EBC中8-isoPG测定在不同肺部疾病中的临床意义

目的研究ARDS、OSAHS和AECOPD患者的EBC中8-isoPG浓度变化及临床意义。对象和方法选择江苏省南通大学第二附属医院的ARDS、OSAHS和AECOPD患者,收集ARDS患者入院第一天、OSAHS患者晨起、AECOPD患者以及健康对照组的EBC;采用ELISA法检测EBC中的8-isoPG浓度。结果 1.ARDS组、OSAHS组、AECOPD组和健康对照组EBC中8-isoPG浓度为[(52.19±11.51 ng/L)、(14.93±1.39 ng/L)、(6.74±3.38 ng/L)、(3.21±0.97 ng/L)];2.ARDS、OSAHS、AECO-PD患者EBC中8-isoPG均高于健康对照组,三者EBC中8-isoPG浓度顺序排列为:ARDS组>OSAHS组>AECOPD组(P<0.01)。结论 EBC中8-isoPG可以反应多种肺部疾病的炎症及氧化应激程度。     

慢性阻塞性肺疾病急性加重期患者治疗前后呼出气冷凝液pH变化及临床意义

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗前后呼出气冷凝液(EBC)中pH变化的意义及临床价值.方法 随机选择AECOPD患者20例,正常健康者20例.比较AECOPD治疗前后EBC pH的变化及与健康对照组EBC pH,探讨AECOPD治疗前EBC PH与肺功能(FEV1、FEV1/FVC、FEV1%预计值)的相关性.结果 EBC pH在AECOPD降低,经治疗后升高,但同对照组比较是降低的,有统计学意义(P＜0.05).但AECOPD的EBC中pH与肺功能无明显相关性(P＞0.05).结论 AECOPD患者EBC中pH显著降低,气道酸化明显,气道炎症严重,但不能反映肺功能和病情严重情况.因此EBC中pH是监测气道酸碱度和COPD急性发作的有效指标.     

呼出气冷凝液检测炎性指标监测在慢性阻塞性肺疾病患者中的临床应用

目的探讨检测老年慢性阻塞性肺疾病(COPD)患者呼出气冷凝液(EBC)中炎症因子水平的临床意义。方法收集COPD急性期患者、COPD缓解期患者和正常对照的EBC标本各43例,并行常规肺功能、酶联免疫分析法(ELISA)检测EBC中白细胞介素(IL)-4、IL-6、IL-8、肿瘤坏死因子(TNF)-α、8-异前列腺素(8-iso-PG)及白三烯B4(LTB4)的水平。结果 COPD急性期患者EBC中IL-6、IL-8、8-iso-PG及LTB4均高于缓解期和正常对照(P<0.05),而IL-4、TNF-α则未发现有差别;COPD缓解期患者IL-6、8-iso-PG及LTB4高于正常对照(P<0.05),而IL-4、IL-8、TNF-α则未发现有差别。相关分析发现EBC检测物中只有IL-8与第1秒用力呼气容积/用力肺活量(FEV1/FVC)呈负相关,LTB4与FEV1呈负相关。结论不同程度患者EBC中炎症反应不同,监测呼吸道炎症因子可采用EBC检测方法。     

呼出气冷凝集液中TNF-α及IL-1β与慢性阻塞性肺疾病发病的相关性

目的探讨呼出气冷凝集液(EBC)中的肿瘤坏死因子(TNF)-α及白介素(IL)-1β与慢性阻塞性肺疾病(COPD)发病的相关性。方法收集不同COPD患者及正常人群的EBC,检测其中的TNF-α及IL-1β。结果 COPD急性加重期患者EBC中TNF-,αIL-1β浓度高于缓解期及正常对照组。结论 EBC中TNF-,αIL-1β浓度变化可以用来预测COPD的发病及进展,从而为监测COPD的发病提供了一个新的诊治手段。     

