Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Korean J Intern Med. 2012 Mar;27(1):13-9. doi: 10.3904/kjim.2012.27.1.13. Epub 2012 Feb 28.
Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. While some of these indications are supported by the results of randomized studies, others are based only on clinical experience and have not been proved in prospective studies. The paucity of well-designed trials, the high cost of albumin, the lack of a clear-cut survival benefit, and fear of transmitting unknown infections make the use of albumin controversial. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect. Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration.
白蛋白已被广泛用于肝硬化患者，试图改善循环和肾功能。白蛋白输注在预防大容量腹腔穿刺、自发性细菌性腹膜炎和已建立的肝肾综合征与血管收缩剂联合使用时与肾功能恶化相关的益处已得到充分证实。虽然这些适应症中的一些得到了随机研究结果的支持，但其他适应症仅基于临床经验，尚未在前瞻性研究中得到证实。缺乏精心设计的试验、白蛋白成本高、缺乏明确的生存获益以及担心传播未知感染，使得白蛋白的使用存在争议。最近开发的分子吸附再循环系统，即白蛋白透析，就是白蛋白通过除其胶体渗透压作用以外的机制发挥作用的一个例子。应努力确定白蛋白使用的适应症、所需剂量和反应预测因素，以使患者从其给药中获得最大益处。
