尸体血液中乙醇质量浓度的分析评价

血液中乙醇质量浓度是分析评价机体内乙醇水平的重要证据,由于尸体内检测到乙醇可能受死后生成、乙醇扩散等因素影响,尸体血液中乙醇质量浓度检测结果未必能反映其死亡时机体内乙醇的真实水平。鉴别尸体内乙醇是否为原始浓度是分析评价的关键。本文对乙醇在体内的分布特点、如何合理取材及死后乙醇扩散、尸体腐败产生的乙醇对乙醇质量浓度分析的影响进行了综述,并对死后乙醇质量浓度检测的分析评价策略进行了讨论。     

血、尿中乙醇含量的测定及其评价——Ⅲ. 乙醇的死后生成及其血、尿样品中乙醇浓度变化

动物实验和实际案例分析结果表明,尸体低温保存较长时间,或室温保存数天,血尿中可生成乙醇正丙醇等,乙醇量一般为正丙醇的20倍内.另一组实验考察了血、尿样品保存时乙醇的稳定性.在评价乙醇含量,判断是否生前饮酒时需考虑这些因素对乙醇含量的影响.     

乙醇脱氢酶在酒精代谢中的作用

酒与人类社会生活密切相关,与酒相关的医学问题和法律问题已受到人们广泛关注。乙醇脱氢酶(ADH)为乙醇氧化分解的主要酶,本文就ADH的性质、ADH遗传多态性与乙醇代谢的关系、ADH不同家系在乙醇代谢中的作用以及ADH与乙醇代谢相关性疾病的关系进行综述,旨在为法庭科学和医学中的应用和研究提供参考。     

血中乙醇及其代谢物乙醛、乙酸的顶空气相色谱法测定

本文用顶空气相色谱法,在 Porapak S 柱上测定人血中乙醇及其代谢物乙醛、乙酸。全血中乙酸在酸性条件下直接加入甲醇酯化成乙酸甲酯,改善了乙酸的挥发性和色谱行为。方法快速,简便,准确。应用本法测定两例正常人饮酒后血中乙醇、乙醛、乙酸浓度,结果表明血液乙醇浓度在酒后90分钟最高,而血液乙醛、乙酸浓度高峰则与人的乙醇代谢能力有关。     

尿样品中乙醇浓度变化

动物实验和实际案例分析结果表明，尸体低温保存较长时间，或室温保存数天，血，尿中可生成乙醇正丙醇等，乙醇量一般为正丙醇的20倍内。另一组实验考察了血，尿样品保存时乙醇的稳定性。在评价乙醇含量，判断是否生前饮酒时需考虑这些因素对乙醇含量的影响。     

唾液中乙醇含量检测试剂条的研究

目的根据唾液和血液中乙醇含量相关性的实验结果,建立了一种简便快速、准确可靠的检测唾液中乙醇含量的方法。方法本方法利用酶学原理,将一定量乙醇氧化酶(ALO)和过氧化物酶以及底物四甲基联苯胺(TMB)固定于试剂条上,当样本中含有乙醇时,酶学反应使底物TMB显色,通过比对反应的不同颜色,对样本中乙醇质量浓度进行半定量。结果用本方法检测300个自愿者的唾液,和用GC/MS法对照检测志愿者唾液中的乙醇含量,定量结果基本一致。本产品检测过程仅需2min,其检测的阈值为0.1mg/mL,敏感度为96.5%,特异性为91%,准确性为94.7%。结论采用酶学方法制备的乙醇含量检测试剂条,通过显色反应对唾液中的乙醇含量进行半定量检测,其特点为快速简便、准确可靠,适合现场使用。     

急性乙醇中毒和外伤在蛛网膜下腔出血致死机制中的作用

目的研究人脑在急性乙醇中毒状态下tPA、MMP-2、MMP-9及AEG-1表达水平与乙醇浓度的关系,分析乙醇与外伤在蛛网膜下腔出血死亡机制中的作用。方法选取15例实际案例,提取脑组织进行组织病理学检查、心血进行乙醇浓度检测,用免疫组织化学法观察人脑干、大脑、小脑tPA、MMP-2、MMP-9及AEG-1表达水平。结果急性乙醇中毒外伤组和急性乙醇中毒组的脑组织肿胀。除小脑tPA外,tPA、MMP-2、MMP-9及AEG-1表达水平在饮酒者较未饮酒者在脑干、大脑、小脑均有升高(P0.05),MMP-2、MMP-9和AEG-1表达水平与心血乙醇浓度存在正相关(P0.05,r0.6)。结论急性乙醇中毒状态下人脑tPA、MMP-2、MMP-9、AEG-1表达较未饮酒者均显著增强,MMP-2、MMP-9及AEG-1表达水平与乙醇浓度存在相关性,乙醇对脑细胞有毒性作用。     

