DISPOSITION OF HEROIN AND ITS METABOLITES IN HEROIN-RELATED DEATHS
DISPOSITION OF HEROIN AND ITS METABOLITES IN HEROIN-RELATED DEATHS
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DOI：
10.1093/jat/18.1.22
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发表时间：
1994-01-01
影响因子：
2.5
通讯作者：
SMIALEK, JE
中科院分区：
文献类型：
--
作者：
GOLDBERGER, BA;CONE, EJ;SMIALEK, JE
虽然每年都有许多人死于海洛因中毒，但在死后组织中没有报告海洛因的存在。认识到海洛因的敏感性，快速的化学和代谢水解，提取程序开发的高效回收海洛因，6-乙酰吗啡，吗啡从死后组织利用固相萃取与气相色谱/质谱联用。从与海洛因有关的死亡中收集了21套血液和尿液样本。这些病例的死亡模式被分类为快速、延迟或未确定。与迟发性死亡相比，快速死亡的特点是：血液中6-乙酰吗啡、游离吗啡和总阿片类药物的平均浓度较高;血液中游离吗啡浓度与总阿片类药物浓度的比值较高;尿液中6-乙酰吗啡和吗啡的平均浓度较低;血液中6-乙酰吗啡检测的可能性较大;尿液中海洛因检测的可能性较小。该研究还包括对两名死于海洛因中毒的受试者的多个组织标本的分析。在尿液和注射部位组织中发现了海洛因。脑脊液、脾和脑中的6-乙酰吗啡浓度显著高于血液、肝、肺和肾。所有样本均为吗啡阳性。在头发标本中检测到海洛因代谢物。生物组织中海洛因和6-乙酰吗啡的鉴定有效地确定了急性麻醉品中毒病例中海洛因的存在。这些研究表明，海洛因及其代谢物的测量为海洛因相关死亡的鉴别诊断提供了有用的信息。
Although many deaths occur annually from heroin intoxication, the presence of heroin has not been reported in postmortem tissues. Recognizing heroin's susceptibility to rapid chemical and metabolic hydrolysis, extraction procedures were developed for the efficient recovery of heroin, 6-acetylmorphine, and morphine from postmortem tissue utilizing solid-phase extraction coupled with gas chromatography/mass spectrometry. From heroin-related deaths, 21 sets of blood and urine specimens were collected. The mode of death in these cases was categorized as rapid, delayed, or undetermined. Compared with delayed deaths, rapid deaths were characterized by the following trends: higher mean concentrations of 6-acetylmorphine, free morphine, and total opiates in blood; a higher ratio of free morphine concentrations to total opiate concentrations in blood; lower mean concentrations of 6-acetylmorphine and morphine in urine; greater likelihood of 6-acetylmorphine detection in blood; and lesser likelihood of heroin detection in urine. The study also included analysis of multiple tissue specimens from two subjects who died of heroin intoxication. Heroin was identified in urine and injection-site tissue. Concentrations of 6-acetylmorphine in cerebrospinal fluid, spleen, and brain were substantially higher than in blood, liver, lung, and kidney. All specimens were positive for morphine. Heroin metabolites were detected in hair specimens. The identification of heroin and 6-acetylmorphine in biological tissues effectively established the presence of heroin in cases of acute narcotic intoxication. These studies demonstrated that measurement of heroin and its metabolites provides useful information for the differential diagnosis of heroin-related deaths.