Stratta P, Canavese C, Dogliani M, Gurioli L, Porcu M C, Todros T, Fianchino O, Benedetto C, Massobrio M, Balbi L
Department of Nephrology, University of Torino, Italy.
Clin Nephrol. 1991 Nov;36(5):234-9.
Since intravascular volume contraction is regarded as an important pathological feature in preeclampsia, it has been proposed that plasma volume expansion could be a therapeutic manoeuver that interrupts the pathogenetic chain of hypovolemia inducing increased vascular resistance. Furthermore, tissue perfusion should be improved and, if albumin is used as plasma expander agent, interstitial edema should also be reduced. We report the results observed in an open pilot study in ten preeclamptic patients treated with daily albumin infusions (0.4 to 1 g/kg) from 7 to 36 days. No acute effects were shown on blood pressure, and the need for antihypertensive therapies did not decrease in the following days. Serial evaluation after at least five or ten days of repeated albumin infusions did not show stable changes in electrolytes excretion, renal clearances, serum protein concentration and hematocrit value, nor in aldosterone, renin and atrial natriuretic peptide basal levels, while proteinuria tended to increase. Uteroplacental and fetoplacental blood flow acutely ameliorated in 3 cases only after albumin 1 g/Kg, but reached basal values again on the next day. The clinical implications are that daily albumin infusions with this schedule dosage do not lower blood pressure and that they are unable to induce stable changes in renal function, uteroplacental and fetoplacental resistance. No maternal complications were observed during the conservative management, but fetal mortality was high (6/10). Given the uncontrolled study, we cannot know whether similar results had been achieved by conventional therapy only.
由于血管内容量收缩被视为先兆子痫的一个重要病理特征，有人提出血浆容量扩充可能是一种治疗手段，可中断低血容量引发血管阻力增加的发病机制链。此外，应改善组织灌注，并且如果使用白蛋白作为血浆扩充剂，还应减轻间质水肿。我们报告了一项开放试点研究的结果，该研究对10例先兆子痫患者进行了为期7至36天的每日白蛋白输注（0.4至1 g/kg）治疗。未观察到对血压的急性影响，且在随后几天中抗高血压治疗的需求并未减少。在重复输注白蛋白至少五天或十天后的系列评估中，未显示电解质排泄、肾清除率、血清蛋白浓度和血细胞比容值有稳定变化，醛固酮、肾素和心房利钠肽的基础水平也未出现稳定变化，而蛋白尿有增加趋势。仅在输注1 g/Kg白蛋白后，3例患者的子宫胎盘和胎儿胎盘血流急性改善，但第二天又恢复到基础值。临床意义在于，按此剂量方案每日输注白蛋白并不能降低血压，也无法引起肾功能、子宫胎盘和胎儿胎盘阻力的稳定变化。在保守治疗期间未观察到母体并发症，但胎儿死亡率很高（10例中有6例）。鉴于该研究为非对照研究，我们无法得知仅采用传统治疗是否会取得类似结果。
