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目的:探讨产前维生素D水平与产后盆底肌肉力量强度的关系。方法:选取148例孕妇,孕36周时单次采集孕妇静脉血,采用ELISA法测定血清25(OH)D3水平,根据维生素D水平及分娩方式分为4组:维生素D水平<15ng/ml、阴道分娩为Ⅰ组(n=42),维生素D水平<15ng/ml、剖宫产为Ⅱ组(n=48),维生素D水平≥15ng/ml、阴道分娩为Ⅲ组(n=24),维生素D水平≥15ng/ml、剖宫产为Ⅳ组(n=34)。记录所有孕妇的每周妊娠状态,分娩方式,出生体重,孕前体质指数(BMI)。产后8~10周,采用排尿困扰量表(UDI-6)评估产妇盆底功能障碍症状,测量产妇盆底肌力(PFMS)。结果:阴道分娩组和剖宫产组分别有63.6%(42/66)和58.5%(48/82)的孕妇患有维生素D缺乏症。Ⅳ组产后PMFS最高,Ⅰ组最低。阴道分娩组中,维生素D缺乏组产妇PFMS显著低于正常产妇(t=3.213,P=0.001)。维生素D水平与肌肉力量耐力相关性分析显示,阴道分娩组、剖宫产组中,维生素D水平均与PMFS呈正相关(r=0.425,P=0.000;r=0.334,P=0.013)。阴道分娩组中新生儿出生体重和PFMS呈负相关(r=-0.209,P=0.044),而在剖宫产组两者无显著相关性(P>0.05)。剖宫产组中,UDI评分和PMFS呈负相关(r=-0.522,P=0.000),而在阴道分娩组中两者无显著相关性(P>0.05)。多因素回归分析结果显示,剖宫产组(B=0.451,P=0.001)、阴道分娩组(B=0.311,P=0.001)维生素D水平回归系数均大于0且P<0.05,提示维生素D水平与PFMS呈正相关,在一定范围内,随着维生素D水平升高PFMS也升高。结论:维生素D缺乏可导致孕妇产后PMFS降低。
Objective: To investigate the relationship between prenatal vitamin D levels and postpartum pelvic floor muscle strength. Methods: 148 pregnant women and 36 weeks pregnant women were enrolled in this study. Serum 25 (OH) D3 levels were measured by ELISA. Four groups were divided into four groups according to the level of vitamin D and mode of delivery: vitamin D level <15ng / ml, Vaginal delivery was in group I (n = 42), vitamin D level <15 ng / ml, cesarean section in group II (n = 48), vitamin D level 15 ng / Vitamin D levels ≥ 15ng / ml, cesarean section for the group Ⅳ (n = 34). Weekly pregnancy status, mode of delivery, birth weight, pre-pregnancy body mass index (BMI) were recorded for all pregnant women. Postpartum 8 to 10 weeks, urinary disturbance disorder scale (UDI-6) was used to assess the symptoms of pelvic floor dysfunction and pelvic floor muscle strength (PFMS). Results: 63.6% (42/66) and 58.5% (48/82) pregnant women in the vaginal delivery group and cesarean section had vitamin D deficiency. Group Ⅳ postpartum PMFS highest, lowest in group Ⅰ. Vaginal delivery group, vitamin D deficiency maternal PFMS was significantly lower than the normal maternal (t = 3.213, P = 0.001). The correlation between vitamin D level and muscle strength and endurance showed that the levels of vitamin D in vaginal delivery group and cesarean section group were positively correlated with PMFS (r = 0.425, P = 0.000; r = 0.334, P = 0.013). Neonatal birth weight was negatively correlated with PFMS in the vaginal delivery group (r = -0.209, P = 0.044), but not in the cesarean section group (P> 0.05). In the cesarean section, the UDI score was negatively correlated with PMFS (r = -0.522, P = 0.000), but no significant correlation was found between the two groups in the vaginal delivery group (P> 0.05). The results of multivariate regression analysis showed that the regression coefficients of vitamin D in caesarean section group (B = 0.451, P = 0.001) and vaginal delivery group (B = 0.311, P = 0.001) were both greater than 0 and P <0.05, suggesting that vitamin D level And PFMS was positively correlated. Within a certain range, PFMS increased with the increase of vitamin D levels. Conclusion: Vitamin D deficiency can lead to postpartum PMFS decrease in pregnant women.