"But I didn't drink!": What to do with discordant phosphatidylethanol results.
"But I didn't drink!": What to do with discordant phosphatidylethanol results.
复制标题
“但我没有喝酒！”：如何处理不一致的磷脂酰乙醇结果。
DOI：
10.1097/lvt.0000000000000223
复制
发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Fernandez,AnneC
中科院分区：
文献类型：
--
作者：
Winder,GeraldScott;Clifton,ErinG;Denysenko,Lex;DiChiara,AlexM;Hathaway,David;Perumalswami,PonniV;Shenoy,Akhil;Suzuki,Joji;Tareen,Kinza;Mellinger,JessicaL;Fernandez,AnneC
肝移植(LT)团队必须熟练地检测、评估和治疗患者的酒精使用，因为它在导致和促进肝脏疾病的心理和行为现象中占有突出地位。磷脂酰乙醇(PEH)是一种非常有用的酒精生物标志物，越来越多地被推荐用于肝病和肝移植的常规使用。在酒精生物标志物中，PEH是独一无二的，因为它的检测窗口宽，灵敏度和特异度高，其数值与不同的酒精使用模式相关。除了肝脏学和LT的无数临床机会外，PEH也带来了许多挑战：几乎没有关于其临床应用的指导；由于担心失去LT的机会以及临床医生和家人的反应，候选人和接受者受到激励，隐瞒他们的酒精使用情况；肝脏临床医生报告缺乏诊断和治疗与物质相关的挑战的专业知识。患者自我报告的酒精使用与毒理学之间的不一致是另一个常见且特别困难的情况。本文讨论了peth的一般毒理学特性；探索了peth结果、患者病史和自我报告饮酒之间可能出现的一致性和不一致性的情况；并提供了详细的临床沟通策略，以探索与肝脏患者的不一致性，这是其使用的一个关键方面。
Liver transplantation (LT) teams must be adept at detecting, evaluating, and treating patients’ alcohol use, given its prominence among psychological and behavioral phenomena which cause and contribute to liver diseases. Phosphatidylethanol (PEth) is a highly useful alcohol biomarker increasingly recommended for routine use in hepatology and LT. PEth is unique among alcohol biomarkers because of its wide detection window, high sensitivity and specificity, and the correlation of its numerical value with different patterns of alcohol use. Alongside myriad clinical opportunities in hepatology and LT, PEth also confers numerous challenges: little guidance exists about its clinical use; fearing loss of LT access and the reactions of their clinicians and families, candidates and recipients are incentivized to conceal their alcohol use; and liver clinicians report lack of expertise diagnosing and treating substance-related challenges. Discordance between patient self-reported alcohol use and toxicology is yet another common and particularly difficult circumstance. This article discusses the general toxicological properties of PEth; explores possible scenarios of concordance and discordance among PEth results, patient history, and self-reported drinking; and provides detailed clinical communication strategies to explore discordance with liver patients, a key aspect of its use.