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It is only for medical professionals to read for reference.
Albumin can improve circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
Ascites is one of the common and serious complications of patients with decompensated liver cirrhosis, and it is also an important sign of the natural course of liver cirrhosis.
Once ascites occurs, the patient's 1-year mortality rate is about 15%, and the 5-year mortality rate is 44%~85 %, therefore, the prevention and treatment of ascites due to cirrhosis is very important [1].
However, there are some difficulties in the clinical treatment of ascites due to cirrhosis.
For example, circulatory disturbances are likely to occur after a large number of puncture and drainage.
About 5% to 10% of patients with cirrhosis and ascites will progress to refractory ascites, which leads to more clinical treatment of ascites due to cirrhosis.
Tricky [2-3].
When patients with liver cirrhosis have ascites, especially refractory ascites, how to effectively treat it? A study on the efficacy of human albumin combined with diuretics in the treatment of cirrhotic ascites A systematic review analysis included 8 randomized controlled trials.
The results showed that for patients with liver cirrhosis with grade 2 ascites, infusion of human albumin combined with diuretics and diuretics alone Compared with liquid resuscitation agents, it can significantly improve the effective rate of treatment (RR=3.
43, 95%CI: 1.
84~6.
38), and it is statistically significant in shortening the time of ascites regression, increasing urinary sodium excretion, and reducing serum creatinine concentration , And there was no statistical difference in the incidence of adverse reactions and 24-hour urine output [4].
Another study on the clinical efficacy of terlipressin combined with human albumin in the treatment of refractory ascites due to cirrhosis showed that the clinical symptoms of patients with refractory ascites due to cirrhosis were improved after treatment with terlipressin combined with human albumin Obviously, the patient's body weight, abdominal circumference, ascites depth, creatinine and prothrombin were all reduced, serum albumin was higher than before treatment, portal vein diameter and splenic vein diameter were shortened, and no serious adverse reactions occurred during treatment [5].
Abdominal puncture and drainage is a common method for the treatment of ascites, and circulatory dysfunction is likely to occur after refractory ascites or a large amount of ascites.
A systematic review (meta) analysis of the results of 12 RCTs showed that compared with other plasma expanders or vasopressin, human albumin can significantly reduce circulatory dysfunction in patients with ascites due to liver cirrhosis.
The incidence rate and hospital mortality rate, and reduce the incidence of kidney injury [4].
Albumin can improve circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
In liver cirrhosis, albumin synthesis is significantly reduced, causing a decrease in plasma colloidal osmotic pressure, causing fluid to leak from plasma into the abdominal cavity and forming ascites [1].
Portal hypertension of liver cirrhosis leads to dilation of visceral blood vessels, which leads to water and sodium retention and a decrease in effective circulating blood volume and cardiac output, which leads to systemic circulatory dysfunction in patients.
It is the earliest understanding of the pathophysiological mechanism of decompensated liver cirrhosis, and it is also albumin.
It can be applied to one of the important mechanisms for the treatment of decompensated cirrhosis [6].
But now studies have found that, in addition to directly increasing plasma osmotic pressure, albumin can directly increase plasma osmotic pressure and effectively increase circulating blood volume.
It can also improve circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
Albumin can enhance the work of the heart and improve heart function by inhibiting the negative inotropic effects related to tumor necrosis factor and oxidative stress; albumin can also improve peripheral vasodilation by inhibiting the production of vasodilator factors, which is beneficial to correct circulatory function Disorder [6].
Albumin can improve hemodynamic disorders and circulatory dysfunction in liver cirrhosis by increasing effective circulating blood volume, enhancing heart function, and inhibiting visceral vasodilation [6].
Multiple guidelines recommend human albumin for the treatment of ascites due to liver cirrhosis.
The "Quick Recommendation Guide for Human Albumin for the Treatment of Cirrhosis" recommends the use of human albumin combined with diuretics for the treatment of ascites due to liver cirrhosis and after a large number of peritoneal puncture in adults Circulatory dysfunction [4].
In addition, the "Guidelines for Diagnosis and Treatment of Liver Cirrhosis" and "Guidelines for the Diagnosis and Treatment of Cirrhotic Ascites and Related Complications" both recommend the supplementation of human albumin to treat cirrhotic ascites and prevent circulatory dysfunction after a large amount of ascites is released [4,7].
At present, human albumin is one of the most commonly used drugs for the treatment of decompensated liver cirrhosis (DLC).
