人血白蛋白在终末期肝病中的应用

杨橹; 熊晔; 黄建荣

doi:10.3969/j.issn.1001-5256.2022.04.040

人血白蛋白在终末期肝病中的应用

DOI: 10.3969/j.issn.1001-5256.2022.04.040

浙江大学医学院附属第一医院传染病诊治国家重点实验室感染性疾病诊治协同中心，杭州 310003

基金项目:

国家科技重大专项 (2017ZX10203201)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：杨橹负责撰写文章，资料收集；熊晔负责资料收集，文章修改；黄建荣负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
黄建荣，hzhuangchina@zju.edu.cn

计量
- 文章访问数: 957
- HTML全文浏览量: 365
- PDF下载量: 92
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-08
- 录用日期: 2021-09-14
- 出版日期: 2022-04-20

Application of human serum albumin in the management of end-stage liver disease

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China

Research funding:

National Science and Technology Major Project (2017ZX10203201)

More Information

Corresponding author: HUANG Jianrong, hzhuangchina@zju.edu.cn(ORCID: 0000-0002-7431-2061)

摘要

摘要: 白蛋白是人体血浆中含量最高的蛋白质，其胶体功能及非胶体功能对于机体具有多方面调节作用。终末期肝病患者体内因白蛋白合成减少、丢失、功能异常而导致的病情恶化及相关并发症在使用人血白蛋白治疗后大多可获得一定程度的缓解，甚至好转。本文结合近期国内外的研究，探讨了人血白蛋白在终末期肝病中的应用及临床疗效，提出有效白蛋白含量监测有可能成为终末期肝病预后及治疗的新指标。
- 血清白蛋白 /
- 终末期肝病 /
- 治疗学
Abstract: Albumin is the most abundant protein in human plasma, and its oncotic and non-oncotic functions can regulate various functions in human body. In patients with end-stage liver disease, the deterioration of disease conditions and related complications caused by the reduction, loss, and abnormal function of albumin can be alleviated or even improved to some extent after the treatment with human serum albumin. This article reviews recent clinical studies in China and foreign countries, discusses the application and clinical effect of human serum albumin in end-stage liver disease, and points out that effective monitoring of albumin content may become a new indicator for the prognosis and treatment of end-stage liver disease.
- Serum Albumin /
- End Stage Liver Disease /
- Therapeutics

HTML全文

参考文献(38)

