妊娠晚期压力性尿失禁患者的盆底超声观察及ROC曲线分析

摘要

目的：探讨会阴超声对妊娠晚期压力性尿失禁（SUI）患者的临床诊断价值。方法应用会阴超声分别观察妊娠晚期患SUI 66例（Ⅰ组）、未患SUI 54例（Ⅱ组）及健康未育女性63例（Ⅲ组）盆底结构，记录各超声参数：静息期及张力期膀胱颈在X轴、Y轴的位置（Djx、Dzx；Djy、Dzy），膀胱尿道后角（αj、αz），膀胱角度（βj、βz）；计算膀胱颈在X轴、Y轴的移动度（ΔDx、ΔDy），膀胱旋转角度（Δβ），测量膀胱颈的移动度（ΔD），进行对比分析；通过受试者工作特征曲线（ROC曲线）分析，寻找各参数的超声诊断临界值。结果3组研究对象膀胱颈在张力状态下均向后下移位；Ⅰ组、Ⅱ组ΔDy、Djx、Dzx值均明显小于Ⅲ组，βj、βz、αj值均明显大于Ⅲ组，Ⅱ组ΔDx值明显大于Ⅲ组，差异有统计学意义（P<0.05）；3组间Djy、Dzy、ΔD、Δβ、αz比较差异有统计学意义（P<0.05）；通过ROC曲线分析Djy、Dzy、ΔDy、ΔD、αz、Δβ临界值为-1.75 cm、-1.71 cm、0.25 cm、0.29 cm、131.5°、3.5°时，敏感度分别为88.9%、88.9%、72.2%、83.3%、88.9%、72.2%，特异度分别为72.2%、81.8%、72.7%、95.5%、86.3%、68.2%。结论会阴超声可以清晰显示妊娠晚期女性盆底结构，患有SUI的妊娠晚期女性膀胱尿道周围支持结构的损伤或缺陷更为严重，各超声参数临界值的确定有助于妊娠晚期女性SUI的筛查。%Objective To investigate the clinical diagnostic value of transperineal ultrasound in women in late pregnancy with stress urinary inconti⁃nence. Method Totally 66 cases of women in late pregnancy were selected,who did not suffer from SUI(groupⅠ),and 54 cases of women in late pregnancy who suffered from SUI(groupⅡ). Another 63 cases of healthy childless women were used as normal control(groupⅢ). Transperineal ultrasound was used to dynamically observe their pelvic floor structure,and the ultrasonic parameters were recorded and analyzed,including the posi⁃tion of bladder neck in X axis and Y axis((Djx,Dzx,Djy,Dzy)during resting period and tension period,the vesicourethral angle(αj,αz),the Bladder angle(βj,βz). The moving of the bladder neck in X axis(ΔDx=Dzx-Djx)and Y axis(ΔDy=Dzy-Djy),as well as the bladder rotation an⁃gle(Δβ=βz-βj)were calculated and the movement of the bladder neck(ΔD)was measured,followed by comparative analysis. The threshold val⁃ues of all ultrasonic parameters were determined by the ROC curve analysis. Results The bladder neck of all three groups were backward during tension period. Compared with groupⅢ,ΔDy,Djx,Dzx obviously decreased in groupⅠand groupⅡ,whileβj,βz,αj increased significantly.ΔDx of groupⅡwas significantly larger than that of groupⅢ(P<0.05);There was significant difference in Djy,Dzy,ΔD,Δβandαz among the three groups(P<0.05);In ROC curve analysis,when the critical value of Djy,Dzy,ΔDy,ΔD,αz andΔβwas-1.75 cm,-1.71 cm,0.25 cm,0.29 cm,131.5° and 3.5° ,their sensitivity was 88.9%,88.9%,72.2%,83.3%,88.9%and 72.2%,and the specificity was 72.2%,81.8%,72.7%, 95.5%,86.3%and 68.2%,respectively. Conclusions The transperineal ultrasound could clearly show the pelvic floor of the women in late preg⁃nancy,the bladder urethral support structure damage or defect was more serious in the women in late pregnancy who were suffering from SUI,and the determination of the critical values of all ultrasonic parameters helped the screening of SUI in women in late pregnancy.