腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水疗效评价

目的 评估腹水超滤浓缩回输腹腔术治疗肝炎肝硬化顽固性腹水患者临床疗效。方法75例肝硬化顽固性腹水患者分为治疗组（50例）和对照组（25例）,两组患者均采用保肝、利尿、对症、支持等常规治疗,疗程4周。对照组在常规治疗基础上,采用多次治疗性腹穿放液治疗;治疗组在常规治疗基础上,采用腹水超滤浓缩回输腹腔治疗,观察并比较两组治疗后体重、腹围、24h尿量和尿钠排出量、肝功能、肾功能、血电解质及不良反应。结果治疗4周后治疗组腹围、体重、24h尿量优于对照组（P〈0．01）;血清白蛋白、肾小球滤过率及24h尿钠量高于对照组（P〈0．01）,肌酐、胱抑素c水平低于对照组（P〈0．05。P〈0．01）;治疗组显效率（48．0％）和总有效率（80．0％）明显好于对照组（24．0％和52．0％）（P〈0．05）：两组均未出现严重不良反应。结论腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水患者临床疗效优于多次治疗性腹穿放液。     

肝硬化腹水诊治争议问题

腹水是肝硬化预后不良的重要指标。近年来尽管出台了很多有关肝硬化腹水的指南和共识,但其处理中仍存在一些争议。回顾了目前肝硬化腹水处置中的难点及争议问题,如补钠和限钠的时机、利尿剂的选择、利水剂的应用价值、大量放腹水后补充白蛋白的方案、经颈静脉肝内门体分流术的指征和疗效等;并指出运用循证医学手段解决上述争议性问题,有助于提高肝硬化腹水的诊疗水平,改善患者预后。     

肝硬化腹水治疗的新进展

腹水是肝硬化最常见并发症之一,预防和控制腹水的发生和发展是改善肝硬化患者预后的关键。就近几年腹水治疗的新进展进行总结与讨论,主要包括病因治疗、限钠摄入、利尿剂治疗等一线治疗方法的更新,以及对于顽固性腹水治疗的新探索。     

肝硬化腹水并发结核性腹膜炎的预警指标分析

目的分析肝硬化腹水并发结核性腹膜炎预警指标。方法回顾性分析2010年1月至2012年12月重庆医科大学附属第二医院62例肝硬化腹水患者的临床资料。其中肝硬化腹水并发结构性腹膜炎(TBP)患者27例(TBP组);肝硬化腹水未发生TBP患者35例(非TBP组),收集2组患者的临床情况和实验室检查结果。采用χ2检验和Mann-Whitney U检验进行单因素分析;Logistic回归多因素检验进行多因素分析。结果性别、原发性腹膜炎病史、血沉(ESR)、血清结核抗体、腹水淋巴细胞为主(≥50%)及凝血酶原活动度(PTA)等指标在2组的差异具有统计学意义(P0.05)。原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞为主(≥50%)的肝硬化腹水患者发生结核性腹膜炎的OR分别为1.933、3.205、2.716、11.701;其工作特征曲线(ROC)下面积(AUC)分别是0.831、0.815、0.775、0.935,P值均0.05。结论既往有原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞≥50%是肝硬化腹水患者发生结核性腹膜炎的预警指标;各预警指标的预测价值均较好,尤其腹水淋巴细胞为主(≥50%)预测价值最大。     

One-week losartan administration increases sodium excretion in cirrhotic patients with and without ascites

