부산대학교 도서관

Background: Cocaine abusers have an increased risk for cardiovascular and CNS complications. Homocysteine has been recognized as a potential risk factor for atherosclerosis and cardiac and cerebrovascular disease. Measurement of free homocysteine (fHcy) along with total homocysteine (tHcy) may prove useful in predicting risk factors for morbidity in cocaine use. Methods: Plasma fHcy and tHcy levels were analyzed using an HPLC method in patients (n = 29) presenting to an urban Emergency Department who quantitatively screened positive (COC+) for cocaine metabolite, benzoylecgonine (BE). These patients were compared to healthy subjects (n = 34) who screened negative (COC-) using fluorescence polarization immunoassay. Also analyzed were plasma and urine for cocaine, norcocaine, BE, and ecgonine methyl ester using GC-MS. Plasma levels for fHcy and tHcy from cocaine abused patients and normal subjects were statistically evaluated using one way analysis of variance (ANOVA). Medical records from 27 of the 29 COC+ were retrospectively reviewed for clinical signs and symptoms consistent with acute cocaine toxicity. Results: COC+ had significantly higher levels of plasma fHcy and tHcy (p [is less than] 0.001) compared to COC-. The mean and 95% confidence intervals for fHcy and fHcy in [micro]mol/L was 3.5 [+ or-] 0.7 and 9.3 [+ or -] 1.1 for COC+ and 1.9 [+ or -] 0.2 and 7.1 [+ or -] 1.3 for COC-, respectively. Also noted was a direct relationship between plasma BE and tHcy levels (p [is less than] 0.01). Retrospective review of patient records testing positive for cocaine demonstrated no consistent clinical correlation with levels of fHcy and tHcy. Conclusion: Measuring fHcy and tHcy may be valuable in the assessment of patients who abuse cocaine. However, no clinical correlation was noted in those who had elevated levels. A prospective trial noting other confounding variables including chronicity and frequency of cocaine use is indicated.
Williams RH, Maggiore JA, Shah SM, Negrusz A, Brown N, Johnson V, Erickson TB. Department of Emergency Medicine, Department of Pathology and the Toxikon Consortium, Chicago, [...]