[1]	Chinese Society of Infectious Diseases, Chinese Medical Association. Expert consensus on diagnosis and treatment of end-stage liver disease complicated with infections[J]. J Clin Hepatol, 2018, 34(9): 1862-1872. DOI: 10.3969/j.issn.1001-5256.2018.09.008. 中华医学会感染病学分会. 终末期肝病合并感染诊治专家共识[J]. 临床肝胆病杂志, 2018, 34(9): 1862-1872. DOI: 10.3969/j.issn.1001-5256.2018.09.008.
[2]	ZHANG W, ZHANG YX, JI ZS, et al. Clinical application analysis of human albumin during perioperative period of liver transplantation patients[J]. Clin Med J, 2020, 18(1): 21-24. DOI: 10.3969/j.issn.1672-3384.2020.01.006. 张维, 张雅鑫, 冀召帅, 等. 肝移植患者围手术期人血白蛋白临床应用分析[J]. 临床药物治疗杂志, 2020, 18(1): 21-24. DOI: 10.3969/j.issn.1672-3384.2020.01.006.
[3]	ARROYO V, GARCÍA-MARTINEZ R, SALVATELLA X. Human serum albumin, systemic inflammation, and cirrhosis[J]. J Hepatol, 2014, 61(2): 396-407. DOI: 10.1016/j.jhep.2014.04.012.
[4]	JAGDISH RK, MARAS JS, SARIN SK. Albumin in advanced liver diseases: The good and bad of a drug![J]. Hepatology, 2021, 74(5): 2848-2862. DOI: 10.1002/hep.31836.
[5]	CHINA L, MAINI A, SKENE SS, et al. Albumin counteracts immune-suppressive effects of lipid mediators in patients with advanced liver disease[J]. Clin Gastroenterol Hepatol, 2018, 16(5): 738-747. e7. DOI: 10.1016/j.cgh.2017.08.027.
[6]	BAI Z, BERNARDI M, YOSHIDA EM, et al. Albumin infusion may decrease the incidence and severity of overt hepatic encephalopathy in liver cirrhosis[J]. Aging (Albany NY), 2019, 11(19): 8502-8525. DOI: 10.18632/aging.102335.
[7]	KREMER H, BARON-MENGUY C, TESSE A, et al. Human serum albumin improves endothelial dysfunction and survival during experimental endotoxemia: Concentration-dependent properties[J]. Crit Care Med, 2011, 39(6): 1414-1422. DOI: 10.1097/CCM.0b013e318211ff6e.
[8]	HARIRI G, JOFFRE J, DERYCKERE S, et al. Albumin infusion improves endothelial function in septic shock patients: A pilot study[J]. Intensive Care Med, 2018, 44(5): 669-671. DOI: 10.1007/s00134-018-5075-2.
[9]	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.
[10]	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.
[11]	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.
[12]	AITHAL GP, PALANIYAPPAN N, CHINA L, et al. Guidelines on the management of ascites in cirrhosis[J]. Gut, 2021, 70(1): 9-29. DOI: 10.1136/gutjnl-2020-321790.
[13]	Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis Chinese Society of Hepatology[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003. 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
[14]	European Association for the Study of the Liver. 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.
[15]	ARORA V, VIJAYARAGHAVAN R, MAIWALL R, et al. Paracentesis-induced circulatory dysfunction with modest-volume paracentesis is partly ameliorated by albumin infusion in acute-on-chronic liver failure[J]. Hepatology, 2020, 72(3): 1043-1055. DOI: 10.1002/hep.31071.
[16]	ALESSANDRIA C, ELIA C, MEZZABOTTA L, et al. Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: Standard vs half albumin doses. A prospective, randomized, unblinded pilot study[J]. Dig Liver Dis, 2011, 43(11): 881-886. DOI: 10.1016/j.dld.2011.06.001.
[17]	HUANG CH, LIN CY, SHEEN IS, et al. Recurrence of spontaneous bacterial peritonitis in cirrhotic patients non-prophylactically treated with norfloxacin: Serum albumin as an easy but reliable predictive factor[J]. Liver Int, 2011, 31(2): 184-191. DOI: 10.1111/j.1478-3231.2010.02377.x.
[18]	THÉVENOT T, BUREAU C, OBERTI F, et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial[J]. J Hepatol, 2015, 62(4): 822-830. DOI: 10.1016/j.jhep.2014.11.017.
[19]	AFINOGENOVA Y, TAPPER EB. The efficacy and safety profile of albumin administration for patients with cirrhosis at high risk of hepatorenal syndrome is dose dependent[J]. Gastroenterol Rep (Oxf), 2015, 3(3): 216-221. DOI: 10.1093/gastro/gov032.
[20]	European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J]. J Hepatol, 2010, 53(3): 397-417. DOI: 10.1016/j.jhep.2010.05.004.
[21]	BAJAJ JS, TANDON P, O'LEARY JG, et al. The impact of albumin use on resolution of hyponatremia in hospitalized patients with cirrhosis[J]. Am J Gastroenterol, 2018, 113(9): 1339. DOI: 10.1038/s41395-018-0119-3.
