Xu Da-Min, Chen Min, Zhou Fu-de, Zhao Ming-Hui
Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People׳s Republic of China, Beijing, PR China.
Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People׳s Republic of China, Beijing, PR China.
Am J Med Sci. 2017 Mar;353(3):230-235. doi: 10.1016/j.amjms.2016.12.019. Epub 2016 Dec 31.
Percutaneous renal biopsy is essential for diagnosis of many renal diseases. Previous studies have revealed a variety of factors associated with bleeding complications of renal biopsy; however, data are not sufficient in the Chinese population. We aimed to investigate the risk factors for severe post-biopsy bleeding events in a large cohort of Chinese patients.
The data of patients who underwent percutaneous renal biopsy from January 2008 to December 2012 were collected. Severe bleeding complication was defined as requiring intervention, including blood transfusion or an invasive procedure (radiological or surgical) due to bleeding. Logistic regression analysis was used to assess risk factors.
Over the 5-year period, 3,577 native kidney biopsies were performed. Severe bleeding complication occurred in 14 biopsies (0.39%). The patients with complications were older, had higher blood pressure, lower hemoglobin, lower platelet count and worse renal function. Multivariable logistic regression demonstrated that platelet level and the estimated glomerular filtration rate were independently associated with the risk of complications. Each 10 × 10/L increase of platelet count was associated with an 11% decrease of severe bleeding risk (odds ratio = 0.89; 95% CI: 0.80-0.98; P = 0.02). Each 1mL/minute/1.73m increase of the estimated glomerular filtration rate was associated with a 4% decrease of severe bleeding risk (odds ratio = 0.96; 95% CI: 0.94-0.99; P = 0.004).
Patients with worse renal function and lower platelet counts had a higher risk of developing severe bleeding events after renal biopsy.
经皮肾活检对于多种肾脏疾病的诊断至关重要。既往研究揭示了与肾活检出血并发症相关的多种因素;然而,中国人群的数据并不充分。我们旨在调查一大群中国患者活检后严重出血事件的危险因素。
收集2008年1月至2012年12月期间接受经皮肾活检患者的数据。严重出血并发症定义为需要干预治疗,包括因出血而进行输血或侵入性操作(放射学或外科手术)。采用逻辑回归分析评估危险因素。
在这5年期间,共进行了3577例自体肾活检。14例活检(占0.39%)发生严重出血并发症。发生并发症的患者年龄较大、血压较高、血红蛋白较低、血小板计数较低且肾功能较差。多变量逻辑回归分析表明,血小板水平和估计肾小球滤过率与并发症风险独立相关。血小板计数每增加10×10⁹/L,严重出血风险降低11%(比值比=0.89;95%置信区间:0.80 - 0.98;P = 0.02)。估计肾小球滤过率每增加1 mL/min/1.73m²,严重出血风险降低4%(比值比=0.96;95%置信区间:0.94 - 0.99;P = 0.004)。
肾功能较差且血小板计数较低的患者肾活检后发生严重出血事件的风险较高。