AECOPD患者呼出气冷凝液中分泌性白细胞蛋白酶抑制剂的检测及其临床意义

目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗前后呼出气冷凝液(EBC)中分泌性白细胞蛋白酶抑制剂(SLPI)浓度的变化,及其与AECOPD各临床指标的相关性。方法随机选择AECOPD患者30例,正常健康者18例,采用ELISA方法检测AECOPD组治疗前后及健康对照组EBC中SLPI浓度,应用Pearson直线相关分析AECOPD组治疗前EBC中SLPI浓度与COPD临床特征、肺功能(PEF、FEV1%预计值)、血气分析、血WBC计数等指标的相关性。结果经抗感染、氧疗、解痉、激素等常规治疗7天后,AECOPD组EBC中SLPI浓度明显高于治疗前(P0.05);AECOPD组治疗前EBC中SLPI浓度与患者FEV1%预计值、痰量、呼吸困难症状密切相关(P0.05),与患者PEF、血白细胞(WBC)计数、动脉血pH值、PaO2/FiO2、PaCO2无相关性(P均0.05)。结论 AECOPD患者EBC中SLPI浓度可作为反映病情的严重程度和临床转归的指标。     

AECOPD 患者呼出气冷凝液中降钙素原检测及其意义

目的：研究慢性阻塞性肺疾病急性加重期(AECOPD)患者呼出气冷凝液(EBC)中降钙素原(PCT)水平的变化及临床意义。方法选取92例 AECOPD 患者,根据急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ评分)将 AECOPD 患者分为高危组、中危组和低危组,检测入院后24 h内的 EBC 和血清中 PCT、C 反应蛋白(CRP)和白细胞计数(WBC)水平,比较各组间的差异;根据预后将 AECOPD 患者分为存活组与死亡组,比较2组间各指标的差异。同期选取41例正常对照组,检测其 EBC 和血清中 PCT 水平。结果①AECOPD 患者 EBC 和血清中 PCT 水平[(0.084±0.043)μg/L,(0.767±0.348)μg/L]高于正常对照组[(0.014±0.006)μg/L,(0.041±0.016)μg/L], P <0.01。②EBC 中 PCT 水平在高危组、中危组和低危组3组间的差异有统计学意义(F =20.555, P <0.01)。③死亡组 EBC 和血清中 PCT 水平均高于存活组(t =7.736,P <0.01)。④AECOPD 患者 EBC 中 PCT 水平与血 PCT、血 CRP、WBC 水平和 APACHEⅡ评分均呈正相关(r 分别为0.437、0.399、0.322、0.548,P 值均<0.01)。结论 AECOPD 患者 EBC 中 PCT 水平与患者病情严重程度具有较好的相关性,是判断 AECOPD 严重程度和预后的敏感指标。     

呼出气冷凝液在慢性阻塞性肺疾病中的研究进展

呼出气冷凝液(exhaled breath condensate,EBC)检测作为一种新的研究肺部疾病的方法,具有无创、简便易行、实时监测、重复性好、患者易耐受等优点.对COPD患者EBC中反映气道炎症、氧化应激状态的生物标记物进行研究有助于COPD的诊断及对药物治疗反应的评估和患者预后的评价.而且EBC中异常炎症介质的研究可能为COPD发病机制开启新思路并发现新的治疗靶点.     

慢性阻塞性肺疾病患者呼出气冷凝液中NO2-、LTB4、PGE2、IL-6、IL-10水平的研究

目的 探讨慢性阻塞性肺疾病(COPD)患者呼出气冷凝液(EBC)中亚硝酸盐(NO2-)、白三烯B4(LTB4)、前列腺素E2(PGE2)、白介素6(IL-6)和IL-10的水平与气道炎症及肺功能的关系.方法 收集20例COPD患者和20名健康体检者,测定肺通气功能,收集EBC,用比色法测定EBC中NO2-水平,用ELISA法测定EBC中LTB4、PGE2、IL-6和IL-10的水平.结果 ①COPD组EBC中NO2-和LTB4的水平分别为(2.029±1.992) μmol/L、(0.400 ±0.235)μmol/L,均显著高于健康对照组(0.400±0.235)μmol/L,(9.742±2.348) ng/L,差异有统计学意义(P值均＜0.05);EBC中PGE2、IL-6、IL-10的水平在两组间比较,差异均无统计学意义(P＞0.05);COPD组EBC中NO2-、LTB4、PGE2、IL-6、IL-10的水平与FEV/FVC和FEV％预计值无相关性(P＞0.05).结论 COPD患者EBC中NO2-、LTB4与气道炎症及氧化应激有关系,PGE2、IL-6、IL-10与气道炎症的关系需进一步研究,这些细胞因子与肺功能无相关性.     

