人血清白蛋白治疗失代偿期肝硬化的研究进展

doi:10.3969/j.issn.1674-8115.2023.01.012

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (1): 95-100.doi: 10.3969/j.issn.1674-8115.2023.01.012

人血清白蛋白治疗失代偿期肝硬化的研究进展

张宸溪¹^,²(), 曹竹君², 项晓刚², 谢青², 耿嘉蔚³()

^1.昆明理工大学医学院，昆明 650500
^2.上海交通大学医学院附属瑞金医院感染科，上海 200025
^3.云南省第一人民医院感染性疾病科及肝病科，昆明 650500

收稿日期:2022-06-14 接受日期:2022-11-30 出版日期:2023-01-28 发布日期:2023-01-28
通讯作者: 耿嘉蔚 E-mail:chenxi96449@163.com;jia_wei_geng@163.com
作者简介:张宸溪（1994—），男，硕士；电子信箱：chenxi96449@163.com。
基金资助:
“十三五”国家科技重大专项(2017ZX10203201-008);国家自然科学基金(82070604);云南省创新团队项目基金(202005AE160010);云南省“万人计划”名医人才专项基金(YNWR-MY-2019-072)

Advances in decompensated cirrhosis treatment by human serum albumin

ZHANG Chenxi¹^,²(), CAO Zhujun², XIANG Xiaogang², XIE Qing², GENG Jiawei³()

^1.Kunming University of Science and Technology School of Medicine, Kunming 650500, China
^2.Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^3.Department of Infectious Diseases and Liver Diseases, The First People's Hospital of Yunnan Province, Kunming 650500, China

Received:2022-06-14 Accepted:2022-11-30 Online:2023-01-28 Published:2023-01-28
Contact: GENG Jiawei E-mail:chenxi96449@163.com;jia_wei_geng@163.com
Supported by:
National Science and Technology Major Project of the 13th Five-Year Plan of China(2017ZX10203201-008);National Natural Science Foundation of China(82070604);Innovative Research Team Program Foundation of Yunnan Province(202005AE160010);Ten-Thousands Talents Program Foundation of Yunnan Province(YNWR-MY-2019-072)

摘要/Abstract

摘要：

人血清白蛋白（human serum albumin，HSA）是人体血浆中一种含量丰富的蛋白质，参与行使机体多种生理功能。该文介绍了HSA的生物合成与代谢、结构与功能，并总结了HSA在失代偿期肝硬化中的临床应用进展以及不良反应。HSA作为一种结构复杂的多功能分子，不仅可以提升血浆胶体渗透压，近年来其结合转运、抗氧化、调节免疫、调节循环功能、维持内皮细胞稳定和毛细血管通透性等非胶体功能也受到广泛重视。HSA结构易受到疾病环境的影响，翻译后修饰可发生多种类型的变化，如N末端或C末端截断、糖基化、第34个半胱氨酸残基（Cys-34）氧化等，其中Cys-34氧化程度与肝硬化病程进展及生存结局相关。除了可以预防腹腔穿刺引流大量腹水后的循环功能紊乱，HSA在肝肾综合征（hepatorenal syndrome，HRS）、自发性腹膜炎（spontaneous peritonitis，SBP）等多种肝硬化并发症的管理中表现出良好的治疗效果。对于非SBP感染、腹水的长期管理、肝性脑病、慢加急性肝衰竭（acute-on-chronic liver failure，ACLF）等其他肝硬化并发症，HSA的治疗效益仍存在争议，需要进一步的临床试验研究。

关键词: 人血清白蛋白, 失代偿期肝硬化, 腹水, 慢加急性肝衰竭

Abstract:

Human serum albumin (HSA) is one of the most abundant proteins in the plasma which participate in plenty of physiological functions. This article reviews recent advances in HSA-related researches with respect to its synthesis, metabolism, structure, function, and clinical application in decompensated cirrhosis and its adverse events. As a multidomain polyfunctional molecule, HSA has not only shown its effect on colloid osmotic pressure elevation, but also its non-colloid functions including ligand binding capacity, antioxidant ability, immunoregulatory effect, and maintaining the stability of endothelium and permeability of capillary. However, the structure of HSA is easily affected by pathology surroundings including various posttranslational modifications of HSA, such as truncated N-terminal or C-terminal, glycosylation, and oxidation of Cys-34. Among these, the oxidation modification of Cys-34 in HSA is closely related to cirrhosis progression and has a strong prognostic ability of clinical outcomes. Besides prevention of post paracentesis circulatory dysfunction, HSA administration also shows excellent treatment potentials in the cirrhotic complications, including hepatorenal syndrome (HRS) and spontaneous peritonitis (SBP). Furthermore, more clinical trials are needed to discuss the potential benefits of HSA in non-SBP infection, long-term administration of ascites, hepatic encephalopathy, acute-on-chronic liver failure (ACLF) and other cirrhotic complications.

Key words: human serum albumin (HSA), decompensated cirrhosis, ascites, acute-on-chronic liver failure (ACLF)

中图分类号:

R575.2

张宸溪, 曹竹君, 项晓刚, 谢青, 耿嘉蔚. 人血清白蛋白治疗失代偿期肝硬化的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(1): 95-100.

ZHANG Chenxi, CAO Zhujun, XIANG Xiaogang, XIE Qing, GENG Jiawei. Advances in decompensated cirrhosis treatment by human serum albumin[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(1): 95-100.

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人血清白蛋白治疗失代偿期肝硬化的研究进展

Advances in decompensated cirrhosis treatment by human serum albumin

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