白蛋白治疗肝硬化患者中的作用

StephenW

December 9, 2013
The Role of Albumin in Treating Patients with Cirrhosis
Atif Zaman, MD, MPH reviewing Garcia-Martinez R et al. Hepatology 2013 Nov.

As its multiple biologic functions become clearer, its therapeutic indications in liver disease continue to expand.

Intravenous albumin has historically been used as a plasma volume expander. In the current review, the authors summarize other potential roles of albumin, including those of antioxidant and immunomodulator, particularly within the scope of treating patients with cirrhosis.

Because of its capacity to bind a wide variety of molecules, albumin plays critical roles in solubilization, transport, and metabolism. In addition, albumin is the source of 80% of the extracellular thiols, which actively scavenge oxidative and nitrosative reactive species, making albumin the most important of the extracellular antioxidants. Its immunomodulatory properties seem to stem from its capacity to bind endotoxins, lower endotoxin activity, and inhibit tumor necrosis factor–α and nuclear factor–κβ. Albumin may also affect hemostasis by impacting platelet aggregation and influence capillary permeability by interacting with the extracellular matrix.

Well-established indications for intravenous albumin include the following:

    Spontaneous bacterial peritonitis: Its addition to antibiotics reduces the incidence of renal failure and improves survival.

    Hepatorenal syndrome: When added to vasoconstrictors, it decreases mortality.

    Paracentesis-induced circulatory dysfunction: Albumin infusion is effective at preventing this syndrome.

Potential uses of albumin that have not yet been fully evaluated include treating severe hepatic encephalopathy and any infection in patients with cirrhosis.
Comment

This excellent review underscores that albumin is more than just a volume expander. Due to its numerous biologic functions, it has therapeutic value for many indications, particularly spontaneous bacterial peritonitis, hepatorenal syndrome, and prevention of paracentesis-induced circulatory dysfunction, conditions for which the evidence is strongest.
Editor Disclosures at Time of Publication
Citation(s):

    Garcia-Martinez R et al. Albumin: Pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology 2013 Nov; 58:1836. (http://dx.doi.org/10.1002/hep.26338)

- See more at: http://www.jwatch.org/na33008/20 ... thash.aKna7SXB.dpuf

StephenW

2013年12月9日
白蛋白治疗肝硬化患者中的作用
与Atif扎曼，医学博士，公共卫生审查加西亚 - 马丁内斯R等。肝脏病学2013十一月

由于其多种生物学功能变得更加清晰，其治疗适应症肝病继续扩大。

静脉注射白蛋白历来被用作血浆容量扩张。在目前的审查，笔者总结其他潜在白蛋白的角色，包括那些抗氧化和免疫调节剂，特别是治疗肝硬化患者的范围内。

因为其结合各种分子的能力，白蛋白起着增溶，运输和代谢至关重要的作用。此外，白蛋白是80％的胞外硫醇，其积极地清除氧化和亚硝化反应性物质，使白蛋白的最重要的细胞外抗氧化剂的来源。它的免疫调节特性似乎从它的能力，以阻止结合内毒素，降低内毒素的活性，抑制肿瘤坏死因子-α及核因子- κβ 。白蛋白也可通过与胞外基质相互作用的影响血小板聚集和影响毛细血管通透性影响止血。

完善的适应症静脉白蛋白包括以下内容：

    自发性细菌性腹膜炎：它除了可减少抗生素的肾功能衰竭的发生率，提高生存率。

    肝肾综合征：当添加到血管收缩剂，它降低死亡率。

    放腹水引起的循环功能障碍：白蛋白输液预防此综合征有效。

白蛋白的潜在用途尚未得到充分评估，包括治疗重度肝性脑病及任何感染的肝硬化患者。
评论

这个优秀的评论强调，白蛋白是不仅仅是一个容量扩充。由于其众多的生物学功能，它有许多迹象表明，特别是自发性细菌性腹膜炎，肝肾综合征，以及预防腹腔穿刺引起的循环功能障碍，条件，其证据是最强的治疗价值。
在出版时编辑披露
引用（S ） ：

    加西亚 - 马丁内斯R等。白蛋白：其于肝硬化及其并发症的治疗作用病理生理基础。肝脏病学2013月; 58:1836 。 （ http://dx.doi.org/10.1002/hep.26338 ）

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