Takyar V, Etzion O, Heller T, Kleiner D E, Rotman Y, Ghany M G, Fryzek N, Williams V H, Rivera E, Auh S, Liang T J, Hoofnagle J H, Koh C
Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Aliment Pharmacol Ther. 2017 Mar;45(5):744-753. doi: 10.1111/apt.13939. Epub 2017 Jan 10.
Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited.
To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle.
Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course.
Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre-biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post-biopsy bleeding.
Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.
肝活检是评估肝脏疾病的金标准，但易引发并发症。关于抽吸针活检的安全性数据仍然有限。
评估使用克拉茨金针进行经皮肝活检的安全性。
回顾性收集1978年至2015年期间接受克拉茨金针肝活检的连续受试者的临床和生化数据。对发生并发症的受试者的住院病历进行全面审查。
在3357例活检中，135例（4%）出现并发症，其中33例（1%）出现严重并发症。78例（2.3%）受试者出现严重疼痛，21例（0.6%）受试者出现出血。8例（0.2%）活检出现胆系损伤。3例受试者因大量腹腔内出血死亡。与病毒性肝炎相比，某些特定诊断的活检出现严重并发症的几率显著更高：非酒精性脂肪性肝炎（比值比：17）、药物性肝损伤（比值比：２０）、移植物抗宿主病（比值比：32）和肝细胞癌（比值比：34）。出现严重并发症的受试者活检前的平均碱性磷酸酶（153对78 U/L，P<0.001）、丙氨酸氨基转移酶（105对64 U/L，P<0.05）、天冬氨酸氨基转移酶（62对47 U/L，P<0.02）较高，同时总胆红素（1.0对0.7 mg/dL，P<0.01）和白蛋白（3.7对4.0 g/dL，P<0.001）略低。多因素向后逻辑回归分析显示，血小板≤100 K/μL和活化部分凝血活酶时间>35秒是活检后出血的独立危险因素。
克拉茨金针肝活检安全，操作相关发病率低。我们的数据表明，某些急性病患者和患有全身性疾病的患者可能发生严重并发症的风险更高。临床医生应权衡这些患者进行肝活检的风险和益处，并考虑其他替代方法。
