Berger Mitchell B, Morgan Daniel M, DeLancey John O
Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA,
Int Urogynecol J. 2014 Oct;25(10):1375-9. doi: 10.1007/s00192-014-2388-8. Epub 2014 May 1.
The goal of this study was to use a well-described system of quantifying levator ani defect (LAD) severity using magnetic resonance imaging (MRI) to examine the relationship between defect severity and the presence or absence of prolapse.
This is a secondary analysis of two case-control studies comparing 284 cases (with prolapse) to 219 controls (normal support) defined by using Pelvic Organ Prolapse Quantification (POP-Q) exams. LAD were assessed on MRI, with scores from 0 (no defects) to 6 (complete, bilateral defects). The number of cases and controls at each score were compared. Logistic regression and receiver operating characteristic (ROC) analyses were used to quantify relationships between LAD and prolapse.
The proportion of cases exceeds the overall prolapse rate in this study at LAD scores ≥3, with higher rates of prolapse at higher LAD scores (p < 0.0000001). Prolapse risk stratifies into low risk at LAD scores 0-2, moderate at 3-5, and high at 6. ROC analysis for classification of prolapse based on LAD scores has an area under the curve of 69.9% (p < 0.001), suggesting LAD alone can discriminate between normal support and prolapse for nearly 70% of patients. Logistic regression identified higher parity and higher LAD scores as independent predictors of prolapse.
There are three clusters of prolapse risk: low (0-2), moderate (3-5), and high (6). Although LAD have a dose-response-like effect for prolapse, other factors are clearly involved.
本研究的目的是使用一种描述详尽的通过磁共振成像（MRI）量化肛提肌缺陷（LAD）严重程度的系统，来研究缺陷严重程度与脱垂存在与否之间的关系。
这是对两项病例对照研究的二次分析，将284例（有脱垂）与219例对照（正常支持结构）进行比较，对照由盆腔器官脱垂定量（POP-Q）检查定义。通过MRI评估LAD，分数从0（无缺陷）到6（完全双侧缺陷）。比较每个分数下的病例数和对照数。使用逻辑回归和受试者工作特征（ROC）分析来量化LAD与脱垂之间的关系。
在本研究中，LAD评分≥3时病例比例超过总体脱垂率，LAD评分越高脱垂率越高（p < 0.0000001）。脱垂风险分为低风险（LAD评分0 - 2）、中度风险（3 - 5）和高风险（6）。基于LAD评分对脱垂进行分类的ROC分析曲线下面积为69.9%（p < 0.001），表明仅LAD就能为近70%的患者区分正常支持结构和脱垂情况。逻辑回归确定较高的产次和较高的LAD评分是脱垂的独立预测因素。
脱垂风险有三个类别：低风险（0 - 2）、中度风险（3 - 5）和高风险（6）。虽然LAD对脱垂有类似剂量反应的效应，但显然还涉及其他因素。
