Correlation of serum estradiol, relaxin levels and pelvic floor ultrasound parameters with the severity of postpartum stress urinary incontinence
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摘要:目的
探讨血清雌二醇(E2)、松弛素(RLX)水平及盆底超声参数与产后压力性尿失禁(PSUI)患者病情严重程度的相关性。
方法选取产后压力性尿失禁患者144例纳入PSUI组。根据患者病情严重程度分为轻度组(n=59)、中度组(n=55)和重度组(n=30)。另选取同期健康产妇91例纳入对照组。比较PSUI组和对照组的一般资料。分析不同病情严重程度患者的血清E2、RLX水平。比较各组盆底超声参数。采用多因素Logistic回归分析筛选患者发生PSUI的影响因素。分析血清E2、RLX水平及盆底超声参数与PSUI病情严重程度的相关性。
结果PSUI组血清RLX水平高于对照组, E2水平低于对照组，差异有统计学意义(P < 0.05)。重度组血清E2水平低于中度组和轻度组, RLX水平高于中度组和轻度组，差异有统计学意义(P < 0.05)。PSUI组多次生产、阴道分娩、家族尿失禁史、会阴侧切患者占比以及高血清RLX水平、低血清E2水平占比高于对照组，差异有统计学意义(P < 0.05)。轻度组、中度组和重度组静息状态和最大Valsalva动作状态的膀胱尿道后角(PUA)、尿道倾斜角(UTA)、肌裂孔面积及Valsalva动作状态的尿道旋转角(URA)、膀胱颈移动度(BND)依次增大，差异有统计学意义(P < 0.05)。轻度组、中度组和重度组Valsalva动作状态的膀胱位置(BDP)、膀胱颈位置(BNP)则依次降低，差异有统计学意义(P < 0.05)。PSUI组、对照组尿道内口漏斗形成率分别为22.22%(32/144)、6.59%(6/91)。多因素Logistic回归分析显示，产次、阴道分娩、家族尿失禁史、会阴侧切以及血清E2、RLX水平是PSUI发生的影响因素(P < 0.05)。PSUI患者血清RLX水平、盆地超声参数与病情严重程度呈正相关(r=0.573、0.590, P < 0.05), 血清E2水平与病情严重程度呈负相关(r=-0.584, P < 0.001)。
结论血清E2水平与PSUI患者病情严重程度呈负相关，血清RLX水平、盆底超声参数与PSUI患者病情严重程度呈正相关。产次、阴道分娩、家族尿失禁史、会阴侧切、血清E2、RLX水平是PSUI发生的影响因素。
Abstract:ObjectiveTo investigate the correlation of serum estradiol (E2), relaxin (RLX) levels and pelvic floor ultrasound parameters with the severity of postpartum stress urinary incontinence (PSUI) in patients.
MethodsA total of 144 patients with PSUI were enrolled in the PSUI group. According to the severity of the disease, they were divided into mild (n=59), moderate (n=55) and severe groups (n=30). Another 91 healthy postpartum women were selected as control group during the same period. General data of the PSUI group and the control group were compared. Serum E2 and RLX levels in patients with different severity levels were analyzed. Pelvic floor ultrasound parameters among groups were compared. Multivariate Logistic regression analysis was used to screen the influencing factors for the occurrence of PSUI. The correlations of serum E2, RLX levels and pelvic floor ultrasound parameters with the severity of PSUI were analyzed.
ResultsThe serum RLX level in the PSUI group was significantly higher than that in the control group, while the E2 level was significantly lower (P < 0.05). The serum E2 level in the severe group was significantly lower than that in the moderate group and mild group, while the RLX level was significantly higher (P < 0.05). The proportions of multiple births, vaginal delivery, family history of urinary incontinence, mediolateral episiotomy and high serum RLX level as well as low serum E2 level in the PSUI group were significantly higher than those in the control group (P < 0.05). In the mild group, moderate group and severe group, the bladder-urethral posterior angle (PUA), urethral tilt angle (UTA), levator hiatus area as well as Valsalva maneuver-related urethral rotation angle (URA), bladder neck descent (BND) at rest and during maximum Valsalva maneuver increased sequentially (P < 0.05). In the mild group, moderate group, and severe group, the bladder position (BDP) and bladder neck position (BNP) during Valsalva maneuver decreased sequentially (P < 0.05). The funnel formation rate of the internal urethral orifice in the PSUI group and the control group were 22.22% (32/144) and 6.59% (6/91), respectively. Multivariate Logistic regression analysis showed that parity, vaginal delivery, family history of urinary incontinence, mediolateral episiotomy and serum E2 and RLX levels were influencing factors for the occurrence of PSUI (P < 0.05). Serum RLX levels and pelvic floor ultrasound parameters in PSUI patients were positively correlated with disease severity (r=0.573, 0.590, P < 0.05), while serum E2 levels were negatively correlated with disease severity (r=-0.584, P < 0.001).
ConclusionSerum E2 levels are negatively correlated with the severity of PSUI, while serum RLX levels and pelvic floor ultrasound parameters are positively correlated with the severity of PSUI. Parity, vaginal delivery, family history of urinary incontinence, mediolateral episiotomy and serum E2 and RLX levels are influencing factors for the occurrence of PSUI.
