Sorvajärvi K, Blake J E, Israel Y, Niemelä O
EP Central Hospital Laboratory, Seinäjoki, Finland.
Alcohol Clin Exp Res. 1996 May;20(3):449-54. doi: 10.1111/j.1530-0277.1996.tb01074.x.
Despite a number of investigations suggesting the value of carbohydrate-deficient transferrin (CDT) as a marker of alcohol abuse, a variety of issues on the applicability of CDT measurements in clinical settings have remained unexplored. Earlier studies in this field have focused on the relationship of CDT and the amount of alcohol consumption or presence of liver disease, whereas the influence of alterations in serum transferrin concentrations on CDT has received less attention. In this study, we compared two different methods for measuring CDT (CDTect and %CDT) and total transferrin concentrations in a sample of 83 alcohol abusers (20 patients with alcoholic liver disease and 63 heavy drinkers who were devoid of liver disease, despite excessive alcohol consumption) and 89 controls, who were social drinkers or abstainers. The control population included 53 hospitalized patients with expected abnormalities in serum transferrin concentrations caused by conditions such as negative iron balance, pregnancy, or nonalcoholic liver disease. Both methods gave significantly higher values in alcohol abusers than in controls (p < 0.01), but the overall sensitivity for detecting alcohol abuse was clearly higher for CDTect (59%) than for %CDT (34%). The correlation between the results obtained by the two methods (r = 0.629) significantly improved, when the CDTect values were replaced by the ratio of CDTect/total transferrin (r = 0.770) (p < 0.05). There was a positive correlation between the CDTect and serum transferrin (r = 0.201, p < 0.01), which was significant both in the alcoholics (r = 0.240, p < 0.05), and especially in the controls (r = 0.727, p < 0.001). A significant inverse correlation emerged between %CDT and total transferrin (r = -0.302, p < 0.01). The sensitivities of CDTect and %CDT for correctly classifying alcohol abusers in the subgroup of alcoholic liver disease patients were 90% and 70% and in the subgroup of heavy drinkers without liver disease (49% and 22%), respectively. Specificities for CDTect and %CDT in this sample were 81% and 100%, respectively. However, in the subgroup of hospitalized control patients with abnormal serum transferrin, the specificity of CDTect was only 48%. According to present data, CDTect seems to be more sensitive than %CDT for detecting alcohol abuse. However, any alteration in serum total transferrin concentration markedly decreases the assay specificity. This should be considered when interpreting the assay results in patients with elevated serum transferrin, such as iron deficiency, pregnancy, or liver diseases.
尽管多项研究表明缺糖转铁蛋白（CDT）可作为酒精滥用的标志物，但CDT检测在临床环境中的适用性方面仍有诸多问题未得到探索。该领域早期的研究主要聚焦于CDT与酒精摄入量或肝脏疾病的关系，而血清转铁蛋白浓度变化对CDT的影响较少受到关注。在本研究中，我们比较了两种测量CDT（CDTect和%CDT）以及总转铁蛋白浓度的不同方法，样本包括83名酒精滥用者（20名酒精性肝病患者和63名重度饮酒但无肝病的人，尽管饮酒过量）以及89名对照者，对照者为社交饮酒者或戒酒者。对照人群包括53名因负铁平衡、妊娠或非酒精性肝病等情况导致血清转铁蛋白浓度预期异常的住院患者。两种方法测得的酒精滥用者的值均显著高于对照者（p < 0.01），但CDTect检测酒精滥用的总体敏感度（59%）明显高于%CDT（34%）。当用CDTect/总转铁蛋白的比值替代CDTect值时，两种方法所得结果之间的相关性（r = 0.629）显著提高（r = 0.770）（p < 0.05）。CDTect与血清转铁蛋白呈正相关（r = 0.201，p < 0.01），在酗酒者中（r = 0.240，p < 0.05）以及尤其在对照者中（r = 0.727，p < 0.001）均具有显著性。%CDT与总转铁蛋白呈显著负相关（r = -0.302，p < 0.01）。在酒精性肝病患者亚组中，CDTect和%CDT正确分类酒精滥用者的敏感度分别为90%和70%，在无肝病的重度饮酒者亚组中分别为49%和22%。本样本中CDTect和%CDT的特异性分别为81%和100%。然而，在血清转铁蛋白异常的住院对照患者亚组中，CDTect的特异性仅为48%。根据现有数据，CDTect在检测酒精滥用方面似乎比%CDT更敏感。然而，血清总转铁蛋白浓度的任何改变都会显著降低检测的特异性。在解释血清转铁蛋白升高患者（如缺铁、妊娠或肝病患者）的检测结果时应考虑到这一点。
