Institute of Legal Medicine, University Hospital Charité, Berlin, Germany.
Forensic Sci Int. 2010 Mar 20;196(1-3):101-10. doi: 10.1016/j.forsciint.2009.12.028. Epub 2010 Jan 12.
In this study the combined use of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) for diagnoses of chronically excessive alcohol abuse is investigated at 174 hair samples from driving ability examination, workplace testing and child custody cases for family courts and evaluated with respect to the basics of interpretation. Using the cut-off values of 0.50 ng/mg for FAEE and 25 pg/mg for EtG, both markers were in agreement in 75% of the cases with 103 negative and 28 positive results and there were 30 cases with FAEE positive and EtG negative and 13 cases with FAEE negative and EtG positive. As the theoretical basis of interpretation, the pharmacokinetics of FAEE and EtG is reviewed for all steps between drinking of ethanol to incorporation in hair with particular attention to relationships between alcohol dose and concentrations in hair. It is shown that the concentrations of both markers are essentially determined by the area under the ethanol concentration in blood vs. time curve AUC(EtOH), despite large inter-individual variations. It is demonstrated by calculation of AUC(EtOH) on monthly basis for moderate, risky and heavy drinking that AUC(EtOH) increases very strongly in the range between 60 and 120 g ethanol per day. This specific feature which is caused by the zero-order elimination of ethanol is a favorable prerequisite for a high discrimination power of the hair testing for alcohol abuse. From the consideration of the different profiles of FAEE and EtG along the hair and in agreement with the literature survey, a standardized hair segment 0-3 cm is proposed with cut-off values of 0.5 ng/mg for FAEE and 30 pg/mg for EtG. This improves also the agreement between FAEE and EtG results in the cases of the present study. A scheme for combined interpretation of FAEE and EtG is proposed which uses the levels of abstinence and the double of the cut-off values as criteria in addition to the cut-off's. Considering the large variations in the relationship between ethanol dose and FAEE and EtG concentrations in hair, the combined use of both parameters strongly increases the accuracy of the diagnosis by mutual confirmation and identification of false positive or false negative results due to biological variations or analytical errors.
在这项研究中,研究了脂肪酸乙酯(FAEE)和乙基葡萄糖醛酸苷(EtG)联合用于诊断慢性过量饮酒,共检测了 174 份来自驾驶能力检查、工作场所检测和儿童监护案件的法庭头发样本,并评估了其解释的基本原则。使用 FAEE 的 0.50ng/mg 和 EtG 的 25pg/mg 的截止值,这两个标志物在 75%的情况下是一致的,103 个阴性结果和 28 个阳性结果,有 30 个 FAEE 阳性和 EtG 阴性,13 个 FAEE 阴性和 EtG 阳性。作为解释的理论基础,回顾了 FAEE 和 EtG 的药代动力学,从饮酒到头发中掺入的所有步骤,特别注意了酒精剂量与头发中浓度之间的关系。结果表明,尽管个体间存在很大差异,但两种标志物的浓度主要取决于血液中乙醇浓度与时间曲线下面积 AUC(EtOH)。通过计算每月适度、有风险和大量饮酒的 AUC(EtOH),证明 AUC(EtOH)在 60 至 120g 乙醇/天的范围内非常强烈地增加。这种由乙醇零级消除引起的特定特征是对酒精滥用的毛发检测具有高区分能力的有利前提。从 FAEE 和 EtG 沿头发的不同分布特征以及与文献综述一致的角度出发,提出了一个标准化的头发段 0-3cm,FAEE 的截止值为 0.5ng/mg,EtG 的截止值为 30pg/mg。这也改善了本研究中 FAEE 和 EtG 结果之间的一致性。提出了 FAEE 和 EtG 的联合解释方案,该方案除了使用截止值外,还使用了戒断水平和截止值的两倍作为标准。考虑到乙醇剂量与头发中 FAEE 和 EtG 浓度之间的关系存在很大差异,因此,通过相互确认和识别由于生物学变化或分析误差导致的假阳性或假阴性结果,联合使用这两个参数可大大提高诊断的准确性。