Komáromi András, Estenberg Ulrika, Hammarqvist Folke, Rooyackers Olav, Wernerman Jan, Norberg Åke
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Crit Care. 2016 Nov 15;20(1):370. doi: 10.1186/s13054-016-1536-6.
Better knowledge of albumin kinetics is needed to define the indications for albumin use in clinical practice. This study involved two approaches: the synthesis rate and transcapillary escape rate of albumin were measured simultaneously at different levels of plasma albumin concentration in relation to acute inflammation and surgery; and two different tracers were compared to determine plasma volume and the transcapillary escape rate.
Healthy volunteers (n = 10), patients with acute inflammatory abdominal disease (n = 10), and patients undergoing elective pancreatic resection (n = 10) were studied. The albumin synthesis rate was measured by the incorporation of deuterium-labeled phenylalanine. Plasma volume and the transcapillary escape rate were assessed using I-labeled and I-labeled albumin.
A 50 % elevated de-novo albumin synthesis rate was seen in patients with acute inflammation and marked hypoalbuminemia, while patients with marginal hypoalbuminemia before the start of surgery had a normal albumin synthesis rate. The transcapillary escape rate was elevated intraoperatively during the reconstructive phase of pancreatic surgery, when plasma albumin was decreased but stable. In acute inflammation with marked hypoalbuminemia, the transcapillary escape rate was no different from normal. I-labeled and I-labeled albumin were found exchangeable for plasma volume determinations, but could be used only in groups of patients for the transcapillary escape rate.
This observational study illustrates the limited information contained in albumin plasma concentrations to reflect albumin kinetics. On the contrary, single measurements of the synthesis rate and/or transcapillary escape rate of albumin obviously cannot explain the plasma level of albumin or the changes seen in plasma albumin concentration.
www.clinicaltrials.gov , study number NCT01686776 . Registered 13 September 2012.
为明确白蛋白在临床实践中的使用指征，需要更好地了解白蛋白动力学。本研究采用了两种方法：在与急性炎症和手术相关的不同血浆白蛋白浓度水平下，同时测量白蛋白的合成率和毛细血管超滤率；比较两种不同的示踪剂以确定血浆容量和毛细血管超滤率。
研究对象包括健康志愿者（n = 10）、急性炎症性腹部疾病患者（n = 10）和择期胰腺切除术患者（n = 10）。通过掺入氘标记的苯丙氨酸来测量白蛋白合成率。使用碘标记的白蛋白评估血浆容量和毛细血管超滤率。
急性炎症和明显低白蛋白血症患者的白蛋白从头合成率升高了50%，而手术开始前存在轻度低白蛋白血症的患者白蛋白合成率正常。在胰腺手术重建阶段，术中血浆白蛋白降低但稳定时，毛细血管超滤率升高。在伴有明显低白蛋白血症的急性炎症中，毛细血管超滤率与正常无异。发现碘标记的白蛋白和碘标记的白蛋白可用于血浆容量测定的交换，但仅可用于患者组来测定毛细血管超滤率。
这项观察性研究表明，血浆白蛋白浓度所包含的反映白蛋白动力学的信息有限。相反，单次测量白蛋白的合成率和/或毛细血管超滤率显然无法解释白蛋白的血浆水平或血浆白蛋白浓度的变化。
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