Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
Forensic Toxicology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
Drug Test Anal. 2022 Oct;14(10):1696-1702. doi: 10.1002/dta.3347. Epub 2022 Jul 18.
Quantitative analysis of postmortem urine, instead of blood, for buprenorphine and metabolites may provide additional evidence for the diagnosis of fatal buprenorphine poisoning. In this study, 247 autopsy urine samples, previously testing positive for buprenorphine or norbuprenorphine, were quantitatively reanalysed with a recently developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for unconjugated buprenorphine (BUP), norbuprenorphine (NBUP), naloxone (NAL), and their respective conjugated metabolites, buprenorphine glucuronide (BUPG), norbuprenorphine glucuronide (NBUPG), and naloxone glucuronide (NALG). The cases were divided, according to medical examiners' decision, to buprenorphine poisonings and other causes of death. The groups were compared for urinary concentrations and metabolite concentration ratios of the six analytes. All median concentrations were higher in the buprenorphine poisoning group. The median concentration of BUPG was significantly higher and the median metabolite ratios NBUP/BUP, NBUPG/BUPG, and NBUPtotal/BUPtotal were significantly lower in poisonings than in other causes of death. Naloxone-related concentrations and ratios were not significantly different between the groups.
对死后尿液（而非血液）进行定量分析，可能为致命性丁丙诺啡中毒的诊断提供更多证据。在本研究中，我们使用最近开发的液相色谱-串联质谱（LC-MS/MS）方法，对 247 例先前检测出丁丙诺啡或去甲丁丙诺啡阳性的尸检尿液样本进行了重新定量分析，用于检测未结合的丁丙诺啡（BUP）、去甲丁丙诺啡（NBUP）、纳洛酮（NAL）及其各自的结合代谢物丁丙诺啡葡萄糖醛酸（BUPG）、去甲丁丙诺啡葡萄糖醛酸（NBUPG）和纳洛酮葡萄糖醛酸（NALG）。根据法医的决定，将这些案例分为丁丙诺啡中毒和其他死因。比较了两组尿液中六种分析物的浓度和代谢物浓度比。丁丙诺啡中毒组的所有中位数浓度均较高。BUPG 的中位数浓度明显更高，中毒组的 NBUP/BUP、NBUPG/BUPG 和 NBUPtotal/BUPtotal 代谢物比值明显低于其他死因。两组之间纳洛酮相关浓度和比值无显著差异。
