重要三环抗抑郁药 ER 在二胺过量服用病例中的错误阳性
Noriko Nishimura1, Sayaka Nagasawa1,2, Go Inokuchi1,3
1Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
过量服用二胺 (DPH) 的病例可能会导致使用SIGNIFYTM ER测试的三环抗抑郁药 (TCA) 错误阳性. 这是由于DPH代谢物,二胺N-氧化物 (DPH-NO) 和二胺N-葡萄糖化物 (DPHG) 干扰了测试.
科学领域:
- 毒理学 毒理学 毒理学
- 分析化学 分析化学
- 临床化学 临床化学
背景情况:
- SIGNIFYTM ER测试用于检测药物过量使用.
- 三环抗抑郁药 (TCA) 的错误阳性结果已在二胺 (DPH) 过量服用的情况下观察到.
- 这使得准确的中毒鉴定变得复杂.
研究的目的:
- 调查DPH过量用药病例中错误阳性TCA结果的原因.
- 为了确定负责测试干扰的特定的二胺代谢物.
主要方法:
- 通过液体染色学四极飞行时间质谱学分析了11例DPH过量剂 (4例TCA错误阳性,7例阴性).
- 测量了DPH及其代谢物 (DPH-NO,DM-DPH,DPHG) 的血液和尿路度.
- 在SIGNIFYTM ER测试中测试了含有DPH,其代谢物和代谢物混合物的刺尿样.
主要成果:
- 在假阳性TCA结果的病例中发现了二胺N-氧化物 (DPH-NO) 和二胺N-葡萄化物 (DPHG) 的尿度升高.
- 含有DPH-NO和DPHG的尖尿样,单独或混合,产生虚假阳性TCA结果.
- 确定了DPH及其代谢物的特定度值,这些值会引发错误阳性结果.
结论:
- 狄芬胺N-氧化物 (DPH-NO) 和狄芬胺N-葡萄化物 (DPHG) 涉及导致SIGNIFYTM ER测试带来的错误阳性TCA结果.
- 临床医生应考虑在没有解释的阳性TCA测试结果的情况下服用迪芬胺过量.
- 建议进一步验证分析方法,以区分DPH和TCA毒性.
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