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表 1 对照组和不同病情严重程度患者血清E2、RLX水平比较(x±s)
组别 n E2/(ng/L) RLX/(pg/mL) 对照组 91 42.48±6.47 35.64±10.97 轻度组 59 38.41±5.03* 50.25±11.59* 中度组 55 34.42±5.20*# 57.57±16.45*# 重度组 30 33.26±4.04*#△ 64.42±21.20*#△ E2: 雌二醇; RLX: 松弛素。与对照组比较, * P＜0.05;
与轻度组比较, #P＜0.05; 与中度组比较, △P＜0.05。
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表 2 各组盆底超声参数比较(x±s)
状态 分类 对照组(n=91) 轻度组(n=59) 中度组(n=55) 重度组(n=30) 静息状态 PUA/° 76.38±5.17 112.64±11.49* 123.50±12.45*# 132.67±13.55*#△ UTA/° 17.95±5.48 19.99±5.34* 22.87±5.88*# 25.39±6.24*#△ 肌裂孔面积/cm2 14.22±1.15 15.17±3.45* 16.84±3.91*# 18.23±4.23*#△ Valsalva动作状态 PUA/° 85.26±9.45 152.48±12.47* 172.94±13.22*# 183.62±15.84*#△ UTA/° 17.87±6.14 33.15±8.64* 36.97±9.07*# 41.06±10.16*#△ URA/° 33.50±9.48 47.01±11.66* 51.42±12.04*# 57.24±13.49*#△ BDP/mm 11.40±5.02 3.79±0.61* 2.40±0.82*# 1.19±0.93*#△ BNP/mm 11.22±4.41 3.98±0.67* 2.61±0.59*# 1.34±0.49*#△ BND/mm 14.50±3.49 21.44±5.02* 26.51±5.71*# 29.04±5.13*#△ 肌裂孔面积/cm2 15.06±3.25 16.43±2.41* 18.39±2.44*# 20.23±2.76*#△ PUA: 膀胱尿道后角; UTA: 尿道倾斜角; URA: 尿道旋转角; BDP: 膀胱位置; BNP: 膀胱颈位置; BND: 膀胱颈移动度。
与对照组比较, * P＜0.05; 与轻度组比较, #P＜0.05; 与中度组比较, △P＜0.05。
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表 3 PSUI组和对照组的一般资料比较[n(%)]
临床特征 分类 对照组(n=91) PSUI组(n=144) χ2/t P 年龄 ≤30岁 38(41.76) 61(42.36) 0.997 0.368 >30岁 53(58.24) 83(57.64) 体质量指数 ≤28 kg/m2 49(53.85) 76(52.78) 0.942 0.397 >28 kg/m2 42(46.15) 68(47.22) 产周 ≤40周 63(69.23) 98(68.06) 0.446 0.723 >40周 28(30.77) 46(31.94) 产次 ≤1次 65(71.43) 38(26.39) 7.844 0.009 >1次 26(28.57) 106(73.61) 分娩方式 阴道分娩 36(39.56) 86(59.72) 7.468 0.012 剖宫产 55(60.43) 58(40.28) 家族性尿失禁史 有 60(65.93) 38(26.39) 8.124 ＜0.001 无 31(34.07) 106(73.61) 吸烟史 有 27(29.67) 41(28.47) 1.435 0.298 无 64(70.33) 103(71.53) 饮酒史 有 25(27.47) 37(25.69) 0.585 0.687 无 66(72.53) 107(74.31) 会阴侧切 有 38(41.76) 82(56.94) 5.349 0.026 无 53(58.24) 62(43.06) 喂养方式 哺乳喂养 28(30.77) 44(30.56) 0.648 0.556 混合喂养 29(31.87) 46(31.94) 其他 34(37.36) 54(37.50) E2 ≤38.92 ng/L 19(20.88) 126(87.50) 8.365 ＜0.001 >38.92 ng/L 72(79.12) 18(12.50) RLX ≥46.53 pg/mL 22(24.18) 124(86.11) 9.425 ＜0.001 ＜46.53 pg/mL 69(75.82) 20(13.89)
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表 4 发生PSUI的多因素Logistic回归分析赋值
自变量 变量说明 赋值情况 产次 分类变量 >1次=1, ≤1次=0 阴道分娩 分类变量 是=1, 否=0 家族尿失禁史 分类变量 是=1, 否=0 会阴侧切 分类变量 是=1, 否=0 E2 分类变量 ≤38.92 ng/L =1, >38.92 ng/L =0 RLX 分类变量 ≥46.53 pg/mL =1, ＜46.53 pg/mL =0
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表 5 发生PSUI的多因素Logistic回归分析
因素 β 标准误 Wald P OR 95%CI 产次 3.336 1.268 8.789 ＜0.001 2.349 1.864~3.549 阴道分娩 3.974 2.008 8.846 ＜0.001 2.761 2.031~3.478 家族尿失禁史 0.206 0.167 7.494 0.028 1.226 0.845~1.651 会阴侧切 1.467 0.267 8.649 ＜0.001 0.867 0.246~1.287 E2 1.591 0.372 8.649 ＜0.001 0.753 0.216~1.249 RLX 0.934 0.568 9.680 ＜0.001 1.234 0.946~3.267
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