Cremonese Carla, Uschner Frank Erhard, Trebicka Jonel
Universitätsklinikum Frankfurt am Main - Medizinische Klinik I, Goethe-Universität Frankfurt am Main.
Dtsch Med Wochenschr. 2020 Jun;145(11):722-726. doi: 10.1055/a-1012-6991. Epub 2020 Jun 3.
The recommended indications for short-term use of human albumin in patients with decompensated cirrhosis are the following: prevention of paracenteses induced circulatory dysfunction, treatment of hypovolemia, prevention of hepatorenal syndrome in high-risk patients with spontaneous bacterial peritonitis, as well as treatment of hepatorenal syndrome. Liver cirrhosis is associated with systemic inflammation, which is further increased in decompensated cirrhosis and acute-on-chronic liver failure. Besides its function as plasma expander, albumin is known to have pleiotropic non-oncotic properties. It serves as antioxidant, scavenging and provides immune-modulating and endothelium protective functions. Albumin treatment may be beneficial to prevent further decompensation and acute-on-chronic liver failure. Recent studies suggest, that long-term albumin administration in patients with cirrhosis and ascites improves survival, prevents complications, facilitates the management of ascites and reduces hospitalizations. Moreover, during infections albumin may prevent development of acute-on-chronic liver failure. Still, further studies are needed to confirm these disease-modifying effects of albumin, define its optimal dosage and administration schedule and detect patients who benefit most from albumin administration in different scenarios.
对于失代偿期肝硬化患者,短期使用人血白蛋白的推荐指征如下:预防腹腔穿刺术引起的循环功能障碍、治疗血容量不足、预防自发性细菌性腹膜炎高危患者发生肝肾综合征以及治疗肝肾综合征。肝硬化与全身炎症相关,在失代偿期肝硬化和慢加急性肝衰竭中这种炎症会进一步加重。除了作为血浆扩容剂的功能外,白蛋白还具有多效性非胶体渗透压特性。它可作为抗氧化剂,进行清除,并提供免疫调节和内皮保护功能。白蛋白治疗可能有助于预防进一步失代偿和慢加急性肝衰竭。最近的研究表明,对肝硬化腹水患者长期给予白蛋白可提高生存率、预防并发症、便于腹水管理并减少住院次数。此外,在感染期间,白蛋白可能预防慢加急性肝衰竭的发生。尽管如此,仍需要进一步研究来证实白蛋白的这些改善疾病的作用,确定其最佳剂量和给药方案,并检测在不同情况下最能从白蛋白给药中获益的患者。