Arques S
Service de cardiologie, centre hospitalier Edmond-Garcin, avenue des Soeurs-Gastine, 13400 Aubagne, France.
Ann Cardiol Angeiol (Paris). 2018 Apr;67(2):82-90. doi: 10.1016/j.ancard.2018.02.002. Epub 2018 Mar 12.
Cardiovascular diseases are the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory status and oxidative stress are at the forefront in the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin, the most abundant plasma protein, has many physiological properties, including anti-inflammatory, antioxidant and antiplatelet aggregation activity. It also plays an essential role in the fluid exchange across the capillary membrane. Definite evidence is that hypo-albuminemia is a powerful prognostic marker in the general population as well as in many pathological settings. In the more specific context of cardiovascular diseases, serum albumin is independently associated with the development of a variety of deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation and stroke. Serum albumin has also emerged as a powerful prognostic parameter in patients with coronary artery disease, heart failure, congenital heart disease, infective endocarditis, cardiovascular surgery and stroke, regardless of usual prognostic markers. This prognostic value probably refers mainly to the malnutrition-inflammation syndrome and the severity of comorbidities. Nevertheless, hypo-albuminemia may act as an unknown and modifiable risk factor that contributes to the emergence and the pejorative evolution of cardiovascular diseases, mainly by exacerbation of inflammation, oxidative stress and platelet aggregation, and by pulmonary and myocardial edema. This article provides an overview of the physiological properties of serum albumin, the prevalence, causes, prognostic value and potential contribution to the emergence and aggravation of cardiovascular disease of hypoalbuminemia, as well as its clinical implications.
心血管疾病是全球首要的死亡原因。从概念上讲，内皮功能障碍、炎症状态和氧化应激在大多数心血管疾病（尤其是冠状动脉疾病和心力衰竭）的发生和发展过程中处于前沿位置。血清白蛋白是血浆中含量最丰富的蛋白质，具有多种生理特性，包括抗炎、抗氧化和抗血小板聚集活性。它在跨毛细血管膜的液体交换中也起着至关重要的作用。确切证据表明，低白蛋白血症在普通人群以及许多病理情况下都是一个强有力的预后指标。在心血管疾病这一更为特定的背景下，血清白蛋白与多种有害病症（如冠状动脉疾病、心力衰竭、心房颤动和中风）的发生独立相关。血清白蛋白在冠状动脉疾病、心力衰竭、先天性心脏病、感染性心内膜炎、心血管手术和中风患者中也已成为一个强有力的预后参数，而不考虑常见的预后指标。这种预后价值可能主要归因于营养不良 - 炎症综合征和合并症的严重程度。尽管如此，低白蛋白血症可能作为一个未知且可改变的危险因素，主要通过加剧炎症、氧化应激和血小板聚集以及引发肺水肿和心肌水肿，促成心血管疾病的发生和恶化演变。本文概述了血清白蛋白的生理特性、低白蛋白血症的患病率、病因、预后价值及其对心血管疾病发生和加重的潜在影响，以及其临床意义。
