Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals, Britannia House, Morley, Leeds LS27 0DQ, UK.
Ann Clin Biochem. 2011 Nov;48(Pt 6):531-41. doi: 10.1258/acb.2011.011116. Epub 2011 Sep 1.
Urine is recognized as the prime matrix for drug test screening with well-established methods and testing protocols. Its major limitation is with regard to the inconvenience of sample collection and lack of integrity due to adulteration, dilution, drug spiking or sample exchange. The question is whether oral fluid, with its apparent better sample integrity, can replace urine for drug screening. This review examines the sample integrity problems and the advantages and limitations of oral fluid and urine in drug screening programmes. The variety of sample collection devices for oral fluid is shown to be a problem with recovery and detection for some drugs. This is examined in relation to the pharmacokinetics of drug metabolism and excretion in this matrix. Buccal contamination with drugs in oral fluid may also cause problems with interpretation. The clinical advantages of oral fluid analysis compared with urine testing are highlighted. Parent drugs are often found in oral fluid where only their metabolites may be found in urine, for example the benzodiazepines. 6-Monoacetylmorphine, an indicative marker of heroin, has a high prevalence in oral fluid from users of this drug but its detection in urine is limited due to its short half-life. Advances in analytical techniques, particularly chromatography linked to tandem mass spectrometry, are helping to promote oral fluid analysis. However, the lack of concordance studies examining both urine and oral fluid drug levels and kinetics in the clinical setting is of some concern.
尿液是药物测试筛选的主要基质，具有成熟的方法和测试方案。其主要局限性在于样本采集不方便，而且由于掺假、稀释、药物添加或样本交换，样本完整性受损。问题是，口腔液由于其明显更好的样本完整性，是否可以替代尿液进行药物筛选。本文综述了口腔液在药物筛选计划中的样本完整性问题以及其在药物筛选中的优势和局限性。口腔液的各种样本采集装置在一些药物的回收率和检测方面存在问题。这与该基质中药物代谢和排泄的药代动力学有关。口腔液中药物的颊部污染也可能导致解释方面的问题。与尿液检测相比，口腔液分析的临床优势被强调。母体药物通常在口腔液中被发现，而其代谢物可能仅在尿液中被发现，例如苯二氮䓬类药物。6-单乙酰吗啡是海洛因的一个指示性标志物，在该药物使用者的口腔液中广泛存在，但由于其半衰期短，在尿液中的检测受到限制。分析技术的进步，特别是与串联质谱联用的色谱技术，有助于促进口腔液分析。然而，在临床环境中，缺乏同时检查尿液和口腔液药物水平和动力学的一致性研究，这令人有些担忧。
