不同病理类型及组织特点对肾活检后出血的影响  

The effects of different pathological types and histological features on bleeding events after ultrasound-guided percutaneous native renal biopsies

作　　者：马晓桃 张亚妮[1] 崔晨凯 郭昭 郭萌 石玥 吴瑶 赵莉[1] 刘静[1] 赵纬昊 付荣国[1] 田李芳[1] Ma Xiaotao;Zhang Yani;Cui Chenkai;Guo Zhao;Guo Meng;Shi Yue;Wu Yao;Zhao Li;Liu Jing;Zhao Weihao;Fu Rongguo;Tian Lifang(Department of Neprology,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,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

出　　处：《首都医科大学学报》2022年第5期700-706,共7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：目的评估不同病理类型及穿刺组织特点对超声引导下经皮肾穿刺活检后出血的影响。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月接受肾活检的患者为研究对象,比较不同病理类型的患者肾活检后的出血比率;分析活检组织的髓皮比、弓状动脉个数、肾小球硬化率及肾间质纤维化评分与肾活检后出血的关系以及在各种病理类型间的差异。结果1026例患者中超声下可探及出血343例,平均出血率33.4%,其中需治疗的大出血5例,占比0.49%。其中出血率较高的4种病理类型由高到低依次为干燥综合征肾损害(100%)、急性/亚急性肾小管损伤(66.7%)、结节硬化性肾炎(50.0%)和膜增生性/毛细血管内增生性肾炎(50.0%)。出血率较低的3种病理类型由低到高依次为微小病变肾病(25.3%)、膜性/非典型肾病(26.3%)、糖尿病性肾病(27.9%)。与非出血组比较,急性/亚急性肾小管损伤(P=0.032)、IgA肾病(P=0.043)出血率较高,膜性肾病/非典型肾病(P=0.003)出血率较低。活检组织中出血组的髓皮比、弓状动脉个数、肾小球硬化率、肾间质纤维化程度均高于未出血组,而仅髓皮比(P=0.032)、弓状动脉个数(P=0.037)差异有统计学意义。不同病理类型间的活检组织特点差异无统计学意义,而常见病理类型的部分临床资料差异有统计学意义。结论不同病理类型对超声引导下肾活检后出血率有影响,肾脏活检组织的髓皮比及弓状动脉个数影响了活检后的出血程度。Objective To evaluate the effects of different pathological types and histological features on 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 bleeding ratio among different pathological type groups.We calculated the medullocortical ratio,number of arcuate artery,glomerulosclerosis and interstitial fibrosis on stained sections of renal biopsy tissues.Correlations were analyzed between bleeding area size and each histological features.Finally we compared each histological feature among different pathological type groups.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 four pathological types with high bleeding rate were as follows:renal damage of Sjogren’s syndrome(100%),acute/subacute renal tubular injury(66.7%),sclerosing nephritis(50.0%),and membranous/endocapillary proliferative nephritis(50.0%).The three pathological types with low bleeding rate were as follows:minimal change nephropathy(25.3%),membranous/atypical membranous nephropathy(26.3%)and diabetic nephropathy(27.9%).Both medullocortical ratio(P=0.032)and number of arcuate artery(P=0.037)positively correlated with bleeding area size,while glomerulosclerosis and interstitial fibrosis were not significantly correlated with bleeding area size.These histological features did not differ between different pathological type groups.There were statistical differences in some clinical data of the common pathological types.Conclusion The bleeding rates were significantly different among pathological types.The medullocortical ratio and number of arcuate artery on renal biopsy tissue can affect on bleeding events after ultrasound-guided percutaneous native renal biopsies.

关 键 词：肾活检 肾出血 肾脏病理类型 髓皮比 弓状动脉 肾小球硬化 肾间质纤维化 

分 类 号：R692[医药卫生—泌尿科学]