Emergency Medicine Department, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK.
Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
Sci Rep. 2022 Apr 28;12(1):6941. doi: 10.1038/s41598-022-10970-x.
Alcohol withdrawal syndrome (AWS) occurs in 2% of patients admitted to U.K. hospitals. Routine treatment includes thiamine and benzodiazepines. Laboratory studies indicate that thiamine requires magnesium for optimal activity, however this has not translated into clinical practice. Patients experiencing AWS were randomized to three groups: (group 1) thiamine, (group 2) thiamine plus MgSO or (group 3) MgSO. Pre- and 2-h post-treatment blood samples were taken. AWS severity was recorded using the Glasgow Modified Alcohol Withdrawal Score (GMAWS). The primary outcome measure was 15% change in erythrocyte transketolase activity (ETKA) in group 3. Secondary outcome measures were change in plasma lactate concentrations and time to GMAWS = 0. 127 patients were recruited, 115 patients were included in the intention-to-treat analysis. Pre-treatment, the majority of patients had normal or high erythrocyte thiamine diphosphate (TDP) concentrations (≥ 275-675/> 675 ng/gHb respectively) (99%), low serum magnesium concentrations (< 0.75 mmol/L) (59%), and high plasma lactate concentrations (> 2 mmol/L) (67%). Basal ETKA did not change significantly in groups 1, 2 or 3. Magnesium deficient patients (< 0.75 mmol/L) demonstrated less correlation between pre-treatment basal ETKA and TDP concentrations than normomagnesemic patients (R = 0.053 and R = 0.236). Median plasma lactate concentrations normalized (≤ 2.0 mmol/L) across all three groups (p < 0.001 for all groups), but not among magnesium deficient patients in group 1 (n = 22). The median time to achieve GMAWS = 0 for groups 1, 2 and 3 was 10, 5.5 and 6 h respectively (p < 0.001). No significant difference was found between groups for the primary endpoint of change in ETKA. Co-administration of thiamine and magnesium resulted in more consistent normalization of plasma lactate concentrations and reduced duration to achieve initial resolution of AWS symptoms.ClinicalTrials.gov: NCT03466528.
酒精戒断综合征（AWS）在英国住院患者中发生率为 2%。常规治疗包括硫胺素和苯二氮䓬类药物。实验室研究表明，硫胺素的最佳活性需要镁，但这尚未转化为临床实践。将出现 AWS 的患者随机分为三组：（第 1 组）硫胺素，（第 2 组）硫胺素加硫酸镁或（第 3 组）硫酸镁。治疗前和治疗后 2 小时采集血样。使用格拉斯哥改良酒精戒断评分（GMAWS）记录 AWS 严重程度。主要观察指标为第 3 组红细胞转酮醇酶活性（ETKA）增加 15%。次要观察指标为血浆乳酸浓度变化和达到 GMAWS=0 的时间。共招募 127 例患者，115 例患者纳入意向治疗分析。治疗前，大多数患者红细胞硫胺素二磷酸（TDP）浓度正常或较高（分别为≥275-675/>675ng/gHb）（99%），血清镁浓度较低（<0.75mmol/L）（59%），血浆乳酸浓度较高（>2mmol/L）（67%）。第 1、2 或 3 组的基础 ETKA 无明显变化。镁缺乏患者（<0.75mmol/L）的基础 ETKA 与 TDP 浓度之间的相关性低于镁正常患者（R=0.053 和 R=0.236）。三组患者的血浆乳酸浓度均正常化（≤2.0mmol/L）（所有组 p<0.001），但第 1 组的镁缺乏患者（n=22）除外。第 1、2 和 3 组达到 GMAWS=0 的中位时间分别为 10、5.5 和 6 小时（p<0.001）。三组之间 ETKA 变化的主要终点无显著差异。硫胺素和镁联合使用可更一致地使血浆乳酸浓度正常化，并缩短 AWS 症状初步缓解的时间。ClinicalTrials.gov：NCT03466528。
