Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.
Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy.
Leg Med (Tokyo). 2021 Jul;51:101877. doi: 10.1016/j.legalmed.2021.101877. Epub 2021 Apr 7.
Heroin-related mortality is a complex phenomenon involving several factors that make an individual more susceptible to opioid toxicity. Among these, pre-existing pathological conditions play an important role. The current paper reviewed 51 autopsied cases performed over the last 30 years, each subject ("frequent heroin user") having taken heroin intravenously alone before death. For each case, total blood morphine concentration determined by gas chromatography-mass spectrometry (GC-MS) was obtained from the archives. For histopathological evaluation we examined microscopic sections of the heart, lung, brain, liver and kidney, and for each organ a score table with a numerical value from 1 to 5, as an indicator of increasing severity, was drawn up. Finally, we created a scoring system based on the Injury Severity Score (ISS), generated by the sum of the squares of the three highest organ scores. We investigated the relationship between total blood morphine value (mg/l) and pathological score by inserting the two variables in a linear regression model: Score = a + b·Morphinemia (p-value <0.001). The results demonstrated a statistically significant correlation between the two variables: individuals with low total blood morphine values tended to have a higher pathological score. Our study provides useful assessment tools for forensic practice, confirming the need to combine two important disciplines in drug death investigation: forensic pathology and toxicology.
海洛因相关死亡率是一种复杂的现象，涉及到几个使个体更容易受到阿片类药物毒性影响的因素。在这些因素中，预先存在的病理状况起着重要作用。本文回顾了过去 30 年进行的 51 例尸检案例，每个案例的对象（“经常使用海洛因者”）在死亡前都单独静脉注射过海洛因。对于每个案例，通过气相色谱-质谱法（GC-MS）从档案中获得总血液吗啡浓度。为了进行组织病理学评估，我们检查了心脏、肺、脑、肝和肾的显微镜切片，并为每个器官制定了一个从 1 到 5 的数值评分表，作为严重程度增加的指标。最后，我们基于损伤严重程度评分（ISS）创建了一个评分系统，该评分由三个最高器官评分的平方和生成。我们通过将两个变量插入线性回归模型来研究总血液吗啡值（mg/l）和病理评分之间的关系：Score=a+b·Morphinemia（p 值<0.001）。结果表明，这两个变量之间存在统计学上显著的相关性：总血液吗啡值低的个体往往具有更高的病理评分。我们的研究为法医学实践提供了有用的评估工具，证实了在药物死亡调查中需要结合毒理学和法医病理学这两个重要学科。
