난치성 복수를 동반한 간경변증 환자의 혈장 Aldosterone 치 = Plasma Aldosterone in Liver Cirrhosis with Refractory Ascites

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

Objectives: Hyperaldosteronism is the most important factor in sustaining salt and water retention in patients with cirrhosis and aldosterone antagonists or loop natriuretic agents are used for the treatment of ascites. But some patients do not respond to the dietary diuretic regime and the cause or mechanism of refractory ascites complex. To evaluate the difference in response after treatment of ascites and the importance of plasma aldosterone level in refractory ascites, pretreatment plasma aldosterone concentration and the degree of cirrhosis by Child-Pugh classification were investigated among cirrhotic patients. Methods: Plasma renin activity (PRA), plasma aldosterone concentration (PAC) and 24 hour urinary Na+ excretion (Una+V) were tested in 16 normal control (group I), 16 cirrhotic patients without ascites (group II), 29 cirrhotic patients with ascites who responded to aldosterone antagonist (group III) and 12 cirrhotic patients with refractory ascites (group IV). Results: The amount of Una+ in group IV (19.1±13.0 mmol/day) was much lower than that of group I (81.8±42.2mmol/day), group II (75.1±12.5mmol/day), and group III (74.9±47.8 mmol/day) (p<0.01). PRA and PAC in group III (10.8±4.1ng/ml/hr, 359.8±196.8pg/ml) and group IV (12.5±8.7ng/ml/hr, 585.9±323.7pg/ml) were significantly elevated as compared to group I (1.5±0.8ng/ml/hr, 127.0±69.1pg/ml) (p<0.01 and p<0.05, respectively) and group II (4.3±2.1ng/ml/hr, 198.8±50.8pg/ml) (p<0.01 and p<0.05, respectively). But no remarkable differences were noted between group III and group IV in PRA and PAC. No negative correlations were noted between Una+V and PRA, or between Una+V and PAC in cirrhotic patients. According to Child-Pugh classification, the majority of the group IV were in C. Conclusion: Hyperaldosteronism itself is not the main cause of low sodium excretion in cirrhosis with refractory ascites. Some other factors related to the advanced cirrhosis may play a major role in the mechanism of diuretics resistance in refractory ascites.