Ackerman Z
Department of Medicine, Hadassah University Hospital, Jerusalem, Israel.
J Clin Gastroenterol. 1996 Jan;22(1):31-4. doi: 10.1097/00004836-199601000-00009.
The pathophysiology of ascites in patients with cirrhosis is complex and includes increases in hepatic sinusoidal pressure, the formation of hepatic and splanchnic lymph, renal sodium retention, and hypoalbuminemia. However, the role of hypoalbuminemia in ascites formation is controversial. Evaluating ascites in hypoalbuminemic patients with nephrotic syndrome could add to our understanding of the role of hypoalbuminemia in ascites development. We conducted a retrospective analysis of 52 adults and 21 children with nephrotic syndrome who were hospitalized in the Hadassah University Hospital on Mount Scopus during 1981-1994. There was a significant difference in the prevalence of ascites between pediatric (52%) and adult patients (23%) (p = 0.024). Pediatric patients had lower serum albumin levels than adults (1.70 +/- 0.08 g/dl vs. 2.10 +/- 0.07 g/dl, p = 0.001). Adult patients with ascites had lower serum albumin levels than adult patients without ascites (1.80 +/- 0.13 g/dl vs. 2.20 +/- 0.07 g/dl, p = 0.01). This difference was not found in pediatric patients. Temporary fluctuations in liver enzymes (up to four times the upper limit of normal for transaminases) were evident in five patients from the pediatric group with ascites, whereas all pediatric patients without ascites had completely normal liver enzymes (p = 0.035). Among the 12 adult patients with ascites, seven had liver disease (three with cirrhosis and four with amyloidosis), and two had right-sided congestive heart failure. Among the 40 adult patients without ascites, only four had liver disease (amyloidosis). The plasma albumin levels of the patients with amyloidosis without ascites were higher than patients with amyloidosis with ascites (1.90 +/- 0.10 g/dl vs. 1.50 +/- 0.07 g/dl, p = 0.03). Two patients with nephrotic syndrome and ascites (one without liver disease) had episodes of spontaneous bacterial peritonitis. Ascites in nephrotic syndrome is more common in children than in adults. Although in most pediatric patients ascites formation is probably a common manifestation of the general fluid retention, in most adult patients with nephrotic syndrome ascites can be attributed to both hypoalbuminemia and the presence of liver disease or congestive heart failure, with increased hepatic sinusoidal pressure.
肝硬化患者腹水的病理生理学较为复杂，包括肝窦压力升高、肝淋巴和内脏淋巴形成、肾钠潴留以及低白蛋白血症。然而，低白蛋白血症在腹水形成中的作用存在争议。评估患有肾病综合征的低白蛋白血症患者的腹水情况，可能有助于我们了解低白蛋白血症在腹水发展中的作用。我们对1981年至1994年间在斯科普斯山哈达萨大学医院住院的52名成人和21名儿童肾病综合征患者进行了回顾性分析。儿童患者（52%）和成人患者（23%）的腹水患病率存在显著差异（p = 0.024）。儿童患者的血清白蛋白水平低于成人（1.70±0.08 g/dl对2.10±0.07 g/dl，p = 0.001）。有腹水的成人患者血清白蛋白水平低于无腹水的成人患者（1.80±0.13 g/dl对2.20±0.07 g/dl，p = 0.01）。在儿童患者中未发现这种差异。小儿腹水组的5名患者出现肝酶暂时波动（转氨酶高达正常上限的四倍），而所有无腹水的小儿患者肝酶完全正常（p = 0.035）。在12名有腹水的成人患者中，7人患有肝脏疾病（3人肝硬化，4人淀粉样变性），2人患有右侧充血性心力衰竭。在40名无腹水的成人患者中，只有4人患有肝脏疾病（淀粉样变性）。无腹水的淀粉样变性患者的血浆白蛋白水平高于有腹水的淀粉样变性患者（1.90±0.10 g/dl对1.50±0.07 g/dl，p = 0.03）。两名患有肾病综合征和腹水的患者（1人无肝脏疾病）发生了自发性细菌性腹膜炎。肾病综合征患者的腹水在儿童中比在成人中更常见。虽然在大多数小儿患者中，腹水形成可能是全身液体潴留的常见表现，但在大多数患有肾病综合征的成人患者中，腹水可归因于低白蛋白血症以及肝脏疾病或充血性心力衰竭的存在，同时伴有肝窦压力升高。
