De Letter Els A, Bouche Marie-Paule L A, Van Bocxlaer Jan F, Lambert Willy E, Piette Michel H A
Department of Forensic Medicine, Ghent University, Jozef Kluyskensstraat 29, 9000 Gent, Belgium.
Forensic Sci Int. 2004 May 10;141(2-3):85-90. doi: 10.1016/j.forsciint.2003.12.015.
The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy" is a currently used or abused designer drug and fatalities are frequently encountered in forensic practice. However, the question remains open whether an MDMA blood level can be toxic or even potentially lethal. In order to provide insight in the interpretation of a detected MDMA concentration, the distribution of MDMA and its metabolite 3,4-methylenedioxyamphetamine (MDA) in various body fluids and tissues was studied and discussed in two different fatalities. Apart from peripheral blood samples (such as femoral and subclavian blood), various blood samples obtained centrally in the human body and several body fluids (such as vitreous humour) were examined. In addition, various tissues such as cardiac muscle, lungs, liver, kidneys, and brain lobes were analysed. In contrast to the peripheral blood levels, high MDMA and MDA levels were found in cardiac blood and the majority of the organs, except for the abdominal adipose tissue. The high concentrations observed in all lung lobes, the liver and stomach contents indicate that post-mortem redistribution of MDMA and MDA into cardiac blood can occur and, as a result, blood sampled centrally in the body should be avoided. Therefore, our data confirm that peripheral blood sampling remains "the golden standard". In addition, a distinct difference in peripheral blood MDMA concentrations in our two overdose cases was established (namely 0.271 and 13.508 microg/ml, respectively). Furthermore, our results suggest that, if a peripheral blood sample is not available and when putrefaction is not too pronounced, vitreous humour and iliopsoas muscle can be valuable specimens for toxicological analysis. Finally, referring to the various mechanisms of death following amphetamine intake, which can result in different survival times (e.g. cardiopulmonary complications versus hyperthermia), the anatomo-pathological findings and the toxicological results should be considered as a whole in arriving at a conclusion.
苯丙胺衍生物3,4-亚甲基二氧基甲基苯丙胺（MDMA，“摇头丸”）是一种目前正在使用或滥用的合成毒品，在法医实践中经常遇到与之相关的死亡案例。然而，MDMA血液水平是否具有毒性甚至潜在致死性这一问题仍未明确。为了深入了解检测到的MDMA浓度的解读情况，在两起不同的死亡案例中研究并讨论了MDMA及其代谢物3,4-亚甲基二氧基苯丙胺（MDA）在各种体液和组织中的分布。除了外周血样本（如股静脉血和锁骨下静脉血）外，还检测了从人体中心部位采集的各种血样以及几种体液（如玻璃体液）。此外，还分析了各种组织，如心肌、肺、肝、肾和脑叶。与外周血水平不同，在心脏血液和大多数器官中发现了高浓度的MDMA和MDA，但腹部脂肪组织除外。在所有肺叶、肝脏和胃内容物中观察到的高浓度表明，MDMA和MDA可在死后重新分布到心脏血液中，因此应避免采集人体中心部位的血液样本。所以，我们的数据证实外周血采样仍然是“金标准”。此外，我们在两起过量用药案例中确定了外周血MDMA浓度存在明显差异（分别为0.271和13.508微克/毫升）。此外，我们的结果表明，如果无法采集外周血样本且尸体腐败不太严重，玻璃体液和髂腰肌可作为毒理学分析的有价值样本。最后，鉴于苯丙胺摄入后可能导致不同存活时间的各种死亡机制（如心肺并发症与体温过高），在得出结论时应综合考虑解剖病理学发现和毒理学结果。
