Fucci Nadia, Gili Alessio, Aroni Kyriaki, Bacci Mauro, Carletti Paola, Pascali Vincenzo Lorenzo, Gambelunghe Cristiana
Forensic Medicine Section, Public Health Institute, Sacred Heart Catholic University, Largo Francesco Vito, 1-00168 Rome, Italy.
Hygiene and Public Health Section, Department of Experimental Medicine, University of Perugia, Piazza Lucio Severi-06132 Perugia, Italy.
Interdiscip Toxicol. 2017 Dec;10(4):155-162. doi: 10.1515/intox-2017-0022. Epub 2018 Mar 1.
Alcohol and illicit drug abuse are major public health problems worldwide. Since alcohol is the predominant substance of choice in polydrug abusers, monitoring its use, along with urinary drug screening in patients in rehabilitation programs, appeared to be crucial in identifying patients at risk of alcohol disorders leading to impaired quality of life. Ethyl β-D-6-glucuronide, a non-oxidative, non-volatile, stable and minor direct ethanol metabolite, has a 6h to 4 day window of detection in urine after the last alcohol intake. Each of the 119 subjects (85 males, 34 females) registered with the Public Health Service for Drug Dependence Treatment provided a urine sample for ethylglucoronide (EtG) determination in an immunochemical test with a 500 ng/ml cutoff. All results were evaluated with confirmation criteria of a fully validated gas chromatography/mass spectrometry assay. The diagnostic performance of the EtG immunochemical test was assessed using Receiver Operating Characteristic Curve analysis. The immunochemical test specificity was 100% for EtG urinary values above 500 ng/ml. No false positive results were found. With levels below 500 ng/ml, 12% of the samples were classified as negative. The average consumption of the incorrectly classified subjects was 171 ng/ml, with a misclassification error of 6.5% to 18.5%. High agreement between EtG as determined in an immunochemical test and gas chromatography/mass spectrometry, suggests that the rapid EtG test is a reliable, cost-effective alcohol monitoring assay for patient management in many non-forensic settings, such as drug rehabilitation programs.
酒精和非法药物滥用是全球主要的公共卫生问题。由于酒精是多药滥用者首选的主要物质，因此在康复项目中监测其使用情况以及对患者进行尿液药物筛查，对于识别有酒精障碍风险从而导致生活质量受损的患者而言似乎至关重要。β-D-6-葡萄糖醛酸乙酯是一种非氧化、非挥发性、稳定且少量的直接乙醇代谢物，在最后一次饮酒后，其在尿液中的检测窗口期为6小时至4天。119名在公共卫生服务机构登记接受药物依赖治疗的受试者（85名男性，34名女性）每人都提供了一份尿液样本，用于免疫化学检测中对葡萄糖醛酸乙酯（EtG）的测定，检测临界值为500 ng/ml。所有结果均根据经过充分验证的气相色谱/质谱分析法的确认标准进行评估。使用受试者工作特征曲线分析评估EtG免疫化学检测的诊断性能。对于尿液中EtG值高于500 ng/ml的情况，免疫化学检测的特异性为100%。未发现假阳性结果。当EtG值低于500 ng/ml时，12%的样本被归类为阴性。被错误分类的受试者的平均EtG值为171 ng/ml，错误分类误差为6.5%至18.5%。免疫化学检测法测定的EtG与气相色谱/质谱分析法之间高度一致，这表明快速EtG检测在许多非法医环境（如药物康复项目）中是一种可靠且具有成本效益的酒精监测检测方法，可用于患者管理。
