Koretz R L
Department of Medicine, Olive View-UCLA Medical Center, Sylmar 91342, USA.
JPEN J Parenter Enteral Nutr. 1995 Mar-Apr;19(2):166-71. doi: 10.1177/0148607195019002166.
IV albumin has been advocated as adjunctive therapy for hypoalbuminemic patients who are receiving nutrition support. This discussion will critically consider the rationale for this recommendation as well as the evidence available in the medical literature.
The medical literature was reviewed.
Randomized controlled trials have shown that IV albumin improves serum albumin levels. However such therapy does not improve clinical outcome in patients receiving parenteral nutrition. Although no trials exist that test the hypothesis in hypoalbuminemic patients receiving enteral nutrition, the purported "supportive evidence" in the medical literature is actually weak and contradictory. IV albumin does have some associated toxicity, and it is expensive.
There is reason to believe that IV albumin is not effective in improving the clinical outcome of hypoalbuminemic patients who are receiving nutrition support. Until more compelling data become available, it is not reasonable to adopt a policy of routinely correcting the hypoalbuminemia in this way. In fact, hypoalbuminemia may be a manifestation of a serious disease state rather than a marker of deficient protein stores.
静脉输注白蛋白已被推荐作为接受营养支持的低白蛋白血症患者的辅助治疗方法。本讨论将批判性地审视这一推荐的理论依据以及医学文献中的现有证据。
对医学文献进行了综述。
随机对照试验表明，静脉输注白蛋白可提高血清白蛋白水平。然而，这种治疗方法并不能改善接受肠外营养患者的临床结局。虽然目前尚无针对接受肠内营养的低白蛋白血症患者进行该假设检验的试验，但医学文献中所谓的“支持性证据”实际上很薄弱且相互矛盾。静脉输注白蛋白确实存在一些相关毒性，且费用昂贵。
有理由相信，静脉输注白蛋白对改善接受营养支持的低白蛋白血症患者的临床结局无效。在获得更有说服力的数据之前，采用常规方法纠正低白蛋白血症的政策是不合理的。事实上，低白蛋白血症可能是严重疾病状态的一种表现，而非蛋白质储备不足的标志。
