Cameron Karla, Nguyen Anke L, Gibson David J, Ward Mark G, Sparrow Miles P, Gibson Peter R
Department of Gastroenterology, School of Translational Medicine, Monash University and Alfred Health, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2025 Apr;40(4):808-820. doi: 10.1111/jgh.16895. Epub 2025 Feb 2.
Circulating albumin concentrations are frequently measured in clinical practice. This review explores biochemical properties and physiological roles of albumin, its place in nutritional assessment, current understanding of perturbed circulating concentrations, and role in clinical management, with special focus on patients with inflammatory bowel disease (IBD).
A detailed literature search was performed.
Albumin is synthesized by hepatocytes and comprises 3% of total body protein. It has a prolonged intravascular half-life (17-19 h) due to neonatal Fc-receptor-mediated salvage and has a multitude of physiological functions. Albumin homeostasis is affected in disease states often resulting in reduced level, which is not a direct marker of malnutrition. In patients with IBD, morbid albumin concentrations provide prognostic information, identification of nonintestinal conditions, guidance to the required aggressiveness of therapy and biologic dosage, monitoring of disease activity, and potential need for therapeutic escalation. Barriers to utilization of morbid albumin levels include the lack of consensus regarding cutoff values and the deficiency of high-quality data in this domain due to the retrospective design of the majority of studies. Serum levels hold greatest clinical potential in prognostication in acute severe ulcerative colitis. The premorbid level in the individual may provide insight into dosing of biologics and potentially enhance interpretation of morbid levels.
Understanding the physiology and pathophysiology of albumin is fundamental to interpreting its circulating levels. The clinical value of its measurement in patients with IBD may be undervalued, as it assists in evaluation of disease severity, prognosis, and therapeutic decision-making.
临床实践中经常测量循环白蛋白浓度。本综述探讨白蛋白的生化特性和生理作用、其在营养评估中的地位、对循环浓度异常的当前认识以及在临床管理中的作用，特别关注炎症性肠病（IBD）患者。
进行了详细的文献检索。
白蛋白由肝细胞合成，占全身蛋白质的3%。由于新生儿Fc受体介导的挽救作用，其血管内半衰期延长（17 - 19小时），并具有多种生理功能。疾病状态会影响白蛋白稳态，常导致其水平降低，但这并非营养不良的直接标志物。在IBD患者中，异常的白蛋白浓度可提供预后信息、识别非肠道疾病、指导所需的治疗积极程度和生物制剂剂量、监测疾病活动以及提示治疗升级的潜在需求。利用异常白蛋白水平的障碍包括缺乏关于临界值的共识，以及由于大多数研究的回顾性设计导致该领域高质量数据的缺乏。血清水平在急性重症溃疡性结肠炎的预后评估中具有最大的临床潜力。个体的病前水平可能有助于了解生物制剂的给药剂量，并可能增强对异常水平的解读。
了解白蛋白的生理和病理生理对于解释其循环水平至关重要。在IBD患者中测量白蛋白的临床价值可能被低估，因为它有助于评估疾病严重程度、预后和治疗决策。
