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目的通过超声检测妊娠晚期及产后膀胱颈移动度(UVJ-M)的大小,评价孕晚期UVJ-M对孕产妇压力性尿失禁(SUI)的预测价值。方法选取2012年12月~2013年3月在唐山市妇幼保健院门诊做常规产前检查的初孕妇120例,按有无SUI分为2组,SUI组52例,非SUI组68例,分别于孕34周﹑孕36周﹑孕38周及产后6周超声检测膀胱颈移动度,采用国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)进行问卷调查,根据孕晚期及产后压力性及非压力性尿失禁者测定的UVJ-M数值,绘制ROC曲线,进行分析处理。结果一般情况:SUI组52例,其平均年龄(26.5±2.38)岁,平均身高(1.59±0.12)米。非SUI组68例,其平均年龄(25.8±2.56)岁,平均身高(1.58±0.13)米,两组间无统计学差异。妊娠晚期及产后UVJ-M的变化:孕34周、孕36周、孕38周、产后6周UVJ-M分别为(3.43±1.52)mm、(4.76±1.33)mm、(6.77±0.98)mm、(2.35±1.04)mm,随孕周的增加UVJ-M逐渐增大,两两比较,有统计学差异(P<0.05)。妊娠UVJ-M的综合ROC曲线分析:以妊娠晚期SUI组及无SUI组测得UVJ-M为分析数据,通过ROC分析,曲线决定的最佳临界点为6.59 mm,该点对应的灵敏度为88.7%,特异度为67.4%,具有较高的灵敏度和特异度。产后SUI与UVJ-M的综合ROC曲线分析:以产后SUI和产后无SUI患者孕期测得的UVJ-M值为分析数据,通过ROC分析,曲线决定的最佳临界点为8.66 mm,该点对应的灵敏度为89.5%,特异度为66.7%,具有较高的灵敏度和特异度。结论孕晚期SUI的患病率随孕周的增加而上升,说明产后尿失禁的发生与孕晚期是否有过尿失禁有关。妊娠晚期SUI的诊断中有意义的UVJ-M切点值为6.59 mm,产后遗留SUI的诊断有意义的妊娠晚期UVJ-M切点值为8.66 mm,为SUI的早期诊断及高危人群的预防性治疗提供一定的参考。
Objective To evaluate the predictive value of UVJ-M for pregnant women with stress urinary incontinence (SUI) in the third trimester of pregnancy by ultrasonography to detect the size of the late stage of pregnancy and postpartum bladder neck mobility (UVJ-M). Methods From December 2012 to March 2013, 120 pregnant women were randomly divided into two groups according to their presence or absence of SUI, 52 patients in SUI group and 68 patients in non-SUI group 36 weeks pregnant, 36 weeks pregnant, 38 weeks pregnant and 6 weeks postpartum bladder neck mobility measured by the International Council on Urinary incontinence questionnaire table (ICI-Q-SF) questionnaire survey, according to the third trimester of pregnancy and Postpartum stress and non-stress urinary incontinence measured UVJ-M values, draw the ROC curve, analysis and processing. Results The general situation: SUI group, 52 cases, the average age (26.5 ± 2.38) years old, average height (1.59 ± 0.12) meters. In the non-SUI group, 68 patients had an average age of (25.8 ± 2.56) years and an average height of (1.58 ± 0.13) m, with no significant difference between the two groups. The changes of UVJ-M in the third trimester and the third trimester were: 34 weeks pregnant, 36 weeks pregnant, 38 weeks pregnant and 6 weeks postpartum. The UVJ-M were (3.43 ± 1.52) mm, (4.76 ± 1.33) mm, (6.77 ± 0.98) mm , (2.35 ± 1.04) mm, UVJ-M gradually increased with gestational weeks increased, with any significant difference (P <0.05). Comprehensive ROC curve analysis of pregnancy UVJ-M: According to ROC analysis, the best critical point determined by curve is 6.59 mm, the sensitivity corresponding to this point is 88.7 %, Specificity of 67.4%, with high sensitivity and specificity. The ROC curve analysis of postpartum SUI and UVJ-M: According to the ROC analysis, the best critical point determined by curve is 8.66 mm, which corresponds to the UVJ-M value measured in postpartum SUI and postpartum patients without SUI The sensitivity was 89.5%, specificity was 66.7%, with high sensitivity and specificity. Conclusions The prevalence of SUI in the third trimester of pregnancy increases with gestational age, indicating that the incidence of postpartum urinary incontinence is related to the presence of urinary incontinence in the third trimester of pregnancy. The mean value of UVJ-M at diagnosis of SUI in late pregnancy was 6.59 mm, and the value of UVJ-M at late pregnancy was 8.66 mm in diagnosis of post-natal SUI, which is an early diagnosis of SUI and a preventive measure for high-risk groups Treatment to provide some reference.