Reid M C, Guo Zhenchao, Van Ness Peter H, O'Connor Patrick G, Concato John
Weill Medical College, Cornell University, 525 East 68th St, Box 39, New York, NY 10021, USA.
Subst Abus. 2005 Jun;26(2):25-32. doi: 10.1300/j465v26n02_04.
Although mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferases (ALT), and the AST/ALT ratio are sometimes used as markers of alcohol disorders, their utility has not been established in older persons. We determined the tests' performance characteristics for (1) at-risk drinking, (2) CAGE positivity, (3) at-risk drinking and CAGE positivity, and (4) a clinician-recorded diagnosis of alcohol abuse/dependence in a study of older male veterans receiving primary care. Participants (n = 587) included patients who had MCV, AST, and/or ALT data collected as part of routine care no more than 12 weeks before or after enrollment. MCV, AST, and ALT test results were obtained from the VA's database. At enrollment, the Timeline Followback and Alcohol Use Disorders Identification Test (AUDIT) were used to identify at-risk drinkers (> or = 15 drinks per week or AUDIT score > or = 8), and the CAGE questionnaire was administered to identify participants with a history abuse/dependent drinking (CAGE score > or = 2). Participants' medical records were reviewed to identify subjects with a clinician-recorded diagnosis of alcohol abuse/dependence. The prevalence of abnormal test results for MCV (threshold value = > 98), AST (> 41), ALT (> 41), and the AST/ALT ratio (> 2) was 11%, 4%, 4%, and 5%, respectively. The occurrence of at-risk drinking, CAGE positivity, at-risk drinking and CAGE positivity, and a clinician-recorded diagnosis of alcohol abuse/dependence was 11%, 25%, 5%, and 9%, respectively. Test sensitivity ranged from 3.9% to 25.4% and specificity from 88.5% to 97.1%, whereas positive likelihood ratios varied from 0.72 to 4.01 and negative likelihood ratios from 0.82 to 1.04. Areas under the receiver operating characteristic curve were similar (range = 0.50-0.58) across tests. In conclusion, MCV, AST, ALT, and the AST/ALT ratio are not useful markers of alcohol disorders in older male veterans.
虽然平均红细胞体积（MCV）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）以及AST/ALT比值有时被用作酒精紊乱的标志物，但它们在老年人中的效用尚未得到证实。在一项针对接受初级保健的老年男性退伍军人的研究中，我们确定了这些检测对于（1）高危饮酒、（2）CAGE问卷阳性、（3）高危饮酒且CAGE问卷阳性以及（4）临床医生记录的酒精滥用/依赖诊断的性能特征。参与者（n = 587）包括在入组前或入组后不超过12周作为常规护理一部分收集了MCV、AST和/或ALT数据的患者。MCV、AST和ALT检测结果来自退伍军人事务部的数据库。在入组时，使用时间线随访和酒精使用障碍识别测试（AUDIT）来识别高危饮酒者（每周饮酒≥15杯或AUDIT评分≥8），并使用CAGE问卷来识别有酗酒/依赖饮酒史的参与者（CAGE评分≥2）。审查参与者的病历以识别临床医生记录有酒精滥用/依赖诊断的受试者。MCV（阈值>98）、AST（>41）、ALT（>41）以及AST/ALT比值（>2）检测结果异常的患病率分别为11%、4%、4%和5%。高危饮酒、CAGE问卷阳性、高危饮酒且CAGE问卷阳性以及临床医生记录的酒精滥用/依赖诊断的发生率分别为11%、25%、5%和9%。检测灵敏度范围为3.9%至25.4%，特异性范围为88.5%至97.1%，而阳性似然比在0.72至4.01之间，阴性似然比在0.82至1.04之间。各检测的受试者操作特征曲线下面积相似（范围 = 0.50 - 0.58）。总之，MCV、AST、ALT以及AST/ALT比值并非老年男性退伍军人酒精紊乱的有用标志物。