Background. Losartan, a highly selective angiotensin II type 1 receptor antagonist, has been reported to have a significant portal hypotensive effect in cirrhotic patients. A recent study also showed that losartan exerted a dramatic natriuretic effect in preascitic cirrhosis. The influence of losartan on renal hemodynamics and sodium homeostasis in cirrhotic patients with ascites is unclear. This study was undertaken to evaluate the renal effects of 1-week losartan treatment in cirrhotic patients with and without ascites. Methods. All 12 patients in the study received a daily oral dose of 25 mg losartan for 7 consecutive days. Effective renal plasma flow, urine volume, creatinine clearance, 24h urine sodium excretion and fractional excretion of sodium, blood urea nitrogen, and serum creatinine were measured before and after treatment. Results. In cirrhotic patients without ascites, creatinine clearance, 24-h urinary sodium excretion, and fractional excretion of sodium were significantly increased after losartan administration. Effective renal plasma flow and serum creatinine showed almost no change after treatment. In cirrhotic patients with ascites, creatinine clearance, 24-h urinary sodium excretion, fractional excretion of sodium, and effective renal plasma flow were significantly increased after losartan administration. In addition, the magnitudes of the increases in the fractional excretion of sodium and in the 24-h urinary sodium excretion were greater in cirrhotic patients with ascites than in those without ascites. Conclusions. One-week treatment with losartan increases sodium excretion in association with an improvement of renal function in cirrhotic patients with and without ascites. The natriuretic effect was more profound in cirrhotic patients with ascites than in those without ascites. Received: May 1, 2001 / Accepted: August 24, 2001     

肝硬化腹水患者的临床特征及预后影响因素分析

目的 分析影响肝硬化腹水患者预后的危险因素及其预测价值,为改善患者预后提供参考。方法 回顾性分析2020年8—12月于石家庄市第五医院住院且病例资料完整的136例诊断为肝硬化腹水的患者临床信息,并根据患者治疗2周后临床症状改善情况将患者分为好转组和未好转组。对2组患者的临床基本信息及实验室检测资料进行对比,从中选出差异有统计学意义的变量进行Logistic回归分析评估影响患者预后的危险因素、并采用ROC曲线判断其对预后的诊断价值。结果 未好转组患者的腹腔感染率明显高于好转组,白细胞计数和中性粒细胞比率也明显高于未好转组。另外,中性粒细胞/淋巴细胞比值、单核细胞/淋巴细胞比值、血小板/淋巴细胞比值在未好转组明显增高。在生化指标方面,未好转组丙氨酸氨基转移酶、门冬氨酸氨基转移酶（aspartate aminotransferase, AST）、尿素氮、碱性磷酸酶、谷氨酰转移酶、总胆红素、直接胆红素和C反应蛋白均高于好转组。Logistic回归分析显示白细胞计数、AST和尿素氮是影响肝硬化预后的独立危险因素,3者对预后预测的AUC分别为0.721、0.784和0.655。结论 肝硬化腹水患者...     

Renal vein dilation predicts poor outcome in patients with refractory cirrhotic ascites

Aim

Renal venous hypertension is known to be associated with worsening of renal function in patients with decompensated heart failure. Intra‐abdominal hypertension including cirrhotic ascites also leads to renal venous hypertension. We aimed to clarify the effect of renal venous hypertension on cirrhotic ascites.

Methods

Two hepatologists measured the left renal vein diameter in 142 consecutive patients with refractory cirrhotic ascites using non‐contrast computed tomography. The renal vein diameter was measured at the renal vein main trunk and upstream of the confluence of collateral veins.

Results

The inter‐observer agreements were high for the measurements of the left renal vein (r = 0.918, P < 0.001). The median overall survival for patients with renal vein diameter ≥11 mm was less than that for patients with renal vein diameter <11 mm (P < 0.001; 2.5 vs. 32.0 months). One‐year survival rates were 15.3% versus 66.4%. Multivariate analysis revealed renal vein diameter ≥11 mm (hazard ratio, 2.94; P < 0.001; 95% confidence interval, 1.67–5.20) and a high Model for End‐stage Liver Disease score combined with serum sodium level (MELD‐Na) (hazard ratio, 3.39; P < 0.001; 95% confidence interval, 2.00–5.74) were significant independent predictors of mortality.

