肝硬化腹水患者的长期白蛋白治疗

StephenW

肝硬化腹水患者的长期白蛋白治疗

    保罗·卡拉塞尼 †
    阿拉斯泰尔奥布莱恩†
    佩雷·吉尼斯 †
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DOI：https://doi.org/10.1016/j.jhep.2022.03.005

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概括
虽然几十年前首次提出，但长期人白蛋白对治疗肝硬化腹水患者有效的可能性已成为过去十年科学和临床讨论的话题。与白蛋白的急性或短期使用相比，长期白蛋白给药代表了完全不同的治疗观点。 ANSWER 和 MACHT 研究的结果表明，长期白蛋白治疗可以是有效、安全的，并且能够改变疾病的进程，前提是白蛋白以足够的剂量和足够的时间给予，以恢复生理水平和功能。在失代偿期肝硬化患者中，循环分子至少部分受损。需要进一步的临床研究和随机试验来证实长期白蛋白治疗的临床益处。进一步研究的重要领域包括确定精确的目标人群、反应的生物标志物、白蛋白输注的最佳剂量和频率、停止规则以及世界各地不同医疗保健系统的治疗成本效益，特别是在那些与定期静脉输液相关的后勤问题和成本可能是在临床实践中实施这种创新方法的重要限制。在这篇综述中，我们将对长期白蛋白治疗的现有数据进行批判性分析，重点关注研究之间存在的差异、有争议的问题和未来的前景。
关键词

    失代偿期肝硬化
    腹水
    长期白蛋白治疗
    改变疾病的干预
    有效白蛋白浓度

StephenW

Long-term albumin treatment in patients with cirrhosis and ascites

    Paolo Caraceni †
    Alastair O’Brien †
    Pere Gines †
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DOI:https://doi.org/10.1016/j.jhep.2022.03.005

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Summary
Although proposed for the first time several decades ago, the possibility that long-term human albumin could be effective for the treatment of patients with cirrhosis and ascites has become a topic of scientific and clinical discussion in the last decade. Long-term albumin administration represents a completely different treatment perspective compared to acute or short-term uses of albumin. Results from the ANSWER and the MACHT studies indicate that long-term albumin treatment can be effective, safe and able to modify the course of the disease provided that albumin is given at a sufficient dose and for a sufficient time to restore physiological levels and functions of the circulating molecule, which are compromised, at least partially, in patients with decompensated cirrhosis. Further clinical studies and randomised trials are warranted to confirm the clinical benefits of long-term albumin therapy. Important areas for further research include determining the precise target population, the biomarkers of response, the optimal dose and frequency of albumin infusions, the stopping rules, and the cost-effectiveness of treatment in different healthcare systems across the world, particularly in those where the logistical issues and costs related to the periodic intravenous infusions may represent an important limitation to the implementation of this innovative approach in clinical practice. In this review, we will critically analyse the available data on long-term albumin treatment, focusing on the differences that exist between studies, the controversial issues and the future perspectives.
Keywords

    decompensated cirrhosis
    ascites
    long-term albumin treatment
    disease-modifying intervention
    effective albumin concentration

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