死後の血漿および脳脊髄液の1,5-アンヒドログルシトール値による糖尿病の法医診断における有用性  [in Japanese] Usefulness of postmortem 1,5-anhydroglucitol analysis in forensic diagnosis  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 高田 智世 TAKATA Tomoyo
    • 愛媛県立医療技術大学保健科学部臨床検査学科|岡山大学医歯薬学総合研究科法医学分野 Department of Medical Technology, Faculty of Health Science, Ehime Prefectural University of Health Sciences|Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 山﨑 雪恵 YAMASAKI Yukie
    • 岡山大学医歯薬学総合研究科法医学分野 Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 北尾 孝司 KITAO Takashi
    • 愛媛県立医療技術大学保健科学部臨床検査学科|岡山大学医歯薬学総合研究科法医学分野 Department of Medical Technology, Faculty of Health Science, Ehime Prefectural University of Health Sciences|Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
    • 宮石 智 MIYAISHI Satoru
    • 岡山大学医歯薬学総合研究科法医学分野 Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

Abstract

死後の血漿および脳脊髄液の1,5-アンヒドログルシトール(1,5-AG)値が,死後における糖尿病の診断に有用かを腎障害のない59例(糖尿病既往歴あり:n = 13,糖尿病既往歴なし:n = 46)について,死後HbA1c値や糖尿病既往歴とともに検討を行った.その結果,血漿1,5-AG値と脳脊髄液1,5-AG値には正の相関があり(r = 0.59),糖尿病既往歴ありの方が糖尿病既往歴なしよりも,血漿や脳脊髄液の平均1,5-AG値がともに統計学的に有意に低かった(血漿1,5-AG値:6.8 ± 8.3 µg/mL vs. 23.6 ± 13.0 µg/mL,脳脊髄液1,5-AG値:6.1 ± 5.3 µg/mL vs. 19.4 ± 7.9 µg/mL).また,糖尿病既往歴のある症例の全てが,血漿か脳脊髄液のいずれか,もしくはその両方で1,5-AG値が低かった.更に,糖尿病既往歴がない症例では,約8割に血漿か脳脊髄液のいずれか,もしくはその両方が正常範囲であったが,HbA1c値6.5%以上の人は,両試料で1,5-AG低値であった.糖尿病既往歴がない症例で血漿1,5-AGのみ低値の症例には溺死による死因の影響が考えられた.法医学における死因診断において,溺死の場合は脳脊髄液を対象とすることを考慮すれば,死後の血漿および脳脊髄液の1,5-AG値の測定は,HbA1c値と合わせて評価することで劇症1型糖尿病を含めた正確な糖尿病による死因診断の一助になることが示唆された.

For postmortem diagnosis of diabetes mellitus including fulminant type 1 diabetes, it is necessary to determine the blood glucose concentration before death, and the concentrations of plasma and cerebrospinal fluid 1,5-anhydroglucitol (1,5-AG) and HbA1c were investigated in 59 individuals including diabetic patients (n = 13) and nondiabetic subjects (n = 46) without renal failure on the basis of anamnesis. The postmortem 1,5-AG concentration in the plasma showed linearity with that in the cerebrospinal fluid (r = 0.59). The mean 1,5-AG concentrations in the plasma and cerebrospinal fluid were significantly lower in diabetes mellitus patients than in nondiabetic subjects (plasma 1,5-AG: 6.8 ± 8.3 µg/mL (diabetes mellitus) vs 23.6 ± 13.0 µg/mL (nondiabetes mellitus); cerebrospinal fluid 1,5-AG: 6.1 ± 5.3 µg/mL (diabetes mellitus) vs 19.4 ± 7.9 µg/mL (nondiabetes mellitus)). The plasma and/or cerebrospinal fluid 1,5-AG concentrations in all the diabetic patients were low. Furthermore, the plasma and cerebrospinal fluid 1,5-AG concentrations in nondiabetic subjects with HbA1c 6.5% or more was low. In nondiabetic subjects with normal HbA1c, only the plasma 1,5-AG concentration was low in those who died because of drowning. In conclusion, we consider that measurements of plasma and cerebrospinal fluid 1,5-AG concentrations in addition to HbA1c concentration are useful for the forensic diagnosis of postmortem diabetes mellitus including fulminant type 1 diabetes, and it is better to apply the measurement of cerebrospinal fluid 1,5-AG concentration in those who died because of drowning.

Journal

  • Japanese Journal of Medical Technology

    Japanese Journal of Medical Technology 63(6), 680-686, 2014

    Japanese Association of Medical Technologists

Codes

  • NII Article ID (NAID)
    130005057062
  • Text Lang
    JPN
  • ISSN
    0915-8669
  • Data Source
    J-STAGE 
Page Top