Conclusions

Renal vein dilation is a risk factor of mortality in patients with refractory cirrhotic ascites, independent of the MELD‐Na score.     

Total body water/fat-free mass ratio as a valuable predictive parameter for mortality in maintenance hemodialysis patients

Hydration of fat-free mass (FFM), defined as the ratio of total body water (TBW) to FFM (TBW/FFM), is stable at 0.739 in adult mammals. However, an increase in the TBW/FFM ratio is common in hemodialysis (HD) patients. This study aimed to evaluate the determinants of TBW/FFM and investigate its predictive value for the prognosis of all-cause mortality in HD patients.We enrolled patients undergoing maintenance HD between July 2020 and May 2021. All patients were prospectively followed until death, HD dropout, or until the end of the study (November 1, 2021). A forward stepwise multivariable linear regression analyses was performed to test the independent relationship between TBW/FMM and other clinical variables. Receiver operating characteristic (ROC) analysis was used to discriminate the TBW/FFM with respect to 180-day mortality.Of the 106 patients, 42 had elevated TBW/FFM levels. Multiple linear regression analysis revealed that the TBW/FFM ratio was significantly associated with extracellular water (ECW)/TBW (standardized regression coefficient [β = 1.131, P < .001], phase angle (PhA) [β = 0.453, P < .001], and sex (β = 0.440, P < .001). We calculated the ROC curve (AUC) of TBW/FFM, ECW, ECW/TBW, and intracellular water (ICW) to compare the discriminatory capacities of these parameters in predicting 180-day mortality. The AUC for TBW/FFM (AUC = 0.849; 95% CI, 0.745–0.953) exhibited better discriminatory potential than ECW (AUC = 0.562; 0.410–0.714), although it had a similar predictive potential as the ECW/TBW ratio (AUC = 0.831; 0.731–0.932). High TBW/FFM can be used as a valuable prognostic index for predicting all-cause mortality in patients on HD.     

Clinical and hormonal conditions associated with sodium retention in cirrhotic patients with ascites

Using multiple regression analysis, we have evaluated the clinical and hormonal conditions associated with impaired urinary sodium excretion in normoazotemic patients with cirrhosis and ascites. We retrospectively identified 13 patients with a urinary sodium excretion lower than 15 mmol/day and 13 patients with a sodium excretion higher than 15 mmol/day. Using univariate analysis, all the patients with poor sodium excretion had abnormally high levels of plasma renin activity, plasma aldosterone, and arginine vasopressin. In addition, they had a diastolic blood pressure lower than patients with high urinary sodium excretion, although otherwise were comparable as regards clinical and biochemical data. The consistency of the above associations was then tested by multiple-regression analysis in an attempt to control for potentially confounding factors and to identify only true, independent associations. After a discriminant stepwise procedure, we found that low diastolic blood pressure (P<0.01) and high plasma aldosterone levels (P<0.05) were the only two conditions independently associated with abnormally low urinary sodium excretion. These findings are consistent with the view that sodium retention in decompensated cirrhosis results from a concomitant severe contraction in the effective blood volume and an increased production and/or retention of aldosterone. The concordance between our results and several pathophysiological findings supports the validity of this statistical approach to confirm physiological and/or clinical predictions.Portions of this work were presented at the Annual Meeting of the Italian Association for the Study of the Liver, Rome, June 1984.     

肝硬化腹水治疗的研究现状与展望

腹水是肝硬化最常见的并发症,并与发生感染、稀释性低钠血症、肾功能衰竭和病死率增加密切相关。无并发症的少量腹水患者早期处理原则是,休息加上低钠饮食。中等量腹水患者,一般选择低剂量利尿剂就能达到利尿效果。大量腹水患者,可大量放腹水＋静点白蛋白（8g/每放腹水1000ml）。顽固性腹水患者,可用重复多次大量放腹水＋血浆扩容治疗或用经颈静脉肝内门体分流术（TIPS）治疗。新药（如V2受拮抗剂和血管收缩剂等）对肝硬化腹水的治疗可能带来希望。     

肝硬化腹水伴自发性细菌性腹膜炎的诊断及治疗

自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)是肝硬化腹水患者的一种常见而严重的并发症,指在无腹腔内邻近器官直接细菌来源(如肠穿孔、肠脓肿)的情况下发生的腹膜急性弥漫性细菌感染,感染主要源于肠道、胆道及泌尿道等,尤其易发生于这些部位存在炎症或梗阻时,血行感染少见[1].     

