Direkte Ethanolmetaboliten als Biomarker für Alkoholkonsum: Grundlagen und Anwendungen

Zusammenfassung

Biomarker sind in Diagnose und Therapie alkoholbezogener Störungen in Ergänzung zu Selbstangaben von relevanter Bedeutung. Traditionelle Biomarker wie Gamma-Glutamyltranspeptidase (GGT) und mittleres korpuskuläres Volumen (MCV) sind indirekte Marker und werden durch Alter, Geschlecht und nicht alkoholbezogene Erkrankungen beeinflusst. Direkte Ethanolmetabolite wie Ethylglukuronid (EtG), Ethylsulfat (EtS) und Phosphatidylethanol (PEth) sind direkte Stoffwechselprodukte von Alkohol. Sie zeichnen sich durch hohe Sensitivität und Spezifität aus, decken ein komplementäres Zeitfenster des Konsumnachweises ab und werden seit einigen Jahren zunehmend routinemäßig eingesetzt. Direkte Ethanolmetabolite sind im Serum für Stunden, im Urin für bis zu 7 Tage, im Vollblut über 2 Wochen und in Haaren über Monate nachweisbar. Zu den Anwendungsbereichen gehören klinisch routinemäßige Anwendungen, der Einsatz in notfallmedizinischen Kontexten, Abstinenznachweis in Alkoholbehandlungsprogrammen, bei Fahreignungsuntersuchungen, Lebertransplantationen, betrieblicher Gesundheitsprävention sowie die Verwendung zur Abschätzung des Alkoholkonsums während der Schwangerschaft im Zusammenhang mit dem fetalen Alkohol-Syndrom. Durch ihre Eigenschaften eröffnen sie neue Perspektiven in Prävention, interdisziplinärer Kooperation, Diagnose und Therapie alkoholbezogener Störungen.

Abstract

In addition to self reports and questionnaires, biomarkers are of relevance in the diagnosis of and therapy for alcohol use disorders. Traditional biomarkers such as gamma-glutamyl transpeptidase or mean corpuscular volume are indirect biomarkers and are subject to the influence of age, gender and non-alcohol related diseases, among others. Direct metabolites of ethanol such as ethyl glucuronide (EtG), ethyl sulphate (EtS) and phosphatidylethanol (PEth) are direct metabolites of ethanol, that are positive after intake of ethyl alcohol. They represent useful diagnostic tools for identifying alcohol use even more accurately than traditional biomarkers. Each of these drinking indicators remains positive in serum and urine for a characteristic time spectrum after the cessation of ethanol intake – EtG and EtS in urine up to 7 days, EtG in hair for months after ethanol has left the body. Applications include clinical routine use, emergency room settings, proof of abstinence in alcohol rehabilitation programmes, driving under influence offenders, workplace testing, assessment of alcohol intake in the context of liver transplantation and foetal alcohol syndrome. Due to their properties, they open up new perspectives for prevention, interdisciplinary cooperation, diagnosis of and therapy for alcohol-related problems.

Schlüsselwörter

Biomarker - Alkohol - Ethylglukuronid - fetales Alkohol-Syndrom - direkte Ethanolmetabolite

Key words

biomarker - alcohol - ethyl glucuronide - foetal alcohol syndrome - direct metabolites of ethanol

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