Kan ve İdrar Örneklerinde Amfetamin ve Türevlerinin Saptanmasında CEDIA ve LC-MS/MS Yöntemlerinin Karşılaştırılması
Öz
Amaç:
Bu çalışmada, kan ve idrar örneklerinde amfetamin ve türevleri tespitinde kullanılan immünolojik analiz yöntemi olan CEDIA ile LC-MS/MS yönteminin karşılaştırılması ve CEDIA yönteminin tarama testi olarak etkinliğinin değerlendirilmesi amaçlanmıştır.
Yöntem:
Çalışmaya, Erzurum Adli Tıp Grup Başkanlığı’na adli toksikolojik inceleme amacıyla gönderilen toplam 196 gerçek adli vakaya ait kan ve idrar örnekleri dâhil edilmiştir. Numuneler herhangi bir ön işleme tabi tutulmadan CEDIA yöntemi ile analiz edilmiş, ardından aynı numuneler katı faz ekstraksiyonu uygulanarak LC-MS/MS cihazında analiz edilmiştir. LC-MS/MS yöntemi referans yöntem olarak kabul edilmiştir. Elde edilen sonuçlar duyarlılık, özgüllük, Cohen’s kappa uyum katsayısı ve McNemar testi kullanılarak istatistiksel olarak değerlendirilmiştir.
Bulgular:
CEDIA yönteminin kan numunelerinde duyarlılığı %3,1 ve özgüllüğü %100 olarak bulunmuştur. İdrar numunelerinde ise duyarlılık %77,4 ve özgüllük %98,1 olarak hesaplanmıştır. Kan örneklerinde CEDIA ile LC-MS/MS arasındaki uyum çok zayıf bulunurken (κ=0,042), idrar örneklerinde iyi düzeyde uyum saptanmıştır (κ=0,762). McNemar testi sonuçları, her iki biyolojik örnek türü için yöntemler arasında istatistiksel olarak anlamlı fark olduğunu göstermiştir (p<0,001).
Sonuç:
Elde edilen bulgular, CEDIA yönteminin özellikle kan numunelerinde tarama testi olarak güvenilir olmadığını ortaya koymaktadır. LC-MS/MS yönteminin ise hem kan hem de idrar numunelerinde yüksek duyarlılık ve özgüllük göstermesi nedeniyle tarama ve doğrulama amacıyla güvenilir bir yöntem olduğu sonucuna varılmıştır.
Etik Beyan
Bu çalışma için Adli Tıp Kurumu Başkanlığı’ndan kurumsal izin alınmış olup, çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür.
Destekleyen Kurum
Adli Tıp Kurumu Başkanlığı
Teşekkür
Bu çalışmanın planlanması ve yürütülmesi sürecinde sağlanan kurumsal destek ve laboratuvar imkânları için Adli Tıp Kurumu Başkanlığı’na teşekkür ederiz.
Kaynakça
- Avcioglu G, Yilmaz G, Yalcin Sahiner S, Kozaci LD, Bal C, Yilmaz FM. Comparison of the immunoassay method with the commercial and in-house LC-MS/MS methods for substance abuse in urine. Turk J Biochem. 2024;49(1):24-37. https://doi.org/10.1515/tjb-2022-0286
- Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010;67(16):1344-1350. https://doi.org/10.2146/ajhp090477
- Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27(3):253-262. https://doi.org/10.1080/09595230801923702
- Drummer OH. Drug testing in blood: sensitivity, specificity and interpretation. Ther Drug Monit. 2004;26(2):194-198. https://doi.org/10.1097/00007691-200404000-00011
- Kalasinsky KS. Immunoassays in forensic toxicology. Forensic Sci Rev. 2003;15(2):99-118.
- Kahl KW, Seither JZ, Reidy LJ. LC-MS-MS vs ELISA: validation of a comprehensive urine toxicology screen by LC-MS-MS and a comparison of 100 forensic specimens. J Anal Toxicol. 2019;43(9):734 745. https://doi.org/10.1093/jat/bkz066
- Maurer HH. Current role of liquid chromatography–mass spectrometry in clinical and forensic toxicology. Anal Bioanal Chem. 2007;388(7):13151325. https://doi.org/10.1007/s00216-007-1367-6
- Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide to methods and interpretation. Mayo Clin Proc. 2008;83(1):66-76. https://doi.org/10.4065/83.1.66
- Musshoff F, Madea B. Analytical pitfalls in drug testing and interpretation of results. Forensic Sci Int. 2006;156(2-3):103-112. https://doi.org/10.1016/j.forsciint.2005.10.017
- Peters FT, Drummer OH, Musshoff F. Validation of new methods. Forensic Sci Int. 2007;165(2-3):216-224. https://doi.org/10.1016/j.forsciint.2006.05.021
- Sundström M, Pelander A, Ojanperä I. Comparison between drug screening by immunoassay and ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry in post-mortem urine. Drug Test Anal. 2015;7(5):420-427. https://doi.org/10.1002/dta.1682
- United Nations Office on Drugs and Crime (UNODC). World Drug Report 2023. Vienna: United Nations; 2023. Available from: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html
- Verstraete AG. Oral fluid testing: promises and pitfalls. Ther Drug Monit. 2004;26(2):195-198. https://doi.org/10.1097/00007691200404000-00012
- Wille SMR, Peters FT, Di Fazio V, Samyn N. Practical aspects concerning validation and quality control for forensic and clinical bioanalytical quantitative methods. Accred Qual Assur. 2011;16:279-292. https://doi.org/10.1007/s00769-011-0775-0
Comparison of CEDIA and LC-MS/MS Methods for the Detection of Amphetamine and Its Derivatives in Blood and Urine Samples
Öz
The aim of this study was to compare the immunological screening method CEDIA with LC-MS/MS for the detection of drugs of abuse, particularly amphetamine and its derivatives, in blood and urine samples, and to evaluate the effectiveness of CEDIA as a screening test.
