人血白蛋白在肝硬化及其并发症中的应用

李雅欣; 丁惠国

doi:10.12449/JCH250303

人血白蛋白在肝硬化及其并发症中的应用

DOI: 10.12449/JCH250303

李雅欣,
丁惠国^, ,

首都医科大学附属北京佑安医院肝病消化中心，北京 100069

基金项目:

首都卫生发展科研专项 (2022-1-2181)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李雅欣负责查找文献，撰写文稿；丁惠国负责确定写作思路，指导文章撰写及最终定稿。

详细信息

通信作者:
丁惠国， dinghuiguo@ccmu.edu.cn （ORCID： 0000-0002-8716-4926）

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出版历程
- 收稿日期: 2024-10-08
- 录用日期: 2025-01-15
- 出版日期: 2025-03-25

The application of human serum albumin in liver cirrhosis and its complications

Yaxin LI,
Huiguo DING^{,
,}

Department of Hepatology and Gastroenterology，Beijing YouAn Hospital，Capital Medical University，Beijing 100069，China

Research funding:

Capital Medical Development and Research Fund (2022-1-2181)

More Information

Corresponding author: DING Huiguo， dinghuiguo@ccmu.edu.cn （ORCID： 0000-0002-8716-4926）

摘要

摘要: 白蛋白由肝脏生物合成，当肝脏严重损伤时，白蛋白不仅合成减少，其结构亦发生变化（如甲基化、糖基化等增多），导致循环中有效白蛋白浓度显著降低。白蛋白不仅能维持血浆胶体渗透压，还具备抗氧化、抗炎、免疫调节和物质运输等非胶体功能。目前，指南推荐人血白蛋白短期用于肝硬化患者大量放腹水、肝肾综合征和自发性细菌性腹膜炎的治疗，可降低病死率；人血白蛋白在肝硬化低钠血症、非自发性细菌性腹膜炎感染和肝性脑病中可能改善预后。但是，人血白蛋白在肝硬化及相关并发症中应用的剂量及长期应用的效果仍存在争议。
- 白蛋白类 /
- 肝硬化 /
- 腹水 /
- 肝肾综合征 /
- 肝性脑病 /
- 治疗学
Abstract: Albumin is synthesized in the liver， and in case of severe liver injury， albumin synthesis is reduced with structural alterations （such as an increase in methylation and glycosylation）， leading to a significant reduction in effective albumin in circulation. Albumin not only maintains plasma oncotic pressure， but also has the functions of antioxidation， anti-inflammation， immunomodulation， and transport. Current guidelines recommend the short-term application of human serum albumin in the treatment of large-volume paracentesis， hepatorenal syndrome， and spontaneous bacterial peritonitis in patients with liver cirrhosis， as it is shown that human serum albumin can help to reduce mortality. In addition， human serum albumin may improve the prognosis of cirrhotic patients with hyponatremia， non-SBP infections， and hepatic encephalopathy. However， there are still controversies over the application of human serum albumin in liver cirrhosis and related complications in terms of optimal dose and long-term efficacy.
- Albumins /
- Liver Cirrhosis /
- Ascites /
- Hepatorenal Syndrome /
- Hepatic Encephalopathy /
- Therapeutics

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表 1 人血白蛋白在肝硬化失代偿期各种并发症、脓毒症治疗相关临床研究结果的总结

Table 1. Summary of clinical research results on human serum albumin for treating various complications in decompensated cirrhosis and sepsis

研究名称	研究对象	白蛋白组 vs 对照组	主要研究结果	结论
ALBIOS 2014年^［43］	严重脓毒症和脓毒性休克患者	20%白蛋白 vs 晶体液	改善血流动力学，但未降低病死率	表明具有稳定血流动力学的潜力
SAFE 2004年^［44］	重症患者（包括脓毒症患者）	4%白蛋白 vs 0.9%生理盐水	两组病死率相似，白蛋白治疗在脓毒症亚组存在获益	可能为脓毒症患者提供获益
EARSS 2011年^［45］	脓毒性休克患者	大剂量白蛋白（60 g/d） vs 0.9%生理盐水	对病死率和器官衰竭无改善	提高生存率的效果有限
FRISC 2021年^［46］	肝硬化合并脓毒症导致的低血压患者	5%白蛋白 vs 0.9%生理盐水	改善低血压，提高短期生存率	在肝硬化合并脓毒症患者中有效
ALPS 2022年^［38］	肝硬化合并脓毒症导致的低血压患者	20%白蛋白（0.5～1.0 g/kg） vs 晶体液	可有效达到目标平均动脉压，减少透析次数	推荐用于肝硬化合并脓毒症患者
ATTIRE 2021年^［34］	肝硬化合并低白蛋白血症住院患者	20%白蛋白14天，维持血清白蛋白30 g/L vs 标准治疗	对3天、15天和出院时感染、肾功能不全及病死率无改善，对6个月病死率无改善	质疑大剂量白蛋白在肝硬化患者中的疗效
RASP 2019年^［47］	合并脓毒症的癌症患者	4%白蛋白 vs 乳酸林格氏液	两组7天、28天病死率无差异	对癌症患者合并脓毒症治疗无效
ANSWER 2018年^［41］	肝硬化单纯性腹水患者	标准治疗联合人血白蛋白（40 g/次，每周2次，共2周；后40 g每周1次） 18个月 vs 标准治疗	血清白蛋白水平明显增加，难治性腹水、感染、HRS和HE发生率显著下降，病死率降低	肝硬化腹水患者长期应用提高生存率
荟萃分析 2023年^［48］	脓毒症和脓毒性休克患者	各种浓度白蛋白 vs 晶体液	20%白蛋白降低了脓毒性休克患者的90天病死率	存在潜在获益，需进一步研究

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