Spies C D, Emadi A, Neumann T, Hannemann L, Rieger A, Schaffartzik W, Rahmanzadeh R, Berger G, Funk T, Blum S
Benjamin Franklin Medical Center, Department of Anesthesiology, Berlin, Germany.
J Trauma. 1995 Oct;39(4):742-8. doi: 10.1097/00005373-199510000-00025.
Every second traumatized patient is a chronic alcoholic. Chronic alcoholics are at risk due to an increased morbidity and mortality. Reliable and precise diagnostic methods for detecting alcoholism are mandatory to prevent posttraumatic complications by adequate prophylaxis. The patient's history, however, is often not reliable, and conventional laboratory markers are not sensitive or specific enough. The aim of this study was to investigate whether carbohydrate-deficient transferrin (CDT) is a sensitive and specific marker to detect alcoholism in traumatized patients. One hundred and five male traumatized patients or their relatives gave their written informed consent to participate in this institutionally approved study. All patients were transferred to the intensive care unit after admission to the emergency room, followed by surgical treatment. Diagnostics included an alcoholism-related questionnaire, conventional laboratory markers (mean corpuscular volume, gamma-glutamyltransferase, aspartate aminotransferase, and alanine aminotransferase), and CDT sampling (microanion-exchange chromatography, turbidimetry, and radioimmunoassay, respectively). Only patients in whom a reliable history could be obtained were included. Alcoholism was diagnosed if the patients met the Diagnostic and Statistical Manual of Mental Disorders criteria for chronic alcohol abuse or dependence. The administration of fluids before CDT sampling was carefully documented. Patients did not differ significantly regarding age, Trauma and Injury Severity Score, and Acute Physiology and Chronic Health Evaluation score. The sensitivity of the CDT research kit was 70% and of the commercially available kit CDTect was 65%. Early sampling in the emergency room and before administration of large volumes of fluid increased the sensitivity to 83% for the CDT research kit and 74% for CDTect, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
每两名创伤患者中就有一名是慢性酗酒者。慢性酗酒者因发病率和死亡率增加而面临风险。为通过适当预防措施预防创伤后并发症，必须采用可靠且精确的诊断方法来检测酗酒情况。然而，患者的病史往往不可靠，传统实验室指标的敏感性或特异性也不够。本研究的目的是调查缺糖转铁蛋白（CDT）是否是检测创伤患者酗酒情况的敏感且特异的标志物。105名男性创伤患者或其亲属书面知情同意参与本机构批准的研究。所有患者在进入急诊室后被转入重症监护病房，随后接受手术治疗。诊断包括一份与酗酒相关的问卷、传统实验室指标（平均红细胞体积、γ-谷氨酰转移酶、天冬氨酸氨基转移酶和丙氨酸氨基转移酶）以及CDT采样（分别采用微阴离子交换色谱法、比浊法和放射免疫分析法）。仅纳入能获取可靠病史的患者。如果患者符合《精神疾病诊断与统计手册》中慢性酒精滥用或依赖的标准，则诊断为酗酒。仔细记录CDT采样前的补液情况。患者在年龄、创伤和损伤严重程度评分以及急性生理与慢性健康评估评分方面无显著差异。CDT研究试剂盒的敏感性为70%，市售试剂盒CDTect的敏感性为65%。在急诊室以及大量补液前尽早采样，分别使CDT研究试剂盒的敏感性提高到83%，CDTect的敏感性提高到74%。（摘要截选至250词）
