Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy.
Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy.
Int J Mol Sci. 2024 Mar 29;25(7):3825. doi: 10.3390/ijms25073825.
Bile has emerged as an alternative matrix for toxicological investigation of drugs in suspected forensic cases of overdose in adults and intoxications in children. Toxicological investigation consists in screening and, subsequently, confirming the result with specific techniques, such as liquid chromatography with tandem mass spectrometry (LC-MS/MS). As there is no screening test on the market to test postmortem bile specimens, the novelty of this study was in investigating the applicability of a chemiluminescence immunoassay, designed for other matrices and available on the market, on bile and validate its use, testing the agreement with LC-MS/MS analysis. Bile specimens were obtained from 25 forensic cases of suspected death from overdose and intoxication. Sample preparation for bile screening consists simply in centrifugation and dilution. Confirmation analysis allows simultaneous identification of 108 drugs and was validated on bile. Kappa analysis assessed a perfect agreement (0.81-1) between the assays for benzodiazepines, methadone, opiates, cocaine, oxycodone, cannabinoids, buprenorphine and pregabalin; a substantial agreement (0.41-0.6) was reported for barbiturates. No agreement was assessed for amphetamines, due to an abundance of putrefactive amines in postmortem specimens. In conclusion, this fast and easy immunoassay could be used for initial screening of bile specimens, identifying presence of drugs, except amphetamines, with reliability.
胆汁已成为用于毒理学研究的替代基质，可用于调查成人疑似过量用药和儿童中毒的案例。毒理学研究包括筛选，随后使用特定技术（如液相色谱-串联质谱法 (LC-MS/MS)）进行确认。由于市场上没有用于检测死后胆汁样本的筛选测试，因此本研究的新颖之处在于研究一种设计用于其他基质且已上市的化学发光免疫分析法在胆汁中的适用性，并验证其使用，测试其与 LC-MS/MS 分析的一致性。从 25 例疑似因过量用药和中毒导致死亡的法医案例中获得了胆汁样本。胆汁的筛选分析只需简单地进行离心和稀释。确认分析可同时鉴定 108 种药物，并在胆汁中得到了验证。kappa 分析评估了两种检测方法（苯二氮䓬类、美沙酮、阿片类、可卡因、羟考酮、大麻素、丁丙诺啡和普瑞巴林）之间具有完美的一致性（0.81-1）；评估了两种检测方法（巴比妥类）之间具有高度一致性（0.41-0.6）。由于死后样本中存在大量腐胺，因此未对安非他命进行评估。总之，这种快速简便的免疫分析法可用于初始筛选胆汁样本，可靠地识别除安非他命以外的药物。