慢性阻塞性肺疾病呼出气冷凝液中的生物标记物及其意义

呼出气冷凝液(exhaled breath condensate,EBC)是一种无创研究气道内衬液成分的方法,也为评估肺部炎症提供可能.目前普遍认为,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是以气道、肺实质和肺血管的慢性炎症为特征的疾病.通过对COPD患者EBC的收集和检测,可实现对气道炎症的实时、无创、简单、重复的监测.     

CAP患者呼出气冷凝液中PCT检测的临床意义

【】目的 通过对社区获得性肺炎(CAP)患者呼出气冷凝液(EBC)中降钙素原(PCT)的检测,探讨其在CAP患者病情评估及疗效评价中的价值。方法 选择72例CAP住院患者,收集患者第1、3、7天的EBC及血清标本,并记录患者入院时白细胞计数、C反应蛋白(CRP)、CURB-65评分。选择健康体检者48例,收集其EBC及血清。结果 ①CAP患者EBC中PCT水平高于正常对照组,P﹤0.01；②与第1天比较CAP患者第3天和第7天EBC中PCT水平下降,差异具有统计学意义(P﹤0.01)；③EBC中PCT水平在高危组、中危组和低危组3组间的差异具有统计学意义(P＜0.01)；④EBC中PCT水平和血PCT、血CRP、WBC水平和CURB-65评分皆呈正相关。结论 CAP患者EBC中PCT水平与患者病情严重程度具有较好的相关性,是判断CAP严重程度和预后的敏感指标。     

Clinical use of exhaled biomarkers in COPD

Exhaled breath analysis holds great promise as a diagnostic and investigative tool in COPD and is a new and rapidly expanding field of research in pulmonary disease. Generally speaking, exhaled breath analysis focuses on two areas: measurement of exhaled nitric oxide (ENO) and the detection of biomarkers in exhaled breath condensate (EBC). ENO measurement may not be as useful in COPD as in other pulmonary diseases, such as asthma, due to the lower levels of ENO found in COPD, although this is an area of ongoing research. Analysis of EBC for proinflammatory biomarkers is an area of great promise but its true value will not be realized until methods of collecting and analyzing EBC have been standardized. Once this is done, biomarkers detected in EBC may assist in the diagnosis of COPD, identification of preclinical disease, phenotyping of COPD patients, evaluation of response to therapies and defining the prognosis of individual patients. Identification of novel inflammatory mediators in EBC may cast new light on the pathogenesis of COPD and identify new therapeutic targets, which are badly needed in this disease.     

Exhaled breath condensate in pulmonary arterial hypertension

Over the last decade, several new agents have been developed for the treatment of pulmonary arterial hypertension (PAH), and blood biomarkers have been developed which aim to monitor such treatment, and which correlate well with physiological parameters, symptoms and mortality. However, little is known regarding biomarkers collected using non-invasive methods such as exhaled breath condensate (EBC). EBC biomarkers show potential as a rapid, repeatable and easy method of sampling the pulmonary vasculature in severely ill patients. The current study aimed to investigate EBC biomarkers in patients with PAH of different aetiologies. We studied 89 patients in four groups: pulmonary arterial hypertension (PAH, n = 30), PAH associated with COPD (COPD/PAH, n = 14), COPD but no PAH (n = 16) and healthy controls (n = 29). Levels of the following EBC markers were measured: amino-terminal pro-brain natriuretic peptide (NT-proBNP), endothelin-1 (ET-1), 6-keto prostaglandin (PG)F(1α), hydrogen peroxide (H(2)O(2)), total oxides of nitrogen (NO(x)), total protein and pH. ET-1 and NT-proBNP were measured in plasma concurrently. Data were analysed with ANOVA or Kruskal Wallis tests where appropriate. Correlations were performed using Pearson's correlation coefficient. NT-proBNP was detectable in EBC and was highest in the PAH group, significantly higher than the COPD/PAH group (194.1 ± 23.3 versus 80.8 ± 22.2 fmol ml(-1), p < 0.05). EBC ET-1 was significantly higher in subjects with PAH (1.53 ± 0.32 fmol ml(-1)) compared to those with COPD/PAH (0.25 ± 0.03 fmol ml(-1), p < 0.05) and controls (0.66 ± 0.18 fmol ml(-1), p < 0.05). 6-keto PGF(1α) was low in the PAH group, significantly lower than the COPD/PAH group (4027 ± 445 versus 8381 ± 1024 pg ml(-1), p < 0.01). EBC biomarkers are measurable in PAH. EBC ET-1 was raised in PAH compared with controls and patients with PAH secondary to COPD, whereas 6-keto PGF(1α) was low. EBC biomarkers may be useful in detection and monitoring of PAH.     

