Pragst Fritz, Yegles Michel
Institute of Legal Medicine, University Hospital Charité, Berlin, Germany.
Ther Drug Monit. 2008 Apr;30(2):255-63. doi: 10.1097/FTD.0b013e318167d602.
The retrospective detection of alcohol consumption during pregnancy is an important part of the diagnosis of the fetal alcohol syndrome. A promising way to solve this problem can be the determination of fatty acid ethyl esters (FAEE) or/and ethyl glucuronide (EtG) in hair of the mothers. In this article, the present state in analytical determination and interpretation of FAEE and EtG concentrations in hair are reviewed. Both FAEE and EtG are minor metabolites of ethanol and as direct alcohol markers very specific for alcohol. They are durably deposited in hair, which enables taking advantage of the long diagnostic time window of this sample material. In the last years, specific and sensitive methods for determination of both alcohol markers in hair were developed. Headspace solid phase microextraction in combination with gas chromatography-mass spectroscopy after hair extraction with an n-heptane/dimethylsulfoxide mixture proved to be a favorable technique for determination of four characteristic FAEE (ethyl myristate, ethyl palmitate, ethyl oleate, and ethyl stearate). EtG is extracted from hair by water and analyzed either by gas chromatography-mass spectroscopy with negative chemical ionization after cleanup with solid phase extraction and derivatization with pentafluoropropionic anhydride or by liquid chromatography-mass spectroscopy-mass spectroscopy. The detection limits of the single FAEE as well as of EtG are in the range of 1 to 10 pg/mg. FAEE as well as EtG were determined in a larger number of hair samples of teetotalers, social drinkers, patients in alcohol withdrawal treatment, and death cases with previous known heavy drinking. From the results, the following criteria were derived: strict abstinence is excluded or improbable at C FAEE >0.2 ng/mg or C EtG >7 pg/mg. Moderate social drinkers should have C FAEE <0.5 ng/mg and C EtG <25 pg/mg; above these values, alcohol abuse is probable. Until now, there has been no evaluation in context of FAS diagnosis; however, a successful application for this purpose can be expected from the good experience in driving ability examination.
孕期酒精摄入情况的回顾性检测是胎儿酒精综合征诊断的重要组成部分。解决这一问题的一个有前景的方法是测定母亲头发中的脂肪酸乙酯（FAEE）或/和葡萄糖醛酸乙酯（EtG）。本文对头发中FAEE和EtG浓度的分析测定及解读现状进行了综述。FAEE和EtG都是乙醇的次要代谢产物，作为直接的酒精标志物，对酒精具有高度特异性。它们持久地沉积在头发中，这使得能够利用这种样本材料较长的诊断时间窗。近年来，开发了测定头发中这两种酒精标志物的特异且灵敏的方法。用正庚烷/二甲基亚砜混合物提取头发后，顶空固相微萃取结合气相色谱 - 质谱法被证明是测定四种特征性FAEE（肉豆蔻酸乙酯、棕榈酸乙酯、油酸乙酯和硬脂酸乙酯）的良好技术。EtG用水从头发中提取，然后通过固相萃取净化并用五氟丙酸酐衍生化后，采用带负化学电离的气相色谱 - 质谱法进行分析，或者通过液相色谱 - 质谱 - 质谱法进行分析。单一FAEE以及EtG的检测限在1至10 pg/mg范围内。在大量戒酒者、社交饮酒者、酒精戒断治疗患者以及先前已知大量饮酒的死亡病例的头发样本中测定了FAEE和EtG。根据结果得出了以下标准：当C FAEE >0.2 ng/mg或C EtG >7 pg/mg时，排除或不太可能存在严格戒酒情况。适度社交饮酒者的C FAEE应<0.5 ng/mg且C EtG <25 pg/mg；高于这些值时，可能存在酒精滥用。到目前为止，尚未在胎儿酒精综合征（FAS）诊断的背景下进行评估；然而，鉴于在驾驶能力检测方面的良好经验，可以预期它能成功用于此目的。
