidence interval:0.794～0.935),0.866(95%confidence interval:0.797～0.936),0.767(95%confidence interval:0.675～0.859),0.860(95%confidence interval:0.786～0.934),0.856(95%confidence interval:0.781～0.930),respectively.The AUC of cE1,cE4,and ΔE2 for predicting the occurrence of POP in primipara all higher than 0.850.A nomogram model was established based on above these three parameters.The nomogram model had a cut-off value of 0.48,with a sensitivity and specificity of 93.8%and 90.5%,respectively.The AUC was 0.952(95%confidence interval:0.910～0.993).The nomogram model was internally validated by the Bootstrap method,a C-index was 0.952,with excellent discriminatory ability.The calibration curve showed an average absolute error of 0.014 between predicted and actual values,with a strong calibration performance of the model.Conclusion The nomogram based on the SWE parameters of levator ani muscle has certain clinical value in predicting POP in primipara.
Shear wave elastographyPelvic organ prolapseLevator ani muscleVaginal deliveryPrimipara
NETL
NSTL
万方数据
