Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan.
J Stud Alcohol Drugs. 2011 Sep;72(5):752-62. doi: 10.15288/jsad.2011.72.752.
Several theoretical typology models have been proposed to classify alcoholism into more homogeneous subtypes using various criteria, for which age at onset of alcohol dependence is shared across many models. We investigated the evidence for the distinction between early- versus late-onset alcoholism by examining relevant phenotypic and genotypic variables.
Data are from 1,248 individuals with alcohol dependence, who were interviewed to collect detailed clinical information. Early versus late onset of alcohol dependence was defined by the age at onset of 22 years. Odds ratio (OR) and Cohen's d were calculated as effect size for comparisons of clinical features between the two groups. We adjusted interviewed age and gender in logistic regression models. Case-control genetic analyses were conducted for the association between HTR1B, SLC6A4, DRD2, and OPRμ1 genes and subgroups of alcohol dependence using a sample of 530 controls screened for alcohol problems.
Early-onset alcoholism exhibited significantly (p < .01) different clinical characteristics from late-onset alcoholism, including higher severity in alcohol dependence symptoms (d = 0.22) and maximum drinking quantity within 24 hours (d = 0.40), more rapid progression from regular drinking to meet alcohol dependence diagnosis (d = 1.73), higher expectancies for alcohol (d = 0.22-0.47), more comorbidity with externalizing disorders (ORs = 2.8-2.9), and greater prevalence of family alcohol use problems (d = 0.26-0.43). In addition, markers in the HTR1B and OPRμ1 genes showed genetic associations with subgroups of alcohol dependence (ORs = 1.5-2.4).
Our findings support that subgroups of alcohol dependence defined by onset age have phenotypic and genetic differences. The early-onset subgroup had more severe features for almost every aspect we examined. Coupled with genetic association findings, age at onset of alcohol dependence may serve as a simple but important clinical marker with implications for future etiological research and intervention.
已有几种理论类型模型提出，使用不同的标准将酒精依赖症分为更同质的亚型，其中许多模型都共享发病年龄。我们通过检查相关的表型和基因型变量，研究了早发性和晚发性酒精依赖症之间的区别的证据。
数据来自 1248 名酒精依赖患者，对他们进行访谈以收集详细的临床信息。通过 22 岁的发病年龄来定义早发性和晚发性酒精依赖症。使用 OR 和 Cohen's d 作为效应量，比较两组间的临床特征。我们在逻辑回归模型中调整了访谈年龄和性别。使用筛选出有酒精问题的 530 名对照者样本，进行 HTR1B、SLC6A4、DRD2 和 OPRμ1 基因与酒精依赖亚组的病例对照遗传分析。
早发性酒精依赖症与晚发性酒精依赖症表现出显著不同的临床特征（p<.01），包括更严重的酒精依赖症状（d=0.22）和 24 小时内最大饮酒量（d=0.40）、更快地从规律饮酒进展到符合酒精依赖诊断（d=1.73）、更高的酒精预期（d=0.22-0.47）、更多与外化障碍共病（ORs=2.8-2.9）和更大的家族酒精使用问题发生率（d=0.26-0.43）。此外，HTR1B 和 OPRμ1 基因的标记物与酒精依赖亚组存在遗传关联（ORs=1.5-2.4）。
我们的发现支持通过发病年龄定义的酒精依赖亚组在表型和遗传上存在差异。早发亚组在我们检查的几乎每一个方面都有更严重的特征。结合遗传关联发现，发病年龄可能是一个简单但重要的临床标志物，对未来的病因学研究和干预具有重要意义。
