Kulaga Vivian, Pragst Fritz, Fulga Netta, Koren Gideon
Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.
Ther Drug Monit. 2009 Apr;31(2):261-6. doi: 10.1097/FTD.0b013e31819c33b8.
A serious challenge in diagnosing fetal alcohol spectrum disorder (FASD) is the need to document alcohol use during pregnancy. Maternal/paternal alcohol abuse affects the likelihood of fetal alcohol exposure, and hence the occurrence of FASD. The objective of the current study was to document the use of the fatty acid ethyl ester (FAEE) hair test, a biomarker of excessive alcohol use, in parents at risk of having children with FASD and quantify the prevalence of alcohol use in this population. Hair samples submitted for FAEE testing between October 2005 and May 2007 were evaluated (n = 324). Subjects consisted of the parents of at-risk children. Samples were analyzed using a previously published method. Briefly, samples underwent a liquid-liquid extraction, followed by headspace solid phase microextraction, and were then analyzed by gas chromatography-mass spectrometry using deuterated FAEE as internal standards. Limit of detection and limit of quantification values were between 0.01-0.04 ng/mg and 0.04-0.12 ng/mg, respectively. Positive levels for excessive drinking were ascertained using a cutoff level of 0.5 ng/mg, offering 90% sensitivity and specificity. The rate of positive hair samples for excessive drinking was 33.3% (32.4% among women and 35.4% among men) (n = 324). The majority of samples (62%) had cumulative FAEE levels above a level that excludes strict abstinence (0.2 ng/mg) and many (19%) were highly positive (above 1.0 ng/mg). Of 26 FAEE hair tests for which women were reported to be pregnant, 38% had FAEE hair levels above 0.2 ng/mg and 19% tested positive for excessive drinking, with levels above 0.5 ng/mg; 12% had levels above 1.0 ng/mg. The high rate of positive FAEE results demonstrates that the FAEE hair test corroborates the clinical suspicion of alcohol use in parents of children at risk for FASD. Our results suggest that FAEE hair analysis may be a powerful tool in detecting excessive alcohol use in the perinatal period.
诊断胎儿酒精谱系障碍（FASD）面临的一项严峻挑战是需要记录孕期酒精使用情况。母亲/父亲的酒精滥用会影响胎儿酒精暴露的可能性，进而影响FASD的发生。本研究的目的是记录脂肪酸乙酯（FAEE）毛发检测（一种过度饮酒的生物标志物）在有生育FASD患儿风险的父母中的应用情况，并量化该人群中酒精使用的患病率。对2005年10月至2007年5月期间提交进行FAEE检测的毛发样本（n = 324）进行了评估。研究对象为有风险儿童的父母。样本采用先前发表的方法进行分析。简要来说，样本先进行液-液萃取，然后进行顶空固相微萃取，接着使用氘代FAEE作为内标通过气相色谱-质谱联用仪进行分析。检测限和定量限分别在0.01 - 0.04 ng/mg和0.04 - 0.12 ng/mg之间。过量饮酒的阳性水平通过0.5 ng/mg的临界值确定，灵敏度和特异性均为90%。毛发样本中过量饮酒的阳性率为33.3%（女性为32.4%，男性为35.4%）（n = 324）。大多数样本（62%）的FAEE累积水平高于排除严格戒酒的水平（0.2 ng/mg），许多样本（19%）呈高度阳性（高于1.0 ng/mg）。在报告女性怀孕的26次FAEE毛发检测中，38%的FAEE毛发水平高于0.2 ng/mg，19%的检测结果显示过量饮酒呈阳性，水平高于0.5 ng/mg；12%的水平高于1.0 ng/mg。FAEE检测结果的高阳性率表明，FAEE毛发检测证实了临床对有FASD风险儿童父母饮酒情况的怀疑。我们的结果表明，FAEE毛发分析可能是检测围产期过度饮酒的有力工具。
