肝硬化腹水患者长期应用白蛋白治疗的现状与前景

田玉; 洪佳; 王冰琼; 尤红

doi:10.3969/j.issn.1001-5256.2021.01.037

肝硬化腹水患者长期应用白蛋白治疗的现状与前景

DOI: 10.3969/j.issn.1001-5256.2021.01.037

首都医科大学附属北京友谊医院肝病中心，国家消化系统疾病临床医学研究中心，北京 100050

基金项目:

国家科技重大专项课题 (2018ZX10302204);

国家科技重大专项课题 (2018ZX09201016)

作者贡献声明：田玉负责撰写论文；洪佳、王冰琼负责修改论文；尤红负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
田玉(1994—)，女，主要从事肝硬化失代偿相关研究

通信作者:
尤红，youhong30@sina.com

中图分类号: R575.2
计量
- 文章访问数: 1399
- HTML全文浏览量: 725
- PDF下载量: 143
- 被引次数: 0
出版历程
- 收稿日期: 2020-07-03
- 录用日期: 2020-07-28
- 出版日期: 2021-01-20

Current status and prospects of long-term albumin treatment in patients with cirrhotic ascites

Liver Research Center, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing 100050, China

摘要

摘要: 目前，白蛋白在肝硬化腹水患者中的应用主要是预防腹腔穿刺术后循环功能障碍、预防自发性腹膜炎患者肾功能障碍和治疗肝肾综合征。近期研究发现，长期白蛋白治疗能够降低肝硬化腹水患者并发症的发生率并改善整体预后，由此带来对白蛋白临床应用指征新的思考。结合目前已开展的肝硬化腹水患者中长期应用白蛋白的临床研究进行阐述，旨在为国内开展长期白蛋白应用临床研究提供循证依据。
- 肝硬化 /
- 腹水 /
- 血清白蛋白
Abstract: At present, albumin is mainly used to prevent post-paracentesis circulatory dysfunction in patients with cirrhotic ascites, prevent renal dysfunction in patients with spontaneous peritonitis, and treat hepatorenal syndrome. Recent studies have shown that long-term albumin treatment can reduce the incidence rate of complications and improve overall prognosis in patients with cirrhotic ascites, which brings new insights into the indication for clinical application of albumin. This article reviews the clinical studies on the long-term administration of albumin in patients with cirrhotic ascites, aiming to provide evidence-based advice for further clinical research on long-term application of albumin in China.
- Liver Cirrhosis /
- Ascites /
- Serum Albumin

HTML全文

参考文献(24)

