ALKOL KULLANIM BOZUKLUKLARI VE KARRBONHİDRATTAN YOKSUN TRANSFERRİN (KYT)

Numan Konuk; Sibel Kıran; Murat Can; Levent Atik; Durmuş Evcuman

ALKOL KULLANIM BOZUKLUKLARI VE KARRBONHİDRATTAN YOKSUN TRANSFERRİN (KYT)

Yazarlar

Numan Konuk Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı
Sibel Kıran Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Halk Sağlığı Anabilim Dalı
Murat Can Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Biyokimya Anabilim Dalı
Levent Atik Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı
Durmuş Evcuman Adli Tıp Kurumu Zonguldak Adli Tıp Şube Müdürlüğü

Anahtar Kelimeler:

Alkol kullanım bozuklukları- biyolojik belirleyici- karbonhidrattan yoksun transferrin- trafik

Özet

Alkol bağımlılığı ve kötüye kullanımının saptanmasında yardımcı bir unsur olarak biyolojik belirleyicilerin kullanımı arayışları yasal bir konu olarak önemini sürdürmektedir. Bu yazıda alkol kullanım bozukluklarının saptanmasında kullanılan çeşitli biyolojik belirleyicilerden birisi olan karbonhidrattan yoksun transferrinin tanısal geçerliliği diğer belirleyicilerle karşılaştırılmış ve yapılan çalışmalar gözden geçirilmiştir. Ülkemizde ciddi bir halk sağlığı sorunu olan alkolle ilişkili trafik kazalarının önlenmesi amacıyla sürücü belgesi verilmesi ve alıkonulan belgelerin iadesi aşamasında yapılabileceklere ilişkin pratik önerilerde bulunulmuştur.

Kaynaklar

Hancı İH. Alkol ve Trafik Kazaları. II. Trafik Şurası, Ankara, 2004.

Ewing JA. Detecting alcoholism: The CAGE guesti-onnaire. JAMA. 1984; 252:1905-7.

Brinkmann B, Kohler H, Banaschak S, et al. ROC analysis of alcoholism markers- 100% specificity. Int. J. Legal Med. 2000; 113; 293-9.

Hacker R, Arndt T, Helwig RA, et al. Investigation by isoelectric focusing of the initial carbohydrate-deficient transferrin (CDT) and non-CDT transferrin isoform fractionation step involved in determination of CDT by the Chron Alcol D assay. Clin. Chem 2000; 46:483-492.

Arndt T. Carbohydrate-deficient transferrin as a marker of chronic alcohol abuse: a critical review of preanalysis, analysis, and interpretation. Clin Chem 2001; 47:13-27.

Xin Y, Lasker JM, Lieber CS. Serum carbohydrate-deficient transferrin: mechanism of increase after chronic alcohol intake. Hepatology 1995;22:1462-8.

Stibler H. Carbohydrate-deficient transferrin in serum: a new marker of potentially harmful alcohol consumption reviewed, Clin. Chem. 1991; 37:2029-37.

Bortolottia F, Tagliaroa F, Cittadinib F, et al. Determination of CDT, a marker of chronic alcohol abuse, for driving license issuing: immunoassay versus capillary electrophoresis. Forensic Science International 2002; 128:53–58.

Anton, RF, Dominick C, Bigelow M, et al. Comparison of Bio-Rad %CDT TIA and CDTect as laboratory markers of heavy alcohol use and their relationships with gamma-glutamyltransferase. Clin Chem. 2001; 47: 1769-75.

Bean P, Liegmann K, Lovli T, et al. Semiautomated procedures for evaluation of carbohydrate-deficient transferrin in the diagnosis of alcohol abuse. Clin Chem 1997; 43: 983-89.

Viitala K, Lahdesmaki K, Niemela O. Comparison of the Axis %CDT TIA and the CDTect method as laboratory tests of alcohol abuse. Clin Chem 1998; 44:1209– 1215.

Gomez A, Conde A, Aguiar JA, et al. Diagnostic usefulness of carbohydrate-deficient transferrin for detecting alcohol-related problems in hospitalized patients. Alcohol Alcohol 2001; 36:267-70.

Mikkelsen IM, Kanitz RD, Nilssen O, et al. Carbohydrate-deficient transferrin: marker of actual alcohol consumption or chronic alcohol misuse? Alcohol Alcohol 1998; 33: 646-50.

Mundle G, Ackermann K, Munkes J, et al. Influence of age, alcohol consumption and abstinence on the sensitivity of combining carbohydrate-deficient transferrin, gamma-glutamyltransferase and mean corpuscular volume. Alcohol Alcohol 1999; 34:760-766.

