Objective: To explore the independent risk factors for bleeding in patients following percutaneous liver biopsy examination. Methods: The clinicopathological data of patients who underwent percutaneous liver biopsy examination at Nanjing Second Hospital from January 2012 to December 2021 were retrospectively collected. Univariate and multivariate logistic regression analysis were used to investigate the effect of age, gender, lesion type (diffuse liver parenchymal lesions, focal liver lesions), number of biopsies, tissue length, presence or absence of cirrhosis, presence or absence of portosystemic shunt, erythrocytes, white blood cells, hemoglobin, platelets, prothrombin time, fibrinogen, international normalized ratio, and liver biochemical indicators on bleeding following liver biopsy, as well as to screen independent risk factors. Results: A total of 3 331 patients were examined by percutaneous liver biopsy, and 3 060 cases were actually included by excluding 271 cases who took consultation from other hospitals. The overall postoperative hemorrhagic rate was 1.6% (49/3 060). Of which, forty-four cases (1.4%) had overt bleeding (hemodynamic changes or hemoglobin decreased by more than 20 g/L), five cases (0.2%) had minor bleeding, three cases had subcapsular hepatic hemaotma, and two cases had local bleeding from liver biopsy. Among the overt bleeding cases, two cases were in the off-label group (platelet<50×109/L or international normalized ratio>1.5), and the rest were in the non-off-label group. The results of univariate analysis showed that factors such as focal liver lesions, portosystemic shunt, prolonged prothrombin time, increased international normalized ratio, bilirubin, and alkaline phosphatase were associated with bleeding after liver biopsy in the non-off-label group. The multivariate collinearity diagnosis revealed statistically significant differences for the indicators. Multivariate logistic regression analysis finally included factors such as lesion type, portosystemic shunt, international normalized ratio, total bilirubin, and alkaline phosphatase. The results showed that patients with focal liver lesions were more prone to bleed after surgery than patients with diffuse liver parenchymal lesions (OR=3.396, P=0.002, 95%CI: 1.596-7.228). Patients with portosystemic shunt were more prone to bleed than those without portosystemic shunt (OR=3.301, P=0.018, 95%CI: 1.232-8.845). Patients were more likely to experience bleeding following liver biopsy when their total bilirubin levels were elevated (OR=1.006, P<0.001, 95%CI:1.003-1.008). Conclusion: Focal liver lesions, portosystemic shunts, and elevated total bilirubin are independent risk factors for bleeding after percutaneous liver biopsy.
目的： 探讨患者经皮肝穿刺活组织检查术后出血的独立危险因素。 方法： 回顾性收集2012年1月至2021年12月南京市第二医院经皮肝穿刺活组织检查患者的临床病理资料。采用单因素分析和多因素logistic回归分析研究年龄、性别、病变类型（弥漫性肝实质病变、肝脏局灶性病变）、穿刺条数、组织长度、有无肝硬化、有无门体分流、红细胞、白细胞、血红蛋白、血小板、凝血酶原时间、纤维蛋白原、国际标准化比值以及肝生物化学指标等因素对肝穿刺术后出血的影响，并筛选独立危险因素。 结果： 经皮肝穿刺活组织检查患者共3 331例，排除外院会诊病例271例，实际纳入3 060例。术后总出血率为1.6%（49/3 060），其中显性失血（血流动力学改变或血红蛋白下降超过20 g/L）者44例（1.4%），轻微出血者5例（0.2%），3例为肝包膜下小血肿，2例为肝穿刺局部渗血。显性失血者中2例位于超适应证组（血小板<50×109/L或国际标准化比值>1.5），其余均在未超适应证组。单因素分析结果显示，在未超适应证组患者中肝脏局灶性病变、门体静脉分流、凝血酶原时间延长、国际标准化比值升高、胆红素以及碱性磷酸酶升高等因素与肝穿刺术后出血相关，并对差异有统计学意义的指标行多重共线性诊断，最终将病变类型、门体静脉分流、国际标准化比值、总胆红素以及碱性磷酸酶等因素纳入多因素logistic回归分析，结果显示肝脏局灶性病变的患者相较于弥漫性肝实质病变的患者术后更容易出血（OR=3.396，P=0.002，95%CI：1.596～7.228）；存在门体静脉分流的患者比无门体静脉分流的患者更容易发生出血（OR=3.301，P=0.018，95%CI：1.232～8.845）；患者总胆红素越高肝穿刺术后越容易出血（OR=1.006，P<0.001，95%CI：1.003～1.008）。 结论： 肝脏局灶性病变、门体静脉分流以及总胆红素升高是经皮肝穿刺术后出血的独立危险因素。.