醫療藥品對尿液中嗎啡及甲基安非他命免疫分析之影響
中文摘要
尿液檢驗結果往往受其他物質的干擾而呈現偽陽性或偽陰性 , 免疫分析方法為 一般初步篩檢採用之方法 , 其所受之影響最大。如尿液檢體攙加清潔劑等強離 子性或強鹼、強酸性化學物質，或受驗者飲食狀況、共同服用藥物等因素都有 可能造成免疫分析方法之偽陽性或偽陰性結果。本研究選用十一種國人常用之 抗組織胺、非類固醇抗發炎藥、維他命等藥品，測試對 DRI 及 TDx 之嗎啡及 甲基安非他命免疫檢驗之干擾，並對 DRI 發生干擾之反應機轉進行研究。
實驗結果如下：所攙加的十一種藥品 tolmetin 因於 UV 340nm 有極高吸光度引 起 DRI 甲基安非他命偽陰性反應； diphenhydramine 、 pheniramine 、 trimetho benzamide 與抗體有結合力造成 DRI 嗎啡檢測值微增， trimethobenzamide 也因 此而引起甲基安非他命檢測值劇增。 Chlorpromazine 因為以上兩種因素使得 D RI 嗎啡檢驗呈現偽陽性，因為 UV 吸收使得 DRI 甲基安非他命檢測值微增。同 樣十一種藥品僅有 chlorpromazine 、 trimethobenzamide 對 TDx 的嗎啡及甲基安 非他命檢測造成偽陽性干擾，統計以上結果 TDx 試劑的偽陽性率略低於 DRI 試劑。同時在本研究我們發現尿液檢體中攙加高濃度 ( 2%) ≧ 還原電位 (pH 7) 大於 NADH 之化合物如 ascorbic acid 等，能抑制 NAD+ 轉變成 NADH 而引起 DRI 試劑檢驗呈現偽陰性。除了含有 chlropromazine 的尿液，所有發生干擾現 象之尿液檢體可以氣相層析質譜分析 (GC/MS) 作確認試驗。Interference of The Therapeutic Dsugs on Immunoassay of
英文摘要
It is known that urine tests may be interfered with other substances to cause false results. Urin e immunoassay, the most common screening method for drugs of abuse, is especially sus-cepti ble to adulterant-induced false results. Eleven adulteratingagents from three types of therapeut ic drugs: antihistamines,nonsteroidal anti-inflammatory drugs (NSAIDs), and vitamins, were e valuated for potential interference with DRI and TDx opiates and amphetamines immunoassay . Mechanisms of adulterant interference with DRI were also discussed. In our study showed th at high molar UV absorbance at 340nm of tolmetin interfered negatively with DRI methamphe tamine immunoassay. Being structure-similarity with the antigen of reagents, diphenhydramin e, pheniramine and trimethobenzamide resulted in slight increasing measurements of morphin e by DRI opiate immunoassay. For the same reason, trimethobenzamide caused dramatically i ncreasing in methamphetamine assay. Chlorpromazine interfered positively with morphine thr ough both cross reaction and UV absorptivity, with methamphetamine through UV absorptivit y. Among the eleven tested adulterants, only chlorpromazine and trimethobenzamide positivel y interfered both immunoassay of TDx. Concurrently we found that adulterated high concentr ation ( 2%) of redox agents, which have more powerful reducing strength than nicotinamide ≧ adenine dinucleotide (NAD+), like ascorbic acid may inhibit the conversion of NAD+ to NAD H, therefore interfer DRI immunoassay negatively. All puzzling specimens but the ones adulte rated with chlorpromazine, could be confirmed by gas chromatography/mass spectrometry (G C/MS).