Methods:
A total of 196 blood and urine samples obtained from real forensic cases submitted to the Erzurum Council of Forensic Medicine were included in the study. Samples were first analyzed by the CEDIA method without any pretreatment, and subsequently analyzed by LC-MS/MS following solid-phase extraction. LC-MS/MS was accepted as the reference method. Diagnostic performance was evaluated using sensitivity, specificity, Cohen’s kappa coefficient, and McNemar test.
Results:
The sensitivity and specificity of the CEDIA method in blood samples were 3.1% and 100%, respectively. In urine samples, sensitivity was 77.4% and specificity was 98.1%. Agreement between CEDIA and LC-MS/MS was very poor in blood samples (κ=0.042), while good agreement was observed in urine samples (κ=0.762). McNemar test revealed statistically significant differences between the two methods for both biological matrices (p<0.001).
Conclusion:
The results indicate that the CEDIA method is not reliable as a screening test in blood samples. LC-MS/MS demonstrated high sensitivity and specificity in both blood and urine samples and can reliably be used for both screening and confirmation purposes in forensic toxicology.
Anahtar Kelimeler
Etik Beyan
For this study, institutional permission was obtained from the Presidency of the Council of Forensic Medicine, and the study was conducted in accordance with the principles of the Declaration of Helsinki.
Destekleyen Kurum
Presidency of the Council of Forensic Medicine
Teşekkür
We would like to thank the Presidency of the Council of Forensic Medicine for the institutional support and laboratory facilities provided during the planning and conduct of this study.
Kaynakça
- Avcioglu G, Yilmaz G, Yalcin Sahiner S, Kozaci LD, Bal C, Yilmaz FM. Comparison of the immunoassay method with the commercial and in-house LC-MS/MS methods for substance abuse in urine. Turk J Biochem. 2024;49(1):24-37. https://doi.org/10.1515/tjb-2022-0286
- Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010;67(16):1344-1350. https://doi.org/10.2146/ajhp090477
- Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27(3):253-262. https://doi.org/10.1080/09595230801923702
- Drummer OH. Drug testing in blood: sensitivity, specificity and interpretation. Ther Drug Monit. 2004;26(2):194-198. https://doi.org/10.1097/00007691-200404000-00011
- Kalasinsky KS. Immunoassays in forensic toxicology. Forensic Sci Rev. 2003;15(2):99-118.
- Kahl KW, Seither JZ, Reidy LJ. LC-MS-MS vs ELISA: validation of a comprehensive urine toxicology screen by LC-MS-MS and a comparison of 100 forensic specimens. J Anal Toxicol. 2019;43(9):734 745. https://doi.org/10.1093/jat/bkz066
- Maurer HH. Current role of liquid chromatography–mass spectrometry in clinical and forensic toxicology. Anal Bioanal Chem. 2007;388(7):13151325. https://doi.org/10.1007/s00216-007-1367-6
- Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide to methods and interpretation. Mayo Clin Proc. 2008;83(1):66-76. https://doi.org/10.4065/83.1.66
- Musshoff F, Madea B. Analytical pitfalls in drug testing and interpretation of results. Forensic Sci Int. 2006;156(2-3):103-112. https://doi.org/10.1016/j.forsciint.2005.10.017
- Peters FT, Drummer OH, Musshoff F. Validation of new methods. Forensic Sci Int. 2007;165(2-3):216-224. https://doi.org/10.1016/j.forsciint.2006.05.021
- Sundström M, Pelander A, Ojanperä I. Comparison between drug screening by immunoassay and ultra-high performance liquid chromatography/high-resolution time-of-flight mass spectrometry in post-mortem urine. Drug Test Anal. 2015;7(5):420-427. https://doi.org/10.1002/dta.1682
- United Nations Office on Drugs and Crime (UNODC). World Drug Report 2023. Vienna: United Nations; 2023. Available from: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html
- Verstraete AG. Oral fluid testing: promises and pitfalls. Ther Drug Monit. 2004;26(2):195-198. https://doi.org/10.1097/00007691200404000-00012
- Wille SMR, Peters FT, Di Fazio V, Samyn N. Practical aspects concerning validation and quality control for forensic and clinical bioanalytical quantitative methods. Accred Qual Assur. 2011;16:279-292. https://doi.org/10.1007/s00769-011-0775-0
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Adli Kimya |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Gönderilme Tarihi | 10 Şubat 2026 |
| Kabul Tarihi | 26 Nisan 2026 |
| Yayımlanma Tarihi | 30 Nisan 2026 |
| DOI | https://doi.org/10.61970/adlitip.1885416 |
| IZ | https://izlik.org/JA86TJ87LE |
| Yayımlandığı Sayı | Yıl 2026 Cilt: 40 Sayı: 1 |
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