| 曾玉亭,解德琼.血栓弹力图联合血小板压积、纤维蛋白原对肾病综合征病人经皮肾穿刺活检术后出血的预测价值[J].安徽医药,2026,30(6):1183-1188. |
| 血栓弹力图联合血小板压积、纤维蛋白原对肾病综合征病人经皮肾穿刺活检术后出血的预测价值 |
| Predictive value of thromboelastography combined with plateletcrit and fibrinogen for postoperative bleeding in patients with nephrotic syndrome undergoing percutaneous renal puncture biopsy |
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| DOI：10.3969/j.issn.1009-6469.2026.06.024 |
| 中文关键词: 肾病综合征 经皮肾穿刺活检术 出血 血栓弹力图 血小板压积 纤维蛋白原 |
| 英文关键词: Nephrotic syndrome Percutaneous renal puncture biopsy Bleeding Thromboelastography Plateletcrit Fibrinogen |
| 基金项目:宜宾市卫生健康委员会( 2020YW067) |
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| 中文摘要: |
| 目的探讨血栓弹力图参数联合血小板压积( PCT)、纤维蛋白原( FIB)在肾病综合征病人经皮肾穿刺活检术后出血中的预测价值。方法回顾性选取 2023年 2—11月宜宾市第二人民医院收治的 75例行超声引导肾脏穿刺活检术肾病综合征病人为研究对象，随访术后出血情况，分为未出血组(镜下血尿或无包膜下血肿) 53例和出血组(肉眼血尿或包膜下血肿) 22例，记录病人血栓弹力图参数、 PCT、FIB及相关临床参数。采用多因素 logistic回归分析探索影响因素；绘制受试者操作特征曲线(ROC曲线)分析血栓弹力图参数［凝血反应时间( R)值、血细胞凝集块形成时间( K)值、最大血块强度( MA)值、血细胞凝集块形成速率( Angle角)］、 PCT、FIB联合预测肾病综合征病人经皮肾穿刺活检术后出血的价值，曲线下面积( AUC)采用 Z检验比较。结果 75例行超声引导肾脏穿刺活检术病人中膜性肾病较多( 33.33%)，其次为免疫球蛋白(Ig)A肾病(20.00%)。微小病变性肾病病人出血比例最高(41.67%)，其次为膜性肾病(40.00%)。出血组 MA值［(76.81±4.09)min比(70.86±2.35)min］、 Angle角［( 81.15±4.48)°比( 72.45±3.91)°］高于未出血组， PCT［( 0.14±0.05)%比( 0.27±0.07)%］、 FIB［( 2.45±0.64)g/L比( 4.96±1.45)g/L］低于未出血组( P<0.05)。出血组术前收缩压、术前舒张压高于未出血组( P<0.05)。 Angle角、 MA值为经皮肾穿刺活检术后出血的独立危险因素， PCT、FIB为经皮肾穿刺活检术后出血的保护因素( P<0.05)。 Angle角、 MA值、 PCT、FIB单独预测的 AUC分别为 0.84、0.85、0.83、0.82，联合 AUC为 0.97，高于单独 AUC(P<0.05)。结论血栓弹力图参数联合 PCT、FIB可有效预测行超声引导肾脏穿刺活检术的肾病综合征病人术后出血，为早期预防提供依据。 |
| 英文摘要: |
| Objective To explore the predictive value of thromboelastography parameters combined with plateletcrit (PCT) and fibrin.ogen (FIB) for postoperative bleeding in patients with nephrotic syndrome undergoing percutaneous renal puncture biopsy. Methods A retrospective study was conducted on 75 patients who underwent ultrasound-guided renal puncture biopsy at the Second People'sHospital of Yibin City from February 2023 to November 2023. Postoperative bleeding was followed up and the patients were divided in.to 53 cases in the non bleeding group (microscopic hematuria or non subcapsular hematoma) and 22 cases in the bleeding group (grosshematuria or subcapsular hematoma), the thromboelastography parameters, PCT, FIB, and related clinical parameters were recorded.Multiple logistic regression analysis was used to identify influencing factors; Receiver operating characteristic curve (ROC curve) wasplotted to evaluate the predictive value of thromboelastography parameters [coagulation reaction time (R), coagulation time (K), maxi.mum amplitude (MA), and blood cell agglutination rate (Angle angle)], PCT and FIB for postoperative bleeding in patients with nephrot.ic syndrome undergoing percutaneous renal puncture biopsy. The area under the curve (AUC) was compared using the Z-test.Results Among 75 patients undergoing ultrasound-guided renal puncture biopsy, membranous nephropathy was the most prevalent (33.33%),followed by immunoglobulin (Ig) A nephropathy (20.00%). With the highest bleeding rate in patients with minimal degenerative ne. phropathy (41.67%), followed by membranous nephropathy (40.00%). The bleeding group exhibited significantly higher MA value[(76.81±4.09) min vs. (70.86±2.35) min] and Angle values [(81.15±4.48)° vs. (72.45±3.91)°], but lower PCT [(0.14±0.05)% vs. (0.27± 0.07)%] and FIB levels [(2.45±0.64) g/L vs. (4.96±1.45) g/L] compared to the non-bleeding group (P<0.05). The preoperative systolicblood pressure and preoperative diastolic blood pressure in the bleeding group were higher than those in the non bleeding group (P< 0.05). Angle angle and MA value are independent risk factors for postoperative bleeding after percutaneous renal biopsy, while PCTand FIB are protective factors for postoperative bleeding after percutaneous renal biopsy (P<0.05). The AUC predicted by Angle angle,MA value, PCT, and FIB alone was 0.84, 0.85, 0.83, and 0.82, respectively, the combined AUC was 0.97, which was higher than thesingle AUC (P<0.05).Conclusion The combination of thromboelastography parameters with PCT and FIB can effectively predict post.operative bleeding in patients with nephrotic syndrome undergoing ultrasound-guided renal puncture biopsy, providing a basis for early prevention. |
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