对肝硬化腹水诊治中若干问题的认识与思考

近年国内对肝硬化腹水发病机制、诊断、治疗有较多研究,与既往相比出现了较大差距,突出问题:(1)根据钠潴留机制限钠、利尿治疗不仅未能抑制肾素-血管紧张素-醛固酮系统(RAAS)活性,反而限钠越严格,RAAS活性就越强。纠正低血钠后RAAS活性受到抑制;(2)肝硬化腹水患者并非因血管活性物质紊乱导致血容量不足而诱发肝肾综合征(HRS),而是限钠、利尿导致血容量不足诱发HRS;(3)国外(美国)肝硬化腹水诊治指南部分条款相互间出现矛盾。根据这些突出问题,应重视对肝硬化腹水的研究。     

Effects of "body compression" on parameters related to ascites formation: therapeutic trial in cirrhotic patients

Decreased effective circulating blood volume is an important factor in ascites formation in liver cirrhosis. We designed a "body compression" apparatus as a means to restore effective blood volume and investigated its effectiveness in reducing ascites formation in cirrhotics in terms of its effect on parameters of ascites formation noted below. The subjects, eight cirrhotics with ascites and eight cirrhotics without ascites were given spironolactone (50–75 mg/day) and furosemide (40–80 mg/day) while they received a diet containing 85 mEq of sodium per day. All four limbs and the lower abdomen were compressed with constant pressure [height (cm) divided by 13.6 mmHg] once, for 3 h, using stroke rehabilitation splints, while patients lay supine. In cirrhotics both with and without ascites, urine volume, urinary sodium excretion, and creatinine clearance during the body compression were greater than values during control (non-compression) periods (urine volume, means 285 vs 169 ml/3 h; P < 0.001, urinary sodium excretion 15.8 vs 9.5mEq/3h; p < 0.001, creatinine clearance 74 vs 59 ml/min, P < 0.001, respectively). The increased basal plasma renin activity, angiotensin II, aldosterone, and norepinephrine levels in all cirrhotics were significantly decreased by the body compression. In another group of six cirrhotics who received no diuretics or albumin, repeat body compression alleviated ascites in three with well preserved renal function, but was ineffective in three with markedly impaired renal function. These results suggest that the improvement in renal function brought about by the body compression is attributable to an increase in effective circulating blood volume. This maneuver may be a useful complementary therapy in patients with cirrhotic ascites with well preserved renal function. (Received Jan. 12, 1998; accepted June 26, 1998)     

甲状腺素治疗肝硬化腹水15例的疗效

目的 观察甲状腺素治疗肝硬化的近期疗效。 方法 肝硬化患者5例在保肝、利尿等综合治疗的同时,加用甲状腺素20 mg/d,连续1个月。随机选择同期住院的肝硬化腹水患者10例做对照进行比较。 结果 小量甲状腺素可以改善肝硬化患者的食欲,提高血清白蛋白和T_3,T_4水平,缩短腹水消退时间,而对TTT及ALT的变化无明显影响。 结论 小量甲状腺素可作为治疗肝硬化腹水的常规用药。     

Serum cystatin C level is a good prognostic marker in patients with cirrhotic ascites and normal serum creatinine levels

