Montalto Norman J, Bean Pamela
Department of Family Medicine, West Virginia University School of Medicine, Charleston, WV, U.S.A.
Med Sci Monit. 2003 Dec;9(12):RA285-90.
Alcohol is the most commonly abused substance yet alcoholism is frequently undiagnosed. The misuse of alcohol is common and frequently an occult problem. More than 10% of current drinkers meet diagnostic criteria for alcohol abuse or dependence while the lifetime prevalence for these conditions in outpatient settings ranges from 16 to 36 percent. Long-term, heavy drinking is associated with significant morbidity, mortality, and economic costs. Clues to alcohol use can be discovered from a patient's history and physical stigmata. Validated screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT), CAGE Questionnaire, and Brief Michigan Alcoholism Screening Tests help confirm the clinical suspicion of alcohol dependence. Laboratory abnormalities of mean corpuscular volume, gamma-glutamyl transferase, alkaline phosphatase, or alanine amino transferase levels are non-specific indicators of possible alcohol-induced liver impairment. Newer, less well-known FDA-approved biochemical markers such as the Carbohydrate Deficient Transferrin and the Early Detection of Alcohol Consumption test may also be used to detect heavy alcohol abuse and to monitor relapse episodes. Brief interventions are successful, making identification and diagnosis a vital role for the family physician. Improved awareness of alcohol misuse, increased use of screening tools, and the appropriate use of biochemical markers will facilitate early intervention and successful management of patients with alcohol use disorders.
酒精是最常被滥用的物质，但酒精中毒却常常未被诊断出来。酒精的滥用很常见，而且往往是个隐匿的问题。超过10%的当前饮酒者符合酒精滥用或依赖的诊断标准，而在门诊环境中，这些情况的终生患病率在16%至36%之间。长期大量饮酒会导致显著的发病率、死亡率和经济成本。可以从患者的病史和身体特征中发现饮酒的线索。经过验证的筛查工具，如酒精使用障碍识别测试（AUDIT）、CAGE问卷和密歇根酒精ism筛查简表，有助于确认对酒精依赖的临床怀疑。平均红细胞体积、γ-谷氨酰转移酶、碱性磷酸酶或丙氨酸氨基转移酶水平的实验室异常是可能由酒精引起的肝损伤的非特异性指标。更新的、鲜为人知的经美国食品药品监督管理局（FDA）批准的生化标志物，如缺糖转铁蛋白和酒精消费早期检测测试，也可用于检测重度酒精滥用并监测复发情况。简短干预是有效的，这使得识别和诊断对家庭医生至关重要。提高对酒精滥用的认识、增加筛查工具的使用以及合理使用生化标志物将有助于对酒精使用障碍患者进行早期干预和成功管理。
