복수를 동반한 간경변증에서 뇌혈류저항의 증가

Background/Aims : Portal hypertension in cirrhosis is associated with a hyperdynamic circulation, which is characterized by hypervolemia, high cardiac output, arterial hypotension and low peripheral vascular resistance. These circulatory abnormalities are thought to be secondary to a splanchnic arteriolar vasodilation related to the increase in portal pressure. Studies assessing regional hemodynamics in patients of cirrhosis with ascites have shown vasoconstriction in the renal circulation and in peripheral vascular territory. This study was designed to assess the cerebral vascular resistance in cirrhotic patients with ascites. Methods : The resistive index in the middle cerebral artery and in a renal interlobar artery were measured by Doppler ultrasonography in 12 cirrhotic subjects without ascites, 23 cirrhotic subjects with ascites, and 8 healthy subjects. The arterial blood pressure and plasma renin and norepinephrine concentration, which reflect the activity of the renin-angiotensin and sympathetic nervous systems respectively, were also measured. Results : The resistive index in the middle cerebral artery were significantly higher in cirrhotic patients with ascites (0.58 0.04, mean standard deviation) than in cirrhotic patients without ascites (0.53 0.02, P