The main indications include control of ascites and prevention of circulatory dysfunction caused by ascites by abdominal puncture [8]. So, when a patient has liver cirrhosis and ascites, how to apply human albumin treatment in clinic? The clinical application of human albumin in the ascites of liver cirrhosis.
The "Guidelines for the rapid recommendations for the treatment of liver cirrhosis of human albumin" suggest that when the plasma albumin concentration of patients without ascites is lower than 25g/L, the plasma albumin of patients with ascites When the concentration is lower than 30g/L, human albumin can be considered [4].
The guidelines recommend the combination of human albumin and diuretics for the treatment of liver cirrhosis with albumin <30 g/L and grade 2 to 3 ascites, and the recommended dose is 10 to 40 g/L.
Long-term treatment should be used as needed, and the recommended dose is 25-100g every 1 to 2 weeks [4].
The "Guidelines of the British Society of Gastroenterology and British Society of Liver Diseases: Management of Cirrhotic Ascites in 2020" recommends the use of human albumin in the treatment of ascites due to cirrhosis: ①When the volume of ascites is more than 5L, when the volume of ascites is more than 5L, every aspiration 1L of ascites is given with 8g human albumin (20% or 25% solution) at the same time; ②For patients with chronic acute liver failure or patients with high risk of acute kidney injury after ascites aspiration by abdominal puncture, even if the volume of ascites is less than At 5L, 8g human albumin (20% or 25% solution) can also be infused for every 1L of ascites drawn [9].
Diuretics are recommended by national guidelines as the first-line treatment for ascites due to liver cirrhosis.
Human albumin combined with diuretics can significantly improve the effect of treating ascites in cirrhosis of grade 2 to 3, and has good safety.
A multi-center, randomized, parallel, non-blinded, live study (ANSWER study) showed that long-term combined use of human albumin in patients with decompensated liver cirrhosis can prolong overall survival for 18 months without increasing adverse effects The incidence of events [4].
Summary Albumin can improve hemodynamic disorders and circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
Studies have shown that human albumin combined with diuretics has a better effect on the treatment of cirrhotic ascites.
When faced with refractory ascites, the combination can still have a better therapeutic effect [4-5].
Many guidelines recommend the use of human albumin to treat ascites due to cirrhosis.
Human albumin combined with diuretics can significantly improve the effect of treating liver cirrhosis 2 to 3 ascites, and has good safety.
Long-term use of albumin to treat liver ascites does not increase the incidence of adverse events [4].
References: [1]Xu Xiaoyuan, et al.
, Zhuang Hui.
Guidelines for the diagnosis and treatment of ascites and related complications of liver cirrhosis[J].
Journal of Clinical Hepatobiliary Diseases,2017,33(10):1847-1863.
[2].
Liver Current status of treatment of refractory ascites due to cirrhosis[J].
Chinese Community Physician (Medical Semi-Monthly),2009,11(18):7-9.
[3],.
Progress in the prevention and treatment of refractory ascites due to liver cirrhosis[J].
J].
Chinese Journal of Clinicians,2019,47(12):1397-1399.
[4]Li Huibo, et al.
Interpretation of "Guidelines for Quick Recommendations for the Treatment of Liver Cirrhosis with Human Albumin"[J].
Journal of Clinical Drug Therapy ,2018,16(12):10-16.
[5]Zhang Huitao, et al.
The clinical efficacy of terlipressin combined with human albumin in the treatment of refractory ascites due to cirrhosis[J].
Guangxi Medicine, 2018, v.
40 (07):33-36.
[6] Tian Yu, et al.
Current status and prospects of long-term use of albumin therapy in patients with liver cirrhosis and ascites[J].
Journal of Clinical Hepatobiliary Diseases, 2021, 37(01): 173-175.
7]Guide for diagnosis and treatment of liver cirrhosis[J].
Modern Medicine and Health,2020,36(02):320+1-18.
[8]Yu Lecheng.
Human serum albumin, systemic inflammation and liver cirrhosis[J].
Liver ,2015,20(02):153-156.
[9] Aithal GP, et al.
Gut.
2021.
VV-MEDMAT-44335 Copyright statement: This information is intended to help medical and health professionals better understand the latest in the field of related diseases progress.
The content of the information published by this site does not mean that it agrees with its description and opinions, but only provides more information.
If copyright issues are involved, please contact us, and we will deal with it as soon as possible.
Only for medical and health professionals to understand the information.
Such information cannot replace professional medical guidance in any way, nor should it be regarded as diagnosis and treatment advice.
If such information is used for purposes other than understanding the information, this site and the author shall not bear related responsibilities.
