Sydow Konrad, Wiedfeld Christopher, Musshoff Frank, Madea Burkhard, Tschoepe Diethelm, Stratmann Bernd, Hess Cornelius
Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
Forensic Toxicological Center, Bayerstraße 53, 80335 Munich, Germany.
Forensic Sci Int. 2018 Jun;287:88-97. doi: 10.1016/j.forsciint.2018.03.002. Epub 2018 Mar 28.
Because of the lack of characteristic morphological findings post mortem diagnosis of diabetes mellitus and identification of diabetic coma can be complicated. 1,5-Anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, competes with glucose for renal reabsorption. Therefore low serum concentrations of 1,5-AG, reflect hyperglycemic excursions over the prior 1-2 weeks in diabetic patients. Next to clinical applications determination of 1,5-AG can also be used in forensic analysis. To investigate the elimination of 1,5-AG, a liquid chromatographic-mass spectrometric method for the determination of 1,5-AG and creatinine in urine was developed and validated according to international guidelines. To evaluate ante mortem concentrations of 1,5-AG spot urine samples of 30 healthy subjects, 46 type 1 and 46 type 2 diabetic patients were analyzed. 1,5-AG urine concentrations of diabetic patients were significantly (p<0.001) lower (mean: 1.54μg/ml, n=92) compared to concentrations of healthy subjects (mean: 4.76μg/ml, n=30) which led to the idea that 1,5-AG urine concentrations post mortem might help in the interpretation of a diabetic coma post mortem. Urine of 47 deceased non-diabetics, 37 deceased diabetic and 9 cases of diabetic coma were measured. Comparison of blood and urine 1,5-AG concentrations in clinic samples (linear, R=0.13) and forensic samples (linear, R=0.02) showed no correlation. Urinary levels of 1,5-AG in deceased diabetic (mean 6.9μg/ml) and in non-diabetic patients (mean 6.3μg/ml) did not show a significant difference (p=0.752). However, urinary 1,5-AG concentrations in deceased due to diabetic coma (mean: 1.7μg/ml) were significantly lower than in non-diabetic (mean: 6.3μg/ml, p=0.039) and lower than in diabetic cases (mean: 4.7μg/ml, p=0.058). The determination of a reliable cut-off for the differentiation of diabetic to diabetic coma cases was not possible. Normalization of urinary 1,5-AG concentrations with the respective creatinine concentrations did not show any gain of information. In clinical (serum) and forensic blood samples a significant difference between all groups could be detected (p<0.05). Comparison of blood and urine 1,5-AG concentrations in clinical samples (linear, R=0.13) and forensic samples (linear, R=0.02) showed no correlation.
由于缺乏特征性的形态学表现，糖尿病的死后诊断和糖尿病昏迷的鉴定可能会很复杂。1,5-脱水葡萄糖醇（1,5-AG）是葡萄糖的1-脱氧形式，与葡萄糖竞争肾脏重吸收。因此，血清1,5-AG浓度低反映了糖尿病患者过去1-2周的血糖波动。除了临床应用外，1,5-AG的测定还可用于法医分析。为了研究1,5-AG的消除情况，根据国际指南开发并验证了一种用于测定尿液中1,5-AG和肌酐的液相色谱-质谱法。为了评估30名健康受试者、46名1型糖尿病患者和46名2型糖尿病患者的1,5-AG生前浓度，对其即时尿样进行了分析。糖尿病患者的尿1,5-AG浓度（平均值：1.54μg/ml，n = 92）显著低于健康受试者（平均值：4.76μg/ml，n = 30）（p<0.001），这使得人们认为死后尿1,5-AG浓度可能有助于解释死后糖尿病昏迷情况。对47名非糖尿病死者、37名糖尿病死者和9例糖尿病昏迷患者的尿液进行了检测。临床样本（线性，R = 0.13）和法医样本（线性，R = 0.02）中血1,5-AG浓度与尿1,5-AG浓度的比较均未显示出相关性。糖尿病死者（平均值6.9μg/ml）和非糖尿病患者（平均值6.3μg/ml）的尿1,5-AG水平无显著差异（p = 0.752）。然而，糖尿病昏迷死者的尿1,5-AG浓度（平均值：1.
