探討酒精代謝基因多型性和飲酒態度與行為之衛教成效評估

Abstract

引言 根據世界衛生組織報告，酒精的不當使用會導致眾多健康問題。然而，不只是酒精本身，酒精代謝基因對於健康風險也影響很大。在東亞人身上ALDH2基因 rs671位點的變異最為人熟知，而這樣的基因多型性和許多健康結果有關。雖然在臺灣有高達47%的民眾帶有ALDH2基因缺陷，但是尚未有研究針對臺灣人去討論究竟得知自己的ALDH2 rs671基因型，同時瞭解其在未來可能帶來的健康風險，是否會改變飲酒行為。因此，本篇研究意在探討ALDH2 rs671基因多型性和飲酒態度與行為之間的關係及衛生教育介入的成效。 方法 本篇研究的對象為國立臺灣大學的學生，年齡介於18至65歲。首先，受試者需填寫自評紙本前測問卷，包含飲酒行為、酒後反應、飲酒態度及酒精不耐症的認知，並且使用口腔拭子採集口腔表皮細胞，用以偵測ALDH2 rs671基因型（GG代表ALDH2酵素有活性、GA代表ALDH2酵素僅有部分活性、AA代表ALDH2酵素幾乎無活性），接著經過一段時間等待實驗結果，受試者會收到電子報告書，內容提及ALDH2 rs671基因型及相關衛教資訊，而在收到報告書的一個月後，受試者需再完成線上後測問卷，包含飲酒行為、飲酒態度及酒精不耐症的認知。在統計分析的部分，我們使用了單變量及雙變量分析來描述樣本組成，並且透過多元線性回歸模型評估衛生教育介入的成效，模型的結果包含飲酒頻率、飲酒量、飲酒態度及酒精不耐症的認知這四項，其中更以受試者的ALDH2基因是否有缺陷進行分層，同時校正性別、年級、飲酒習慣及基線分數。 結果 在本篇研究的樣本中，ALDH2缺陷（GA+AA）的盛行率為47.65%。超過八成的受試者目前偶爾飲酒，僅有約一成五的受試者目前有持續飲酒的習慣（達到每週150 c.c.且持續六個月以上）。飲酒量（p<0.001）、暴飲（p<0.001）、飲酒頻率（p=0.001）、酒後臉紅（p<0.001）、酒後心跳加速（p<0.001）都和ALDH2 rs671的基因型有顯著相關。在受試者收到報告書的一個月後，我們也發現到那些ALDH2 rs671為GG基因型的男性受試者其飲酒頻率顯著下降。此外，那些目前有持續飲酒習慣的受試者，不論ALDH2 rs671的基因型為何，相比於目前偶爾喝酒者，他們的飲酒頻率（GG: p=0.006, GA+AA: p<0.001）及飲酒量（GG: p=0.002, GA+AA: p<0.001）都有顯著降低。 結論 飲酒行為及酒後反應與ALDH2 rs671的基因型有顯著關聯，而在介入的一個月後，那些目前有持續飲酒習慣的受試者其飲酒行為顯著減少，本篇的研究結果也為臺灣校園探討ALDH2 rs671基因多型性與飲酒的關聯提供了初步的證據。

Background According to WHO's global status report, harmful use of alcohol can cause multiple health problems. However, not only alcohol itself, but genes involved in alcohol metabolism also have strong effects on health risks. The most well-known East-Asian specific variant is rs671 from ALDH2. The influences of genetic polymorphism of ALDH2 rs671 are associated with various health outcomes. Although Taiwan ranks the highest in the world with about 47% of its population are ALDH2 deficient, none research in Taiwan has yet examined whether knowing future health risk specific to ALDH2 genotype would influence drinking behavior. Therefore, the aim of this study is to explore the relationship between ALDH2 rs671 polymorphism and attitudes and behaviors toward drinking and effectiveness of health education. Materials and Methods In this study, participants were students from National Taiwan University between 18 to 65 years old. At the beginning, self-reported questionnaires (paper) were used to ask participants about their drinking behaviors, reaction after drinking, attitudes toward drinking and knowledge about alcohol intolerance. Furthermore, buccal swab samples were collected to determine ALDH2 rs671 genotype (GG: active, GA: partially inactive, AA: completely inactive). Report attachments were designed to provide participants with their genetic testing results and health education materials. One month after receiving report attachment, participants completed self-reported questionnaires (online), including drinking behaviors, attitudes toward drinking and knowledge about alcohol intolerance. For statistical analysis, univariate and bivariate statistics were used to describe the study samples. Multiple linear regression model was built to examine the changes of score, stratified by ALDH2 deficiency status, in drinking frequency, alcohol consumption, attitudes and knowledge, adjusted for gender, grade, drinking habit and baseline score. Results In this study, the prevalence of ALDH2 deficiency (GA+AA) was 47.65%. Over 80% of the participants were occasional drinkers, while only 15% of the participants were current drinkers. Alcohol consumption (p<0.001), binge drinking (p<0.001), drinking frequency (p=0.001), facial flushing (p<0.001) and rapid heartbeat (p<0.001) were all significantly associated with ALDH2 rs671 genotype. One month after receiving report attachments, male participants with GG genotype had significant decreases in drinking frequency. In addition, current drinkers were significantly associated with the reductions in both drinking frequency (GG: p=0.006, GA+AA: p<0.001) and alcohol consumption (GG: p=0.002, GA+AA: p<0.001) comparing to occasional drinkers. Conclusions Drinking behaviors and reactions after drinking were significantly associated with ALDH2 rs671 genotype. One month after the intervention, current drinkers were significantly associated with the reductions in both drinking frequency and alcohol consumption. Results provided the initial evidence for the on-campus study regarding rs671 polymorphism and drinking in Taiwan.