急性乙醇中毒者体内乙醇动力学研究

根据乙醇在体内的代谢动力学特点,本文建立了研究急性乙醇中毒者血液乙醇动力学数学模型,其表达式为:x(t)=x_0(1-e-~(kat))-k_bt。从该数学模型可求得乙醇在体内的吸收速率常数(K_a)和消除速率常数(K_b),从而可以获得体内乙醇浓度动态变化曲线。所以,饮用乙醇饮料后的时刻乙醇浓度(x(t))均可由曲线中查得。实验研究证实,以该数学模型导出的参数与实验获得的结果相一致。     

乙醇与镇静催眠剂联合中毒的研究进展

乙醇(酒精)与镇静催眠剂在日常生活和临床治疗中使用广泛,所引起的中毒较常见。临床治疗及法医学鉴定中常遇到乙醇与镇静催眠剂联合服用引起中毒甚至致死的情况。目前,对于乙醇与镇静催眠剂联合服用的中毒,尚缺乏比较系统的介绍。本文综述了乙醇与镇静催眠剂联合服用中毒的发生率、中毒方式和途径、中毒症状、毒性协同作用的证据及机制等研究进展,以期引起法医工作者及临床医师的重视,为此类中毒的研究提供理论参考。     

血液乙醇同源化合物分析及其法医学意义

酒精饮料申除含多量乙醇外,还含有微量甲醇、杂醇等乙醇同源化合物,且具有和乙醇类似的代谢及药代动力学特征,均参与肝ADH代谢,并与乙醇存在条件性竞争抑制。利用其代谢特性,在某些复杂醉酒驾车案件的法医学调查中,可根据血液中乙醇同源化合物的定量检测结果,结合对应血液乙醇质量浓度,帮助核实或推算饮酒者申诉的饮酒时间的真实性。     

Alcohol Consumption and Females’ Recognition in Response to Date Rape Risk: The Role of Sex-Related Alcohol Expectancies

This study examined the pharmacological and psychological effects of alcohol on women’s recognition of and response to dating sexual aggression. Female participants completed measures of prior sexual victimization experiences, sex related alcohol expectancies, general alcohol expectancies, and drinking habits. Using a 2 (alcohol) × 2 (expectancy) balanced placebo research design, women were exposed to an audiotape date rape vignette and asked to press a button when the man’s sexual advances had gone to far. Upon pressing the button, the tape was stopped and participants were instructed to imagine themselves in the same situation and generate a response describing what they would say and/or do at that point. Results indicated that although alcohol and expectancy were not related to risk perception, individuals who consumed alcohol displayed significantly less resistant role play refusals. A significant interaction between expectancy set and pre-existing sex-related alcohol expectancies was observed indicating participants believing alcohol affects sexual behavior generated less resistant refusal responses when they expected to receive alcohol. Moreover, for those who expected to receive alcohol, stronger pre-existing sex-related alcohol expectancies predicted less resistant refusal responses over above the effects of blood alcohol level and general alcohol expectancies. The implications of these findings are discussed.     

The elimination rate of mouth alcohol: mathematical modeling and implications in breath alcohol analysis.

Mouth alcohol, if present in high enough concentrations, can falsely bias the accurate measurement of end-expiratory breath alcohol. Mouth alcohol will be eliminated over time, however, and can be modeled with a single term decaying exponential of the form: B0e-kt + C. It is important, however, to determine the model and its parameters when alcohol is already present within the biologic system. Using three individuals as their own controls, mouth alcohol was administered both before and after alcohol consumption followed by breath alcohol analysis performed at approximately 0.5 min intervals. The results showed that both model parameters (B0 and k) are effected and that the asymptotic value (C) is reached much sooner when alcohol already exists in the end-expiratory breath. Considering only three individuals were involved, the forensic-science importance appears to be that, as the end-expiratory breath alcohol concentration increases, the time necessary for the mouth alcohol to decrease to unbiased levels is decreased. Fifteen min of observation time prior to breath alcohol analysis appears to be more than adequate at forensically relevant concentrations.     

