Stewart Scott H, Reuben Adrian, Anton Raymond F
Division of General Internal Medicine, University at Buffalo , 462 Grider Street, Buffalo, NY 14215, USA
Division of Gastroenterology and Hepatology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
Alcohol Alcohol. 2017 Jan;52(1):24-28. doi: 10.1093/alcalc/agw069. Epub 2016 Oct 7.
Serum carbohydrate-deficient transferrin (CDT) is a validated test for chronic heavy alcohol drinking, but CDT abnormalities have been associated with liver disease, limiting its use in these patients. We report here on the association between poor chromatographic resolution of disialotransferrin from trisialotransferrin (the so-called 'di-tri bridging') and liver disease severity and etiology.
Subjects were patients in whom detailed clinical data, including histology results, were available on their existing liver diseases (n=139). Percent disialo-CDT (%dCDT) was measured by high-performance liquid chromatography, and the risks for di-tri bridging associated with cirrhosis, with and without adjustment for alcohol use and alcohol-related liver disease, were estimated.
Di-tri bridging was present in 22/73 (30%) cirrhotic subjects and 7/66 (11%) non-cirrhotic subjects. The unadjusted risk for di-tri bridging in cirrhotics relative to non-cirrhotics was 3.6 (95% confidence interval 1.4-9.2). Adjustment for alcohol-related liver disease and current drinking had little effect on this estimate (adjusted odds ratio 3.4), and neither alcohol-related liver disease nor current drinking were independently associated with di-tri bridging after accounting for the effect of cirrhosis.
The presence of di-tri bridging was associated with cirrhosis in individuals with both alcohol-related and non-alcoholic liver disease, although most cirrhotic subjects did not exhibit di-tri bridging. When di-tri bridging is seen in individuals being tested for chronic heavy drinking, investigation for cirrhosis should be considered.
There are known liver-disease-associated abnormalities in CDT. In this study, we found that such abnormalities were strongly associated with cirrhosis rather than less-advanced disease, but were only clinically evident in 30% of cirrhotics. Abnormalities also occurred in severe hepatitis without cirrhosis and were not specific for liver disease etiology.
血清缺糖转铁蛋白（CDT）是慢性重度饮酒的一项有效检测指标，但CDT异常与肝脏疾病有关，限制了其在这些患者中的应用。我们在此报告双唾液酸转铁蛋白与三唾液酸转铁蛋白的色谱分离不佳（即所谓的“双-三桥接”）与肝脏疾病严重程度和病因之间的关联。
研究对象为139例患有现有肝脏疾病且有详细临床资料（包括组织学结果）的患者。采用高效液相色谱法测定双唾液酸CDT（%dCDT）百分比，并评估与肝硬化相关的双-三桥接风险，同时对饮酒情况和酒精性肝病进行了校正。
22/73（30%）的肝硬化患者和7/66（11%）的非肝硬化患者存在双-三桥接。肝硬化患者与非肝硬化患者相比，未校正的双-三桥接风险为3.6（95%置信区间1.4-9.2）。校正酒精性肝病和当前饮酒情况对该估计值影响不大（校正比值比3.4），在考虑肝硬化的影响后，酒精性肝病和当前饮酒均与双-三桥接无独立关联。
双-三桥接的存在与酒精性和非酒精性肝病患者的肝硬化有关，尽管大多数肝硬化患者未表现出双-三桥接。在检测慢性重度饮酒的个体中发现双-三桥接时，应考虑对肝硬化进行检查。
已知CDT存在与肝脏疾病相关的异常。在本研究中，我们发现这些异常与肝硬化密切相关，而非病情较轻的疾病，但仅在30%的肝硬化患者中具有临床显著性。异常情况也发生在无肝硬化的严重肝炎患者中，且并非肝脏疾病病因所特有。