Mundle G, Munkes J, Ackermann K, et al. Sex differences of carbohydrate-deficient transferrin γ-glutamyltransferase, and mean corpuscular volume in alcohol dependent patients. Alcohol Clin Exp Res 2000; 24:1400-05.

Fagerberg B, Agewall S, Urbanavicius V, et al. Carbohydrate-deficient transferrin is associated with insulin sensitivity in hypertensive men. J Clin Endocrinol Metab 1994; 79:712–5.

Borg S, Helander A, Voltaire CA, et al. Detection of relapses in alcohol-dependent patients using carbohydrate-deficient transferrin: improvement with individualized reference levels during longterm monitoring. Alcohol Clin Exp Res 1995; 19:961–3.

Anton RF, Lieber C, Tabakoff B. Carbohydrate-deficient transferrin and g-glutamyltransferase for the detection and monitoring of alcohol use: results from a multisite study. Alcohol Clin Exp Res 2002; 26:1215-122.

Huseby NE, Bjordal E, Nilssen O, et al. Utility of biological markers during outpatient treatment of alcohol-dependent subjects: carbohydrate-deficient transferrin responds to moderate changes in alcohol consumption. Alcohol Clin Exp Res 1997; 21:1343- 46.

Lesch OM, Walter H, Freitag H, et al. Carbohydra-tedeficient transferrin as a screening marker for drinking in a general hospital population. Alcohol Alcohol 1996; 31:249-56.

Allen JP, Litten RZ, Anton RF, et al. Carbohydrate-deficient transferrin as a measure of immoderate drinking: remaining issues. Alcohol Clin Exp Res 1994; 18:799–812.

Gronbaek M, Henriksen JH, Becker U. Carbohydrate deficient transferin a valid marker of alcoholism in population studies? Results from the Copenhagen City Heart Study. Alcohol Clin Exp Res 1995; 19:457-61.

Meerkerk GJ, Njoo KH, Bongers IMB, et al. The specificity of the CDT assay in general practice: the influence of common chronic diseases and medication on the serum CDT concentration. Alcohol Clin Exp Res 1998; 22:908-13.

Bell H, Tallaksen CME, Try K, et al. Carbohydrate-deficient transferin and other markers of high alcohol consumption: a study of 502 patients admitted consecutively to a medical department. Alcohol Alcohol 1994; 18:1103-1108.

Golka K, Sondermann R, Reich SE, et al. Carbohydrate-deficient transferrin (CDT) as a biomarker in persons suspected of alcohol abuse. Toxicology Letters 2004; 151:235-41

Reynaud M, Schellenberg F, Loisequx-Meunier MN, et al. Objective diagnosis of alcohol abuse: compared values of carbohydrate-deficient transferrin (CDT), γ-glutamyltransferase (GGT), and mean corpuscular volume (MCV). Alcohol Clin Exp Res 2000; 24:1414-19.

Litten RZ, Allen JP, Fertig JB. g-Glutamyltranspepti-dase and carbohydrate deficient transferrin: alternative measures of excessive alcohol consumption. Alcohol Clin Exp Res 1995; 19:1541-46.

Conigrave KM, Degenhardt JL, Whitfield JB, et al. CDT, GGT, and AST as markers of alcohol use: the WHO/ISBRA collaborative project. Alcohol Clin Exp Res 2002; 26:332-39.

Gül S, Akvardar Y, Taş G, ve ark. Alkol Kullanım Bozukluklarında Tarama Testleri ve Laboratuvar Belirteçlerinin Tanısal Etkinliği. Türk Psikiyatri Dergisi 2005; 16:3-12.

Anton, RF. The use of carbohydrate deficient transferrin as an indicator of alcohol consumption during treatment and follow-up. Alcohol Clin Exp Res 1996; 20:54–56.

Mitchell C, Simpson D, Chick J. Carbohydrate deficient transferin in detecting relapse in alcohol dependence. Drug Alcohol Depend. 1997; 48:97-103.

Schmidt LG, Schmidt K, Dufeu P, et al. Superiority of carbohydrate-deficient transferrin to g-glu-tamyltransferase in detecting relapse in alcoholism. Am J Psychiatry 1997; 154:75– 80.

Şengül CB, Şengül C, Dilbaz N, et al. Alkol kullanım bozukluklarında yeni bir biyokimyasal belirleyici: Carbonhydrate Deficient Transferrin (CDT) Bağımlılık Dergisi 2004; 5: 139-46.

ALKOL KULLANIM BOZUKLUKLARI VE KARRBONHİDRATTAN YOKSUN TRANSFERRİN (KYT)