Soeters Peter B
Department of Surgery, Maastricht University Medical Center, The Netherlands.
Curr Opin Clin Nutr Metab Care. 2009 May;12(3):258-64. doi: 10.1097/MCO.0b013e32832a3e1a.
To describe the metabolism and function of albumin, and to scrutinize the evidence that infusion of albumin may be beneficial in disease. To explain why albumin infusion does not improve clinical outcome in most disease states, studied.
Albumin acts as a binding protein and an oncotic agent. However, albumin may also act as an extracellular scavenger, which leads to oxidation of albumin. It is likely that this compromises its function and it is possible that this drives its degradation. In disease, these useful processes are accelerated leading to rapid ageing of the molecule.Albumin infusion does not improve clinical outcome despite increasing oncotic pressure in chronic disease. It is not superior to nonprotein colloids or electrolyte solutions in acute hypovolemia with one or two exceptions (liver failure, possibly cerebral infarction). One potential explanation is that pharmaceutical albumin does not have the oxidative qualities that freshly synthesized albumin has.
Albumin infusion has not proven to achieve clinical benefit in many acute and chronic disease states with a few exceptions in acute hypovolemia (e.g. postparacentesis). Future studies should reveal whether infusion of freshly synthesized nonoxidized albumin is of greater clinical benefit.
描述白蛋白的代谢与功能，并仔细审查白蛋白输注在疾病中可能有益的证据。解释为何在大多数所研究的疾病状态下，白蛋白输注并不能改善临床结局。
白蛋白可作为一种结合蛋白和胶体渗透压物质。然而，白蛋白也可能作为一种细胞外清除剂，这会导致白蛋白氧化。很可能这会损害其功能，并且有可能这会促使其降解。在疾病状态下，这些有益过程会加速，导致该分子快速老化。尽管在慢性疾病中增加了胶体渗透压，但白蛋白输注并不能改善临床结局。在急性低血容量症中，除了一两个例外情况（肝衰竭、可能还有脑梗死），它并不优于非蛋白胶体或电解质溶液。一种可能的解释是，药用白蛋白不具备新合成白蛋白所具有的氧化特性。
除了急性低血容量症中的少数情况（如腹腔穿刺术后）外，白蛋白输注在许多急性和慢性疾病状态下并未被证明能带来临床益处。未来的研究应揭示输注新合成的未氧化白蛋白是否具有更大的临床益处。