慢性阻塞性肺疾病呼出气冷凝液中的生物标记物及其意义

呼出气冷凝液(exhaled breath condensate,EBC)是一种无创研究气道内衬液成分的方法,也为评估肺部炎症提供可能.目前普遍认为,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是以气道、肺实质和肺血管的慢性炎症为特征的疾病.通过对COPD患者EBC的收集和检测,可实现对气道炎症的实时、无创、简单、重复的监测.     

COPD患者呼出气冷凝液中8-异前列腺素的检测及其意义

目的研究COPD患者呼出气冷凝液（EBC）中8-异前列腺素（8-isoPG）浓度的改变及临床意义。方法收集COPD患者（39例）急性发作期和缓解期以及正常对照组（32例）的EBC,用酶标记法检测EBC中8-isoPG,同时检测AECOPD患者的第一秒呼气容量（FEV1）、最大呼气流速（PEF）、pH值、PaCO2、PaO2及血白细胞总数。结果①COPD患者急性发作期8-isoPG为6.44±3.68 ng/L,高于缓解期（4.04±1.25 ng/L）及正常对照组（3.31±0.91 ng/L）,P〈0.05;②COPD患者8-isoPG浓度与痰量呈正相关,r=0.217,P〈0.05。结论 COPD的急性发作期,8-isoPG升高反映了氧化应激增强。     

Enhanced Exhalation of Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Patients with COPD Exacerbation: A Prospective Study

Background: Matrix metalloproteinase-9 (MMP-9) and its inhibitor tissue inhibitor of metalloproteinase-1 (TIMP-1) are involved in the pathogenesis of airway inflammation in patients with chronic obstructive pulmonary disease (COPD). However, no study so far has addressed their value as noninvasive biomarkers of airways inflammation. Objective: To evaluate MMP-9 and TIMP-1 concentrations in the exhaled breath condensate (EBC) of patients with stable COPD and also during the exacerbation episode. Methods: EBC and serum samples were collected in 17 stable-phase COPD patients who were current smokers as well as during their first exacerbation episode, and in 22 asymptomatic smokers. EBC and serum levels of MMP-9 and TIMP-1 were measured with ELISA kit. Results: Mean EBC MMP-9 and TIMP-1 levels were higher in patients with stable COPD than in asymptomatic smokers. Exacerbation of COPD increased 2-fold the exhalation of MMP-9 (18.5 ± 10.1 ng/ml vs. 8.9 ± 6.2 ng/ml, p = 0.01) and TIMP-1 (to 41.1 ± 20.4 ng/ml vs. 16.4 ± 6.8 ng/ml, p < 0.001). Both, MMP-9 and TIMP-1 in EBC correlated negatively with FEV(1) (% predicted) at baseline (r = -0.78, p < 0.001 and r = -0.73, p < 0.001) and during the exacerbation episode (r = -0.57, p = 0.02 and r = -0.65, p = 0.005). Similar negative correlations were noted with FVC (% predicted), except for MMP-9 in EBC at exacerbation. Exhaled MMP-9 and TIMP-1 did not correlate with serum concentrations in COPD patients, either at baseline or during exacerbation. Conclusion: Exhaled MMP-9 and TIMP-1 increased during COPD exacerbation and was negatively correlated with spirometric variables, which suggests the usefulness of their measurement in EBC for the monitoring of airways inflammation. However, to better assess their diagnostic or prognostic value larger studies are necessary.     