Oral fluid results compared to self reports of recent cocaine and heroin use by methadone maintenance patients

A novel breath-alcohol analyzer based on the standardization of the breath alcohol concentration (BrAC) to the alveolar-air water vapour concentration has been developed and evaluated. The present study compares results with this particular breath analyzer with arterial blood alcohol concentrations (ABAC), the most relevant quantitative measure of brain alcohol exposure. The precision of analysis of alcohol in arterial blood and breath were determined as well as the agreement between ABAC and BrAC over time post-dosing. Twelve healthy volunteers were administered 0.6g alcohol/kg bodyweight via an orogastric tube. Duplicate breath and arterial blood samples were obtained simultaneously during the absorption, distribution and elimination phases of the alcohol metabolism with particular emphasis on the absorption phase. The precision of the breath analyzer was similar to the determination of blood alcohol concentration by headspace gas chromatography (CV 2.40 vs. 2.38%, p=0.43). The ABAC/BrAC ratio stabilized 30min post-dosing (2089±99; mean±SD). Before this the BrAC tended to underestimate the coexisting ABAC. In conclusion, breath alcohol analysis utilizing standardization of alcohol to water vapour was as precise as blood alcohol analysis, the present "gold standard" method. The BrAC reliably predicted the coexisting ABAC from 30min onwards after the intake of alcohol.     

酒的种类对乙醇代谢动力学的影响

目的乙醇代谢动力学受诸多因素影响,关于酒的种类对其影响少见报道。方法本研究让志愿者在相同的饮酒时间内,饮用含相同乙醇量的啤酒、白酒,将所得数据用药代动力学计算程序DAS Ver1.0进行处理。结果乙醇的体内过程符合一级吸收、非线性消除、一室模型,权重为1。啤酒与白酒相比,吸收速度快,峰浓度高,达峰时间早,消除速度快。结论酒的种类对乙醇代谢动力学有影响,如果根据乙醇的代谢动力学规律来推测饮酒个体某一时刻的BAC,或根据BAC推测实际饮酒量,应该充分考虑到酒的种类对乙醇代谢动力学的影响。     

The Effects of Gastroesophageal Reflux Disease on Forensic Breath Alcohol Testing

Fifteen test subjects, 10 of whom were diagnosed with gastroesophageal reflux disease (GERD), were dosed with alcohol to BACs above 0.150 g/dL. Blood and breath assays taken at 20-min intervals for 8 h after dosing demonstrated close agreement between postabsorptive BAC and BrAC values. Three subjects exhibited elevated breath alcohol concentrations up to 0.105 g/dL during the absorptive phase that were apparently due to the passage of gastric alcohol through the lower esophageal sphincter not attributable to eruction or regurgitation. The effect of gastric alcohol was not consistently proportional to the amount of unabsorbed gastric alcohol. Absorption of alcohol in the esophagus explains the nonproportionality. Breath samples contaminated by GERD-related alcohol leakage from the stomach into a breath sample were found only when there was a high concentration of alcohol in the stomach. When contaminated breath samples were encountered, they were irreproducible in magnitude.     

THE RELATIONSHIP OF ALCOHOL WITHDRAWAL SYMPTOMS TO SUGGESTIBILITY AND COMPLIANCE

People who are experiencing alcohol withdrawal are disadvantaged in terms of their ability to cope with leading questions and interrogative pressure (i.e. interrogative suggestibility). What had not been studied previously was the relationship of the severity of alcohol withdrawal symptoms with suggestibility and compliance. Suggestibility and compliance scores, obtained during the first week of hospital admission, were correlated with the severity of alcohol symptoms measured on a daily basis over a 7‐day period in a group of 393 patients attending treatment for alcohol abuse problems. Separate analyses were performed for the male and female patients. Significant gender differences emerged. Among males, alcohol withdrawal symptoms correlated positively with suggestibility and compliance across days. In contrast, among the females alcohol withdrawal symptoms were not significantly correlated with suggestibility and compliance, but were related to confabulations in memory recall. The findings suggest that in relation to psychological vulnerabilities during questioning, alcohol withdrawal symptoms are associated with different psychological factors in males and females. The findings have implications for the potential unreliability of information obtained from people interviewed during alcohol withdrawal.     

Genetically-induced variability of alcohol metabolism and its effect on drinking behavior and predisposition to alcoholism

