사후 당뇨병 관련 검사의 유용성 연구
A Study on the Usefulness of Postmortem Diabetes Mellitus-Related Tests
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model. Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.
Abstract
Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model. Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.
참고문헌 (17)
- Ugochukwu NH, "The effect of Gongronema latifolium extracts on serum lipid profile and oxidative stress in hepatocytes of diabetic rats", J Biosci, 28, pp.1~5 (2003)
- 정종운, "가시五加皮藥鍼이 糖尿誘發抑制 및 腎臟保護活性에 미치는 영향", Journal of Acupuncture Research, 20(3), pp.1~ (2003), 대한침구의학회
- 김영택, "지역사회건강조사의 조사 기획과 수행", 대한의사협회지, 55(1), pp.74~83 (2012), 대한의사협회
- Bonow RO, "Risk stratification in coronary artery disease and special populations", Am J Med, 101, pp.17S~24S (1996)
- Madea B, "Is there recent progress in the estimation of the postmortem interval by means of thanatochemistry", Forensic Sci Int, 151, pp.139~149 (2005)
- Palmiere C, "Postmortem chemistry update part I", Int J Legal Med, 126, pp.187~198 (2012)
- Boulagnon C, "Post-mortem biochemistry of vitreous humor and glucose metabolism : an update", Clin Chem Lab Med, 49, pp.1265~1270 (2011)
- Palmiere C, "Postmortem diagnosis of diabetes mellitus and its complications", Croat Med J, 56, pp.181~193 (2015)
- Osuna E, "Postmortem vitreous humor beta-hydroxybutyrate : its utility for the postmortem interpretation of diabetes mellitus", Forensic Sci Int, 153, pp.189~195 (2005)
- 박종필, "사후검사를 통한 당뇨병케톤산증의 진단", 대한법의학회지, 40(1), pp.19~22 (2016), 대한법의학회
- Uezono T, "Simultaneous analyses of hypoglycemic agents and C-peptide are essential in a homicide case with the combined dosing insulin and insulin-releasing drug", Leg Med(Tokyo), 4, pp.34~36 (2002)
- Chaturvedi AK, "Vitreous fluid and", or urine glucose concentrations in 1335 civil aviation accident pilot fatalities, 2009, pp.54, 715~720
- Zilg B, "Postmortem identification of hyperglycemia", Forensic Sci Int, 185, pp.89~95 (2009)
- Karlovsek MZ, "Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humour: our experiences", Forensic Sci Int, 146(Suppl), pp.S19~S23 (2004)
- Na JY, "Point-of-care hemoglobin A1c testing in postmortem examination", Forensic Sci Med Pathol, 14, pp.322~326 (2018)
- Kanetake J, "The relationship of a high level of serum beta-hydroxybutyrate to cause of death", Leg Med(Tokyo), 7, pp.169~174 (2005)
- Iten PX, "Beta-hydroxybutyric acid : an indicator for an alcoholic ketoacidosis as cause of death in deceased alcohol abusers", J Forensic Sci, 45, pp.624~632 (2000)