Mobarhan S
University of Illinois, Chicago, Department of Medicine 60612.
J Am Coll Nutr. 1988 Dec;7(6):445-52. doi: 10.1080/07315724.1988.10720260.
Hypoalbuminemia is considered one of the hallmarks of protein-calorie malnutrition and chronic liver disease. Recently, serum albumin has also been proposed as a critical predictor of the response to nutritional support and tolerance to enteral feeding in critically ill patients. Albumin is essential for maintenance of plasma colloidal osmotic pressure, prevention of edema, and transport of certain drugs and nutrients. Experimental studies have shown that rapid plasma expansion and reduced plasma protein concentration and osmotic pressure induce a net secretion of sodium and water into the small intestinal lumen. However, the effects of chronic hypoalbuminemia per se on intestinal absorption, independent of malnutrition, have not been fully studied. It is documented that both chronic illness and malnutrition may profoundly affect intestinal anatomical structure and function, inducing some degree of malabsorption. In the last few years, some have advocated albumin infusion to improve clinical response to patients with hypoalbuminemia receiving parenteral nutritional support or to reduce intestinal intolerance and diarrhea in patients receiving enteral tube feeding. A review of the literature shows that both clinical and experimental data to support these suggestions are scarce and further investigations are needed. Hypoalbuminemia is one of many parameters of malnutrition, and it is unlikely that correction of a single parameter for a short time would lead to major clinical benefits.
低白蛋白血症被认为是蛋白质 - 热量营养不良和慢性肝病的标志之一。最近，血清白蛋白也被提议作为危重症患者对营养支持反应和肠内喂养耐受性的关键预测指标。白蛋白对于维持血浆胶体渗透压、预防水肿以及某些药物和营养物质的运输至关重要。实验研究表明，快速的血浆扩容以及降低的血浆蛋白浓度和渗透压会导致钠和水向小肠腔内净分泌。然而，慢性低白蛋白血症本身对肠道吸收的影响，独立于营养不良之外，尚未得到充分研究。有文献记载，慢性疾病和营养不良都可能深刻影响肠道的解剖结构和功能，导致一定程度的吸收不良。在过去几年中，一些人主张输注白蛋白以改善接受肠外营养支持的低白蛋白血症患者的临床反应，或减少接受肠内管饲患者的肠道不耐受和腹泻。文献综述表明，支持这些建议的临床和实验数据都很匮乏，需要进一步研究。低白蛋白血症是营养不良的众多参数之一，短期内纠正单一参数不太可能带来重大临床益处。
