自体肾经皮肾穿刺活检术后出血并发症的危险因素分析  

Risk factors for bleeding complications of percutaneous renal biopsy of native kidneys

作　　者：李思倩 孙婧[1] 蒋栋[2] 于光[1] 郭志勇[1] 边琪[1] LI Si-qian;SUN Jing;JIANG Dong;YU Guang;GUO Zhi-yong;BIAN Qi(Department of Nephrology,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院肾内科,上海200433 [2]海军军医大学(第二军医大学)长海医院超声科,上海200433

出　　处：《临床肾脏病杂志》2020年第10期769-774,共6页Journal Of Clinical Nephrology

基　　金：国家自然科学基金(81600550)。

摘　　要：目的回顾性分析超声引导下自体肾经皮肾穿刺活检(percutaneous renal biopsy,PRB)术后出血并发症的发生率及其危险因素。方法纳入2017年1月至2018年12月于海军军医大学(第二军医大学)长海医院行PRB术的患者,采集完整的临床和病理资料。PRB术后复查血常规和肾脏超声。根据患者术后出血并发症的发生情况分为无出血组、轻度出血组(肾周血肿长短径之和<5 cm且术后Hb下降<10%)和中重度出血组(出现肉眼血尿,和/或术后Hb下降≥10%,和/或肾周血肿长短径之和≥5 cm,和/或需输血、介入、手术干预以及患者死亡)。比较各组患者临床和病理指标的差异。采用多因素Logistic回归模型法分析PRB术后出血并发症的相关危险因素。结果纳入研究的357例患者中男性183例(51.2%),年龄47.0(34.0,61.0)岁,其中合并急性肾损伤23例(6.4%),合并高血压病157例(44.0%)。209例(58.5%)患者发生PRB术后出血并发症,其中发生中重度出血并发症105例(29.4%),需输血和/或介入治疗3例(0.84%)。轻度出血组PRB术后出院时间与无出血组无差异,提示轻度出血对患者短期预后无不良影响。与无出血组比较,中重度出血组患者体质量指数(body mass index,BMI)更低、血白蛋白水平更低、24 h尿蛋白定量更高、D-二聚体水平更高、合并肾病综合征比例更高、肾穿刺后住院时间更长、血尿素氮(blood urea nitrogen,BUN)水平更高、估算肾小球滤过率更低(均P<0.05)。利用前进筛选法对相关因素进行多因素Logistic回归分析后发现,BMI(OR=0.883,P<0.05)、24 h尿蛋白定量(OR=1.124,P<0.05)、BUN(OR=1.078,P<0.05)、D-二聚体(OR=1.204,P<0.05)和肾脏长径(OR=0.683,P<0.05)是PRB术后患者发生中重度出血并发症的独立危险因素。结论PRB术后患者发生出血并发症并不少见,但需要输血或介入干预的严重并发症罕见。低BMI、24 h尿蛋白定量高、高BUN水平、D-二聚体增高和肾脏长径短的患Objective To retrospectively analyze the incidence of and risk factors for bleeding complications after percutaneous renal biopsy(PRB)of native kidneys.Methods The patients undergoing native PRB in Changhai Hospital of Naval Medical University(Second Military Medical University)from January 2017 to December 2018 were enrolled.Complete clinical and pathological data were collected.Blood routine and renal ultrasonography were conducted after PRB.Based on post-operative occurrence of bleeding complications in patients,the enrolled patients were divided into non-bleeding group(NBG),mild bleeding group(MBG,defined as the summation of the long and short diameter less than 5cm as well as the hemoglobin decrease less than 10%after PRB)and moderate to severe bleeding group(SBG,defined as gross hematuria,and/or hemoglobin decrease no less than 10%,and/or the summation of the long and short diameters no less than 5 cm and/or the need for transfusion/interventional therapy/surgery/death).The differences of clinical and pathological indices between the groups were compared.The risk factors of bleeding complications were analyzed by logistic regression model.Results A total of 357 patients were included in the study.The average age of patients was 47(34.0,61.0)and 51.2%(183 patients)of the patients were male.Among the patients,23 patients(6.4%)were complicated with acute kidney injury and 157 patients(44.0%)were complicated with hypertension.Overall,the rate of bleeding complications was 58.5%(209 patients),of which 105 patients(29.4%)developed severe bleeding complications,3 patients(0.84%)required transfusion and/or surgery intervention.Discharge time after PRB was not significantly different between NBG and MBG,suggesting that mild bleeding has no adverse effect on patients’short-term prognosis.Compared to the NBG,Patients in the SBG had lower levels of BMI,lower serum albumin,higher 24-hour urine protein,higher D-Dimer levels,higher rates of nephritic syndrome,longer hospital stay,higher serum urea nitrogen and higher es

关 键 词：活检 出血 危险因素 肾脏疾病 

分 类 号：R699.2[医药卫生—泌尿科学]