Dergi Ara >>
Yıl:2008; Cilt: 9; Sayı: 3>> Özet
Bağımlılık Dergisi; 2008;9(3):141-147
Alkol Kullanım Bozukluklarında Tarama Testleri ve Biyokimyasal Belirleyiciler
S Gül, Y Akvardar
Dokuz Eylül Üniversitesi Tıp Fakültesi Psikiyatri AD
Tarama testleri alkol kullanım bozukluklarının saptanmasını kolaylaştırır. CAGE (Cut down. Annoyed, Guilty, Eye-opener) ve Alkol Kullanım Bozuklukları Tanıma Testi (AKBTT) (AUDIT; Alcohol Use Disorders Identification Test) yaygın kullanılan tarama testleridir. Michigan Alkolizm Tarama Testi'nin (MATT) (MAST; Michigan Alcoholism Screening Test) seçiciliği düşüktür. Kısa tarama testleri (CAGE ve AKBTT gibi) daha yüksek geçerlilik göstermektedir.
Tarama testlerinin kısıtlılığı olguların bellek ve dürüstlüklerine güvenilmesini gerektirmeleridir. Alkolün neden olduğu bellek sorunlarının yanında, bu bozukluklarda yadsımanın sık görülmesi testlere olan güveni azaltmaktadır. Bu nedenle biyokimyasal belirleyicilere de gereksinim duyulmaktadır. Karbonhidrattan yoksun transferin (CDT, carbonhydrate-deficient transferrin), son 20 yılda üzerinde yaygın olarak çalışılan ve en çok ümit veren ağır içicilik belirleyicisi olmuştur. Ancak karışık test yöntemi, yüksek maliyet ve ulaşılabilirlik sorunu vardır. GGT'nin (gama-glutamiltransferaz) duyarlık bakımından CDT'den daha az tanısal değer taşıdığı bildirilse de kolay ulaşılabilir olması, ucuzluğu ve basit test yöntemi gibi avantajları vardır. CDT'nin en önemli avantajları yüksek özgüllüğü ve nüks belirleyicisi olarak uygunluğudur. GGT bu açılardan CDT'ye göre kısıtlılık göstermektedir.
Alkol kullanım bozukluklarının objektif göstergeleri olarak yeni belirleyiciler üzerinde çalışmalar sürmektedir. CDT dışında beta-heksozamînidaz ((3-Hex) ve 5-hidroksitriptofol (5-HTOL) üzerinde durulmaktadır. Tarama testleri ve biyokimyasal belirleyicilerin değerli olduğu alanlar; tedavide motivasyon artırma, bazı iş kollarında güvenlik önlemi amacıyla kullanım, toplum sağlığı çalışmaları ve diğer bilimsel çalışmalardır.

Screening Tests and Biochemical Markers in Alcohol Use Disorders
Screening tests facilitate the alcohol use disorder diagnosis. CAGE (acronym for Cut down, Annoyed, Guilty, Eye-opener) and Alcohol Use Disorder Identification Test (AUDIT) are frequently used screeening tests. The sensitivity of Michigan Alcoholism Screening Test is lower. The validity of shorter screening tests (eg. CAGE, AUDIT) is higher.
The limitation of screening tests is the necessity to rely on the memory and honesty of cases. Besides the alcohol related memory problems, denial often seen in these disorders makes these tests less reliable. Therefore biochemical markers are needed. In the past two decades carbohydrate deficient transferrin (CDT) has been most widely studied and most hopeful marker. Butthecomplicated test procedure, high cost and less avalibility are problems about this marker. GGT (gama glutamyltransferase) which is reported to have lower sensitivity has advantages such as the higher avalibility, low price and simple test procedure. The high specifity and suitability as a relapse marker are the most important advantages of CDT. GGT has limitations on these aspects according to CDT.
The studies on the new markers for alcohol use disorders as objective indicators are going on. Beta-hexozaminidase ((3-Hex) and 5-hydroxytryptophol (5-HTOL) has been proposed. Screening tests and biochemical markers are valuable for motivation enhancement in treatment, security measures in certain professions, public health and other scientific studies.

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