产后压力性尿失禁风险预测模型的外部验证研究

背景本研究团队前期分别开发了针对初产妇和经产妇的产后压力性尿失禁（SUI）风险预测模型，旨在早期识别孕产妇SUI的高危人群并提供有效干预，但尚未进行外部验证。目的外部验证前期开发的产后SUI风险预测模型，探索该模型在临床应用的可能性。方法于2020年7—9月在南方医科大学深圳医院、香港大学深圳医院进行电话随访，通过电子病历系统选取产后6个月的产妇作为验证组进行产后SUI风险预测模型的外部验证。使用电子医疗记录收集研究对象年龄、身高、妊娠前体质量、流产史和分娩史的相关信息；并通过电话随访调查研究对象产后6个月SUI发生情况。采用受试者工作特征（ROC）曲线下面积（AUC）和Hosmer-Lemeshow拟合优度检验分别评价产后SUI风险预测模型区分度和校准度。结果最终纳入298例研究对象为验证组，其中初产妇203例（68.1%），经产妇95例（31.9%）。初产妇队列中，非SUI者158例，SUI者45例。经产妇队列中，非SUI者72例，SUI者23例。产后SUI风险预测模型在初产妇外部验证人群中AUC为0.719〔95%CI（0.643，0.795）〕，在经产妇外部验证人群中AUC为0.833〔95%CI（0.738，0.928）〕。Hosmer-Lemeshow拟合优度检验提示产后SUI风险预测模型在初产妇人群中校准欠佳（χ2=34.11，P<0.001），而在经产妇人群中拟合度良好（χ2=9.62，P=0.293）。结论初产妇产后SUI预测模型能有效区分患者是否发生产后SUI，但尚需进一步更新以提高模型的外部适用性；经产妇产后SUI预测模型具有可接受的外部效能，鼓励将其作为产后早期盆底康复干预的评估工具进行推广。

External Validation of Risk Prediction Models for Postpartum Stress Urinary Incontinence

Background Our research team developed two prediction models of postpartum stress urinary incontinence(PSUI),one for primiparas,and the other for multiparae,aiming at early identifying women at high risk of PSUI,and providing effective interventions,but they have not yet been externally validated.Objective To externally validate the risk prediction models of PSUI previously developed by us to assess their clinical applicability.Methods This study was conducted between July and September 2020.Participants were 6-month postpartum women(validation group)who were selected from the electronic medical record system of Shenzhen Hospital of Southern Medical University,and the University of Hong Kong-Shenzhen Hospital.Information about age,height,pre-pregnancy weight,abortion history,and delivery history was collected from the electronic medical record system of the two hospitals.A telephone follow-up was conducted to investigate the incidence of stress urinary incontinence within 6-month postpartum.The area under the receiver operating characteristic curve(AUC)was computed to estimate the value of the predictive models in discriminating PSUI.Hosmer-Lemeshow goodness-of-fit test was used to examine the calibration of the prediction models.Results A total of 298 cases were included,and 203 of them(68.1%)were primiparas(158 with PSUI,and other 45 without),other 95(31.9%)were multiparae(72 with PSUI,and other 23 without).The AUC of the risk prediction model for PSUI in primiparas was 0.719〔95%CI(0.643,0.795)〕,and that of the risk prediction model for PSUI in multiparae was 0.833〔95%CI(0.738,0.928)〕.Hosmer-Lemeshow goodness-of-fit test suggested that the PSUI risk prediction model for primiparas had poor calibration(χ²=34.11,P<0.001),while that for multiparae had satisfactory calibration(χ²=9.62,P=0.293).Conclusion The PSUI risk prediction model for primiparas could effectively distinguish PSUI,but its applicability needs to be further improved.The PSUI risk prediction model for multiparae had acceptable performance,which may be used and promoted as an evaluation tool for early pelvic floor rehabilitation in multiparae.