超声引导下经皮肝穿刺活组织检查出血并发症危险因素分析  

Analysis of risk factors for bleeding as a complication of ultrasound-guided percutaneous liver biopsy examination

作　　者：陈妙洋 胡一帆 熊清芳 钟艳丹 刘杜先 杨永峰 Chen Miaoyang;Hu Yifan;Xiong Qingfang;Zhong Yandan;Liu Duxian;Yang Yongfeng(Department of Liver Diseases,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine&The Second of Nanjing Hospital,Nanjing210003,China;Department of Pathology,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine&The Second of Nanjing Hospital,Nanjing210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)肝病科,南京210003 [2]南京中医药大学附属南京医院(南京市第二医院)病理科,南京210003

出　　处：《中华肝脏病杂志》2024年第10期923-928,共6页Chinese Journal of Hepatology

基　　金：国家自然科学基金(81970454);江苏省卫健委重点项目(ZD2021061);江苏省研究生科研与实践创新计划项目(KYCX23_2102)。

摘　　要：目的探讨患者经皮肝穿刺活组织检查术后出血的独立危险因素。方法回顾性收集2012年1月至2021年12月南京市第二医院经皮肝穿刺活组织检查患者的临床病理资料。采用单因素分析和多因素logistic回归分析研究年龄、性别、病变类型(弥漫性肝实质病变、肝脏局灶性病变)、穿刺条数、组织长度、有无肝硬化、有无门体分流、红细胞、白细胞、血红蛋白、血小板、凝血酶原时间、纤维蛋白原、国际标准化比值以及肝生物化学指标等因素对肝穿刺术后出血的影响,并筛选独立危险因素。结果经皮肝穿刺活组织检查患者共3331例,排除外院会诊病例271例,实际纳入3060例。术后总出血率为1.6%(49/3060),其中显性失血(血流动力学改变或血红蛋白下降超过20 g/L)者44例(1.4%),轻微出血者5例(0.2%),3例为肝包膜下小血肿,2例为肝穿刺局部渗血。显性失血者中2例位于超适应证组(血小板<50×10^(9)/L或国际标准化比值>1.5),其余均在未超适应证组。单因素分析结果显示,在未超适应证组患者中肝脏局灶性病变、门体静脉分流、凝血酶原时间延长、国际标准化比值升高、胆红素以及碱性磷酸酶升高等因素与肝穿刺术后出血相关,并对差异有统计学意义的指标行多重共线性诊断,最终将病变类型、门体静脉分流、国际标准化比值、总胆红素以及碱性磷酸酶等因素纳入多因素logistic回归分析,结果显示肝脏局灶性病变的患者相较于弥漫性肝实质病变的患者术后更容易出血(OR=3.396,P=0.002,95%CI:1.596~7.228);存在门体静脉分流的患者比无门体静脉分流的患者更容易发生出血(OR=3.301,P=0.018,95%CI:1.232~8.845);患者总胆红素越高肝穿刺术后越容易出血(OR=1.006,P<0.001,95%CI:1.003~1.008)。结论肝脏局灶性病变、门体静脉分流以及总胆红素升高是经皮肝穿刺术后出血的独立危险因素。ObjectiveTo explore the independent risk factors for bleeding in patients following percutaneous liver biopsy examination.MethodsThe clinicopathological data of patients who underwent percutaneous liver biopsy examination at Nanjing Second Hospital from January 2012 to December 2021 were retrospectively collected.Univariate and multivariate logistic regression analysis were used to investigate the effect of age,gender,lesion type(diffuse liver parenchymal lesions,focal liver lesions),number of biopsies,tissue length,presence or absence of cirrhosis,presence or absence of portosystemic shunt,erythrocytes,white blood cells,hemoglobin,platelets,prothrombin time,fibrinogen,international normalized ratio,and liver biochemical indicators on bleeding following liver biopsy,as well as to screen independent risk factors.ResultsA total of 3331 patients were examined by percutaneous liver biopsy,and 3060 cases were actually included by excluding 271 cases who took consultation from other hospitals.The overall postoperative hemorrhagic rate was 1.6%(49/3060).Of which,forty-four cases(1.4%)had overt bleeding(hemodynamic changes or hemoglobin decreased by more than 20 g/L),five cases(0.2%)had minor bleeding,three cases had subcapsular hepatic hemaotma,and two cases had local bleeding from liver biopsy.Among the overt bleeding cases,two cases were in the off-label group(platelet<50×10^(9)/L or international normalized ratio>1.5),and the rest were in the non-off-label group.The results of univariate analysis showed that factors such as focal liver lesions,portosystemic shunt,prolonged prothrombin time,increased international normalized ratio,bilirubin,and alkaline phosphatase were associated with bleeding after liver biopsy in the non-off-label group.The multivariate collinearity diagnosis revealed statistically significant differences for the indicators.Multivariate logistic regression analysis finally included factors such as lesion type,portosystemic shunt,international normalized ratio,total bilirubin,and alkaline phosphata

关 键 词：出血 并发症 危险因素 诊断 经皮肝穿刺活组织检查 超声引导 

分 类 号：R575[医药卫生—消化系统]