白蛋白在肝硬化及其并发症中的临床应用

Clinical applications of albumin in the management of cirrhosis and its complications

白蛋白是血液中最为丰富的蛋白,维持着血浆胶体70%~80%的渗透压。白蛋白复杂的三级结构决定了其除了血浆扩容的渗透性作用之外,还有结合和运输许多疏水性内源性分子和外源性分子的作用,对活性氧、活性氮类的抗氧化作用,调节免疫和炎症反应以及维护微循环功能完整性的非渗透性生理功能。目前国内临床应用人血白蛋白可能存在使用不规范及不合理用药的情况。本文对现有的循证医学证据进行检索、收集、评价,明确了人血白蛋白在肝硬化及其并发症中发挥的治疗作用,包括用于治疗肝硬化腹水、预防自发性细菌性腹膜炎、预防腹腔穿刺大量放液之后的循环功能障碍,以及提高肝肾综合征患者的生存率。从输注血液制品的安全性、资源获得的有限性以及药品的经济性方面综合考虑,有必要规范人血白蛋白的合理应用,避免医疗资源的浪费。

Albumin is the most abundant circulating protein and accounts for about 70%~80% of the plasma colloid osmotic pressure. Albumin has a complex structure, which accounts for a variety of non-oncotic functions, such as binding and transport of many hydrophobic endogenous and exogenous molecules, scavenging and detoxification of reactive oxygen and nitrogen species, modulation of the immune and inflammatory responses and preservation of the functional integrity of the microcirculation. However, the curative effect of human albumin（HA） is overhyped and a large proportion of HA prescriptions is inappropriate. Abundant evidence-based clinical studies were searched, collected and evaluated, which clarified the role of HA in the treatment or prevention of severe complications of cirrhosis, such as ascites, renal failure induced byspontaneous bacterial peritonitis, prevention of post-paracentesis circulatory dysfunction after largevolume paracentesis and the treatment of hepatorenal syndrome in association with vasoconstrictors. In consideration of the safety of blood products transfusion, resource limitation and drug economy, it is necessary to standardize the application of HA.