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題名 | 比較以酵素免疫分析法及氣相層析質譜儀法測定安非他命及嗎啡準確性之研究=Comparison of Emit and GC/MS in Detection of Amphetamine and Morphine in Urine |
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作者 | 林裕峰; 郭建偉; 馬正平; 李安榮; 鄧昭芳; 盧國成; 戴良恭; 曾素珊; 徐如瑋; 邱文君; 謝善德; | 書刊名 | 醫學研究 |
卷期 | 16:4 1996.01[民85.01] |
頁次 | 頁239-250 |
分類號 | 418.81 |
關鍵詞 | 氣相層析質譜儀; 酵素免疫分析儀; 安非他命; 嗎啡; Emit; GC/MS; Amphetamine; Morphine; |
語文 | 中文(Chinese) |
中文摘要 | 安非他命是一種中樞神經刺激劑,過度吸食將導致中暑症狀、高燒、急性心肺衰竭、腎衰竭、腦出血及死亡。慢性吸食則引起幻覺、幻想等神經症狀。海洛因是一種中樞神經麻醉劑。過度吸食將引發水腫、中樞神經及呼吸抑制,甚至抽筋死亡。慢性吸食亦會引起幻覺幻想等精神症狀及盜汗、腹痛、流淚、嘔吐、骨骼酸痛等戒斷症狀。這兩種毒品最近於國內盛行,並入侵部隊,嚴重威脅官兵之身心健康。因此,精確地篩檢及鑑定尿液中毒品,以及早治療吸毒病患,並杜絕其來源實為當務之急。本實驗乃選取1065件檢送至本毒物中心之尿液檢體,比較以酵素免疫分析法及氣相層析質譜儀法(GC/MS)偵測安非他命及海洛因之準確性。結果顯示以酵素免疫分析法篩檢,安非他命之檢體共881件,篩檢陽性者為81件(9.2%);經氣相層析質譜儀法鑑定後,發現71件真正含有甲基安非他命(8%),6件為偽陽性(7.4%)。酵素免疫分析法篩檢海洛因之檢體共184件,結果顯示篩檢陽性者為31件(16.8%);經氣相層析質譜儀法鑑定後,發現23件為嗎啡(海洛因)(12.5%)。7件為Codeine,偽陽性率(22.5%)。酵素免疫分析法之敏感度為100%,專一性則分別為98.7%(安非他命)及95%(海洛因);然而其偽陽性率偏高(安非他命7.4%,嗎啡22.5%)。氣相層析質譜儀之敏感度及專一性均為100%且沒有偽陽性或偽陰性。氣相層析質譜儀法準確度及精密度均優於酵素免疫分析法。因此我們建議基層部隊可以採購簡易酵素免疫檢盤作初步篩檢;四五級醫院則應有酵素免疫分析儀之配備。而百分之百的鑑定則有賴於氣相層析質譜儀。 |
英文摘要 | Amphetamines are representative of a class of noncatecholamine drugs that can cause marked central nervous system (CNS) stimulation. Severe acute amphetamine intoxication may lead to heatstroke, hyperpyrexia (>40℃), acute cardiorespiratory failure, acute renal failure, cerebrovascular accident, and finally sudden death. Patients with chronic amphetamine abuse may typically experience visual, tactile or olfactory hallucinations and delusions. Heroin is a kind of opioid analgesics with CNS depressant effect. Acute heroin poisoning may result in pulmonary edema, CNS and respiratory depression, seizure and death. Chronic heroin abuse may result in hallucination, delusions, and withdrawal syndrome such as diaphoresis, abdominal pain, lacrimation, vomiting, skeletal aches and pain. Nowadays, the increasing abuse of these drugs in Taiwan has also been noted in the military and this is a threat to the physical and psychological health status of the military soldiers. Therefore, reliable methods of screening and confirmation of the presence of these drugs and their metabolites in the urine is necessary for early treatment of addiction and intoxication. Intensive eradication of the source of drugs is required. A number of 1,065 urine samples were collected and screened in our toxicology laboratory to compare the accuracy of the Enzyme Multiplied Immunoassay Technique (EMIT) and Gas Chromatography/Mass Spectrometry (GC/MS) in detection of amphetamine and heroin in the urine. 881 samples were analysed using EMIT; 81 (9.2%) samples were positive for amphetamine in which 71 (8%) samples were positive for methamphetamine using GC/MS and 6 (7.4%) out or 81 samples were false positive. Detection of heroin using EMIT in 184 samples showed 31 (16.8%) samples positive whereas rechecked with GC/MS showed 23 (12%) samples positive for morphine (heroin) and 7 (22.5%) out or 31 samples were false positive due to codeine. The sensitivity of EMIT reach 100%, specificity 98.7% for amphetamine and 95% for heroin, with a high false positive rate. As for GC/MS both sensitivity and specificity reach 100%, without false positive or false negative results. Thus, we advise that the immunoenzymatic plate should be available in all our Military bases for first line screening. EMIT test kit should also be feasible in all the 4th and 5th grade Military Hospital even though GC/MS, which is more expensive, is still the method of choice in screening the urinary content of amphetamine and heroin, and is of 100% accuracy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。