Galatius S, Bent-Hansen L, Wroblewski H, Sørensen V B, Nørgaard T, Kastrup J
Heart Center, the Rigshospital, Copenhagen, Denmark.
Circulation. 2000 Jul 18;102(3):319-25. doi: 10.1161/01.cir.102.3.319.
BACKGROUND-The increased plasma disappearance of albumin has previously been described in decompensated congestive heart failure (CHF); this disappearance normalized after diuretic treatment. Cardiac transplantation (HTX) and current medical treatment affect microvascular structure and function. We investigated the plasma disappearance of albumin and the impact of microvascular thickness and electrostatic properties in patients with compensated CHF and after HTX. METHODS AND RESULTS-The fraction of intravascular albumin that passes to the extravascular space per unit time, as determined from the plasma disappearance of intravenously injected (131)I-labeled albumin, was increased to 7.8+/-1.7% in 16 patients with CHF compared with 18 controls (6.5+/-1.9%, P<0.05); these levels normalized after HTX (5.8+/-2.6%, P<0.01, n=17). The change in ratio between (131)I-albumin and simultaneously injected negatively charged glycosylated (125)I-albumin (selectivity index, >1/hour in controls) was lower in patients with HTX (0.993+/-0. 022/hour) than in controls (1.008+/-0.019/hour; P<0.05), which indicated a relatively increased plasma disappearance of negatively charged albumin in HTX patients. Capillary basement membrane thickness was evaluated semiquantitatively from skin biopsies and showed no difference in the 3 groups (control, CHF, and HTX patients). However, in all 3 study groups, subjects with thicker capillary basement membranes had lower albumin escape rates (6.1+/-1. 8%, n=32, versus 7.6+/-2.6% in subjects without thickening of capillary basement membranes, n=19; P<0.05). CONCLUSIONS-The plasma disappearance of albumin increased in patients with compensated CHF and it normalized after HTX. The present normalized capillary basement thicknesses in patients with CHF and the direct association between this parameter and plasma albumin disappearance indicate that previous compensatory microvascular basement membrane growth results in restricted permeability. Microvascular electrostatic properties did not relate to plasma albumin disappearance.
背景——先前已描述过失代偿性充血性心力衰竭（CHF）患者血浆白蛋白清除率增加；利尿剂治疗后这种清除率恢复正常。心脏移植（HTX）和当前的药物治疗会影响微血管结构和功能。我们研究了代偿性CHF患者及HTX术后患者的血浆白蛋白清除率以及微血管厚度和静电特性的影响。
方法与结果——根据静脉注射（131）I标记白蛋白的血浆清除率测定，单位时间内从血管内进入血管外空间的白蛋白比例，在16例CHF患者中增至7.8±1.7%，而18例对照组患者为6.5±1.9%（P<0.05）；HTX术后这些水平恢复正常（5.8±2.6%，P<0.01，n = 17）。HTX患者（0.993±0.022/小时）注射（131）I白蛋白与同时注射带负电荷的糖基化（125）I白蛋白之间的比率变化（选择性指数，对照组>1/小时）低于对照组（1.008±0.019/小时；P<0.05），这表明HTX患者中带负电荷白蛋白的血浆清除率相对增加。通过皮肤活检对毛细血管基底膜厚度进行半定量评估，结果显示三组（对照组、CHF组和HTX患者组）之间无差异。然而，在所有三个研究组中，毛细血管基底膜较厚的受试者白蛋白逃逸率较低（6.1±1.8%，n = 32，而毛细血管基底膜未增厚的受试者为7.6±2.6%，n = 19；P<0.05）。
结论——代偿性CHF患者血浆白蛋白清除率增加，HTX术后恢复正常。CHF患者目前正常的毛细血管基底膜厚度以及该参数与血浆白蛋白清除率之间的直接关联表明，先前微血管基底膜的代偿性生长导致通透性受限。微血管静电特性与血浆白蛋白清除率无关。
