超声引导下经皮肾穿刺活检后出血的危险因素  

Analysis of risk factors associated with bleeding events after ultrasound-guided percutaneous native renal biopsies

作　　者：赵纬昊 张亚妮[1] 李柯 姚恬 景兰梅 霍雨佳 马小琴[1] 王欣[1] 刘静[1] 马晓桃 付荣国[1] 田李芳[1] Zhao Weihao;Zhang Yani;Li Ke;Yao Tian;Jing Lanmei;Huo Yujia;Ma Xiaoqin;Wang Xin;Liu Jing;Ma Xiaotao;Fu Rongguo;Tian Lifang(Department of Neprology,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Health Science Center,Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第二附属医院肾病内科,西安710004 [2]西安交通大学医学部,西安710061

出　　处：《首都医科大学学报》2022年第5期694-699,共6页Journal of Capital Medical University

基　　金：国家自然科学基金面上项目(82170697);西安交通大学第二附属医院科研骨干项目[RC(GG)201906]。

摘　　要：目的探究超声引导下经皮肾穿刺活检后出血的高危因素。方法以西安交通大学第二附属医院肾病内科2019年1月至2021年12月接受肾活检的1026例患者为研究对象,根据肾活检病例是否发生术后出血分为无出血组(对照组,683例)和出血组(病例组,343例)。采用单因素分析筛选影响因素,采用多因素Logistic回归模型分析肾活检后出血的危险因素。结果超声下可探及出血的343例(33.4%)患者中,需治疗的大出血5例(0.49%)。单因素分析显示,出血组病例女性比例及平均体质量指数、血红蛋白浓度、红细胞数量、血小板数量、尿相对密度、尿蛋白定量、三酰甘油及总胆固醇浓度、凝血酶原活动度及凝血酶时间低于无出血组(P<0.05);而出血组病例的凝血酶原时间、国际标准化比值高于无出血组(P<0.05)。出血组中血肿面积与空腹血糖、活化部分凝血活酶时间呈显著正相关。多因素Logistic回归分析显示,血小板计数与肾穿刺后出血有关(OR=0.996,P<0.05)。结论血小板计数降低是超声引导下经皮肾穿刺活检后出血的高危因素。Objective To identify the risk factors associated with bleeding events after ultrasound-guided percutaneous native renal biopsies.Methods Research subjects were 1026 admitted patients who underwent renal biopsy in the second affiliated Hospital of Xi’an Jiaotong University from January 2019 to December 2021.We compared means of clinical indicators between bleeding patients(343 cases)and non-bleeding(683 cases)patients.Correlations were analyzed between bleeding size and each clinical indicator in all patients or bleeding patients.We selected the influence factors associated with bleeding events by Logistic regression.Results There were 343(33.4%)cases with bleeding which were detected by ultrasound,including 5 cases(0.49%)with major bleeding which received therapy.The bleeding rate in women after renal biopsy was significantly higher than that in men(37.8%vs 29.4%,P<0.05).Among all the basic information and clinical indicators,body mass index,hemoglobin,red blood cells,platelets,urine specific gravity,urine protein,triglyceride,total cholesterol,prothrombin activity,thrombin time in bleeding group were all significantly lower than non-bleeding group.Oppositely,prothrombin time,international normalized ratio in bleeding group were all significantly higher than non-bleeding group.By further analyzing the data of the bleeding group,we found that the size of the hematoma was significantly positively correlated with fasting blood glucose and activated partial thromboplastin time.Through multivariate Logistic regression analysis,platelet counts were identified as high risk factors for bleeding events(OR=0.996,P<0.05).Conclusion Lower platelets counts are the high risk factors associated with bleeding events after ultrasound-guided percutaneous native renal biopsies.

关 键 词：肾活检 肾出血 高危因素 

分 类 号：R692[医药卫生—泌尿科学]