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.     

慢性阻塞性肺疾病呼出气冷凝液中生物标记物的研究进展

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.对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者EBC中反映气道炎症、氧化应激状态的生物标...     

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.     

呼出气冷凝液成分检测在COPD中的应用

呼出气冷凝液(exhaled breath condensate,EBC)检查为近年来新开展的一种无创的呼吸道疾病炎症状态检测方法。通过对EBC检测,可了解气道内衬液中抗氧化物,可溶性标记物等多种生化分子的变化。目前,EBC检测在欧洲已经应用于了解COPD、哮喘、囊性纤维化、吸烟损害、支气管扩张以及急性肺损伤、急性呼吸窘迫综合征(ARDS)等呼吸系统疾病时肺内、气道内出现的氧化应激状态和酸碱状态、炎症状态变化。吕晓东等[1]在呼出气冷凝液中NO的检测发现哮喘与COPD有显著差异,本文就EBC收集原理和方法及在COPD中应用作一介绍。1呼出气冷凝液的收…     

呼出气冷凝液检测在呼吸系统疾病中的应用

呼出气冷凝液 (exhaledbreathcondensate,EBC)检查为新的呼吸道炎症状态检测方法。气道内衬液体中抗氧化物、可溶性标记物等多种生化分子 ,平静呼吸时可随气体呼出 ,遇冷则随水蒸气凝结而进入EBC。EBC中某些成分的显著异常 ,可反映哮喘、慢性阻塞性肺疾病、急性呼吸窘迫综合征、肺间质疾病等肺内及气道内氧化应激、炎症状态的变化及程度。EBC与传统方法如诱导痰、支气管镜肺泡灌洗液等相比 ,具有实时、无创、简单、可多次重复等特点 ,结果也有可比性。目前EBC检测尚属探索阶段 ,但随着检测技术的提高和了解的深入 ,EBC检测在未来会有广泛的前景     

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.     

呼出气冷凝液检测在呼吸系统疾病中的应用

呼出气冷凝液(exhaled breath condensate，EBC)检查为新的呼吸道炎症状态检测方法。气道内衬液体中抗氧化物、可溶性标记物等多种生化分子，平静呼吸时可随气体呼出，遇冷则随水蒸气凝结而进入EBC。EBC中某些成分的显著异常，可反映哮喘、慢性阻塞性肺疾病、急性呼吸窘迫综合征、肺间质疾病等肺内及气道内氧化应激、炎症状态的变化及程度。EBC与传统方法如诱导痰、支气管镜肺泡灌洗液等相比，具有实时、无创、简单、可多次重复等特点，结果也有可比性。目前EBC检测尚属探索阶段，但随着检测技术的提高和了解的深入，EBC检测在未来会有广泛的前景。     

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.     

呼出气体冷凝物与气道炎症和氧化应激反应

许多肺部疾病包括支气管哮喘 (简称哮喘 )、慢性阻塞性肺疾病 (COPD)、支气管扩张和间质性肺疾病等 ,都与气道慢性炎症和氧化应激反应有关 ,对于气道炎症的监测和治疗 ,一直是世界各国学者普遍关注的问题。在临床实践中 ,可供选择直接监测气道炎症反应的程度及对治疗效果评价的方法是很有限的。临床上应用纤维支气管镜 (简称纤支镜 )活组织检查 (简称活检 )及应用诱导痰液排出的方法 ,可以间接检测气道炎症反应 ,但有其局限性。肺功能检查也不能反应气道炎症的变化情况。近 10年来 ,呼出气体冷凝物(EBC)的收集和分析已成为人们关注的焦点…     

支气管哮喘患者呼出气冷凝液中半胱氨酰白三烯水平

相对于常规的判断气道炎症的方法,呼出气冷凝液(EBC)成分测定是一种完全无创的检测技术.本研究通过测定不同分期、分级及吸入糖皮质激素治疗前后哮喘患者EBC中半胱氨酰白三烯水平,初步探讨半胱氨酰白三烯水平能否反映气道炎症情况及其与疾病严重程度的关系,旨在为哮喘气道炎症的监测寻找一种无创的客观指标.     

呼出气冷凝液中生物标记物在COPD的意义

COPD是全球范围内发病率和病死率最高的疾病之一,目前发病机制尚未明确,主要认为其与气道、肺实质及肺血管的慢性炎症、氧化应激及蛋白酶-抗蛋白酶的失衡有关.呼出气冷凝液可有效收集呼吸过程中气道表面形成的气溶胶和挥发性分子,是检测呼吸道炎症因子的重要标本来源,可反映氧化损伤、炎症以及治疗等导致的气道内环境的变化.应用呼出气冷凝液可对COPD的发生发展及急性加重过程实现无创、简单的监测.     

Exhaled markers of inflammatory lung diseases: ready for routine monitoring?

Assessing airway inflammation is important for investigating the underlying mechanisms of many lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). Yet these are not measured directly in routine clinical practice because of the difficulties in monitoring inflammation. The presence and type of airway inflammation can be difficult to detect clinically, and may result in delays in initiating appropriate therapy. Non-invasive monitoring may assist in differential diagnosis of lung diseases, assessment of their severity and response to treatment. There is increasing evidence that breath analysis may have an important place in the diagnosis and clinical management of asthma, COPD, primary ciliary dyskinesia (PCD) and other major lung disease. The article reviews whether current noninvasive measurements of exhaled gases, such as nitric oxide (NO), hydrocarbons, inflammatory markers exhaled breath condensate (EBC) are ready for routine use in clinical practice.     

