阿片类药物母体-代谢物比率的临床意义。

IF 3.2 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2024-10-09 DOI:10.1016/j.cca.2024.119995

Hsuan-Chieh Liao, William S. Phipps, Michael W. Keebaugh, Andrew N. Hoofnagle, Geoffrey S. Baird

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引用次数: 0

摘要

背景：阿片类药物的流行凸显了尿液药物检测在慢性疼痛治疗中的重要性。然而，解读检测结果可能具有挑战性，尤其是在为模拟依从性而在尿样中直接添加药物的情况下：我们使用液相色谱-串联质谱法（LC-MS/MS）对 9690 份阿片类药物检测结果进行了回顾性分析。研究旨在确定八种常用处方阿片类药物的母药和代谢物之间的预期比率。对母体与代谢物比率高于第 95 百分位数的病例进行病历审查：结果：共有 13 个病例可能符合丁丙诺啡的模拟依从性，2 个病例符合美沙酮的模拟依从性，14 个病例符合羟考酮的模拟依从性，1 个病例符合氢可酮的模拟依从性。母体-代谢物比率的异常模式也可能与超急性药物暴露/使用、药物不纯或潜在肝酶缺乏有关。此外，未达到判定限度的患者可能表现出其他非法用药或异常行为：结论：进行基于 LC-MS/MS 的阿片类药物检测的实验室可通过分析母体-代谢物比率更客观地识别异常情况。在与医疗服务提供者协商时，实验室可以在提出模拟依从性的可能性时指出这些数据，并帮助确定需要进一步调查的病例。

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Clinical implications of opioid parent-metabolite ratios

Background

The opioid epidemic has underscored the importance of urine drug testing in the management of chronic pain. However, interpreting test results can be challenging, especially in scenarios where medications may have been directly added to urine samples to simulate compliance.

Methods

We conducted a retrospective analysis of 9,690 opioid testing results using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The study aimed to define the expected ratios between parent drugs and metabolites for eight commonly prescribed opioids. Cases with a parent-metabolite ratio above the 95th percentile were subjected to chart review.

Results

A total of 13 cases appeared likely consistent with simulated compliance with buprenorphine, 2 with methadone, 14 with oxycodone, and one with hydrocodone. The unusual patterns of parent-metabolite ratio can also be associated with hyperacute drug exposures/use, pharmaceutical impurity, or underlying liver enzyme deficiency. Furthermore, patients who failed the decision limits could exhibit other illicit use or aberrant behaviors.

Conclusion

Laboratories conducting LC-MS/MS-based opioid testing can more objectively identify anomalies by analyzing parent-metabolite ratios. When in consultation with providers, laboratories can point to these data when suggesting the possibility of simulated compliance and help identify cases warranting further investigation.

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来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.