基于判别分析的产后早期压力性尿失禁超声诊断模型的建立

目的分析产后早期压力性尿失禁(SUI)患者盆底结构的变化,建立基于判别分析的产后早期SUI超声诊断模型。方法选取我院门诊行产后早期常规体检者115例,随机分为训练样本98例和验证样本17例,其中训练样本中SUI者52例,非SUI者46例;验证样本中SUI者10例,非SUI者7例;应用盆底超声检查所有受检者静息状态下膀胱颈在X轴的距离(HBL)、张力状态下膀胱颈在Y轴上的移动度(BND)、膀胱旋转角度(URA)、静息及张力状态下膀胱尿道后角(PVUA1、PVUA2);利用Fisher逐步判别分析法建立诊断模型,并对诊断模型进行验证;绘制受试者工作特征(ROC)曲线评估其诊断产后早期SUI的效能。结果训练样本中,SUI者HBL、BND、URA、PVUA1、PVUA2均较非SUI者增加,差异均有统计学意义(均P0.05)。SUI诊断模型:Y0=-108.764+2.223X2+1.187X3+1.404X5;Y1=-144.728+4.145X2+1.879X3+1.499X5(其中Y0为非SUI者,Y1为SUI者;X2为BND,X3为URA,X5为PVUA2)。通过训练样本进行自身检验及交叉验证,所得到的准确率分别为94.9%、93.9%;通过验证样本验证,所得诊断准确率为82.3%。ROC曲线评估其诊断产后早期SUI的曲线下面积及95%可信区间为0.939(0.895～0.983)。结论通过Fisher判别分析综合盆底超声建立的多变量联合诊断模型可以客观反映产后早期SUI患者盆底功能的变化,为临床早期诊断及干预提供依据。

Establishment of Ultrasound Diagnosis Model of Stress Urinary Incontinence in Early Stage of Postpartum Based on Discriminant Analysis

ABSTRACT Objective To analyze the changes of pelvic floor structure in patients with stress urinary incontinence (SUI) in early stage of pregnancy. Establish the ultrasound diagnosis model of SUI based on discriminant analysis.Methods Select 115 female cases who had been given physical examination in early stage of postpartum at Affiliated Hospital of North China University of Technology from August 2017 to September 2019.They were randomly divided into the experimental group(98 training samples) and the test group (12 validation samples).The experimental group consisted of 52 SUI cases and 42 non-SUI cases. Pelvic floor ultrasound was examined on all of the cases and the value of HBL,BND,URA,PVUA1,PVUA were recorded. Analysis and compare the according data, use Fisher stepwise discriminant analysis method to establish the diagnosis model, validate the according model and use ROC curve to evaluate the model.Results (1)Value of HBL,BND,URA,PVUA1,PVUA2 in the SUI group were significantly higher than those in the non-SUI group (P< 0.05), the difference has statistic significance.It indicated that women with SUI in the early postpartum period have a lower bladder neck position.The mobility and rotation of bladder neck in tension state are greater.(2)Diagnostic model of SUI: group without SUI :Y0=-108.764+2.223X2+1.187X3+1.404X5;group with SUI:Y1=-144.728+4.145 X2+1.879 X3 +1.499X5.(Y0 represents the group without SUI, Y1 represents the group with SUI; X2 represents BND, X3 represents URA and X5 represents PVUA2). (3) The results was obtained by self-test and cross-validation in the experimental group with an accuracy of 94.9%and 93.9%.The results were checked in the test group with an accuracy of 82.3%.It shows that the diagnostic effect of the model is ideal. Throw evaluating ROC curve we get that the area in the curve is 0.939,it is further proved that the diagnosis value of the model is higher. Conclusion The multi-variable combined diagnostic model established by Fisher discriminat analysis pelvic floor ultrasound can objectively reflect the changes of pelvic floor function of SUI patients in the early stage of postpartum which provide evidence for early clinical diagnosis and intervention.