Arques S
Service de cardiologie, centre hospitalier d'Aubagne, France.
Ann Cardiol Angeiol (Paris). 2011 Nov;60(5):272-8. doi: 10.1016/j.ancard.2011.07.006. Epub 2011 Aug 17.
Hypoalbuminemia is a common condition in patients with heart failure and is mainly related to the malnutrition-inflammation complex syndrome. Other causal factors can be involved, which include hemodilution, liver dysfunction, increased transcapillary escape rate, renal and enteral loss. Evidence is growing that hypoalbuminemia independently predicts incident heart failure in patients with end-stage renal disease and elderly patients, as well as mortality in patients with heart failure regardless of left ventricular ejection fraction and clinical presentation. Hypoalbuminemia induces a low plasma oncotic pressure, which facilitates pulmonary edema in patients without critical increase in pulmonary capillary hydrostatic pressures. Hypoalbuminemia may also contribute to the progression of heart failure by favoring myocardial edema, volume overload, diuretic resistance and exacerbation of oxidative stress and inflammation. If relevant, removal of subclinical excess of fluid and renutrition may be indicated in patients with heart failure and hypoalbuminemia. Additional research is warranted to determine the specific role of serum albumin in the pathophysiologic process of heart failure and the potential benefits of targeted therapeutic interventions.
低白蛋白血症是心力衰竭患者的常见情况，主要与营养不良 - 炎症复合综合征有关。还可能涉及其他病因，包括血液稀释、肝功能障碍、毛细血管通透性增加、肾脏和肠道丢失。越来越多的证据表明，低白蛋白血症可独立预测终末期肾病患者和老年患者发生心力衰竭的风险，以及心力衰竭患者的死亡率，而与左心室射血分数和临床表现无关。低白蛋白血症会导致血浆胶体渗透压降低，在肺毛细血管静水压无显著升高的情况下，促使患者发生肺水肿。低白蛋白血症还可能通过促进心肌水肿、容量超负荷、利尿剂抵抗以及氧化应激和炎症加剧，从而导致心力衰竭的进展。如果相关，对于心力衰竭合并低白蛋白血症的患者，可能需要去除亚临床过多的液体并进行营养补充。有必要进行更多研究，以确定血清白蛋白在心力衰竭病理生理过程中的具体作用以及靶向治疗干预的潜在益处。
