Nishida Atsushi, Funaki Hironao, Kobayashi Masaki, Tanaka Yuka, Akasaka Yoshihisa, Kubo Toshikazu, Ikegaya Hiroshi
Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan; Department of Orthopedic Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.
Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.
Sci Justice. 2015 May;55(3):195-9. doi: 10.1016/j.scijus.2014.12.005. Epub 2015 Jan 5.
Blood chemical analysis for the diagnosis of diseases in forensic cases should be conducted in the same way as for clinical cases. However, it is sometimes difficult to obtain serum samples in forensic cases because of postmortem changes such as hemolysis and putrefaction. This study aimed to evaluate renal function in postmortem cases by blood creatinine analysis. The blood creatinine level was measured by high performance liquid chromatography (HPLC) using whole blood samples taken from 77 postmortem cases, and the relationships between blood creatinine level, postmortem interval, and cause of death were examined. The median blood creatinine level was found to be 1.15 mg/dL, with no significant differences between blood samples taken from different parts of the body. The blood creatinine level was stable for 3 days after death and gradually increased after that period, in line with a previous study using enzymatic analysis that found the serum creatinine level was stable in the early postmortem period. The blood creatinine level was high in the cases of blunt injury, intoxication, and in deaths caused by fire. This was considered to reflect acute renal dysfunction. However, the postmortem blood creatinine level remained higher than the clinical normal value despite omitting cases with renal dysfunction from the analysis. Therefore, we next investigated the change in postmortem creatinine levels in mice and found that the blood creatinine level increased with the emergence of rigor mortis. Our findings indicate that HPLC is useful in the postmortem evaluation of renal function even in the cases where serum cannot be obtained. However, the presence of rigor mortis should be considered in the evaluation of blood creatinine values.
法医案件中用于疾病诊断的血液化学分析应与临床病例采用相同的方式进行。然而，在法医案件中，由于溶血和腐败等死后变化，有时很难获取血清样本。本研究旨在通过血肌酐分析评估死后病例的肾功能。使用从77例死后病例采集的全血样本，通过高效液相色谱法（HPLC）测量血肌酐水平，并检查血肌酐水平、死后间隔时间和死因之间的关系。发现血肌酐水平中位数为1.15mg/dL，取自身体不同部位的血样之间无显著差异。死后3天血肌酐水平稳定，此后逐渐升高，这与之前一项使用酶分析法的研究结果一致，该研究发现死后早期血清肌酐水平稳定。钝器伤、中毒和火灾致死病例的血肌酐水平较高。这被认为反映了急性肾功能障碍。然而，尽管分析中排除了肾功能障碍病例，但死后血肌酐水平仍高于临床正常值。因此，我们接下来研究了小鼠死后肌酐水平的变化，发现血肌酐水平随着尸僵的出现而升高。我们的研究结果表明，即使在无法获取血清的情况下，HPLC在死后肾功能评估中也很有用。然而，在评估血肌酐值时应考虑尸僵的存在。
