慢性酒精依赖成人中硫胺素血液水平与认知之间关系的进一步证据：口服补充方案住院解毒的前瞻性试点研究。
Further evidence of relationship between thiamine blood level and cognition in chronic alcohol-dependent adults: Prospective Pilot Study of an inpatient detoxification with oral supplementation protocol.
机构信息
Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, D-44577, Castrop-Rauxel, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, D-45147, Essen, Germany.
Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, D-44577, Castrop-Rauxel, Germany.
出版信息
Alcohol. 2023 Aug;110:23-31. doi: 10.1016/j.alcohol.2023.03.001. Epub 2023 Mar 8.
BACKGROUND
The relationship between thiamine blood level (TBL) and cognition remains uncertain, including among alcohol-dependent persons (ADP).
AIM
To evaluate this relationship during protocol-driven inpatient alcohol detoxification treatment including thiamine supplementation (AD + Th).
METHODS
Prospective 3-week study with 100 consecutively admitted detoxification-seeking ADP (47.7 ± 11 years old, 21% females) without superseding comorbidities requiring treatment. TBL and Montreal Cognitive Assessment (MoCA) were measured at admission (t, pre-AD + Th) and discharge (t, post-AD + Th). Frontal Assessment Battery (FAB) was performed at t. AD + Th included abstinence, pharmacological alcohol withdrawal syndrome treatment, and oral thiamine supplementation (200 mg/day for 14 days). Regression and mediation analyses assessed TBL-cognition relationships.
RESULTS
We found no cases of Wernicke Encephalopathy (WE) and only one case of thiamine deficiency. Both MoCA and TBL significantly improved across AD + Th (with medium-to-large effect sizes). At t, TBL significantly predicted MoCA and FAB sum scores (medium effect sizes; extreme and very strong evidence, respectively). The clear TBL-MoCA association disappeared at t. In multivariate regression and mediation analyses exploring key influential factors of cognition (identified by LASSO regression), the TBL-MoCA interactions did not relevantly change at t and t. Age, serum transaminases, vitamin D levels, drinking-years, and depression score weakly modified the relationship.
CONCLUSION
TBL was a robust predictor of pre-detoxification cognitive impairment, and both TBL and cognition improved significantly during AD + Th (including abstinence) in our ADP population, supporting routine thiamine supplementation for ADP, even those at low WE-risk. The TBL-cognition relationship was minimally confounded by age, alcohol-toxicity proxies, mood, and vitamin D levels.
背景
硫胺素血水平（TBL）与认知之间的关系尚不确定，包括在酒精依赖者（ADP）中。
目的
在包括硫胺素补充（AD + Th）的协议驱动的住院酒精解毒治疗期间评估这种关系。
方法
前瞻性 3 周研究，连续纳入 100 名寻求解毒的 ADP（47.7 ± 11 岁，21%为女性），无需要治疗的并发疾病。TBL 和蒙特利尔认知评估（MoCA）在入院时（t，AD + Th 前）和出院时（t，AD + Th 后）进行测量。在 t 时进行额叶评估量表（FAB）。AD + Th 包括戒酒、药物戒断综合征治疗和口服硫胺素补充（14 天每天 200mg）。回归和中介分析评估了 TBL-认知关系。
结果
我们没有发现威尼克脑病（WE）的病例，只有一例硫胺素缺乏症。AD + Th 后，MoCA 和 TBL 均显著改善（具有中到大的效应量）。在 t 时，TBL 显著预测 MoCA 和 FAB 总分（中效应量；分别为极端和极强证据）。在 t 时，TBL-MoCA 关联消失。在探索认知的关键影响因素的多元回归和中介分析（由 LASSO 回归确定）中，t 和 t 时 TBL-MoCA 相互作用没有明显变化。年龄、血清转氨酶、维生素 D 水平、饮酒年限和抑郁评分微弱地改变了这种关系。
结论
TBL 是解毒前认知障碍的有力预测因子，在我们的 ADP 人群中，AD + Th（包括戒酒）期间 TBL 和认知都显著改善，支持对 ADP 进行常规硫胺素补充，即使是低 WE 风险的患者。TBL-认知关系受年龄、酒精毒性指标、情绪和维生素 D 水平的影响最小。
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