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尸体解剖毒理学中的分析前因素

Preanalytic aspects in postmortem toxicology.

作者信息

Skopp G

机构信息

Institut für Rechtsmedizin und Verkehrsmedizin, Ruprecht-Karls-Universität, Vossstr. 2, 69115 Heidelberg, Germany.

出版信息

Forensic Sci Int. 2004 Jun 10;142(2-3):75-100. doi: 10.1016/j.forsciint.2004.02.012.

Abstract

The preanalytic phase has been recognized to have a substantial role for the quality and reliability of analytical results, which very much depend on the type and quality of specimens provided. There are several unique challenges to select and collect specimens for postmortem toxicology investigation. Postmortem specimens may be numerous, and sample quality may be quite variable. An overview is given on specimens routinely collected as well as on alternative specimens that may provide additional information on the route of administration, a long term or a recent use/exposure to a drug or poison. Autolytic and putrefactive changes limit the selection and utility of specimens. Some data from case reports as well as experimental investigations on drug degradation and/or formation during putrefaction are discussed. Diffusion processes as well as postmortem degradation or formation may influence ethanol concentration in autopsy specimens. Formalin fixation of specimens or embalmment of the corpse may cause considerable changes of initial drug levels. These changes are due to alterations of the biological matrix as well as to dilution of a sample, release or degradation of the drug or poison. Most important seems a conversion of desmethyl metabolites to the parent drug. Some general requirements for postmortem sampling are given based on references about specimen collection issues, for a harmonized protocol for sampling in suspected poisonings or drug-related deaths does not exist. The advantages and disadvantages of specimen preservation are shortly discussed. Storage stability is another important issue to be considered. Instability can either derive from physical, chemical or metabolic processes. The knowledge on degradation mechanisms may enable the forensic toxicologist to target the right substance, which may be a major break down product in the investigation of highly labile compounds. Although it is impossible to eliminate all interfering factors or influences occurring during the preanalytic phase, their consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample.

摘要

分析前阶段已被认为对分析结果的质量和可靠性起着重要作用,而这在很大程度上取决于所提供标本的类型和质量。在死后毒理学调查中选择和采集标本存在一些独特的挑战。死后标本可能数量众多,且样本质量可能差异很大。本文概述了常规采集的标本以及可能提供给药途径、药物或毒物长期或近期使用/接触情况的额外信息的替代标本。自溶和腐败变化限制了标本的选择和效用。讨论了一些病例报告以及关于腐败过程中药物降解和/或形成的实验研究的数据。扩散过程以及死后降解或形成可能会影响尸检标本中的乙醇浓度。标本的福尔马林固定或尸体防腐可能会导致初始药物水平发生相当大的变化。这些变化是由于生物基质的改变以及样本的稀释、药物或毒物的释放或降解所致。最重要的似乎是去甲基代谢物向母体药物的转化。基于有关标本采集问题的参考文献,给出了死后采样的一些一般要求,因为目前还没有一个统一的疑似中毒或与药物相关死亡的采样方案。简要讨论了标本保存的优缺点。储存稳定性是另一个需要考虑的重要问题。不稳定性可能源于物理、化学或代谢过程。对降解机制的了解可能使法医毒理学家能够针对正确的物质,这在高度不稳定化合物的调查中可能是主要的分解产物。尽管不可能消除分析前阶段出现的所有干扰因素或影响,但对它们的考虑应有助于评估样本质量以及从该样本获得的分析结果。

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