盆底超声参数联合血清雌二醇、血生化指标对产后压力性尿失禁的评估价值

Predictive value of pelvic floor ultrasonographic parameters combined with serum estradiol and biochemical markers for postpartum stress urinary incontinence

摘要:

目的 探究盆底超声参数联合血清雌二醇、血生化指标对产后压力性尿失禁的评估价值。方法 连续纳入2022年5月—2025年2月孕36～38周、尚未临产且入组时未发生压力性尿失禁的孕妇102例。根据随访情况，将孕妇归入压力性尿失禁组（21例）与非压力性尿失禁组（81例）。比较两组的盆底超声参数、血清雌二醇、血生化指标，采用多因素一般Logistic回归分析产后压力性尿失禁的影响因素并构建列线图，绘制受试者工作特征（ROC）曲线分析盆底超声参数联合血清雌二醇、血生化指标对产后压力性尿失禁的预测价值。结果 压力性尿失禁组的膀胱颈漏斗形成率、尿道旋转角、膀胱颈移动度均高于非压力性尿失禁组（P <0.05）。压力性尿失禁组的雌二醇、弹性蛋白酶抑制因子（Elafin）水平均低于非压力性尿失禁组，骨桥蛋白（OPN）高于非压力性尿失禁组（P <0.05）。多因素一般Logistic回归分析结果显示，膀胱颈漏斗形成率高［O^R =19.840（95% CI：2.284，172.371）］、膀胱颈移动度大［O^R =10.098（95% CI：1.158，88.041）］、雌二醇水平低［O^R =0.796（95% CI：0.664，0.953）］、Elafin水平低［O^R =0.587（95% CI：0.361，0.953）］、OPN水平高［O^R =2.015（95% CI：1.050，3.868）］均为产后压力性尿失禁的危险因素（P <0.05）。ROC曲线分析结果显示，膀胱颈漏斗形成、膀胱颈移动度、雌二醇、Elafin、OPN联合预测的曲线下面积为0.979（95% CI：0.960，0.999），敏感性为90.5%（95% CI：0.696，0.988），特异性为97.5%（95% CI：0.914，0.997）。结论 盆底超声参数联合血清雌二醇、血生化指标对产后压力性尿失禁有良好的预测价值。

Abstract:

Objective To evaluate the predictive value of pelvic floor ultrasound parameters combined with estradiol and blood biochemical indicators for postpartum stress urinary incontinence (SUI).Methods A total of 102 pregnant women at 36–38 weeks of gestation, who had not yet gone into labor and were free of stress urinary incontinence (SUI) at enrollment, were consecutively enrolled from May 2022 to February 2025. Based on follow-up outcomes, the participants were classified into the SUI group (n = 21) and the non-SUI group (n = 81). The pelvic floor ultrasound parameters, serum estradiol, and blood biochemical indicators were compared between the two groups. Logistic regression was used to analyze the influencing factors of postpartum SUI and construct a nomogram. ROC curves were plotted to assess the predictive value of pelvic floor ultrasound parameters combined with serum estradiol and blood biochemical indicators for postpartum SUI.Results The rate of bladder neck funneling and the urethral rotation angle and bladder neck mobility in the SUI group were significantly higher than those in the non-SUI group (P < 0.05). Serum estradiol and elafin levels were lower in the SUI group than in the non-SUI group, whereas the serum OPN level was higher (P < 0.05). Multivariable logistic regression analysis showed that a high rate of bladder neck funneling [O^R = 19.840 (95% CI: 2.284, 172.371) ], excessive bladder neck mobility [O^R = 10.098 (95% CI: 1.158, 88.041) ], low estradiol levels [O^R = 0.796 (95% CI: 0.664, 0.953) ], low elafin levels [O^R = 0.587 (95% CI: 0.361, 0.953) ], and high OPN levels [O^R = 2.015 (95% CI: 1.050, 3.868) ] were all risk factors for postpartum SUI in women (P < 0.05). ROC results demonstrated that the combined prediction of bladder neck funneling, bladder neck mobility, estradiol, elafin, and OPN yielded an AUC value of 0.979 (95% CI: 0.960, 0.999), with a sensitivity of 90.5% (95% CI: 0.696, 0.988) and a specificity of 97.5% (95% CI: 0.914, 0.997).Conclusion Pelvic floor ultrasound parameters combined with serum estradiol and blood biochemical indicators show good predictive value for postpartum SUI.