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Abstract：
Heroin-related mortality is a complex phenomenon involving several factors that make an individual more susceptible to opioid toxicity. Among these, pre-existing pathological conditions play an important role. The current paper reviewed 51 autopsied cases performed over the last 30 years, each subject (\"frequent heroin user\") having taken heroin intravenously alone before death. For each case, total blood morphine concentration determined by gas chromatography-mass spectrometry (GC-MS) was obtained from the archives. For histopathological evaluation we examined microscopic sections of the heart, lung, brain, liver and kidney, and for each organ a score table with a numerical value from 1 to 5, as an indicator of increasing severity, was drawn up. Finally, we created a scoring system based on the Injury Severity Score (ISS), generated by the sum of the squares of the three highest organ scores. We investigated the relationship between total blood morphine value (mg/l) and pathological score by inserting the two variables in a linear regression model: Score = a + b·Morphinemia (p-value <0.001). The results demonstrated a statistically significant correlation between the two variables: individuals with low total blood morphine values tended to have a higher pathological score. Our study provides useful assessment tools for forensic practice, confirming the need to combine two important disciplines in drug death investigation: forensic pathology and toxicology.
摘要：
海洛因相关死亡率是一种复杂的现象，涉及多种因素，使个体更容易受到阿片类药物毒性的影响。其中,预先存在的病理状况起着重要作用。本论文回顾了过去30年进行的51例尸检案例，每个受试者（“经常使用海洛因”）在死前单独静脉注射海洛因。对于每种情况，通过气相色谱-质谱（GC-MS）测定的总血液吗啡浓度从档案中获得。为了进行组织病理学评估，我们检查了心脏的显微切片，肺，大脑,肝脏和肾脏,每个器官都有一个数值从1到5的评分表，作为严重程度增加的指标，是起草的。最后,我们创建了一个基于伤害严重度评分(ISS)的评分系统，由三个最高器官分数的平方和生成。我们通过在线性回归模型中插入两个变量来研究总血液吗啡值（mg/l）与病理评分之间的关系：评分=ab·吗啡血症（p值<0.001）。结果表明，这两个变量之间具有统计学上的显着相关性：总血液吗啡值低的个体倾向于具有较高的病理评分。我们的研究为法医实践提供了有用的评估工具，确认需要在药物死亡调查中结合两个重要学科：法医病理学和毒理学。
