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目的 探讨应用盆底测试仪压力气囊测试最大阴道收缩压(MVCP)与手测肌力检查评估盆底肌力的相关性和一致性。方法 前瞻性选取于2018年6月至2019年7月在北京协和医院体检、因盆底功能障碍性疾病(PFD)就诊及产后1年内随访的女性，分别为非PFD组、PFD组及产后组。由同一名医生对受试者进行手测肌力检查，包括改良牛津肌力分级(MOS)和肛提肌检测分级(LAT);再依据随机数字表对受试者进行随机互盲分组，由两名盆底治疗师作为检查者，以交叉顺序使用盆底测试仪的压力气囊进行MVCP评估，每名检查者对同一受试者进行两次评估。采用Spearman秩相关系数(r)进行相关性评价，采用组内相关系数(ICC)、Bland-Altman分析进行一致性评价。结果 非PFD组163例、PFD组154例和产后组151例受试者完成所有评估。在全部受试者中，盆底测试仪记录的MVCP与MOS和LAT之间相关性强(r=0.779～0.814,P<0.001),MVCP结果在同一检查者内存在高度一致性[分别为ICC=0.815,95%CI(0.782,0.843)和ICC=0.818,95%CI(0.785,0.846)],在不同检查者间也存在高度一致性[ICC=0.719,95%CI(0.663,0.765)]。MVCP的Bland-Altman分析显示，其95%一致性界限区间较窄，且落在95%一致性界限外的点比例在0.025～0.071之间，属可接受范围。在非PFD组、PFD组及产后组的亚组分析中，MVCP与MOS和LAT也存在强相关性(r=0.749～0.867,P<0.001),检查者内和检查者间一致性均较好。结论 盆底测试仪通过压力气囊测试的MVCP与医生手测MOS和LAT相关性强，MVCP在同一检查者和不同检查者间均存在高度一致性。本研究结果表明盆底测试仪压力气囊在评估盆底肌力方面有效性好，具有较好的应用前景。
Abstract：Objective:To investigate the correlation between manometry with air filled vaginal probe and vaginal palpation scales in pelvic floor muscle(PFM) strength evaluation, with the agreement of manometry also evaluated.Methods:Prospective data were collected from patients with pelvic floor dysfunction(PFD group),without PFD(non-PFD group),and women within 1 year after delivery(postpartum group) who were treated or followed up in Peking Union Medical College Hospital from June, 2018 to July, 2019. Vaginal palpation was performed by a physician first, including the modified Oxford grading scale(MOS) and levator ani testing(LAT),followed by manometry evaluations by two therapists in a randomized order. Manometry assessments were performed twice by each therapist. Spearman's rank correlation coefficient(r) was adopted to evaluate the correlation, and intraclass correlation coefficient(ICC) and Bland-Altman plot were adopted to evaluate the agreement. Results:There were 163,154,and 151 participants were recruited in the non-PFD,PFD,and postpartum groups, respectively. In the whole population(all 3 groups taken together) of this study, the correlation between maximum voluntary contraction pressure(MVCP) and vaginal palpation was strong(r=0.779-0.814,P<0.001). MVCP measurements showed a very high intrarater agreement [ICC=0.815,95%CI(0.782,0.843) and ICC=0.818,95%CI(0.785,0.846),respectively] and a high interrater agreement [ICC=0.719,95%CI(0.663,0.765)] for two individual therapists. In the Bland-Altman plot of MVCP,the rates beyond the 95% limits of agreement(LoA) ranged from 0.025 to 0.071 with a narrow LoA scope. These results were consistent in the subgroup analysis.Conclusions:MVCP had a strong correlation with the MOS and LAT. MVCP also had strong intra-and interrater agreement. This study indicated that MVCP tested by manometry with air filled vaginal probe is effective in evaluating PFM with application prospects.
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基本信息:
中图分类号:R711.5
引用信息:
[1]付琳茹,郭涛,孙智晶,等.通过盆底测试仪压力气囊评估盆底肌力的有效性研究[J].生殖医学杂志,2023,32(06):866-874.
基金信息:
北京市自然科学基金(Z190021); 中华预防医学会中国妇女盆底功能障碍防治专项资金(201801004); 中国医学科学院医学与健康科技创新工程项目CIFMS 2020-I2M-C&T-B-043; 国家自然科学基金(81971366)