Laboratory of Clinical and Experimental Toxicology, Pavia Poison Centre, National Toxicology Information Centre, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa - SB, Institute of G Nervi, Genoa, Italy.
Alcohol. 2021 Aug;94:43-56. doi: 10.1016/j.alcohol.2021.04.004. Epub 2021 Apr 19.
A bulk of evidence in the field of translational medicine applied to clinical toxicology and rehabilitation has highlighted the possibility of using biomarkers as a support in the diagnosis of alcohol-related diseases and in monitoring of alcohol withdrawal. In a cohort of 55 subjects admitted to a 4-week residential rehabilitation period for alcohol detoxification, we applied a complementary approach correlating novel and conventional peripheral blood and urine parameters in combination with clinical and functional evaluation, contextually considered with the patient's history. Biomarkers of oxidative, inflammatory, hepatic, and neurochemical effects paralleled by alcohol craving and clinical scale measurements were determined at two specific time points, i.e., admission and discharge. Concerning the post-discharge assessment (i.e., relapse evaluation one month after discharge), a follow-up oral interview during a clinical examination was applied to evaluate alcohol abstinence.Selected biomarkers, i.e., MCP1, F2-IsoPs, and SOD1, were altered in chronic alcoholics at admission, and then showed a clearly changing trend during hospitalization. Our findings demonstrated that these specific non-traditional biomarkers, measured together with more conventional ones (e.g., CDT, EtG, IL8, ALT, AST, GGT), could represent novel key parameters for monitoring alcohol use disorders and withdrawal, being also suggestive of the complexity of the psychoneuroimmune response to alcohol. A general improvement in psychological functioning (i.e., decreases in anxiety, depression, and psychological distress) was also revealed during the 4-week rehabilitation treatment, paralleled by an increase of well-being and positive changes in terms of scores. Moreover, a positive association between SOD1 and drink craving at admission was evidenced. Notably, both SOD1 and well-being displayed a significant relation with lower risk of alcohol relapse one month after discharge, indicating that SOD1 is a good predictor of reduced relapse probability. This 4-week residential rehabilitation protocol represents a sound strategy enabling identification of alcohol use disorders and monitoring of alcohol addiction state and withdrawal. However, it has to be emphasized that results derived from this pilot study need to be extensively validated in large and independent cohorts of subjects.
大量转化医学领域的证据应用于临床毒理学和康复医学，强调了使用生物标志物作为支持酒精相关疾病诊断和监测酒精戒断的可能性。在一个接受为期 4 周的住院康复治疗以戒除酒精的 55 名受试者队列中，我们采用了一种补充方法，将新型和传统外周血和尿液参数与临床和功能评估相结合，并结合患者的病史进行综合考虑。在两个特定时间点（即入院时和出院时）测定了与酒精渴求和临床量表测量相关的氧化、炎症、肝和神经化学效应的生物标志物。在出院后的评估（即出院后一个月的复发评估）中，应用临床检查中的随访口服访谈来评估酒精禁欲。选择生物标志物，即 MCP1、F2-IsoPs 和 SOD1，在慢性酒精中毒患者入院时发生改变，然后在住院期间呈现出明显的变化趋势。我们的研究结果表明，这些特定的非传统生物标志物，与更传统的标志物（如 CDT、EtG、IL8、ALT、AST、GGT）一起测量，可能代表监测酒精使用障碍和戒断的新关键参数，也表明了对酒精的心理神经免疫反应的复杂性。在 4 周的康复治疗期间，还揭示了心理功能的普遍改善（即焦虑、抑郁和心理困扰的减少），同时幸福感也有所提高，评分也有所改善。此外，在入院时 SOD1 和饮酒渴求之间存在正相关关系。值得注意的是，SOD1 和幸福感与出院后一个月的酒精复发风险呈显著相关，表明 SOD1 是降低复发概率的良好预测指标。这个为期 4 周的住院康复方案是一种有效的策略，可以识别酒精使用障碍，并监测酒精成瘾状态和戒断。然而，必须强调的是，从这项试点研究中得出的结果需要在更大的、独立的受试者队列中进行广泛验证。
