基于Lasso-Logistic回归构建产妇产后早期盆底功能障碍性疾病的预测模型-东南大学学报医学版

基于Lasso-Logistic回归构建产妇产后早期盆底功能障碍性疾病的预测模型

单位：1. 邢台医学高等专科学校第一附属医院(邢台市第一医院) 产科, 河北邢台 054001;
2. 衡水市第四人民医院产科, 河北衡水 053000;
3. 邢台市中心医院体检中心, 河北邢台 054001

分类号：R714.46;R711.5

出版年·卷·期（页码）：2025·44·第三期（355-363）

摘要：

目的: 探讨产妇产后早期盆底功能障碍性疾病(PFD)的影响因素,并基于Lasso-Logistic回归建立预测产后PFD发生风险的列线图模型。方法: 选取2023年1月至2024年7月期间顺利分娩的373名产妇为研究对象,并分为建模队列组(n=261)和验证队列组(n=112)。所有产妇于产后6~8周进行PFD筛查,并基于Lasso-Logistic回归分析筛选的产后PFD的影响因素在R 4.3.1中构建列线图模型。采用受试者工作特征(ROC)曲线、Hosmer-Lemeshow检验和校准曲线评价模型预测产后PFD发生风险的效能。决策曲线分析(DCA)评估模型的临床应用价值。结果: 建模队列组中72例发生PFD,验证队列组中34例发生PFD,373例产妇产后PFD总发生率为28.4%。与非PFD组相比,PFD组产妇平均年龄和新生儿平均体质量较高(P＜0.05),且两组在PFD家族史、产次、分娩方式、会阴裂伤情况、第2产程方面比较差异有统计学意义(P＜0.05)。Lasso-Logistic回归分析显示,产妇年龄、产次、分娩方式、会阴裂伤、第2产程、新生儿体质量均为产后PFD的影响因素(P＜0.05)。ROC曲线分析显示,建模队列的曲线下面积(AUC)为0.827(95%CI:0.772~0.882),验证队列的AUC为0.838(95%CI:0.762~0.915)。Hosmer-Lemeshow检验中,建模队列:χ²=7.556,P=0.478;验证队列:χ²=4.680,P=0.791。DCA表明模型的临床应用价值较高。结论: 产妇年龄、产次、分娩方式、会阴裂伤、第2产程、新生儿体质量为产后PFD的影响因素,基于这6个因素建立的列线图模型预测效能较佳,有助于指导临床进行产后PFD预防。

Objective: To explore the influencing factors of early postpartum pelvic floor dysfunction diseases(PFD) in parturients and establish a column chart model for predicting the risk of postpartum PFD based on Lasso-Logistic regression. Methods: A total of 373 women who delivered successfully in the First Hospital of Xingtai from January 2023 to July 2024 were selected as the study objects and divided into modeling cohort group(n=261) and validation cohort group(n=112). All parturients underwent PFD screening at 6-8 weeks postpartum, and a column chart model was constructed in R4.3.1 based on the influencing factors of postpartum PFD screened by Lasso-Logistic regression analysis. Receiver operating characteristic(ROC) curve, Hosmer-Lemeshow test, and calibration curve were used to evaluate the effectiveness of the model in predicting the risk of postpartum PFD. The clinical application value of model was evaluated by decision curve analysis(DCA). Results: 72 cases of PFD occurred in the modeling cohort group, 34 cases of PFD occurred in the validation cohort group, and the total incidence of PFD in 373 postpartum women was 28.4%. Compared with the non-PFD group, the average maternal age and average neonatal body mass in the PFD group were higher(P<0.05), and there were statistically significant differences in PFD family history, delivery times, delivery mode, perineal laceration and the second stage of labor between the two groups(P<0.05). Lasso-Logistic regression analysis showed that age of parturients, delivery times, delivery mode, perineal laceration, the second stage of labor, and neonatal body mass were all influencing factors of postpartum PFD(P<0.05). ROC curve analysis showed that the area under the curve(AUC) of the modeling cohort was 0.827(95%CI:0.772-0.882), and the AUC of the validation cohort was 0.838(95%CI:0.762-0.915). In the Hosmer-Lemeshow test, the modeling cohort showed χ²=7.556, P=0.478; the validation cohort showed χ²=4.680,P=0.791. DCA showed that the model had high value in clinical application. Conclusion: The age of parturients, delivery times, delivery mode, perineal laceration, the second stage of labor, and neonatal body mass are the influencing factors for postpartum PFD. The column chart model established based on these six factors has better predictive performance and it can help guide clinical prevention of postpartum PFD.

