Heinemann A, Sterneck M, Kuhlencordt R, Rogiers X, Schulz K H, Queen B, Wischhusen F, Püschel K
Institute of Legal Medicine, University Hospital Hamburg, Germany.
Alcohol Clin Exp Res. 1998 Nov;22(8):1806-12. doi: 10.1111/j.1530-0277.1998.tb03985.x.
We tested the diagnostic validity of carbohydrate-deficient transferrin (CDT) as an indicator for relapse into elevated alcohol consumption among patients who were examined under follow-up treatment before (n = 147) and after (n = 102) orthotopic liver transplantation (OLT) in the outpatient-department of the University Hospital Department of Surgery in Hamburg-Eppendorf. CDT measurements were performed with two commercial kits in parallel (CDTect-RIA and CDT%-RIA). Short-term parameters of alcohol consumption (ethanol, methanol) indicated relapses into elevated alcohol consumption in 11.4% of the evaluated patients with alcoholic liver disease (ALD) before transplantation. Before OLT, median CDT values were determined to be elevated among patients with alcoholic as well as nonalcoholic end-stage liver diseases (NALD). Among patients with ALD, we found elevated CDT medians even in those who were successfully scheduled for OLT after long-term evidence of abstinence proved by biochemical short-term parameters and psychological tests. Both CDTect and CDT% assays had comparable low specificities in selected patient groups before transplantation. CDT% and CDTect were negatively correlated with the albumin level. Before the study ended, CDT was no longer implemented in the evaluation of whether an OLT should be administered. This was due to inconsistent results of CDT in ALD as well as NALD. After OLT, patients with ALD, as well as NALD, had statistically significant lower CDT medians than before OLT, which ranged within reference levels. We determined, according to CDT, elevated alcohol consumption subsequent to OLT in 4 of 13 patients with ALD who underwent transplantation during the study (median observation period: 10 months). CDT does not appear to be useful in evaluating patients before OLT. With regained specificity and high sensitivity in patients after OLT, CDT could be recommended as a standard instrument for quality control in patients with ALD after liver transplantation.
我们在汉堡 - 埃彭多夫大学医院外科门诊，对接受原位肝移植（OLT）前后接受随访治疗的患者（移植前n = 147，移植后n = 102）进行了测试，以评估碳水化合物缺乏转铁蛋白（CDT）作为酒精摄入量回升指标的诊断有效性。使用两种商用试剂盒并行进行CDT测量（CDTect - RIA和CDT%-RIA）。酒精摄入量的短期参数（乙醇、甲醇）表明，在移植前评估的酒精性肝病（ALD）患者中，11.4%出现酒精摄入量回升。在OLT前，酒精性和非酒精性终末期肝病（NALD）患者的CDT中值均升高。在ALD患者中，即使是那些经生化短期参数和心理测试长期证明戒酒成功后成功安排OLT的患者，我们也发现其CDT中值升高。在移植前的特定患者组中，CDTect和CDT%检测的特异性都较低。CDT%和CDTect与白蛋白水平呈负相关。在研究结束前，CDT不再用于评估是否应进行OLT。这是由于CDT在ALD和NALD中的结果不一致。OLT后，ALD患者以及NALD患者的CDT中值在统计学上显著低于OLT前，且在参考水平范围内。根据CDT，在研究期间接受移植的13例ALD患者中有4例在OLT后酒精摄入量升高（中位观察期：10个月）。CDT在评估OLT前的患者时似乎无用。由于OLT后患者恢复了特异性且具有高敏感性，CDT可被推荐作为肝移植后ALD患者质量控制的标准工具。
