108 KB156 KB44 KB192920262008Kravos, MatejMalešič, Ivan10 straništevilka:3letnik:77str. 189-198ISSN:1318-0347COBISSID:24200153URN:URN:NBN:SI:doc-0OB420NQslSlovensko zdravniško društvoZdravniški vestnikAlcohol, EthylAlcoholismalkoholAlkoholizemBiological MarkersBiološki označevalciCDTDiagnosisdiagnostikakriRoc CurveROK krivuljaTemperanceTransferinTransferrinTreznostTransferin z zmanjšanim deležem ogljikovih hidratov (CDT) kot označevalec sindroma odvisnosti od alkohola| Carbohydrate-deficient transferrin (CDT) as a marker of alcohol dependency|Background Excessive alcohol consumption starts to change the structure of transferrin into the carbohydrate-deficient transferrin (CDT). CDT is the onlyspecific laboratory marker for alcohol dependency. However no one at all is sensitive enough. Method In our study we wanted to confirm the alcohol dependency by means of questionnaires and laboratory markers, particularly CDT. Results Investigated were 68 (92.6% males, 7.4% females) general practicehealthy patients and blood donors and 186 (89.2% males, 10.8% females)inpatient alcoholics. A blood sample was taken once from every healthysubject and three times from every alcoholic: on admission to hospital,after 12 days and again after 42 days. In alcoholics we found statistically significantly elevated CDT, glutamate dehidrogenaze (GLDH), aspartate-aminotransferaze (AST), alanine-aminotransferaze (ALT), gamaglutamyltransferaze (GGT) and mean corpuscular volume (MCV) and decreased urea values. CDT was the most reliable marker with high specificity (91.2%) and sensitivity (81.4%). The area under ROC-curve was exceptional with 99.9%. The kinetics of CDT, AST, ALT, GGT, MCV and creatinine normalization after 14 days were also statistically significant as well as kinetics of CDT, AST, GGT,MCV and creatinine normalization after 42 days. We estimated the course ofCDT value normalization as the most applicable. The most important diagnostic marker combination was composed by CDT, MCV and AST. GGT had lower importance as expected. Conclusions In our population CDT was the most specific marker of all, attaining high sensitivity. But it was not reliable enough as the sole marker or as the screening one for alcohol dependency. Its main applicability is in diagnostics of alcoholism, control of alcohol abstention and forensic cases but solely in combination with other laboratory markers of alcoholismIzhodišča Čezmerno uživanje alkohola prične spreminjati strukturo transferina v transferin z zmanjšanim deležem ogljikohidratov (CDT). Od vseh znanih laboratorijskih označevalcev je edino CDT specifičen, noben pa ni dovolj občutljiv za dokazovanje odvisnosti od alkohola. Metode V raziskavi smo hotelipotrditi odvisnost od alkohola s pomočjo vprašalnikov in laboratorijskihoznačevalcev, s posebnim poudarkom na CDT. Rezultati Vključenihje bilo 68 (92,6% moških, 7,4% žensk) krvodajalcev in ambulantnih kontrolnih oseb ter 186 (89,2% moških, 10,8% žensk), bolnišnično zdravljenih zaradi odvisnosti od alkohola. Prvim smo označevalce določili enkrat, drugim ob sprejemu v bolnišnico, po 14 in po 42 dneh. Odvisni od alkohola so imeli statistično značilno zvišane vrednosti CDT, glutamat dehidrogenaze (GLDH), aspartat-aminotransferaze (AST), alanin-aminotransferaze (ALT), gama-glutamil transferaze (GGT), povprečnega volumna eritrocitov (MCV) in znižane vrednosti sečnine. Najbolj zanesljiv je bil CDT z visokima specifičnostjo (91,2%) in občutljivostjo (81,4%). Površina pod krivuljo ROC je bila izjemna z 99,9%. Statistično značilna je bila tudi kinetika normalizacije CDT, AST, ALT, GGT, MCV in kreatinina po 14 dneh ter CDT, AST, GGT, MCV in kreatinina po 42 dneh abstinence. Potek normalizacije vrednosti CDT smo ocenili kot klinično najuporabnejši. Diagnostično najpomembnejša je bila kombinacija CDT, MCV in AST. Pomen GGT je bil nižji od naših pričakovanj. Zaključki V naši populaciji je CDT, v primerjavi z ostalimi, najbolj specifičen označevalec z visoko občutljivostjo. Kot samostojen označevalec ali kot presejalni test odvisnosti od alkohola pa ni dovolj zanesljiv. Njegova uporabnost je ključna v diagnostiki, kontroli abstinence in izvedenstvu, vendar le v kombinaciji z ostalimi laboratorijskimi označevalciTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo