Wang Bei-Tzu, Colby Jennifer M, Wu Alan H B, Lynch Kara L
Department of Laboratory Medicine, University of California, San Francisco General Hospital, 1001 Potrero Ave. NH2M16, San Francisco, CA 94110, USA.
Department of Laboratory Medicine, University of California, San Francisco General Hospital, 1001 Potrero Ave. NH2M16, San Francisco, CA 94110, USA
J Anal Toxicol. 2014 Nov-Dec;38(9):672-5. doi: 10.1093/jat/bku103. Epub 2014 Sep 23.
Fentanyl and its analogs, such as acetylfentanyl, have become a concern for potential abuse. Fentanyl compliance monitoring and urine drug testing are becoming increasingly necessary; however, a limited number of fentanyl immunoassays have been validated for clinical use. The purpose of this study was to validate the use of the DRI® fentanyl immunoassay, determine the potential cross-reactivity of acetylfentanyl and other pharmaceuticals, and investigate acetylfentanyl use in San Francisco. All urine toxicology samples from patients presenting to the emergency department were analyzed using the fentanyl immunoassay for 4 months. Positive samples were analyzed qualitatively using liquid chromatography-high resolution mass spectrometry (LC-HRMS) for fentanyl, fentanyl metabolites, fentanyl analogs and greater than 200 common drugs and metabolites. Subsequently, quantitative analysis was performed using LC-tandem mass spectrometry (LC-MS-MS). Acetylfentanyl, risperidone and 9-hydroxyrisperidone were found to cross-react with the fentanyl immunoassay. No acetylfentanyl was detected in our emergency department patient population. The fentanyl immunoassay demonstrated 100% diagnostic sensitivity in a subset of urines tested; however, the specificity was only 86% due to seven false-positive samples observed. Five of the seven samples were positive for risperidone and 9-hydroxyrisperidone. The DRI® fentanyl immunoassay can be used to screen for fentanyl or acetylfentanyl; however, confirmatory testing should be performed for all samples that screen positive.
芬太尼及其类似物，如乙酰芬太尼，已成为潜在滥用的一个问题。芬太尼合规监测和尿液药物检测变得越来越必要；然而，已被验证可用于临床的芬太尼免疫测定法数量有限。本研究的目的是验证DRI®芬太尼免疫测定法的用途，确定乙酰芬太尼和其他药物的潜在交叉反应性，并调查旧金山地区乙酰芬太尼的使用情况。对急诊科患者的所有尿液毒理学样本使用芬太尼免疫测定法进行了4个月的分析。对阳性样本使用液相色谱 - 高分辨率质谱（LC - HRMS）对芬太尼、芬太尼代谢物、芬太尼类似物以及200多种常见药物和代谢物进行定性分析。随后，使用液相色谱 - 串联质谱（LC - MS - MS）进行定量分析。发现乙酰芬太尼、利培酮和9 - 羟基利培酮与芬太尼免疫测定法存在交叉反应。在我们急诊科的患者群体中未检测到乙酰芬太尼。芬太尼免疫测定法在一部分检测的尿液中显示出100%的诊断敏感性；然而，由于观察到7例假阳性样本，特异性仅为86%。7个样本中有5个利培酮和9 - 羟基利培酮呈阳性。DRI®芬太尼免疫测定法可用于筛查芬太尼或乙酰芬太尼；然而，对于所有筛查呈阳性的样本都应进行确证检测。
