Yonemitsu K, Pounder D J
Department of Forensic Medicine, Kumamoto University, Japan.
Forensic Sci Int. 1993 May;59(2):177-84. doi: 10.1016/0379-0738(93)90157-6.
Site and temporal changes in tranylcypromine (TCP) and lithium concentrations in blood were studied in a human poisoning case. Blood samples from peripheral vessels and six central vessels were obtained at 0, 6, 24, 48 and 72 h after starting the autopsy. Nine tissue samples were obtained on completion. TCP showed preferential concentration in liver (2.21 micrograms/g) and brainstem (2.46 micrograms/g). There was a moderate post mortem redistribution phenomenon with TCP concentrations lowest in peripheral blood (0.17 micrograms/ml) at 0 h and highest in central vessels at 24 h (0.52 micrograms/ml). At 72 h blood TCP concentrations fell below those at 0 time but the samples showed marked putrefactive changes. Control blood samples spiked with TCP and incubated for 48 h at 37 degrees C showed a 58% fall in drug concentration. By contrast with TCP, lithium, which has a small Vd (0.8 l/kg) and is chemically stable, did not show this pattern of change in blood concentration. The site and temporal differences in TCP concentration in blood can be explained by the competing effects of post mortem redistribution and drug degradation. Redistribution is an early post mortem phenomenon characterised by diffusion, along a concentration gradient, from drug reservoirs in solid organs into adjacent blood vessels. Drug degradation is a later phenomenon associated with putrefactive change.
在一例人体中毒病例中，研究了反苯环丙胺（TCP）和锂在血液中的部位及时间变化。在尸检开始后的0、6、24、48和72小时，采集外周血管和六个中心血管的血样。完成后采集九个组织样本。TCP在肝脏（2.21微克/克）和脑干（2.46微克/克）中浓度较高。存在中度的死后再分布现象，TCP浓度在0小时时外周血中最低（0.17微克/毫升），在24小时时中心血管中最高（0.52微克/毫升）。在72小时时，血液中TCP浓度降至0小时时以下，但样本显示出明显的腐败变化。添加了TCP并在37℃下孵育48小时的对照血样显示药物浓度下降了58%。与TCP相比，锂的分布容积较小（0.8升/千克）且化学性质稳定，其血液浓度未表现出这种变化模式。血液中TCP浓度的部位和时间差异可由死后再分布和药物降解的竞争效应来解释。再分布是一种早期死后现象，其特征是沿着浓度梯度从实体器官中的药物储存库扩散到相邻血管中。药物降解是一种与腐败变化相关的后期现象。
