Aim. Reveal the influence of excessive alcohol consumption on blood coagulation system, levels of blood proteins in patients with atrial fibrillation treated with warfarin. Methods. The study included 80 patients with a diagnosis of atrial fibrillation, treated with vitamin K antagonists. The study group included 34 patients with excessive alcohol consumption (according to the questionnaire), the comparison group - 46 patients with no excessive alcohol consumption. Transferrin, hemopexin, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, carbohydrate-deficient transferrin levels were measured in venous blood serum, serum protein electrophoresis was performed. Parameters of plasma hemostasis tests and D-dimer level were also analyzed. Results. Gamma-glutamyl transferase activity in patients of study group was 1.5 times higher compared to the comparison group (p=0.021). There was no statically significant differences in aspartate transaminase and alanine transaminase activity, but their levels were increased in alcohol abusers with gamma-glutamyl transferase above normal values (55 U/l). None of the patients had increased level of carbohydrate-deficient transferrin. Absolute and relative serum β1-globulin concentrations were significantly reduced in study group patients, while hemopexin and transferrin levels were at the same level as in the control group. No differences of coagulation parameters were between the groups. In the study group, in patients with β1-globulin levels below the median values, international normalized ratio was significantly closer to the target values, but the same patients had higher D-dimer levels, which apparently indicates low effect of anticoagulants. Conclusion. The effect of anticoagulant was low in patients with excessive alcohol consumption and atrial fibrillation, as evidenced by elevated D-dimer levels at international normalized ratio close to the target values. Patients with atrial fibrillation and excessive alcohol consumption with elevated D-dimer levels had serum β1-globulin levels reduced compared to median values.
Aim. To compare the results of the questionnaire and biomarker-based risk assessment of alcohol abuse among persons receiving higher and mid-level medical professional education. Methods. Among students of mid-level and higher medical education age 18 to 27 years (77 and 124 subjects, respectively), activity of indicator enzymes was measured in blood serum, and with the help of questionnaires the risk of alcohol abuse (CRAFFT, CAGE, AUDIT) and psychological features of the person were determined [A.G. Zverkovs and E.V. Eidmans questionnaires of willpower and self-control, R. Baumeisters self-control questionnaire, hardiness survey (Maddi S.R.) adapted by D.A. Leontyev, Barratt Impulsiveness Scale Test, test for revealing risk groups of psychoactive drug abuse in the educational institution]. Statistical significance was assessed with the use of nonparametric statistics. Results. The activity of enzymes (aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase) in the blood of the subjects did not have significant intergroup differences. Additionally (beyond this study), we characterized the database of laboratory tests of the students aged 18 to 27 years seeking medical care in the academic center of laboratory diagnosis of Omsk State Medical University. Among 646 subjects, 52 (8.1%) had laboratory analyses exceeding the reference so the differences were expected. Absence of results exceeding reference values of the activity of the studied enzymes was necessary in our study to confirm the absence of pathology associated with cytolysis as well as the signs of chronic alcohol abuse with harmful consequences, which is equivalent to meeting the inclusion criteria (absence of pathology according to medical professional consultation report 086/u and to the results of periodic health examination). Among all surveyed, the CRAFFT questionnaire showed a 2.7-fold higher number of groups at risk of alcohol abuse than CAGE and 1.4 times more than AUDIT. The results of CAGE and CRAFFT test questionnaires showed a greater prevalence of the risk of alcohol abuse among students of higher medical education programs compared to those receiving mid-level medical education (CAGE by 2.7 times; CRAFFT by 1.68 times) . The AUDIT test revealed no statistically significant differences between the groups (p=0.093). Analysis of the results of psychological testing to identify the propensity for addictive behavior, showed a weak correlation with self-control (r=0,406, p=0,014 and r=0,313, p=0,016 for CRAFFT and AUDIT, respectively). Correlation between the self-control violation and risk of alcohol abuse was quite weak according to the results, hence, the students with disordered self-control are not alwaysa characterized by alcohol motivation. In the context of our received data, psychological survey for monitoring the risk of abuse cannot substitute CRAFFT and AUDIT tests. Conclusion. The CRAFFT questionnaire is most effective in assessing the risk of alcohol abuse in a population of young people; the results of the questionnaires used weakly correlated with tests that reflect the psychological characteristics of the person; the activity of the studied enzymes in the blood serum of did not correlate with the results of surveys and is within the population reference interval.
Aim. To compare the diagnostic capabilities of indirect laboratory markers of alcohol consumption - alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase and carbohydrate-deficient transferrin, depending on the social status and age group of the subjects. Methods. The activity of enzymes were assessed in the blood serum of socially adapted young subjects (18-25 years, 201 people) and adults (35-50 years, 121 people) by standard biochemical methods, and the level of carbohydrate-deficient transferrin was determined by capillary electrophoresis. With the use of questionnaires, the subjects were tested for alcohol abuse. Non-parametric criteria of statistical significance were used to evaluate the difference. Results. No differences in the activity of enzymes associated with the level of alcohol consumption were found in the youth group (p = 0.911 for alanine aminotransferase, p = 0.669 for aspartate aminotransferase, p = 0.303 for gamma-glutamyltranspeptidase). Activity of gamma-glutamyltranspeptidase was significantly higher in adult group of alcohol abuse (p = 0.021), but individual values of enzyme activity of some subjects from this group fit into the population reference interval. Differences in the level of carbohydrate-deficient transferrin in the youth group, associated with the volume and frequency of alcohol consumption, were not revealed (p = 0.348), and all individual values were within the reference interval. In the adult group, values of this parameter were higher in high-dose alcohol drinkers (p = 0.019) but the diagnostic threshold of alcohol abuse was reached only in 2 subjects. Conclusion. Indirect laboratory markers do not have sufficient diagnostic significance for screening of alcohol abuse among socially adapted young people and adults. Informativeness of carbohydrate-deficient transferrin may be sufficient if the diagnostic threshold corresponding to a definite social and age group replaces the standard population-established concentration limit.
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