关于白蛋白治疗肝硬化的争议。

IF 12.9 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Pub Date : 2025-01-01 Epub Date: 2023-08-07 DOI:10.1097/HEP.0000000000000521
Jonel Trebicka, Guadalupe Garcia-Tsao
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引用次数: 0

摘要

白蛋白是人体内最丰富的蛋白质,完全由肝脏合成。因此,急性和/或慢性肝病患者血清白蛋白水平降低。在肝硬化中,低水平的白蛋白可以预测预后。在晚期肝硬化中,由于高氧化应激和促炎状态,白蛋白的质量下降。因此,静脉注射白蛋白似乎具有病理生理学相关性和益处。然而,仍然存在的问题是谁,何时,多少,以及多久。虽然在大容量穿刺后推荐白蛋白输注,但在诊断自发性细菌性腹膜炎、急性肾损伤和肝肾综合征时,白蛋白的输注量和时间表需要改进,特别是考虑到与容量过载相关的并发症越来越明显。白蛋白的其他适应症,如自发性细菌性腹膜炎以外的感染、低钠血症、HE、住院和肝硬化门诊患者预后不良的预防,仍存在争议。在这些环境下的研究结果要么是否定的,要么是有争议的,要么是不确定的。这使人们对白蛋白作为“一刀切”策略的使用产生了一些怀疑。适应症和患者选择是至关重要的,并不总是直观的。数量和频率似乎也在白蛋白的成功或失败中起作用。本综述将批判性地讨论证据,并强调有白蛋白适应症的领域和证据仍然不足的其他领域,必须等待随机对照试验的发展/结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Controversies regarding albumin therapy in cirrhosis.

Albumin is the most abundant protein in the human body and is synthetized exclusively by the liver. Therefore, serum albumin levels are reduced in acute and/or chronic liver disease. In cirrhosis, low levels of albumin predict the outcome. In advanced cirrhosis, the quality of albumin is decreased due to high oxidative stress and a proinflammatory state. Therefore, the administration of i.v. albumin would seem to be of pathophysiological relevance and benefit. Yet, the questions that remain are who, when, how much, and how often. While albumin infusion is recommended after large-volume paracentesis, at diagnosis of spontaneous bacterial peritonitis, in acute kidney injury, and in hepatorenal syndrome, the amount and schedule of albumin to be administered require refinement, particularly given complications related to volume overload that have become increasingly apparent. Other indications for albumin such as infections other than spontaneous bacterial peritonitis, hyponatremia, HE, prevention of poor outcomes in hospitalized, and in outpatients with cirrhosis are still debated. The results of studies in these settings are either negative, controversial, or inconclusive. This sheds some doubts regarding the use of albumin as a "one size fits all" strategy. The indication and patient selection are crucial and not always intuitive. The amount and frequency also seem to play a role in the success or failure of albumin. This review will critically discuss the evidence and underline areas where there are indications for albumin use and others where evidence is still insufficient and will have to await the development/results of randomized controlled trials.

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来源期刊
Hepatology
Hepatology 医学-胃肠肝病学
CiteScore
27.50
自引率
3.70%
发文量
609
审稿时长
1 months
期刊介绍: HEPATOLOGY is recognized as the leading publication in the field of liver disease. It features original, peer-reviewed articles covering various aspects of liver structure, function, and disease. The journal's distinguished Editorial Board carefully selects the best articles each month, focusing on topics including immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases, liver cancer, and drug metabolism.
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