参考文献：

[1] CATTANI L, VAN SCHOUBROECK D, DE BRUYN C, et al.Body image and pelvic floor dysfunction in pregnancy and postpartum: a prospective one-year follow-up cohort study[J].BJOG, 2024, 131(10):1420-1429.
[2] 王亦丹, 王明婷, 陈伶, 等.经会阴超声评估产后早期盆底功能的观察性研究[J].东南大学学报(医学版), 2023, 42(2):294-298.
[3] SNYDER K, MOLLARD E, BARGSTADT-WILSON K, et al.Pelvic floor dysfunction in rural postpartum mothers in the United States: prevalence, severity, and psychosocial correlates[J].Women Health, 2022, 62(9-10):775-787.
[4] 周维敏, 施锦金, 黄彩仙.产后盆底功能障碍性疾病影响因素分析[J].中国妇幼保健, 2021, 36(15):3583-3585.
[5] PALMIERI S, DE BASTIANI S S, DEGLIUOMINI R, et al.Prevalence and severity of pelvic floor disorders in pregnant and postpartum women[J].Int J Gynaecol Obstet, 2022, 158(2):346-351.
[6] JANSSON M H, FRANZÉN K, TEGERSTEDT G, et al.Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy[J].Acta Obstet Gynecol Scand, 2023, 102(8):1034-1044.
[7] CAI Q Y, LI Z H, DENG B N, et al.A nomogram for predicting the risk of preeclampsia in women with intrahepatic cholestasis of pregnancy based on prenatal monitoring time: a multicenter retrospective cohort study[J].J Hypertens, 2024, 42(1):143-152.
[8] 周惠玲, 汤佩玲, 杨存珍, 等.轻、中度盆腔器官脱垂的超声诊断与临床定量分期相关性研究[J].中国实用妇科与产科杂志, 2017, 33(10):1062-1065.
[9] 中华医学会妇产科学分会妇科盆底学组.女性压力性尿失禁诊断和治疗指南(2017)[J].中华妇产科杂志, 2017, 52(5):289-293.
[10] HILDE G, STAER-JENSEN J, SIAFARIKAS F, et al.Postpartum pelvic floor muscle training, levator ani avulsion and levator hiatus area: a randomized trial[J].Int Urogynecol J, 2023, 34(2):413-423.
[11] 陶乃菊, 陆欢, 陈芸.产后盆底功能障碍性疾病的危险因素及风险模型构建[J].中国妇幼保健, 2022, 37(18):3417-3420.
[12] 郑茗琼, 陈娜.产后PDF危险因素分析及电刺激联合kegel训练效果[J].中国计划生育学杂志, 2023, 31(12):2921-2925.
[13] 王琦, 程贤鹦.初产妇产后早期盆底功能障碍性疾病与分娩相关因素分析[J].中华全科医学, 2022, 20(1):76-79.
[14] 陈蕾.产后早期盆底功能障碍性疾病的临床相关因素研究[D].杭州:浙江中医药大学, 2024.
[15] ROMEIKIENE· K E, BARTKEVIIENE· D.Pelvic-floor dysfunction prevention in prepartum and postpartum periods[J].Medicina(Kaunas), 2021, 57(4):387-409.
[16] BORGES A C, SOUSA N, SARABANDO R, et al.Pelvic floor dysfunction after vaginal delivery: MOODS-a prospective study[J].Int Urogynecol J, 2022, 33(6):1539-1547.
[17] LIMA C T S, BRITO G A, KARBAGE S A L, et al.Pelvic floor ultrasound finds after episiotomy and severe perineal tear: systematic review and meta-analysis[J].J Matern Fetal Neonatal Med, 2022, 35(12):2375-2386.
[18] LIU X, WANG Q, CHEN Y, et al.Factors associated with stress urinary incontinence and diastasis of rectus abdominis in women at 6-8 weeks postpartum[J].Urogynecology(Phila), 2023, 29(10):844-850.
[19] PARDO E, ROTEM R, GLINTER H, et al.Is there a correlation between pelvic floor dysfunction symptoms during preg-nancy and the duration of the second stage of labor?[J].J Matern Fetal Neonatal Med, 2022, 35(22):4418-4423.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录