[22]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007. 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.
[23]	BAI Z, GUO X, TACKE F, et al. Association of serum albumin level with incidence and mortality of overt hepatic encephalopathy in cirrhosis during hospitalization[J]. Therap Adv Gastroenterol, 2019, 12: 1756284819881302. DOI: 10.1177/1756284819881302.
[24]	SHARMA BC, SINGH J, SRIVASTAVA S, et al. Randomized controlled trial comparing lactulose plus albumin versus lactulose alone for treatment of hepatic encephalopathy[J]. J Gastroenterol Hepatol, 2017, 32(6): 1234-1239. DOI: 10.1111/jgh.13666.
[25]	BOSSEN L, GINÈS P, VILSTRUP H, et al. Serum sodium as a risk factor for hepatic encephalopathy in patients with cirrhosis and ascites[J]. J Gastroenterol Hepatol, 2019, 34(5): 914-920. DOI: 10.1111/jgh.14558.
[26]	XUE X, YUAN L, LI RX, et al. The influence of human serum albumin and hydroxyethyl starch on pulmonary complications in the early stage after liver transplantation[J/CD]. Chin J Transplant(Electronic Edition), 2016, 10(4): 169-173. DOI: 10.3877/cma.j.issn.1674-3903.2016.04.005. 薛欣, 袁莉, 李如霞, 等. 人血白蛋白和羟乙基淀粉对肝移植术后早期肺部并发症的影响[J/CD]. 中华移植杂志(电子版), 2016, 10(4): 169-173. DOI: 10.3877/cma.j.issn.1674-3903.2016.04.005.
[27]	ERTMER C, KAMPMEIER TG, VOLKERT T, et al. Impact of human albumin infusion on organ function in orthotopic liver transplantation—a retrospective matched-pair analysis[J]. Clin Transplant, 2015, 29(1): 67-75. DOI: 10.1111/ctr.12486.
[28]	TRULL A, HUGHES V, COOPER D, et al. Influence of albumin supplementation on tacrolimus and cyclosporine therapy early after liver transplantation[J]. Liver Transpl, 2002, 8(3): 224-232. DOI: 10.1053/jlts.2002.31347.
[29]	SHEN Y, DING F. The development and prospects of artificial liver support system[J]. Shanghai Med Pharm J, 2018, 39(9): 20-24. DOI: 10.3969/j.issn.1006-1533.2018.09.006. 沈玥, 丁峰. 人工肝支持系统的发展与前景[J]. 上海医药, 2018, 39(9): 20-24. DOI: 10.3969/j.issn.1006-1533.2018.09.006.
[30]	CHEN Q, ZHOU CY, XI MX, et al. Application value of albumin in plasma exchange treatment of patients with drug-induced liver failure[J]. China J Pharm Eco, 2021, 16(4): 34-37. DOI: 10.12010/j.issn.1673-5846.2021.04.006. 陈琼, 周朝阳, 席明霞, 等. 白蛋白在药物性肝衰竭患者血浆置换治疗中的应用价值[J]. 中国药物经济学, 2021, 16(4): 34-37. DOI: 10.12010/j.issn.1673-5846.2021.04.006.
[31]	ZHANG XF, DENG QZ, PANG ZQ, et al. Evaluation of effectiveness and safety of application of 5% albumin on artificial liver selective plasma exchange treatment[J]. China Modern Doctor, 2016, 54(13): 27-30, 35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201613008.htm 张行芬, 邓勤智, 庞中强, 等. 5%白蛋白用于人工肝选择性血浆置换治疗的有效性和安全性评价[J]. 中国现代医生, 2016, 54(13): 27-30, 35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201613008.htm
[32]	HE GL, FENG L, DUAN CY, et al. Meta-analysis of survival with the molecular adsorbent recirculating system for liver failure[J]. Int J Clin Exp Med, 2015, 8(10): 17046-17054.
[33]	BAÑARES R, IBÁÑEZ-SAMANIEGO L, TORNER JM, et al. Meta- analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: Focus on treatment intensity[J]. Therap Adv Gastroenterol, 2019, 12: 1756284819879565. DOI: 10.1177/1756284819879565.
[34]	WALLON G, GUTH C, GUICHON C, et al. Extracorporeal albumin dialysis in liver failure with MARS and SPAD: A randomized crossover trial[J]. Blood Purif, 2022, 51(3): 243-250. DOI: 10.1159/000515825.
[35]	BALDASSARRE M, NALDI M, ZACCHERINI G, et al. Determination of effective albumin in patients with decompensated cirrhosis: Clinical and prognostic implications[J]. Hepatology, 2021, 74(4): 2058-2073. DOI: 10.1002/hep.31798.
[36]	CLÀRIA J, STAUBER RE, COENRAAD MJ, et al. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure[J]. Hepatology, 2016, 64(4): 1249-1264. DOI: 10.1002/hep.28740.
[37]	GIANNONE FA, DOMENICALI M, BALDASSARRE M, et al. Ischaemia-modified albumin: A marker of bacterial infection in hospitalized patients with cirrhosis[J]. Liver Int, 2015, 35(11): 2425-2432. DOI: 10.1111/liv.12860.
[38]	XIAO LL, ZHANG F, ZHAO YL, et al. Using advanced oxidation protein products and ischaemia-modified albumin to monitor oxidative stress levels in patients with drug-induced liver injury[J]. Sci Rep, 2020, 10(1): 18128. DOI: 10.1038/s41598-020-75141-2.