Aertgeerts B, Buntinx F, Ansoms S, Fevery J
Department of General Practice, Clinical Epidemiology Unit, University Hospital Gasthuisberg, Catholic University of Leuven, Belgium.
Br J Gen Pract. 2001 Mar;51(464):206-17.
Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems.
To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP).
A diagnostic cross-sectional study.
A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium.
Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard.
The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients.
This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.
在全科医疗中，早期识别酒精滥用或酒精依赖十分重要，因为许多疾病都受酒精影响。然而，全科医生往往无法识别大多数有酒精问题的患者。
评估CAGE问卷、酒精使用障碍识别测试（AUDIT）问卷、它们的衍生问卷以及实验室检查在筛查初级保健人群（男性和女性患者）酒精滥用或酒精依赖方面的诊断性能，这些患者前来就诊于他们的全科医生（GP）。
诊断性横断面研究。
从比利时同一地区69家全科诊所中随机抽取年龄超过18岁的患者（n = 1992）。
完成酒精问卷（复合国际诊断访谈问卷1.1第一部分、CAGE问卷、AUDIT问卷、AUDIT-C问卷、五题速筛问卷、AUDIT Piccinelli问卷），记录人口统计学信息，并让患者接受常规血液检查，包括平均红细胞体积、肝功能检查、γ-谷氨酰转移酶检测以及缺糖转铁蛋白（CDT，用%CDT估算）。以《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）作为参考标准，计算不同问卷得分和实验室检查的敏感性、特异性、阳性预测值、阴性预测值、比值比及其95%置信区间，以及受试者工作特征（ROC）曲线。
该人群中过去一年酒精滥用或酒精依赖的患病率为8.9%（178/1992），其中有132名男性和45名女性患者前来全科诊所就诊。全科医生识别出了33.5%的酒精滥用或酒精依赖患者。在男性患者中，所有问卷的敏感性在68%至93%之间，较为合理，因此切点低于推荐值。只有CAGE问卷即使在最低切点≥1时敏感性也较低（62%）。在女性患者中，敏感性较低；然而，不同问卷的比值比更高。各问卷的受试者工作特征（ROC）曲线没有差异。实验室检查的诊断准确性较低，女性患者的ROC曲线下面积（AUC）在0.60至0.67之间，男性患者在0.57至0.65之间。
这是已知关于家庭医疗诊所中酒精滥用或酒精依赖规模最大的研究之一。我们证实了早期的结果，即AUDIT问卷似乎对男性和女性同样适用；然而，在男性患者中的筛查特性更高。尽管如此，五题速筛问卷更简短，在全科医疗环境中更易于使用，并且在男性和女性全科医疗患者群体中具有几乎相同的诊断特性。我们证实，在初级保健环境中，常规实验室检查对于检测酒精滥用或酒精依赖没有用处。此外，%CDT也不能作为该全科医疗人群的筛查工具。
