吗啡/可待因比率，兴奋剂案件调查的关键
Morphine/Codeine Ratio, a Key in Investigating a Case of Doping.
作者信息
Seif-Barghi Tohid, Moghadam Navid, Kobarfard Farzad
机构信息
Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, IR Iran ; Iran Football Medical Assessment and Rehabilitation Center (IFMARC), Tehran, IR Iran.
Iran Football Medical Assessment and Rehabilitation Center (IFMARC), Tehran, IR Iran ; Sports Medicine Department, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
出版信息
Asian J Sports Med. 2015 Dec;6(4):e28798. doi: 10.5812/asjsm.28798. Epub 2015 Dec 1.
INTRODUCTION
Consumption of codeine can lead to positive urine test for morphine in athletes. Morphine is classified as a prohibited doping drug while Codeine is not. Morphine/codeine ratio is used in forensic medicine to distinguish the consumption of codeine from abuse of morphine and other narcotics.
CASE PRESENTATION
We present an athlete with positive urine test for morphine with a history of consumption of codeine. The disciplinary committee came to conclusion that the athlete had not consumed morphine and did not violate doping code based on morphine/codeine ratio.
CONCLUSIONS
Analysis of codeine to morphine metabolism rate is needed when we are using morphine/codeine ratio to rule out abuse of narcotics. WADA should consider analysis for the CYP2D6 alleles (main metabolizer of codeine) in case of including morphine/codeine ratio in future prohibited list. The possibility of ultra-rapid CYP2D6 cannot be ruled out in certain results of morphine/codeine near the cut point.
引言
服用可待因会导致运动员尿液吗啡检测呈阳性。吗啡被列为违禁兴奋剂药物，而可待因则不是。法医领域利用吗啡/可待因比值来区分可待因的服用与吗啡及其他麻醉品的滥用。
病例报告
我们报告一名有可待因服用史、尿液吗啡检测呈阳性的运动员。纪律委员会根据吗啡/可待因比值得出结论，该运动员未服用吗啡，未违反兴奋剂规定。
结论
在使用吗啡/可待因比值排除麻醉品滥用情况时，需要分析可待因向吗啡的代谢率。如果世界反兴奋剂机构（WADA）未来的禁用清单中纳入吗啡/可待因比值，应考虑对CYP2D6等位基因（可待因的主要代谢酶）进行分析。在某些接近临界值的吗啡/可待因检测结果中，不能排除CYP2D6超快速代谢的可能性。
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