Ondruschka Benjamin, Woydt Lina, Bernhard Michael, Franke Heike, Kirsten Holger, Löffler Sabine, Pohlers Dirk, Hammer Niels, Dreßler Jan
Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
Emergency Department, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
Int J Legal Med. 2019 May;133(3):871-881. doi: 10.1007/s00414-018-1925-2. Epub 2018 Aug 30.
The aim of the given study was to test the in situ stability of biochemical markers of cerebral damage and acute phase response in the early post-mortem interval to assess their usability for forensic pathology. A monocentric, prospective study investigated post-mortem femoral venous blood samples at four time points obtained within 48 h post-mortem starting at the death of 20 deceased, using commercial immunoassays for the ten parameters: S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), ferritin, soluble tumor necrosis factor receptor type 1 (sTNFR1), and lactate dehydrogenase (LDH). Significant changes in serum levels were observed only later than 2 h after death for all markers. Inter-laboratory comparability was high, and intra-assay precision was sufficient for most markers. Most of the biomarker levels depended on the severity of hemolysis and lipemia but were robust against freeze-thaw cycles. Serum levels increased with longer post-mortem intervals for S100B, NSE, ferritin, sTNFR1, and LDH (for all p < 0.001) but decreased over this period for CRP (p = 0.089) and PCT (p < 0.001). Largely unchanged median values were found for GFAP (p = 0.139), BDNF (p = 0.106), and IL-6 (p = 0.094). Serum levels of CRP (p = 0.059) and LDH (p = 0.109) did not differ significantly between the final ante-mortem (resuscitation) and the first post-mortem sample (moment of death). Collecting the post-mortem blood sample as soon as possible will reduce the influence of post-mortem blood changes. Serum GFAP for detection of cerebral damage as well as serum IL-6 and CRP as proof of acute phase response seemed to be preferable due to their in situ stability in the first 2 days after death.
本研究的目的是测试脑损伤生化标志物和急性期反应在死后早期的原位稳定性，以评估其在法医病理学中的可用性。一项单中心前瞻性研究调查了20名死者死亡后48小时内四个时间点的死后股静脉血样，使用商业免疫测定法检测以下十个参数：S100钙结合蛋白B（S100B）、胶质纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）、脑源性神经营养因子（BDNF）、白细胞介素-6（IL-6）、C反应蛋白（CRP）、降钙素原（PCT）、铁蛋白、可溶性肿瘤坏死因子受体1型（sTNFR1）和乳酸脱氢酶（LDH）。所有标志物在死后2小时后才观察到血清水平的显著变化。实验室间可比性高，大多数标志物的批内精密度足够。大多数生物标志物水平取决于溶血和脂血的严重程度，但对冻融循环具有耐受性。S100B、NSE、铁蛋白、sTNFR1和LDH的血清水平随死后间隔时间延长而升高（所有p < 0.001），但在此期间CRP（p = 0.089）和PCT（p < 0.001）降低。GFAP（p = 0.139）、BDNF（p = 0.106）和IL-6（p = 0.094）的中位数基本不变。最终生前（复苏）和首次死后样本（死亡时刻）之间的CRP（p = 0.059）和LDH（p = 0.109）血清水平无显著差异。尽快采集死后血样将减少死后血液变化的影响。血清GFAP用于检测脑损伤，血清IL-6和CRP用于证明急性期反应，由于它们在死后头两天的原位稳定性，似乎更可取。
