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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.3101

摘要内容如下：

重要性

酒精使用障碍（定义为导致临床显著损伤或痛苦的有问题的酒精使用模式）筛查测试的准确性需要重新评估，以符合《精神疾病诊断与统计手册》（第五版）（DSM-5）的最新定义。

目的

评估筛查工具在识别DSM-5中定义的酒精使用障碍个体时的诊断准确性。

数据来源和研究选择

根据DSM-5定义，在MEDLINE和EMBASE数据库（2013年1月-2023年2月）中搜索关于简单筛查工具诊断酒精使用障碍的诊断准确性的原始研究。由于酒精使用障碍的诊断不包括过量饮酒作为标准，因此还保留了在年轻人（9-18岁）、老年人（≥65岁）和孕妇中识别过量或高风险饮酒的筛查工具的研究。

数据提取与合成

计算敏感性、特异性和似然比（LR）。在适当的情况下，进行荟萃分析以计算总结性LR。

结果

在确定的4303项研究中，保留了35项（n=79633）。有11691人有酒精使用障碍或过度饮酒史。在所有年龄组中，酒精使用障碍识别测试（AUDIT）得分为8或更高会增加酒精使用障碍的可能性（LR，6.5[95%CI，3.9-11]）。使用AUDIT的阳性筛查结果表明，女性（LR，6.9[95%CI，3.9-12]）比男性（LR，3.8[95%CI，2.6-5.5]）更容易发现酒精使用障碍（P=.003）。对于男性和女性来说，低于8分的审计分数同样降低了酒精使用障碍的可能性（LR，0.33[95%CI，0.20-0.52]）。简化的AUDIT-COUSTION（AUDIT-C）对男性的性别特异性临界值为4或更高，对女性的性别特异性临界值为3或更高，但对识别酒精使用障碍的作用较小（男性：LR，1.8[95%CI，1.5-2.2]；女性：LR，2.0[95%CI，1.8-2.3]）。AUDIT-C似乎有助于确定年轻人（9-18岁）和60岁以上人群过量饮酒的措施。对于18岁以下的患者，国家酒精滥用和酒精中毒年龄特异性饮酒阈值有助于评估最低风险阈值（LR，0.15[95%CI，0.11-0.21]）、中度风险阈值（LR，3.4[95%CI，2.8-4.1]）和最高风险阈值（LR，15[95%CI，12-19]）的酒精使用障碍的可能性。在怀孕并在分娩后48小时内接受筛查的人群中，审计分数为4或更高的人更可能患有酒精使用障碍（LR，6.4[95%CI，5.1-8.0]），而耐受性、担心、睁眼、健忘和减少筛查工具的分数低于2，以及耐受性、烦恼、减少和睁眼筛查工具的分数低于2的人同样可能患有酒精使用障碍（LR，0.05[95%CI，0.01-0.20 ] ) .

结论和相关性

审计筛查工具可用于识别成人和产后48小时内的酒精使用障碍。国家酒精滥用和酒精中毒研究所青少年筛查工具有助于识别患有酒精使用障碍的儿童和青少年。AUDIT-C似乎有助于确定年轻人和老年人过量饮酒的各种措施。

英文原文如下：

Abstracts

Importance  The accuracy of screening tests for alcohol use disorder (defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress) requires reassessment to align with the latest definition in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5).

Objective  To assess the diagnostic accuracy of screening tools in identifying individuals with alcohol use disorder as defined in the DSM-5.

Data Sources and Study Selection  The databases of MEDLINE and Embase were searched (January 2013-February 2023) for original studies on the diagnostic accuracy of brief screening tools to identify alcohol use disorder according to the DSM-5 definition. Because diagnosis of alcohol use disorder does not include excessive alcohol use as a criterion, studies of screening tools that identify excessive or high-risk drinking among younger (aged 9-18 years), older (aged ≥65 years), and pregnant persons also were retained.

Data Extraction and Synthesis  Sensitivity, specificity, and likelihood ratios (LRs) were calculated. When appropriate, a meta-analysis was performed to calculate a summary LR.

Results  Of 4303 identified studies, 35 were retained (N = 79 633). There were 11 691 individuals with alcohol use disorder or a history of excessive drinking. Across all age categories, a score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT) increased the likelihood of alcohol use disorder (LR, 6.5 [95% CI, 3.9-11]). A positive screening result using AUDIT identified alcohol use disorder better among females (LR, 6.9 [95% CI, 3.9-12]) than among males (LR, 3.8 [95% CI, 2.6-5.5]) (P = .003). An AUDIT score of less than 8 reduced the likelihood of alcohol use disorder similarly for both males and females (LR, 0.33 [95% CI, 0.20-0.52]). The abbreviated AUDIT-Consumption (AUDIT-C) has sex-specific cutoff scores of 4 or greater for males and 3 or greater for females, but was less useful for identifying alcohol use disorder (males: LR, 1.8 [95% CI, 1.5-2.2]; females: LR, 2.0 [95% CI, 1.8-2.3]). The AUDIT-C appeared useful for identifying measures of excessive alcohol use in younger people (aged 9-18 years) and in those older than 60 years of age. For those younger than 18 years of age, the National Institute on Alcohol Abuse and Alcoholism age-specific drinking thresholds were helpful for assessing the likelihood of alcohol use disorder at the lowest risk threshold (LR, 0.15 [95% CI, 0.11-0.21]), at the moderate risk threshold (LR, 3.4 [95% CI, 2.8-4.1]), and at the highest risk threshold (LR, 15 [95% CI, 12-19]). Among persons who were pregnant and screened within 48 hours after delivery, an AUDIT score of 4 or greater identified those more likely to have alcohol use disorder (LR, 6.4 [95% CI, 5.1-8.0]), whereas scores of less than 2 for the Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down screening tool and the Tolerance, Annoyed, Cut-Down and Eye-Opener screening tool identified alcohol use disorder similarly (LR, 0.05 [95% CI, 0.01-0.20]).

Conclusions and Relevance  The AUDIT screening tool is useful to identify alcohol use disorder in adults and in individuals within 48 hours postpartum. The National Institute on Alcohol Abuse and Alcoholism youth screening tool is helpful to identify children and adolescents with alcohol use disorder. The AUDIT-C appears useful for identifying various measures of excessive alcohol use in young people and in older adults.

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