[1]	CARACENI P, RIGGIO O, ANGELI P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): An open-label randomised trial[J]. Lancet, 2018, 391(10138): 2417-2429. DOI: 10.1016/S0140-6736(18)30840-7
[2]	di PASCOLI M, FASOLATO S, PIANO S, et al. Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites[J]. Liver Int, 2019, 39(1): 98-105. DOI: 10.1111/liv.13968
[3]	ANGELI P, BERNARDI M, VILLANUEVA C, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024
[4]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.11.006 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006
[5]	CARACENI P, ANGELI P, PRATI D, et al. AISF-SIMTI position paper: The appropriate use of albumin in patients with liver cirrhosis[J]. Blood Transfus, 2016, 14(1): 8-22. http://europepmc.org/abstract/PMC/PMC4731339;jsessionid=pt8jgEa27FCZKCJW0WgK.0
[6]	BERNARDI M, MOREAU R, ANGELI P, et al. Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis[J]. J Hepatol, 2015, 63(5): 1272-1284. DOI: 10.1016/j.jhep.2015.07.004
[7]	BERNARDI M, CARACENI P. Novel perspectives in the management of decompensated cirrhosis[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(12): 753-764. DOI: 10.1038/s41575-018-0045-2
[8]	GENTILINI P, CASINI-RAGGI V, DI FIORE G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: Results of a randomized, controlled trial[J]. J Hepatol, 1999, 30(4): 639-645. DOI: 10.1016/S0168-8278(99)80194-9
[9]	ROMANELLI RG, LA VILLA G, BARLETTA G, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial[J]. World J Gastroenterol, 2006, 12(9): 1403-1407. DOI: 10.3748/wjg.v12.i9.1403
[10]	GARCIA-TSAO G. Long-term albumin in cirrhosis: Is it the ANSWER?[J]. Lancet, 2018, 391(10138): 2391-2392. DOI: 10.1016/S0140-6736(18)30948-6
[11]	BORTOLUZZI A, CEOLOTTO G, GOLA E, et al. Positive cardiac inotropic effect of albumin infusion in rodents with cirrhosis and ascites: Molecular mechanisms[J]. Hepatology, 2013, 57(1): 266-276. DOI: 10.1002/hep.26021
[12]	FERNÁNDEZ J, MONTEAGUDO J, BARGALLO X, et al. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis[J]. Hepatology, 2005, 42(3): 627-634. DOI: 10.1002/hep.20829
[13]	O'BRIEN AJ, FULLERTON JN, MASSEY KA, et al. Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2[J]. Nat Med, 2014, 20(5): 518-523. DOI: 10.1038/nm.3516
[14]	FERNÁNDEZ J, CLÀRIA J, AMORÓS A, et al. Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis[J]. Gastroenterology, 2019, 157(1): 149-162. DOI: 10.1053/j.gastro.2019.03.021
[15]	JVRGENS G, MVLLER M, GARIDEL P, et al. Investigation into the interaction of recombinant human serum albumin with re-lipopolysaccharide and lipid A[J]. J Endotoxin Res, 2002, 8(2): 115-126. DOI: 10.1177/09680519020080020501
[16]	DAVID SA, BALARAM P, MATHAN VI. Characterization of the interaction of lipid A and lipopolysaccharide with human serum albumin: Implications for an endotoxin carrier function for albumin[J]. Innate Immunity, 1995, 2(2): 99-106. http://ini.sagepub.com/content/2/2/99.abstract
[17]	FUKUI H. Relation of endotoxin, endotoxin binding proteins and macrophages to severe alcoholic liver injury and multiple organ failure[J]. Alcohol Clin Exp Res, 2005, 29(11 Suppl): 172S-179S. http://europepmc.org/abstract/MED/16344605
[18]	DZIARSKI R. Cell-bound albumin is the 70-kDa peptidoglycan-, lipopolysaccharide-, and lipoteichoic acid-binding protein on lymphocytes and macrophages[J]. J Biol Chem, 1994, 269(32): 20431-20436. http://www.ncbi.nlm.nih.gov/pubmed/8051139?dopt=Abstract
[19]	SOLÀ E, SOLÉ C, SIMÓN-TALERO M, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation. A randomized placebo-controlled trial[J]. J Hepatol, 2018, 69(6): 1250-1259. DOI: 10.1016/j.jhep.2018.08.006
[20]	BERNARDI M, ANGELI P, CLARIA J, et al. Albumin in decompensated cirrhosis: New concepts and perspectives[J]. Gut, 2020, 69(6): 1127-1138. DOI: 10.1136/gutjnl-2019-318843
[21]	EVANS TW. Review article: Albumin as a drug—biological effects of albumin unrelated to oncotic pressure[J]. Aliment Pharmacol Ther, 2002, 16(Suppl) 5: 6-11.
[22]	GARCIA-MARTINEZ R, CARACENI P, BERNARDI M, et al. Albumin: Pathophysiologic basis of its role in the treatment of cirrhosis and its complications[J]. Hepatology, 2013, 58(5): 1836-1846. DOI: 10.1002/hep.26338
[23]	CARACENI P, RIGGIO O, ANGELI P, et al. Serum albumin concentration as guide for long-term albumin treatment in patients with cirrhosis and uncomplicated ascites: Lessons from the ANSWER study[J]. J Hepatol, 2019, 70(1): e53. http://www.sciencedirect.com/science/article/pii/S0618827819300957
[24]	LI HB, MEN P, WANG Y, et al. Experts consensus on rapid advice guidelines for the pharmacological management of human albumin in patients with liver cirrhosis[J]. J Clin Med, 2018, 16(12): 10-16. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-LCYW201812003.htm 李慧博, 门鹏, 王宇, 等. 《人血白蛋白用于肝硬化治疗的快速建议指南》解读[J]. 临床药物治疗杂志, 2018, 16(12): 10-16. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYW201812003.htm