Todorović Milos S, Mitrović Slobodanka, Aleksandrić Branimir, Mladjenović Nenad, Matejić Suzana
University of Kragujevac, School of Medicine, Serbia.
Vojnosanit Pregl. 2011 Aug;68(8):639-42. doi: 10.2298/vsp1108639t.
BACKGROUND/AIM: Drug abuse remains a significant social problem in many countries. The aim of the study was to estimate association between pulmonary histopathological changes and results of toxicological analyses in forensic autopsies of illicit drug users.
This investigation was performed in the Institute of Forensic Medicine, Belgrade, and in the Clinical Center, Department of Forensic Medicine, Kragujevac, from 2000 to 2004, and included 63 medicolegal autopsies of heroin or other drug consumers who suddenly died. Autopsies, postmortem toxicological examination of drugs and serological analyses of anti-HIV/HBV/HCV antibodies were performed.
The deceased persons were mostly male, 46/63 (73.01%), ranged in age from 19 to 49 years (mean 31 years) and all were whites. Postmortem toxicological examination was performed on all of the deceased persons and drugs in the fatal range were identified in only eight of them (12.7%), in the toxic range in ten (15.87%), and in minimal concentrations in 35 (55.56%) of the deceased persons. Drugs identified in the fatal, toxic or minimal range included heroin-morphine (38/53), cocaine (4/53), tramadol (3/53), and lorazepam (1/53). In the 7 remaining subjects, ethanol in combination with heroin was found in 4 cases, and diazepam in combination with heroin in 3 cases. Dominant pathomorphological changes were findings in the lung tissue. Most common histological changes observed in drug users were pulmonary edema--55/63 (87.3%), acute alveolar hemorrhages--49/63 (77.78%), hemosiderin-laden macrophages (siderophages)--52/63 (82,54%), and emphysematous changes--51/63 (80,95%).
Pulmonary edema is the frequent non-specific autopsy finding which is associated with virtually all routes of drug administration. The histopatological study is necessary to determinate a cause of death when a deceased person has the history of dependence or abouse of psychoactive drugs with negative toxicological results.
背景/目的：药物滥用在许多国家仍然是一个严重的社会问题。本研究的目的是评估非法药物使用者法医尸检中肺部组织病理学变化与毒理学分析结果之间的关联。
本调查于2000年至2004年在贝尔格莱德法医学研究所和克拉古耶瓦茨临床中心法医部进行，包括63例突然死亡的海洛因或其他药物使用者的法医学尸检。进行了尸检、死后药物毒理学检查以及抗HIV/HBV/HCV抗体的血清学分析。
死者大多为男性，46/63（73.01%），年龄在19至49岁之间（平均31岁），均为白人。对所有死者进行了死后毒理学检查，仅在其中8例（12.7%）中发现致命剂量的药物，10例（15.87%）中发现中毒剂量的药物，35例（55.56%）中发现微量浓度的药物。在致命、中毒或微量范围内发现的药物包括海洛因-吗啡（38/53）、可卡因（4/53）、曲马多（3/53）和劳拉西泮（1/53）。在其余7名受试者中，4例发现乙醇与海洛因联用，3例发现地西泮与海洛因联用。主要的病理形态学变化见于肺组织。吸毒者中观察到的最常见组织学变化是肺水肿——55/63（87.3%）、急性肺泡出血——49/63（77.78%）、含铁血黄素巨噬细胞（铁血巨噬细胞）——52/63（82.54%）和气肿性改变——51/63（80.95%）。
肺水肿是常见的非特异性尸检发现，几乎与所有给药途径相关。当死者有精神活性药物依赖或滥用史且毒理学结果为阴性时，组织病理学研究对于确定死因是必要的。