-End-
Albumin can improve circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
Ascites is one of the common and serious complications of patients with decompensated liver cirrhosis, and it is also an important sign of the natural course of liver cirrhosis.
Once ascites occurs, the patient's 1-year mortality rate is about 15%, and the 5-year mortality rate is 44%~85 %, therefore, the prevention and treatment of ascites due to cirrhosis is very important [1].
However, there are some difficulties in the clinical treatment of ascites due to cirrhosis.
For example, circulatory disturbances are likely to occur after a large number of puncture and drainage.
About 5% to 10% of patients with cirrhosis and ascites will progress to refractory ascites, which leads to more clinical treatment of ascites due to cirrhosis.
Tricky [2-3].
When patients with liver cirrhosis have ascites, especially refractory ascites, how to effectively treat it? A study on the efficacy of human albumin combined with diuretics in the treatment of cirrhotic ascites A systematic review analysis included 8 randomized controlled trials.
The results showed that for patients with liver cirrhosis with grade 2 ascites, infusion of human albumin combined with diuretics and diuretics alone Compared with liquid resuscitation agents, it can significantly improve the effective rate of treatment (RR=3.
43, 95%CI: 1.
84~6.
38), and it is statistically significant in shortening the time of ascites regression, increasing urinary sodium excretion, and reducing serum creatinine concentration , And there was no statistical difference in the incidence of adverse reactions and 24-hour urine output [4].
Another study on the clinical efficacy of terlipressin combined with human albumin in the treatment of refractory ascites due to cirrhosis showed that the clinical symptoms of patients with refractory ascites due to cirrhosis were improved after treatment with terlipressin combined with human albumin Obviously, the patient's body weight, abdominal circumference, ascites depth, creatinine and prothrombin were all reduced, serum albumin was higher than before treatment, portal vein diameter and splenic vein diameter were shortened, and no serious adverse reactions occurred during treatment [5].
Abdominal puncture and drainage is a common method for the treatment of ascites, and circulatory dysfunction is likely to occur after refractory ascites or a large amount of ascites.
A systematic review (meta) analysis of the results of 12 RCTs showed that compared with other plasma expanders or vasopressin, human albumin can significantly reduce circulatory dysfunction in patients with ascites due to liver cirrhosis.
The incidence rate and hospital mortality rate, and reduce the incidence of kidney injury [4].
Albumin can improve circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
In liver cirrhosis, albumin synthesis is significantly reduced, causing a decrease in plasma colloidal osmotic pressure, causing fluid to leak from plasma into the abdominal cavity and forming ascites [1].
Portal hypertension of liver cirrhosis leads to dilation of visceral blood vessels, which leads to water and sodium retention and a decrease in effective circulating blood volume and cardiac output, which leads to systemic circulatory dysfunction in patients.
It is the earliest understanding of the pathophysiological mechanism of decompensated liver cirrhosis, and it is also albumin.
It can be applied to one of the important mechanisms for the treatment of decompensated cirrhosis [6].
But now studies have found that, in addition to directly increasing plasma osmotic pressure, albumin can directly increase plasma osmotic pressure and effectively increase circulating blood volume.
It can also improve circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
Albumin can enhance the work of the heart and improve heart function by inhibiting the negative inotropic effects related to tumor necrosis factor and oxidative stress; albumin can also improve peripheral vasodilation by inhibiting the production of vasodilator factors, which is beneficial to correct circulatory function Disorder [6].
Albumin can improve hemodynamic disorders and circulatory dysfunction in liver cirrhosis by increasing effective circulating blood volume, enhancing heart function, and inhibiting visceral vasodilation [6].
Multiple guidelines recommend human albumin for the treatment of ascites due to liver cirrhosis.
The "Quick Recommendation Guide for Human Albumin for the Treatment of Cirrhosis" recommends the use of human albumin combined with diuretics for the treatment of ascites due to liver cirrhosis and after a large number of peritoneal puncture in adults Circulatory dysfunction [4].
In addition, the "Guidelines for Diagnosis and Treatment of Liver Cirrhosis" and "Guidelines for the Diagnosis and Treatment of Cirrhotic Ascites and Related Complications" both recommend the supplementation of human albumin to treat cirrhotic ascites and prevent circulatory dysfunction after a large amount of ascites is released [4,7].
At present, human albumin is one of the most commonly used drugs for the treatment of decompensated liver cirrhosis (DLC).
The main indications include control of ascites and prevention of circulatory dysfunction caused by ascites by abdominal puncture [8]. So, when a patient has liver cirrhosis and ascites, how to apply human albumin treatment in clinic? The clinical application of human albumin in the ascites of liver cirrhosis.
