醫療藥品對尿液中嗎啡及甲基安非他命免疫分析之影響

Interference of The Therapeutic Dsugs on Immunoassay of

張秀圭(Chang Shiow-Guei)

指導教授 ： 陳朝洋

臺北醫學大學/藥學院/藥學研究所/碩士(1998年)

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 、trimethobenzamide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DRI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。

關鍵字

尿液免疫分析 ； 嗎啡 ； 甲基安非他命 ； 干擾

並列摘要

It is known that urine tests may be interfered with other substances to cause false results. Urine immunoassay, the most common screening method for drugs of abuse, is especially sus- ceptible to adulterant-induced false results. Eleven adulterating agents from three types of therapeutic drugs: antihistamines, nonsteroidal anti-inflammatory drugs (NSAIDs), and vitamins, were evaluated for potential interference with DRI and TDx opiates and amphetamines immunoassay. Mechanisms of adulterant interference with DRI were also discussed. In our study showed that high molar UV absorbance at 340nm of tolmetin interfered negatively with DRI methamphetamine immunoassay. Being structure-similarity with the antigen of reagents, diphenhydramine, pheniramine and trimethobenzamide resulted in slight increasing measurements of morphine by DRI opiate immunoassay. For the same reason, trimethobenzamide caused dramatically increasing in methamphetamine assay. Chlorpromazine interfered positively with morphine through both cross reaction and UV absorptivity, with methamphetamine through UV absorptivity. Among the eleven tested adulterants, only chlorpromazine and trimethobenzamide positively interfered both immunoassay of TDx. Concurrently we found that adulterated high concentration (≧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 NADH, therefore interfer DRI immunoassay negatively. All puzzling specimens but the ones adulterated with chlorpromazine, could be confirmed by gas chromatography/mass spectrometry (GC/MS).

並列關鍵字

urine immunoassay ； morphine ； methamphetamine ； interference