Steyl C, Van Zyl-Smit R
University of Pretoria.
S Afr Med J. 2009 Jan;99(1):57-9.
Seriously ill patients often suffer from disorders of salt and water balance and present with clinical signs of either dehydration or oedema. The relationship of hypoalbuminaemia to oedema is complex and controversial and formed the central issue of this study.
Prospective study.
Medical wards of New Somerset Secondary Hospital, November 2004.
50 patients admitted consecutively to the medical wards at New Somerset Hospital were evaluated; 26 males and 24 females participated.
An attempt was made to correlate causes of salt and water imbalance with the clinical assessment of volume status, oedema formation, nutritional state and serum albumin levels.
Hypoalbuminaemia was not related to oedema in this study. Of 24 patients with a serum albumin level below 30 g/l, only 6 had oedema. These patients all had other abnormalities that could have resulted in the oedema, notably primary salt retention by failing kidneys, cor pulmonale and malignancy. None of the patients with serum albumin levels below 15 g/l had any signs of oedema. The combined insult of a chronic inflammatory disease and malnutrition had a marked effect on serum albumin levels.
Significant hypoalbuminaemia was present in many of our patients, yet oedema was detected infrequently and generally had an easily identifiable cause not related to low albumin levels. Most patients with hypoalbuminaemia presented with normal or positive water balance. This study supports the notion that hypoalbuminaemia is infrequently associated with oedema and plays a minor role in its formation.
重症患者常伴有水盐平衡紊乱,表现为脱水或水肿的临床症状。低蛋白血症与水肿的关系复杂且存在争议,这构成了本研究的核心问题。
前瞻性研究。
新萨默塞特二级医院内科病房,2004年11月。
对新萨默塞特医院内科病房连续收治的50例患者进行评估;其中男性26例,女性24例。
试图将水盐失衡的原因与容量状态、水肿形成、营养状况及血清白蛋白水平的临床评估相关联。
本研究中低蛋白血症与水肿无关。在24例血清白蛋白水平低于30g/L的患者中,仅有6例出现水肿。这些患者均有其他可能导致水肿的异常情况,尤其是肾功能衰竭导致的原发性钠潴留、肺心病和恶性肿瘤。血清白蛋白水平低于15g/L的患者均无水肿迹象。慢性炎症性疾病和营养不良的综合损害对血清白蛋白水平有显著影响。
我们的许多患者存在明显的低蛋白血症,但水肿很少见,且通常有易于识别的与低白蛋白水平无关的原因。大多数低蛋白血症患者的水平衡正常或为正向平衡。本研究支持低蛋白血症很少与水肿相关且在水肿形成中起次要作用这一观点。