The "Guidelines for the rapid recommendations for the treatment of liver cirrhosis of human albumin" suggest that when the plasma albumin concentration of patients without ascites is lower than 25g/L, the plasma albumin of patients with ascites When the concentration is lower than 30g/L, human albumin can be considered [4].
The guidelines recommend the combination of human albumin and diuretics for the treatment of liver cirrhosis with albumin <30 g/L and grade 2 to 3 ascites, and the recommended dose is 10 to 40 g/L.
Long-term treatment should be used as needed, and the recommended dose is 25-100g every 1 to 2 weeks [4].
The "Guidelines of the British Society of Gastroenterology and British Society of Liver Diseases: Management of Cirrhotic Ascites in 2020" recommends the use of human albumin in the treatment of ascites due to cirrhosis: ①When the volume of ascites is more than 5L, when the volume of ascites is more than 5L, every aspiration 1L of ascites is given with 8g human albumin (20% or 25% solution) at the same time; ②For patients with chronic acute liver failure or patients with high risk of acute kidney injury after ascites aspiration by abdominal puncture, even if the volume of ascites is less than At 5L, 8g human albumin (20% or 25% solution) can also be infused for every 1L of ascites drawn [9].
Diuretics are recommended by national guidelines as the first-line treatment for ascites due to liver cirrhosis.
Human albumin combined with diuretics can significantly improve the effect of treating ascites in cirrhosis of grade 2 to 3, and has good safety.
A multi-center, randomized, parallel, non-blinded, live study (ANSWER study) showed that long-term combined use of human albumin in patients with decompensated liver cirrhosis can prolong overall survival for 18 months without increasing adverse effects The incidence of events [4].
Summary Albumin can improve hemodynamic disorders and circulatory dysfunction in patients with liver cirrhosis through a variety of mechanisms.
Studies have shown that human albumin combined with diuretics has a better effect on the treatment of cirrhotic ascites.
When faced with refractory ascites, the combination can still have a better therapeutic effect [4-5].
Many guidelines recommend the use of human albumin to treat ascites due to cirrhosis.
Human albumin combined with diuretics can significantly improve the effect of treating liver cirrhosis 2 to 3 ascites, and has good safety.
Long-term use of albumin to treat liver ascites does not increase the incidence of adverse events [4].
References: [1]Xu Xiaoyuan, et al.
, Zhuang Hui.
Guidelines for the diagnosis and treatment of ascites and related complications of liver cirrhosis[J].
Journal of Clinical Hepatobiliary Diseases,2017,33(10):1847-1863.
[2].
Liver Current status of treatment of refractory ascites due to cirrhosis[J].
Chinese Community Physician (Medical Semi-Monthly),2009,11(18):7-9.
[3],.
Progress in the prevention and treatment of refractory ascites due to liver cirrhosis[J].
J].
Chinese Journal of Clinicians,2019,47(12):1397-1399.
[4]Li Huibo, et al.
Interpretation of "Guidelines for Quick Recommendations for the Treatment of Liver Cirrhosis with Human Albumin"[J].
Journal of Clinical Drug Therapy ,2018,16(12):10-16.
[5]Zhang Huitao, et al.
The clinical efficacy of terlipressin combined with human albumin in the treatment of refractory ascites due to cirrhosis[J].
Guangxi Medicine, 2018, v.
40 (07):33-36.
[6] Tian Yu, et al.
Current status and prospects of long-term use of albumin therapy in patients with liver cirrhosis and ascites[J].
Journal of Clinical Hepatobiliary Diseases, 2021, 37(01): 173-175.
7]Guide for diagnosis and treatment of liver cirrhosis[J].
Modern Medicine and Health,2020,36(02):320+1-18.
[8]Yu Lecheng.
Human serum albumin, systemic inflammation and liver cirrhosis[J].
Liver ,2015,20(02):153-156.
[9] Aithal GP, et al.
Gut.
2021.
VV-MEDMAT-44335 Copyright statement: This information is intended to help medical and health professionals better understand the latest in the field of related diseases progress.
The content of the information published by this site does not mean that it agrees with its description and opinions, but only provides more information.
If copyright issues are involved, please contact us, and we will deal with it as soon as possible.
Only for medical and health professionals to understand the information.
Such information cannot replace professional medical guidance in any way, nor should it be regarded as diagnosis and treatment advice.
If such information is used for purposes other than understanding the information, this site and the author shall not bear related responsibilities.
-End-