Exhaled breath condensate analysis in chronic obstructive pulmonary disease

The increasing focus on airway inflammation in the pathogenesis of chronic obstructive pulmonary disease (COPD) has led to development and evolution of tools to measure it. Direct assessment of airway inflammation requires invasive procedures, and hence, has obvious limitations. Non-invasive methods to sample airway secretions and fluids offer exciting prospects. Analysis of exhaled breath condensate (EBC) is rapidly emerging as a novel non-invasive approach for sampling airway epithelial lining fluid and offers a convenient tool to provide biomarkers of inflammation. It has definite advantages that make it an attractive and a feasible option. It is a source of mediators and molecules that are the causes or consequences of the inflammatory process. Measurement of such markers is increasingly being explored for studying airway inflammation qualitatively and quantitatively in research studies and for potential clinical applications. These biomarkers also have the potential to develop into powerful research tools in COPD for identifying various pathways of pathogenesis of COPD that may ultimately provide specific targets for therapeutic intervention. The EBC analysis is still an evolving noninvasive method for monitoring of inflammation and oxidative stress in the airways. The limited number of studies available on EBC analysis in COPD have provided useful information although definite clinical uses are yet to be defined. Evolving technologies of genomics, proteomics, and metabonomics may provide deeper and newer insights into the molecular mechanisms underlying the pathogenesis of COPD.     

The effects of volatile salivary acids and bases on exhaled breath condensate pH

RATIONALE: Recent studies have reported acidification of exhaled breath condensate (EBC) in inflammatory lung diseases. This phenomenon, designated "acidopnea," has been attributed to airway inflammation. OBJECTIVES: To determine whether salivary acids and bases can influence EBC pH in chronic obstructive pulmonary disease (COPD). METHODS: Measurements were made of pH, electrolytes, and volatile bases and acids in saliva and EBC equilibrated with air in 10 healthy subjects and 10 patients. RESULTS: The average EBC pH in COPD was reduced (normal, 7.24 +/- 0.24 SEM; range, 6.11-8.34; COPD, 6.67 +/- 0.18; range, 5.74-7.64; p = 0.079). EBCs were well buffered by NH(4)(+)/NH(3) and CO(2)/HCO(3)(-) in all but four patients, who had NH(4)(+) concentrations under 60 micromol/L, and acetate concentrations that approached or exceeded those of NH(4)(+). Saliva contained high concentrations of acetate (approximately 6,000 micromol/L) and NH(4)(+) (approximately 12,000 micromol/L). EBC acetate increased and EBC NH(4)(+) decreased when salivary pH was low, consistent with a salivary source for these volatile constituents. Nonvolatile acids did not play a significant role in determining pH of condensates because of extreme dilution of respiratory droplets by water vapor (approximately 1:12,000). Transfer of both acetic acid and NH(3) from the saliva to the EBC was in the gas phase rather than droplets. CONCLUSIONS: EBC acidification in COPD can be affected by the balance of volatile salivary acids and bases, suggesting that EBC pH may not be a reliable marker of airway acidification. Salivary acidification may play an important role in acidopnea.     

Reproducibility of exhaled breath condensate pH in chronic obstructive pulmonary disease.

Increasingly, exhaled breath condensate (EBC) is being used to sample airway fluid from the lower respiratory tract. EBC pH may be a biomarker of airway inflammation in chronic obstructive pulmonary disease (COPD). In this study, the reproducibility of EBC pH in COPD was investigated. A total of 36 COPD patients and 12 healthy nonsmoking subjects participated in several investigations: duration of argon deaeration, within-sample variability, effect of freezing, leaving samples at room temperature, nose-peg use, within- (WD) and between-day (BD) variability. Analysis of repeated measurements was performed using the Bland-Altman method with limits of agreement (LOA; mean difference+/-2 SD). Wider LOA indicate greater variability. EBC pH became significantly higher with argon deaeration for < or =5 min. Variability during sample analysis was minimal; LOA of within-sample variability, freezing for 3 months and leaving at room temperature for 3 h were -0.29-0.45, -0.37-0.42 and -0.13-0.09, respectively. In contrast, variability due to nose-peg use (LOA -1.46-1.99), WD (LOA -1.50-2.48) and BD variability (LOA -2.52-3.02) were higher in COPD. In healthy nonsmoking subjects, nose-peg use (LOA -0.27-0.23), WD (LOA -0.33-0.40) and BD variability (LOA -0.46-0.44) were more reproducible. In conclusion, the variability of exhaled breath condensate pH in chronic obstructive pulmonary disease patients is mainly due to changes in airway pH over time, which are not seen in healthy nonsmoking subjects. Reasons for these fluctuations in exhaled breath condensate pH are unclear and require further investigation.     

炎性因子在慢性阻塞性肺疾病气道炎症中的作用

COPD是一种以气道慢性炎症为特征之一的慢性呼吸系统疾病,气道炎性反应在COPD占有重要作用。炎性细胞因子是机体内最重要的一类细胞因子,多种炎性细胞因子参与气道炎症的病理生理机制,对肺组织和支气管产生损害,并发肺外效应。在COPD的自然病程中存在炎性细胞因子网络系统,调控COPD的气道炎症的发生发展。     

慢性阻塞性肺疾病气道黏液高分泌研究进展

慢性阻塞性肺疾病(COPD)是由慢性气道和肺实质炎症引起的进行性气流受限的阻塞性疾病,气流受限不完全可逆.COPD是全球范围内慢性病发病和死亡的重要原因,而气道黏液高分泌是COPD发病和死亡的重要因素.黏液高分泌导致黏液纤毛清除受损、细菌定植、气道黏液栓形成以及气体交换功能障碍.为了阻止这个恶性循环,必须控制气道慢性炎...