Reisfield Gary M, Goldberger Bruce A, Bertholf Roger L
Department of Community Health and Family Medicine, University of Florida College of Medicine, 655 West 8th Street, Jacksonville, FL 32209, USA.
Bioanalysis. 2009 Aug;1(5):937-52. doi: 10.4155/bio.09.81.
The terms 'false-positive' and 'false-negative' are widely used in discussions of urine drug test (UDT) results. These terms are inadequate because they are used in different ways by physicians and laboratory professionals and they are too narrow to encompass the larger universe of potentially misleading, inappropriate and unexpected drug test results. This larger universe, while not solely comprised of technically 'true' or 'false' positive or negative test results, presents comparable interpretive challenges with corresponding clinical implications. In this review, we propose the terms 'potentially inappropriate' positive or negative test results in reference to UDT results that are ambiguous or unexpected and subject to misinterpretation. Causes of potentially inappropriate positive UDT results include in vivo metabolic conversions of a drug, exposure to nonillicit sources of a drug and laboratory error. Causes of potentially inappropriate negative UDT results include limited assay specificity, absence of drug in the urine, presence of drug in the urine, but below established assay cutoff, specimen manipulation and laboratory error. Clinical UDT interpretation is a complicated task requiring knowledge of recent prescription, over-the-counter and herbal drug administration, drug metabolism and analytical sensitivities and specificities.
“假阳性”和“假阴性”这两个术语在尿液药物检测（UDT）结果的讨论中被广泛使用。但这些术语并不恰当，因为医生和实验室专业人员对它们的使用方式不同，而且它们过于狭窄，无法涵盖潜在的误导性、不恰当和意外的药物检测结果的更大范畴。这个更大的范畴虽然不完全由技术上“真”或“假”的阳性或阴性检测结果组成，但也带来了类似的解释挑战以及相应的临床意义。在本综述中，我们针对UDT结果中模糊、意外且易被误解的情况，提出了“潜在不恰当”的阳性或阴性检测结果这一术语。潜在不恰当的阳性UDT结果的原因包括药物的体内代谢转化、接触非非法来源的药物以及实验室误差。潜在不恰当的阴性UDT结果的原因包括检测方法特异性有限、尿液中无药物、尿液中有药物但低于既定检测下限、样本处理以及实验室误差。临床UDT解读是一项复杂的任务，需要了解近期的处方用药、非处方用药和草药用药情况、药物代谢以及分析灵敏度和特异性。
