活化部分凝血活酶时间延长但血栓弹力图正常患者肾穿刺活检术后出血风险评估

Risk assessment of hemorrhagic complication after renal biopsy in patients with prolonged APTT and normal thromboelastography

目的评估活化部分凝血活酶时间(activated partial thromboplastin time,APTT)延长而血栓弹力图(thromboelastography,TEG)正常的患者肾穿刺活检术后出血风险。方法选取2021年1月至2022年7月华中科技大学同济医学院附属同济医院收治的327例超声引导下经皮肾穿刺活检术患者,根据APTT有无延长分为APTT正常组(n=272)和APTT延长/TEG正常组(n=55)。比较两组及亚组间(APTT延长≤5 s和APTT延长>5 s)患者术后显性出血情况,同时比较两组患者中有TEG数据患者的TEG各项参数及显性出血情况,并分析TEG参数和凝血四项的相关性。结果APTT正常组和APTT延长/TEG正常组患者相比,两组患者的基线特征差异无统计学意义(P>0.05)。APTT正常组显性出血发生率为3.68%,而APTT延长/TEG正常组为5.45%,两组显性出血发生率差异无统计学意义(P>0.05),APTT延长/TEG正常组出血风险没有增加。同时,APTT延长>5 s与APTT延长≤5 s亚组间显性出血发生率差异也没有统计学意义。对有TEG数据患者分析发现两组患者TEG各项参数及显性出血发生率差异无统计学意义,反应时间和APTT有较弱的相关性。结论APTT延长无法准确预测肾穿刺活检术后出血风险,APTT延长但TEG正常患者可行肾穿刺活检术。

Objective To evaluate the risk of hemorrhagic complication after renal biopsy in patients with prolonged APTT and normal thromboelastography(TEG).Methods A total of 327 patients underwent ultrasound-guided percutaneous renal biopsy from January 2021 to July 2022.According to whether or not APTT was prolonged,they were divided into two groups of normal APTT(n=272)and prolonged APTT and normal TEG(n=55).Overt hemorrhagic complications were compared between two groups and subgroups(APTT prolonged<5 s and APTT prolonged>5 s).Also TEG parameters and overt hemorrhagic complication of patients with TEG data in two groups were compared and the correlation was examined between TEG and coagulation.Results No significant inter-group difference existed in baseline characteristics(P>0.05).The incidence of overt hemorrhagic complication was 3.68%in normal APTT group and 5.45%in prolonged APTT and normal TEG group.No significant inter-group difference existed in the incidence of overt hemorrhagic complication(P>0.05).The risk of hemorrhagic complication was not elevated in prolonged APTT and normal TEG group.Furthermore,no significant difference existed in the incidence of overt hemorrhagic complication between subgroups of APTT prolonged<5 s and APTT prolonged>5 s.Analysis of patients with TEG data revealed no significant inter-group differences in TEG parameters or the incidence of overt hemorrhage.Also weak correlation existed between reaction time and APTT.Conclusions APTT can not accurately predict the hemorrhagic risk after biopsy.And renal biopsy is feasible for patients with prolonged APTT and normal TEG.