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摘要:
目的 探讨超声引导下移植肝穿刺活组织检查(活检)出血的危险因素。 方法 回顾性分析2013年2月至2015年4月在中山大学附属第三医院行超声引导下肝穿刺活检的51例肝移植患者的临床资料。以穿刺术后出血作为应变量, 将患者年龄、性别、凝血功能、活检时间、活检次数、活检组织条数、是否使用抗凝药物及患者能否配合呼吸屏气作为自变量, 对所有自变量进行多因素非条件Logistic回归分析, 筛选出与超声引导下移植肝穿刺活检出血相关的危险因素。 结果 51例肝移植患者共穿刺活检84次, 术后出血5例(6%)。多因素非条件Logistic回归分析显示有明显出血倾向、使用抗凝药物及呼吸配合欠佳是肝穿刺活检出血的独立危险因素(OR分别为8.71、3.16、2.03, 均为P < 0.05)。 结论 有明显出血倾向、使用抗凝药物及呼吸配合欠佳是超声引导下移植肝穿刺活检出血的危险因素。 Abstract:Objective To investigate the risk factors of hemorrhage after ultrasound-guided liver graft biopsy. Methods Clinical data of 51 liver transplant patients undergoing ultrasound-guided liver graft biopsy in the Third Affiliated Hospital, Sun Yat-sen University between February 2013 and April 2014 were retrospectively studied. Hemorrhage after biopsy was taken the dependent variable. Age, gender, coagulation, duration of biopsy, frequency of biopsy, number of biopsy tissues, medication of anticoagulant or not and cooperation in breathing and breath holding or not were taken as the independent variables. Multivariate non-conditional Logistic regression analysis was performed for all independent variables to screen out the risk factors associated with hemorrhage after ultrasound-guided liver graft biopsy. Results Fifty-one patients underwent 84 biopsies in total and 5 cases (6%) had hemorrhage after biopsy. The multivariate non-conditional Logistic regression analysis showed that obvious hemorrhagic tendency, medication of anticoagulant and poor cooperation in breathing were independent risk factors of hemorrhage after liver graft biopsy (OR was respectively 8.71, 3.16 and 2.03, all in P < 0.05). Conclusions Obvious hemorrhagic tendency, medication of anticoagulant and poor cooperation in breathing are independent risk factors of hemorrhage after ultrasound-guided liver graft biopsy. -
Key words:
- Liver transplantation /
- Puncture biopsy /
- Ultrasound-guided /
- Hemorrhage /
- Risk factor
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表 1 超声引导下移植肝穿刺活检出血的多因素非条件Logistic回归分析结果
Table 1. Logistic regression analysis result of hemorrhage after ultrasound-guided liver graft biopsy
变量 β值 SE Wald χ2值 P值 OR值 明显出血倾向 2.331 0.761 9.536 0.002 8.71 使用抗凝药物 0.991 0.394 11.723 0.003 3.16 呼吸配合欠佳 0.712 0.494 6.719 0.031 2.03 
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[1] Banff Working Group on Liver Allograft Pathology. Importance of liver biopsy findings in immunosuppression management: biopsy monitoring and working criteria for patients with operational tolerance[J]. Liver Transpl, 2012, 18(10):1154-1170. doi: 10.1002/lt.v18.10 [2] Lenci I, Tisone G, Di Paolo D, et al. Safety of complete and sustained prophylaxis withdrawal in patients liver-transplanted for HBV-related cirrhosis at low risk of HBV recurrence[J]. J Hepatol, 2011, 55(3):587-593. doi: 10.1016/j.jhep.2010.12.036 [3] Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial[J]. Clin Gastroenterol Hepatol, 2010, 8(10):877-883. doi: 10.1016/j.cgh.2010.03.025 [4] Caldwell S, Northup PG. Bleeding complication with liver biopsy: is it predictable?[J]. Clin Gastroenterol Hepatol, 2010, 8(10):826-829. doi: 10.1016/j.cgh.2010.06.010 [5] Boursier J, Brochard C, Bertrais S, et al. Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver-prognosis in chronic hepatitis C[J]. Aliment Pharmacol Ther, 2014, 40(2):178-188. doi: 10.1111/apt.2014.40.issue-2 [6] Liou IW. Management of end-stage liver disease[J]. Med Clin North Am, 2014, 98(1):119-152. doi: 10.1016/j.mcna.2013.09.006 [7] Guerrero-Misas M, Rodríguez-Perálvarez M, De la Mata M. Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation[J]. World J Hepatol, 2015, 7(4):649-661. doi: 10.4254/wjh.v7.i4.649 [8] Tariq H, Nasir H. Spectrum of histopathological findings in live donor liver graft biopsies[J]. J Coll Physicians Surg Pak, 2015, 25(6):412-416. http://cn.bing.com/academic/profile?id=2411241264&encoded=0&v=paper_preview&mkt=zh-cn [9] Hu WY, Wu LQ, Su Z, et al. Expression of human leukocyte antigen-G and acute rejection in patients following liver transplantation[J]. Exp Ther Med, 2014, 8(4):1291-1295. http://cn.bing.com/academic/profile?id=2058206652&encoded=0&v=paper_preview&mkt=zh-cn [10] 董辉, 夏春燕, 王斌, 等.肝移植术后1 052例次肝活组织检查病理学诊断分析[J].中华肝脏病杂志, 2010, 18(4):300-301.Dong H, Xia CY, Wang B, et al. Pathological diagnosis of 1 052 liver biopsies after liver transplantation[J]. Chin J Hepatol, 2010, 18(4):300-301. [11] Howlett DC, Drinkwater KJ, Lawrence D, et al. Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy.part Ⅱ. minor and major complications and procedure-related mortality[J]. Radiology, 2013, 266(1):226-235. doi: 10.1148/radiol.12120224 [12] Sparchez Z. Complications after percutaneous liver biopsy in diffuse hepatopathies[J]. Rom J Gastroenterol, 2005, 14(4):379-384. http://cn.bing.com/academic/profile?id=2417957403&encoded=0&v=paper_preview&mkt=zh-cn [13] Filingeri V, Sforza D, Tisone G. Complications and risk factors of a large series of percutaneous liver biopsies in patients with liver transplantation or liver disease[J]. Eur Rev Med Pharmacol Sci, 2015, 19(9):1621-1629. http://cn.bing.com/academic/profile?id=2163975904&encoded=0&v=paper_preview&mkt=zh-cn [14] 张瑶, 王丽萍, 罗艳, 等.超声引导下肝脏穿刺活检并发症探讨与研究[J].中国医药导报, 2013, 10(2):94-96. http://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201302039.htmZhang Y, Wang LP, Luo Y, et al. Discussion and research on complications of liver biopsy under the guidance of color Doppler ultrasound[J]. Chin Med Herald, 2013, 10(2):94-96. http://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201302039.htm [15] 余松远, 邓远, 屈亚莉, 等.超声引导肝穿刺活检并发症及处理对策.中华超声影像学杂志, 2011, 20(6):496-498. http://d.wanfangdata.com.cn/periodical_zhcsyx201106011.aspxYu SY, Deng Y, Qu YL, et al. Analysis and management of the complications of ultrasound-guided hepatic puncture biopsy[J]. Chin J Ultrason, 2011, 20(6):496-498. http://d.wanfangdata.com.cn/periodical_zhcsyx201106011.aspx [16] Mueller M, Kratzer W, Oeztuerk S, et al. Percutaneous ultrasonographically guided liver punctures: an analysis of 1 961 patients over a period of ten years[J]. BMC Gastroenterol, 2012, 12:173. doi: 10.1186/1471-230X-12-173 [17] Warkentin AE, Donadini MP, Spencer FA, et al. Bleeding risk in randomized controlled trials comparing warfarin and aspirin: a systematic review and meta-analysis[J]. J Thromb Haemost, 2012, 10(4):512-520. doi: 10.1111/j.1538-7836.2012.04635.x [18] Aribaȿ BK, Arda K, Ciledagğ N, et al. Accuracy and safety of percutaneous US-guided needle biopsies in specific focal liver lesions: comparison of large and small needles in 1 300 patients[J]. Panminerva Med, 2012, 54(3):233-239. http://cn.bing.com/academic/profile?id=2192939528&encoded=0&v=paper_preview&mkt=zh-cn -
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