目的 分析基于会阴实时三维超声评估盆底功能障碍性疾病（PFD）患者盆底结构改变及与血清松弛素、结缔组织生长因子（CTGF）、可溶性微纤维相关蛋白4（sMFAP4）的关系。 方法 回顾性收集2022年8月至2025年7月收治的产后42 ~ 60 d出现PFD的102例产妇临床资料（PFD组），根据盆腔脏器脱垂分度分为PFD Ⅰ度亚组（43例）、PFD Ⅱ度亚组（59例），并收集同期行产后检查的非PFD产妇32例作为对照组，所有产妇在检查当日采集空腹外周肘静脉血，检测血清松弛素、CTGF及sMFAP4水平，并在检查当日行会阴实时三维超声盆底结构检查，比较3组会阴实时三维超声参数、血清松弛素、CTGF及sMFAP4水平差异，使用Pearson相关性分析评估PFD组会阴实时三维超声参数与血清松弛素、CTGF及sMFAP4的相关性，使用多元线性回归分析校正混杂因素进一步评估会阴实时三维超声参数与血清指标的关联性。 结果 3组静息状态下肛提肌裂孔面积等超声盆底参数比较，均P > 0.05；PFD Ⅱ度亚组最大Valsalva动作下肛提肌裂孔面积及血清松弛素、CTGF水平均高于PFD Ⅰ度亚组及对照组（P < 0.05），PFD Ⅰ度亚组上述指标均高于对照组（P < 0.05）；PFD Ⅱ度亚组血清sMFAP4低于PFD Ⅰ度亚组及对照组（P < 0.05），PFD Ⅰ度亚组sMFAP4低于对照组（P < 0.05）。Pearson相关性分析显示，PFD组产妇最大Valsalva动作下肛提肌裂孔面积与血清松弛素、CTGF呈显著正相关（r = 0.655、0.721，P < 0.05），与血清sMFAP4呈显著负相关（r = -0.493，P < 0.05）。多元线性回归分析校正混杂因素（年龄、分娩孕周、产后至检查时间、体质量指数、初产妇/经产妇、新生儿体质量）后，最大Valsalva动作下肛提肌裂孔面积与血清松弛素（β = 0.312，95%CI：0.070 ~ 0.596，P < 0.05）、CTGF（β = 0.972，95%CI：0.571 ~ 1.682，P < 0.05）仍具有正向关联，与sMFAP4仍具有负向关联（β = -0.352，95%CI：-0.614 ~ -0.102，P < 0.05）。 结论 PFD产妇会阴实时三维超声显示最大Valsalva动作下肛提肌裂孔面积明显增大，且与血清松弛素、CTGF、sMFAP4具有关联性，可为PFD临床管理提供新思路。

Objective To analyze alterations in pelvic floor structure among patients with pelvic floor dysfunction （PFD） using perineal real-time three-dimensional ultrasound and to investigate the associations with serum levels of relaxin， connective tissue growth factor （CTGF）， and soluble microfibril-associated protein 4 （sMFAP4）. Methods The clinical data of 102 puerperae diagnosed with PFD at 42 ~ 60 days postpartum between August 2022 and July 2025 were retrospectively reviewed （PFD group）. Based on the severity of pelvic organ prolapse， the patients were further classified into a mild （Stage Ⅰ） subgroup （n = 43） and a moderate （Stage Ⅱ） subgroup （n = 59）. Additionally， 32 puerperae without PFD who underwent routine postpartum examinations during the same period were enrolled as the control group. Fasting peripheral cubital venous blood samples were collected on the day of examination to measure serum levels of relaxin， CTGF， and sMFAP4， and perineal real-time three-dimensional ultrasound was performed to evaluate pelvic floor structural parameters. The differences in these ultrasound parameters and serum biomarker levels were compared across the three groups. Pearson correlation analysis was employed to assess the association between perineal real-time three-dimensional ultrasound parameters and serum levels of relaxin， CTGF， and sMFAP4 in the PFD group. To account for potential confounding factors， multivariate linear regression analysis was subsequently performed to further examine these associations. Results There were no significant differences in ultrasound-based pelvic floor parameters， such as levator hiatus area at rest， among the three groups （P > 0.05）. However， the levator hiatus area during maximal Valsalva maneuver， as well as serum levels of relaxin and CTGF， were significantly higher in the PFD grade Ⅱ subgroup compared to both the PFD grade Ⅰ subgroup and the control group （P < 0.05）. Moreover， these parameters were also elevated in the PFD grade Ⅰ subgroup relative to the control group （P < 0.05）. Serum sMFAP4 levels were significantly lower in the PFD Ⅱ subgroup compared to both the PFD I subgroup and the control group （P < 0.05）， and were also lower in the PFD I subgroup than in the control group （P < 0.05）. Pearson correlation analysis showed that in the PFD group， the levator hiatus area during maximum Valsalva maneuver was significantly positively correlated with serum relaxin and CTGF levels （r = 0.655， r = 0.721， P < 0.05）， and significantly negatively correlated with serum sMFAP4 （r = -0.493， P < 0.05）. Multivariate linear regression analysis revealed that， after adjusting for potential confounding factors?including age， gestational age at delivery， time from postpartum to examination， body mass index， parity （primipara vs. multipara）， and neonatal birth weight—the levator hiatus area during maximal Valsalva maneuver remained significantly positively associated with serum relaxin （β = 0.312， 95%CI： 0.070 ~ 0.596， P < 0.05） and CTGF （β = 0.972， 95% CI： 0.571 ~ 1.682， P < 0.05）， and significantly negatively correlated with sMFAP4 （β = -0.352， 95% CI： -0.614 ~ -0.102， P < 0.05）. Conclusion Perineal real-time three-dimensional ultrasound imaging of puerperal women with PFD revealed a significantly increased area of the levator hiatus during maximal Valsalva maneuver， which was correlated with serum levels of relaxin， CTGF， and sMFAP4， offering potential insights for clinical management strategies.