Skinner H A, Holt S, Sheu W J, Israel Y
Br Med J (Clin Res Ed). 1986 Jun 28;292(6537):1703-8. doi: 10.1136/bmj.292.6537.1703.
To determine reliable indicators of alcohol abuse a comprehensive set of clinical and laboratory information was acquired from three groups of subjects with a wide range of drinking histories: 131 outpatients with alcohol problems, 131 social drinkers, and 52 patients from family practice. Findings from clinical examination provided greater diagnostic accuracy than laboratory tests for detecting alcohol abuse. Logistic regression analysis produced an overall accuracy of 85-91% for clinical signs, 84-88% for items from the medical history, and 71-83% for laboratory tests in differentiating the three groups. Further analyses showed 17 clinical signs and 13 medical history items that formed a highly diagnostic instrument (alcohol clinical index) that could be used in clinical practice. A probability of alcohol abuse exceeding 0.90 was found if four or more clinical signs or four or more medical history items from the index were present. Despite recent emphasis on the laboratory diagnosis of alcohol abuse simple clinical measures seem to provide better diagnostic accuracy.
为了确定酒精滥用的可靠指标，从三组饮酒史各异的受试者中获取了一套全面的临床和实验室信息：131名有酒精问题的门诊患者、131名社交饮酒者以及52名家庭医疗患者。在检测酒精滥用方面，临床检查结果比实验室检查具有更高的诊断准确性。逻辑回归分析显示，区分这三组时，临床体征的总体准确率为85% - 91%，病史项目的准确率为84% - 88%，实验室检查的准确率为71% - 83%。进一步分析显示，17项临床体征和13项病史项目构成了一种高度诊断性工具（酒精临床指数），可用于临床实践。如果该指数中有四项或更多临床体征或四项或更多病史项目存在，则酒精滥用的概率超过0.90。尽管最近强调酒精滥用的实验室诊断，但简单的临床措施似乎能提供更好的诊断准确性。
