Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO.
Department of Pathology and Pediatrics, St. Louis University School of Medicine, St. Louis, MO.
Clin Chem. 2022 May 18;68(5):635-645. doi: 10.1093/clinchem/hvac004.
Ethanol use can lead to many health and socio-economic problems. Early identification of risky drinking behaviors helps provide timely clinical and social interventions. Laboratory testing of biomarkers of ethanol use supports the timely identification of individuals with risky drinking behaviors. This review provides an overview of the utility and limitations of ethanol biomarkers in the clinical laboratory.
Direct assessment of ethanol in tissues and body fluids has limited utility due to the pharmacokinetics of ethanol. Therefore, the evaluation of ethanol use relies on nonvolatile metabolites of ethanol (direct biomarkers) and measurement of the physiological response to the toxic metabolites of ethanol (indirect biomarkers). Ethanol biomarkers help monitor both chronic and acute ethanol use. The points discussed here include the clinical utility of ethanol biomarkers, testing modalities used for laboratory assessment, the specimens of choice, limitations, and clinical interpretation of results. Finally, we discuss the ethical principles that should guide physicians and laboratorians when using these tests to evaluate alcohol use.
Indirect biomarkers such as carbohydrate-deficient transferrin, mean corpuscular volume, and liver enzymes activities may suggest heavy ethanol use. They lack sensitivity and specificity for timely detection of risky drinking behavior and have limited utility for acute ethanol use. Direct biomarkers such as ethyl glucuronide, ethyl sulfate, and phosphatidylethanol are considered sensitive and specific for detecting acute and chronic ethanol use. However, laboratory assessment and result interpretation lack standardization, limiting clinical utility. Ethical principles including respect for persons, beneficence, and justice should guide testing.
乙醇的使用会导致许多健康和社会经济问题。尽早识别危险的饮酒行为有助于提供及时的临床和社会干预。乙醇使用生物标志物的实验室检测有助于及时识别有危险饮酒行为的个体。本文综述了乙醇生物标志物在临床实验室中的应用价值和局限性。
由于乙醇的药代动力学，直接评估组织和体液中的乙醇的实用性有限。因此，对乙醇使用的评估依赖于乙醇的非挥发性代谢物（直接生物标志物）和对乙醇毒性代谢物的生理反应的测量（间接生物标志物）。乙醇生物标志物有助于监测慢性和急性乙醇使用。这里讨论的要点包括乙醇生物标志物的临床应用、用于实验室评估的检测模式、首选的标本、局限性以及结果的临床解释。最后，我们讨论了在使用这些测试来评估酒精使用时应指导医生和实验室人员的伦理原则。
间接生物标志物，如糖蛋白缺乏转铁蛋白、平均红细胞体积和肝酶活性，可能提示大量乙醇使用。它们对及时检测危险饮酒行为的敏感性和特异性有限，对急性乙醇使用的实用性有限。直接生物标志物，如乙基葡萄糖醛酸、乙基硫酸盐和磷脂酰乙醇，被认为对检测急性和慢性乙醇使用具有敏感性和特异性。然而，实验室评估和结果解释缺乏标准化，限制了其临床应用。包括尊重人、行善和正义在内的伦理原则应指导检测。
