盆底超声联合血清TGF-β1和弹性蛋白对初产妇产后早期盆底功能的评估价值

张强; 李婕; 张易欣; 申向辉

盆底超声联合血清TGF-β1和弹性蛋白对初产妇产后早期盆底功能的评估价值

The evaluation value of pelvic floor ultrasound combined with serum TGF-β1 and elastin in early postpartum pelvic floor function of primipara

摘要

摘要:
目的： 评估盆底超声联合血清转化生长因子-β1（TGF-β1）和弹性蛋白对初产妇产后早期盆底功能的价值。
方法： 选取妇产科分娩并定期在超声医学科进行产后复查的122例初产妇，根据产后42 d是否发生盆底功能障碍（PFD）分为PFD组与非PFD组。所有病人均接受经会阴超声检查，分别在静息状态、Valsalva状态采集超声图像，比较2组超声参数、血清TGF-β1和弹性蛋白表达。分析影响初产妇产后PFD发生的因素，绘制受试者工作特征（ROC）曲线评估超声参数、血清TGF-β1及弹性蛋白表达对初产妇产后早期PFD的预测价值。
结果： 122例病人中39例发生PFD，发生率为31.97%。PFD组在静息状态、Valsalva状态下的肛提肌裂孔面积（LHA）、静息时LHA与Valsalva时LHA差值（ΔLHA）高于非PFD组，耻骨直肠肌厚度（PMT）、静息时PMT与Valsalva时PMT差值（ΔPMT）、血清TGF-β1及弹性蛋白表达低于非PFD组（P ＜ 0.01）。年龄升高、产前体质量指数增加、第二产程延长、ΔLHA、ΔPMT是影响初产妇产后早期PFD的危险因素，产后血清TGF-β1及弹性蛋白表达升高是保护因素（P ＜ 0.05）。ROC结果显示，ΔLHA、ΔPMT、血清TGF-β1及弹性蛋白联合检测早期PFD的AUC为0.914。
结论： ΔLHA、ΔPMT、血清TGF-β1及弹性蛋白与初产妇产后早期PFD密切相关，联合检测效能高于单独检测，可作为产后PFD的早期预测指标。

Abstract:
Objective To investigate the evaluation value of pelvic floor ultrasonography combined with serum TGF-β1 and elastin in early postpartum pelvic floor function of primipara.
Methods A total of 122 primiparas who delivered in the obstetrics and gynecology department and underwent regular postpartum reexaminations in the ultrasound medicine department, were selected. The patients were divided into the PFD group and non-PFD group according to whether pelvic floor dysfunction (PFD) occurred after 42 days of delivery. All patients underwent perineal ultrasound examination. Ultrasound images were collected in the resting state and Valsalva state, respectively. The ultrasound parameters, serum TGF-β1 and elastin expressions between two groups were compared. To analyze the factors influencing the occurrence of postpartum PFD in primiparas, and the receiver operating characteristic (ROC) curve was drew to evaluate the predictive value of ultrasound parameters and serum levels of TGF-β1 and elastin for early postpartum PFD in primiparas.
Results Among the 122 patients, 39 developed PFD, with an incidence rate of 31.97%. The area of the levator ANI muscle hole (LHA) in the rest and Valsalva state and difference value of LHA between rest and Valsalva state (ΔLHA) in the PFD group were higher than those in non-PFD group. The thickness of the puborectalis muscle (PMT), difference value of PMT between rest and Valsalva state (ΔPMT) and expression levels of serum TGF-β1 and elastin in the PFD group were all lower than those in non-PFD group (P ＜ 0.01). The age increasing, prenatal body mass index increasing, second stage of labor prolonging, ΔLHA and ΔPMT were the risk factors affecting early postpartum PFD in primiparas, while the serum levels of TGF-β1 and elastin increasing was a protective factor (P ＜ 0.05). The results of ROC showed that the AUC of the combined detection of early PFD by ΔLHA, ΔPMT, serum TGF-β1 and elastin was 0.914.
Conclusions The ΔLHA, ΔPMT, serum TGF-β1 and elastin are closely related to early postpartum PFD in primiparas. The combined detection efficiency is higher than that of single detection, which can be used as an early predictor of postpartum PFD.

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