慢性阻塞性肺疾病患者呼出气冷凝液中髓过氧化物酶的检测及其意义

目的 检测COPD患者呼出气冷凝液（EBC）中髓过氧化物酶（MPO）浓度,探讨MPO与COPD发病发展的关系.方法 纳入49例COPD患者、18例健康体检者作为研究对象,采用EcoscrecnEBC收集仪采集标本,以酶免疫法测定EBC中MPO浓度.结果 COPD组EBC中MPO浓度显著高于健康对照组[（35.68±0.32）μg/L vs （11.72±0.34）μg/L,P＜0.05];COPD组EBC中MPO浓度与患者FEV1％ pred、呼气流量峰值呈正相关（相关系数r分别为0.418、0.327,P值均＜0.05）.结论 EBC中的MPO浓度能监测肺组织局部的炎症和氧化应激程度,能反映COPD患者病情严重程度,有助于发现COPD的病情变化,是一种较好的评价COPD病情的生物学指标.     

Detection of microorganisms in exhaled breath condensate during acute exacerbations of COPD

Background and objective: One hallmark of COPD is colonization and infection of the lung. Acute exacerbations of COPD (AECOPD) are acute deteriorations of the chronic disease and are associated with a change of the pulmonary microbial balance. The collection of exhaled breath condensate (EBC) can be used to non‐invasively determine markers of lung disease. The aim of the present study was to compare the results of assays based on the detection of microbial nucleic acids from EBC and from spontaneous sputum in patients with AECOPD. Methods: EBC and sputa of 29 adults with AECOPD were obtained. Isolated DNA or RNA were used as starting material for the PCR assays to detect Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae, influenza viruses (AH 1, AH 3) and respiratory syncytial virus. Results: Bacterial or viral nucleic acids were identified in 14 EBC and 21 sputa from 29 patients. Results from EBC did not correlate well with those from sputum. Viral and S. pneumoniae nucleic acids were detected only in sputum, whereas L. pneumophila DNA was only found in EBC. In three EBC and 10 sputa nucleic acids of more than one microorganism was detected. Conclusions: Bacterial nucleic acids can be identified in EBC of COPD patients with exacerbations. The results obtained from EBC and sputum did not correlate well.     

Markers of inflammation in exhaled breath condensate of young healthy smokers

INTRODUCTION: Although a strong correlation exists between long-term cigarette smoking, pulmonary inflammation, and COPD, efforts to identify populations at risk of acquiring COPD have so far been unsuccessful. To this end, noninvasive detection and monitoring of biomarkers of pulmonary inflammation in young healthy smokers may assist in this task. STUDY OBJECTIVES: The purpose of this study was to determine the concentrations of total protein, nitrites, interleukin (IL)-1beta, and tumor necrosis factor (TNF)-alpha, and neutrophil chemotactic activity in exhaled breath condensate (EBC) collected from healthy college student smokers and nonsmokers. DESIGN: EBC was collected from 20 volunteers (9 nonsmokers and 11 smokers) during tidal breathing for 20 min. EBC was also collected from smokers 30 min after smoking one filtered cigarette. The concentrations of total protein, nitrite, IL-1beta, and TNF-alpha in EBC was determined by enzyme-linked immunosorbent assay. Neutrophil chemotactic activity in EBC was determined in vitro using the blind-well technique. RESULTS: The concentrations of total protein and nitrite, and neutrophil chemotactic activity were significantly higher in EBC of smokers in comparison to nonsmokers (p < 0.05). The concentrations of total protein and nitrite in the condensate of smokers did not change significantly after smoking one cigarette. The concentrations of IL-1beta and TNF-alpha in EBC were similar in nonsmokers and smokers. CONCLUSIONS: Concentrations of certain inflammatory mediators and neutrophil chemotactic activity are increased in EBC of young healthy smokers. Collection and analysis of EBC may assist in early detection of cigarette smoke-induced pulmonary inflammation and identifying populations at risk for acquiring COPD.