Diagnostic Accuracy of Biomarkers of Alcohol Use in Patients With Liver Disease: A Systematic Review.
Diagnostic Accuracy of Biomarkers of Alcohol Use in Patients With Liver Disease: A Systematic Review.
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DOI：
10.1111/acer.14512
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Verbeek J
中科院分区：
文献类型：
--
作者：
Arnts J;Vanlerberghe BTK;Roozen S;Crunelle CL;Masclee AAM;Olde-Damink SWM;Heeren RMA;van Nuijs A;Neels H;Nevens F;Verbeek J
酒精性肝病是导致肝硬变的最常见原因，也是肝移植的主要适应症。近年来已经开发了几个酒精使用生物标记物，并已在几个中心使用。然而，在肝病患者中，他们的诊断能力可能受到肝脏损伤导致的生物标志物形成的改变、肾功能障碍和利尿剂使用造成的排泄改变以及头发和指甲沉积改变的影响。我们系统地回顾了有关酒精使用的生物标志物在肝病患者中诊断准确性的研究，并进行了详细的研究质量评估。在PubMed/Medline/Embase数据库中对相关研究进行结构化搜索，发表至2019年4月28日。根据修订的诊断准确性研究质量评估-2(QUADAS-2)检查表评估偏倚和适用性问题的风险。6449项研究中有12项符合纳入标准。尿乙基葡萄糖醛酸脂和尿硫酸乙酯对评估过去几天的任何饮酒量都有很高的敏感性(分别为70~89%和73~82%)和特异性(分别为93~99%和86~89%)。过去几周，血清碳水化合物缺乏的转铁蛋白对检测过量饮酒的敏感性较低，但特异性较高(分别为40%至79%和57%至99%)。在检测前几周的任何饮酒量时，全血磷脂乙醇表现出很高的灵敏度和特异度(分别为73%到100%和90%到96%)。头发乙基葡萄糖醛酸脂对检测过去3~6个月慢性过量饮酒的敏感性(85%~100%)和特异性(97%~100%)较高。目前证据的主要局限性是缺乏评估酒精使用的绝对黄金标准、研究人群的异质性以及研究的匮乏。尿液和头发乙基葡萄糖醛酸乙酯是目前在肝病患者中最有效的酒精使用生物标志物，具有良好的诊断准确性。磷脂酰乙醇是一种很有前途的酒精使用生物标志物，但到目前为止在肝脏患者中的有效性较低。在诊断时间窗方面，酒精使用生物标志物可以相互补充。需要对肝病患者的酒精使用生物标记物进行更多的验证研究。酒精使用生物标记物可能有很大的好处，但对其在肝病患者中的适用性存在担忧。Arnts，Vanlerberghe等人。对其在肝病患者中的诊断准确性进行深入回顾。尿液和头发乙基葡萄糖醛酸乙酯是最有效的酒精使用生物标志物。磷脂酰乙醇的诊断准确性是非常有希望的，但到目前为止还没有在肝脏患者中得到验证。他们的审查有助于在日常实践中正确应用和解释这些酒精使用生物标记物。
Alcohol‐related liver disease is the most frequent cause of cirrhosis and a major indication for liver transplantation. Several alcohol use biomarkers have been developed in recent years and are already in use in several centers. However, in patients with liver disease their diagnostic performance might be influenced by altered biomarker formation by hepatic damage, altered excretion by kidney dysfunction and diuretics use, and altered deposition in hair and nails. We systematically reviewed studies on the diagnostic accuracy of biomarkers of alcohol use in patients with liver disease and performed a detailed study quality assessment. A structured search in PubMed/Medline/Embase databases was performed for relevant studies, published until April 28, 2019. The risk of bias and applicability concerns was assessed according to the adapted quality assessment of diagnostic accuracy studies‐2 (QUADAS‐2) checklist. Twelve out of 6,449 studies met inclusion criteria. Urinary ethyl glucuronide and urinary ethyl sulfate showed high sensitivity (70 to 89 and 73 to 82%, respectively) and specificity (93 to 99 and 86 to 89%, respectively) for assessing any amount of alcohol use in the past days. Serum carbohydrate‐deficient transferrin showed low sensitivity but higher specificity (40 to 79 and 57 to 99%, respectively) to detect excessive alcohol use in the past weeks. Whole blood phosphatidylethanol showed high sensitivity and specificity (73 to 100 and 90 to 96%, respectively) to detect any amount of alcohol use in the previous weeks. Scalp hair ethyl glucuronide showed high sensitivity (85 to 100%) and specificity (97 to 100%) for detecting chronic excessive alcohol use in the past 3 to 6 months. Main limitations of the current evidence are the lack of an absolute gold standard to assess alcohol use, heterogeneous study populations, and the paucity of studies. Urinary and scalp hair ethyl glucuronide are currently the most validated alcohol use biomarkers in patients with liver disease with good diagnostic accuracies. Phosphatidylethanol is a highly promising alcohol use biomarker, but so far less validated in liver patients. Alcohol use biomarkers can complement each other regarding diagnostic time window. More validation studies on alcohol use biomarkers in patients with liver disease are needed. Alcohol use biomarkers can be of great benefit, but concerns exist regarding their applicability in patients with liver disease. Arnts, Vanlerberghe et al. provide an in‐depth review of their diagnostic accuracy in liver patients. Urinary and scalp hair ethyl glucuronide are the most validated alcohol use biomarkers. The diagnostic accuracy of phoshatidylethanol is highly promising, but so far less validated in liver patients. Their review aids in the correct application and interpretation of these alcohol use biomarkers in daily practice.
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影响因子：
2.4
作者：
Fagan KJ;Irvine KM;McWhinney BC;Fletcher LM;Horsfall LU;Johnson L;O'Rourke P;Martin J;Scott I;Pretorius CJ;Ungerer JP;Powell EE
通讯作者：
Powell EE
影响因子：
2.2
作者：
Cappelle, Delphine;Neels, Hugo;van Nuijs, Alexander L. N.
通讯作者：
van Nuijs, Alexander L. N.
影响因子：
2.5
作者：
Goll, M;Schmitt, G;Aderjan, RE
通讯作者：
Aderjan, RE
影响因子：
2.8
作者：
Helander, Anders;Bottcher, Michael;Beck, Olof
通讯作者：
Beck, Olof
影响因子：
1.6
作者：
Hagan, Andrew K.;Wang, Maomao;Liu, Li
通讯作者：
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