Alcoholism is one of the most challenging current health problems in the Western countries with far-reaching medical, social, and economic consequences. There are a series of factors that interact in predisposing or protecting an individual against alcoholism and alcohol-related disorders. This article surveys the state of our knowledge concerning the biochemical and genetic variations in alcohol metabolism and their implications in alcohol sensitivity, alcohol drinking habits, and alcoholism in different racial/ethnic groups. The major pathway for the degradation of ethanol is its oxidation to hydrogen and acetaldehyde--to which many of the toxic effects of ethanol can be attributed. Variations in alcohol and acetaldehyde metabolism via genetically determined polymorphisms in alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) seem to play an important role in individual and racial differences in acute and chronic reactions to alcohol, alcohol drinking habits, as well as vulnerability to organ damage after chronic alcohol abuse. Alcohol sensitivity and associated discomfort symptoms accompanying alcohol ingestion may be determinental for the significantly low incidence of alcoholism among the Japanese, Chinese and other Orientals of Mongoloid origin. An abnormal ALDH isozyme has been found to be widely prevalent among individuals of the Mongoloid race and is mainly responsible for the acute sensitivity to alcohol commonly observed in this race. Persons sensitive to alcohol by virtue of their genetically controlled ALDH isozyme deficiency may be discouraged from drinking large amounts of alcohol in their daily life due to the initial adverse reaction experienced after drinking alcohol. Indeed, a significantly low incidence of the mitochondrial ALDH isozyme deficiency has been observed in alcoholics as compared to psychiatric patients, drug dependents and healthy controls in Japan. How far any variation in ADH and/or ALDH activity among individuals of Caucasian origin will have similar effects has yet to be studied.     

Effects of Delinquency on Alcohol use Among Juveniles in Europe: Results from the ISRD-2 Study

The existence of a correlation between the use of alcohol and juvenile delinquency has long been acknowledged. In order to evaluate the strength and the characteristics of this association in various cultural contexts, we analysed data collected as part of the International Self-Report Delinquency Study- 2 (ISRD-2). The sample consisted of of young people (N?=?57,771) of both sexes, aged between 12 and 16 years, in 25 European countries. After estimating the prevalence of alcohol consumption among young people involved in property offences and violent offences, we assessed the degree to which these types of delinquency were associated with the use of alcohol in the 25 countries. In addition, we attempted to ascertain the influence of belonging to various types of deviant groups on alcohol use. To this end, we used a Mokken Scale Analysis. With this method, we constructed a scale of “gangness” and correlated the scores with alcohol use among juveniles. The results yielded by the present study indicate that alcohol use and delinquency are closely related with one another. In particular, we observed that alcohol consumption seems to be strongly influenced by involvement in delinquent activities. The nature and characteristics of these relationships suggest that the associations between alcohol use and delinquency are reciprocal rather than one-directional. Consequently, alcohol use constitutes a risk factor for criminal behaviour. Likewise, involvement in delinquency increase the risk of alcohol consumption and, especially, of alcohol abuse.     

Evaluation of certifier practices regarding alcohol-related deaths: Fulton County Medical Examiner's Center, Atlanta, Georgia, 2004

CONTEXT: Alcohol can contribute to various manners of death by acute intoxication that places a person at risk for fatal injury, acute fatal alcohol poisoning, or the various fatal complications of chronic abuse with or without superimposed acute intoxication. The reporting of alcohol use on the death certificate may vary with office policy or procedure, certifier judgment, and the timing of information received during investigation. OBJECTIVE: To determine the number of deaths including mention of alcohol use in the investigative case file, the number of death certificates on which alcohol use is reported, the number of discrepancies between the 2, and the possible reasons for observed discrepancies. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case review of all deaths where alcohol use was mentioned in the investigative case file and/or on the death certificate for deaths investigated by the Fulton County Medical Examiner in Atlanta, Georgia, during a 1-year period between January 1, 2004, and December 31, 2004. MAIN OUTCOME MEASURES: Percentage of deaths with alcohol use reported on the death certificate, tabulation of where and how alcohol use is reported on the death certificate, and tabulation of the differences between the investigative case file and death certificate regarding alcohol's possible role in causing death. RESULTS: Among the 1324 deaths certified by the office, 105 (8%) had alcohol use reported on the death certificate. The majority (67%) of these cases were natural deaths. Sixty-nine (5%) deaths had mention of alcohol use in the investigative case notes but did not include it on the death certificate. Twenty-five (2%) deaths had mention of alcohol on the death certificate but did not have mention of it in the investigative case file based on our search criteria. However, subsequent review of additional case follow-up information disclosed a history of alcohol use or acute intoxication in each case. CONCLUSIONS: The data show that more natural deaths are considered to be directly caused by alcohol than other manners of death. For the unnatural manners of death (excluding acute alcohol poisoning), alcohol use is often viewed by medical examiners as an incidental, associated finding or risk factor surrounding the circumstances of death rather than being an actual cause of death. In such cases, alcohol use is often omitted from the death certificate. For deaths directly caused by alcohol, the proportion of cases involving possible underreporting or overreporting of alcohol involvement was relatively small and usually involved the omission of chronic alcohol use from the death certificate. Researchers need to be aware of potential limitations of death certificate data for studying alcohol-related deaths.