Background/Aims: Serum creatinine (Cr) is not a reliable marker for early detection of renal dysfunction in patients with cirrhotic ascites. Several reports have suggested that cystatin C (CysC) is more sensitive than Cr for detecting reduced renal function in these patients. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and a normal serum Cr level. Methods: We enrolled patients with ascites and a normal serum Cr level (<1.2 mg/dl). Liver function tests, international normalized ratio (INR) and serum Cr and CysC levels were measured on the same day for all patients. CysC levels were measured using the automated latex‐enhanced immunonephelometric method. The endpoint of follow‐up was the development of hepatorenal syndrome (HRS) or mortality. Results: Seventy‐eight patients with cirrhotic ascites were enrolled in the study (58 men and 30 women; age, 53±11 years). The underlying liver diseases in these patients were chronic hepatitis B (37%), chronic hepatitis C (4%), alcoholic liver disease (53%) and others (6%). Forty‐six (59%) and 32 (41%) patients were in Child–Pugh classes B and C respectively. HRS developed in 14 patients during the follow‐up period (349±241 days), with cumulative incidences of 10.2% and 20.4% at 6 and 12 months respectively. The CysC level was the only independent predictive factor for HRS. Twenty‐three patients died during the follow‐up period. CysC level and INR were independent factors for predicting mortality. Conclusion: Serum CysC level is a good marker for predicting HRS and survival in patients with cirrhotic ascites and a normal Cr level.     

消胀贴膏外敷对小鼠肝硬化腹水的消退作用及对腹腔血管通透性的影响

目的评价消胀贴膏外敷对实验性肝硬化腹水的药效作用,探讨其影响腹腔血管通透性的作用机制。方法以二甲基亚硝胺(DMN)腹腔注射,药效评价实验模型动物随机分为模型对照组、安慰剂对照组、消胀贴膏低、中、高剂量组共5组,机制实验分为模型对照组、消胀贴膏中剂量组共2组,均设正常对照组。消胀贴膏组脐部外敷消胀贴膏,安慰剂对照组脐部外敷空白贴膏,每日1贴,共7d,模型对照组不敷贴任何药物。称量或测量模型动物的腹水量、腹围、体重,HE与天狼星红染色观察肝组织炎症与纤维化,生化检测血清ALT活性和Alb、TBil与一氧化氮(NO)含量,蛋白质印迹法分析肝组织血管内皮生长因子(VEGF)表达水平,通过测定小鼠腹腔积液及肝组织中渗漏伊文氏蓝(EB)含量的方法检测动物腹腔血管通透性。结果敷药前,各组模型动物的腹围、体重等基线资料一致。给药结束,与正常组比较,模型对照组小鼠的体重、腹围、腹水、腹水体重比等明显增加,腹腔积液及肝组织中渗漏EB含量明显增多,血清NO浓度及肝组织中VEGF蛋白表达明显增加。与模型对照组比较,安慰剂对照组的腹水量、腹围与体重等无明显改变。与安慰剂对照组比较,消胀贴膏中、高剂量组的腹水量、腹水体重比值明显下降,高剂量组的腹围、体重也明显下降;高剂量组与低剂量组比较,腹围、体重明显下降。各剂量消胀贴膏对肝功能及肝组织病理均无明显影响。与模型对照组比较,中剂量消胀贴膏组小鼠腹腔积液中渗漏EB含量降低,血清NO浓度及肝组织中VEGF蛋白表达明显减少。结论消胀贴膏明显减少肝硬化腹水模型动物的腹水量,中剂量(0.25 cm2消胀贴膏,652.9 mg生药/kg小鼠)开始发挥药效,其部分机制在于下调肝硬化腹水模型动物的肝组织VEGF表达、降低血清NO含量,从而抑制其异常增强的腹腔血管通透性。     

Total therapeutic paracentesis (TTP) with and without intravenous albumin in the treatment of cirrhotic tense ascites: a randomized controlled trial

ABSTRACT— We studied 35 cirrhotic patients with tense ascites assigned at random into two groups: Group I consisted of 17 patients treated by total therapeutic paracentesis (TTP) (6–15 1) plus i.v. albumin (5 g/l of fluid) and Group II consisted of 18 patients treated by TTP (5.5–15.5 1) without albumin. On 19 patients we performed a sequential assessment of cardiac output (CO), plasma renin activity (PRA) and plasma aldosterone (PA). Both groups were similar in age, sex, and etiology of cirrhosis. CO, PRA and PA values were expressed as mean changes occurring in relation to their respective baseline values. CO changes after TTP (1/min): Group I: 2.5 after 6 h and 2.2 after 12 h; Group II: 2.2 after 6 h and –0.4 after 12 h, (p<0.05 comparing values after 12 h between the two groups). PRA changes after TTP (ng/dl/h): Group I: –7.4 after 1 h, –7.8 after 6 h and –3.2 after 24 h; Group II: –2.4 after 1 h, –0.8 after 6 h and 3.9 after 24 h (p<0.05 comparing values between both groups after 6 and 24 h). PA changes after TTP (ng/dl): Group I: –50.5 after 1 h, –36.7 after 6 h and –34.6 after 24 h; Group II: –18.2 after 1 h, –2.2 after 6 h and 20 after 24 h, (p < 0.05 comparing values between both groups after 1 and 6 h). Complications were minimal in both groups. In conclusion, there was an increase of CO and a decrease of PRA and PA in all patients early after TTP. However, after 6 h there was a decrease of CO and an increase of PRA and PA, suggesting hypovolemia, only in patients without albumin. The frequency of complications after 24 h was similar in both groups. Since we do not exclude the possibility of complications over a longer period of time, we recommend the use of plasma expanders until their impact on morbidity and mortality in the long term is well established. The best time to infuse them is about 6 h after the procedure.     

Natural history of hepatitis B virus-related cirrhotic patients hospitalized to control ascites

Background and Aim: Few studies have assessed the natural history of hepatitis B virus (HBV)–related cirrhotic ascites. We investigated the natural history of patients with HBV‐related cirrhotic ascites hospitalized to control ascites and determined their prognosis, including survival rates and prognostic factors affecting survival. Methods: Between January 1996 and December 2005, 203 consecutive patients with HBV‐related cirrhotic ascites were followed for a median of 80.7 months (range, 15–149) after their first significant ascitic decompensation that required hospitalization. Results: The mean age of all patients was 52.6 years. Male gender predominated (male/female, 138/65). A subgroup analysis of 165 patients who had ascitic decompensation as their first episode of hepatic decompensation revealed that gastrointestinal variceal bleeding developed after a median interval of 8 months following ascitic decompensation in 31 (18.8%) patients, hepatic encephalopathy occurred at 9 months in 53 (32.1%), spontaneous bacterial peritonitis appeared at 12.7 months in 24 (14.5%), hepatorenal syndrome occurred at 8.1 months in five (3%), and hepatocellular carcinoma was observed at 21.2 months in 10 (6.1%). The overall median survival was 12.4 months. The 1‐ and 3‐year survival rates were 50.7 and 18.7%. The prognostic factors that independently correlated with survival at the time of ascitic decompensation were Child–Pugh classification B/C (P = 0.030), serum white blood cell (WBC; P = 0.035), serum creatinine (Cr; P = 0.039), serum sodium (Na; P = 0.010), and antiviral therapy (P = 0.040). Conclusions: The prognosis of HBV‐related cirrhotic patients with ascitic decompensation is poor. Child–Pugh class, serum WBC/Cr/Na, and antiviral therapy primarily influenced survival.     

恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水的效果观察

目的观察恩替卡韦与前列地尔联合治疗乙型肝炎肝硬化腹水的临床疗效。方法选取2012年5月-2014年2月德州市中医院收治的乙型肝炎肝硬化腹水患者100例,随机分为治疗组与对照组,每组各50例,两组均常规给予保肝、利尿、间断补充白蛋白(Alb)治疗,其中治疗组加用恩替卡韦0.5 mg口服,1次/d,联合前列地尔20μg+5%葡萄糖注射液100 ml静滴,1次/d,观察组只加用恩替卡韦0.5 mg口服,1次/d。住院治疗4周,观察两组治疗前后腹水消退情况、ALT、TBil、Alb、血液尿素氮(BUN)、肌酐(Cr)、凝血酶原活动度(PTA)、HBV DNA水平变化。出院后两组患者继续口服恩替卡韦0.5 mg,1次/d,随访3个月观察远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者治疗后腹水量较治疗前均有不同程度降低,治疗组总有效率(84%)高于对照组(64%),差异有统计学意义(χ2=6.018,P0.05);两组患者肝肾功能各项指标(ALT、TBil、Alb、BUN、Cr)及PTA治疗后较治疗前均有不同程度改善,且治疗组疗效优于对照组,两组治疗后各项指标相比差异均有统计学意义(t值分别为7.567、6.875、-4.782、6.786、8.542、8.976,P值均0.01);两组患者治疗后HBV DNA水平均较治疗前有不同程度下降,差异均有统计学意义(t值分别为8.976、5.758,P值均0.01)),但两组间治疗后比较差异无统计学意义(P0.05);患者出院后随访3个月,治疗组在肝肾功能稳定、腹水反复方面优于对照组。结论恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水疗效确切,远期疗效较好,值得临床应用与推广;恩替卡韦单用对肾功能改善不明显,但肝功能可获得明显改善。     

Measurements of total body and extracellular water in cirrhotic patients with and without ascites

Using H2[18O] tracer isotope dilution and corrected bromide space as standard reference techniques, we determined total body water and extracellular water in cirrhotic patients with (four men and four women) and without (seven men and six women) ascites and compared them with a normal control group (eight men and six women). These results were then compared with calculations of total body and extracellular water determined by the bioelectrical impedance analysis technique. According to H2[18(O)] dilution, total body water was similar in cirrhotic patients without ascites and in controls (60.8% +/- 2.1% vs. 60.3% +/- 1.4% body wt), but was increased in patients with ascites (69.7% +/- 1.2% body wt; p less than 0.002). Correlation was excellent between the H2[18(O)] dilution and bioelectrical impedance measurements of total body water in controls and cirrhotic patients without ascites (r = 0.98; p less than 0.0001). However, this correlation was poor in cirrhotic patients with ascites (r = 0.17; not significant). According to the bromide space, extracellular water (expressed as a percentage of total body water) was increased in cirrhotic patients with (57.8% +/- 1.8%; p less than 0.001) and without (44.0% +/- 1.2%; p less than 0.001) ascites compared with controls (36.6% +/- 1.0%). A poor correlation (r = 0.41; p less than 0.13) was seen for extracellular water measurements between the bromide space method and the bioelectrical impedance method, which failed to detect the differences among the three groups observed with the bromide space technique. Furthermore, bioelectrical impedance failed to detect any change in total body or extracellular water after paracentesis, with a degree of inaccuracy that increased linearly as the amount of ascitic fluid removed increased (r = 0.97; p less than 0.001). All these intergroup comparisons remained the same, whether the analysis was of both men and women combined or for each gender individually. However, we saw differences between men and women in the control group and cirrhotic group without ascites. These results demonstrate that abnormalities in water homeostasis and compartmentalization between intracellular (the difference between total body and extracellular water fluid) and extracellular water may exist in cirrhosis whether or not fluid accumulation is clinically evident. These data further indicate that alterations in the metabolically active body cell mass (as represented by intracellular water) in cirrhosis may occur independently of total body water and calculated fat-free body mass. In addition, gender is an important variable to control for in studies of this type.(ABSTRACT TRUNCATED AT 400 WORDS)