龚娥 李宁 龚法伍 劳双丽 杨丽莹 张树华

【摘要】 目的：探討基于前盆腔超声的多指标联合对轻中度压力性尿失禁（SUI）的诊断价值。方法：选取104例在本院就诊的轻中度SUI女性患者作为病例组（轻度、中度），选取同一时间段40例来本院正常体检并排除SUI的女性作为对照组，两组均接受盆底超声检查，并记录Hx、Hy、BND、BRA，比较各组间超声参数的差异、分析各超声指标与SUI程度的相关性，以临床诊断为金标准，构建单超声指标及多超声指标联合诊断轻中度SUI的ROC曲线，确立最佳诊断界值。结果：三组Hx、Hy、BND、BRA值比较，差异均有统计学意义（P<0.05）。相关分析显示：各超声指标均与SUI程度有相关性（P<0.05），其中BND、BRA与SUI程度相关系数较高，分别为0.770、0.747。单超声指标与多指标联合诊断SUI的ROC曲线：Hy、BND、BRA、BND联合BRA的ROC曲线下面积均>0.7，BND、BRA诊断界值分别为10.97 mm、22.06°时及BND联合BRA，敏感度、特异度分别为81.7%、77.5%，86.5%、72.5%，89.4%、80.0%。单超声指标与多指标联合诊断中度SUI的ROC曲线：Hy、BND、BRA、BND联合BRA的ROC曲线下面积均>0.7，诊断界值分别为12.51 mm、27.38°时及BND联合BRA，敏感度、特异度分别为89.6%、78.1%，85.4%、79.2%，95.8%、80.1%;其中BND与BRA联合诊断SUI及中度SUI的敏感度及特异度均高于单超声指标。结论：盆底超声可清晰显示轻中度SUI患者盆底结构的变化，多超声指标联合对轻中度SUI的诊断价值明显优于单一超声指标。

【关键词】 盆底超声 压力性尿失禁 多超声指标联合 ROC曲线

[Abstract] Objective： To explore the diagnostic value of multiple indicators combination based on anterior pelvic ultrasound in mild to moderate stress urinary incontinence （SUI）. Method： A total of 104 patients with mild-to-moderate female SUI in our hospital were selected as case group （mild， moderate）， 40 women who came to our hospital for normal physical examination and excluded SUI were selected as the control group， two groups accepted pelvic floor ultrasound， and Hx， Hy， BND and BRA were recorded， the differences of ultrasound parameters among the groups were compared， the correlation between ultrasound parameters and SUI was analyzed， the clinical diagnosis was as the gold standard， ROC curve of single ultrasound index and multi ultrasound index in the diagnosis of mild to moderate SUI were constructed， the best diagnostic threshold was established. Result： The Hx， Hy， BND and BRA of three groups were compared， there were statistical significance（P<0.05）. Correlation analysis showed that all ultrasonic indicators were correlated with the severity of SUI （P<0.05）， among which the correlation coefficients of BND and BRA were relatively high， 0.770 and 0.747 respectively. The area under the ROC curve of Hy， BND， BRA and BND combined with BRA multiple indicators in diagnosing of SUI were >0.7， and the diagnostic boundary value of BND and BRA were 10.97 mm， 22.06° and BND combined with BRA， the sensitivity and specificity were 81.7% and 77.5%， 86.5% and 72.5%， 89.4% and 80.0%， respectively. The area under the ROC curve of Hy， BND， BRA and BND combined with BRA multiple indicators for the combined diagnosis of moderate SUI were >0.7， when the diagnostic boundary values of BND and BRA were 12.51mm， 27.38° and BND combined with BRA， and the sensitivity and specificity were 89.6% and 78.1%， 85.4% and 79.2%， 95.8% and 80.1% respectively. The sensitivity and specificity of combined diagnosis of SUI and moderate SUI by combined diagnosis of BND and BRA were higher than those by single ultrasound. Conclusion： Pelvic floor ultrasound can clearly show changes in pelvic floor structure of patients with mild to moderate SUI， and the diagnostic value of multiple ultrasound indicators combined with in mild to moderate SUI is significantly better than that of single ultrasound indicators.

[Key words] Pelvic floor ultrasound Stress urinary incontinence Multiple ultrasound indicators combined

ROC curve

First-authors address： North China University of Science and Technology Affiliated Hospital， Tangshan 063000， China

doi：10.3969/j.issn.1674-4985.2021.09.001

女性盆底功能障碍性疾病（female pelvic floor dysfunction disease，FPFD）是指由各种原因导致的盆底支持结构功能障碍以及结构损伤性的疾病，主要表现为压力性尿失禁（stress urinary incontinence，SUI）、盆腔器官脫垂（pelvic organ prolapse，POP）、粪失禁、女性性功能障碍等[1]。FPFD并不危及生命，但其症状易引起患者精神及心理障碍，对女性的健康和生活有重要影响[2]，尤其是老年女性。有研究报道，近一半的女性可能会出现SUI的症状，并随着人口老龄化，其发病率有着明显上升[3]。临床……