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。     

呼出气冷凝液中NO、8-异前列腺素与哮喘严重程度关系

目的分析支气管哮喘患者呼出气冷凝液(EBC)中一氧化氮(NO)、8-异前列腺素(8-isoprostane)浓度与肺功能、ACT变化之间的关系。方法病例对照研究。结果 36例患者参加了本次研究,慢性持续期26例、缓解期10例,健康对照19例。缓解期、慢性持续期及健康对照组之间,8-isoprostane、NO与FEV1/pre、ACT评分有统计学差异(P<0.01)。FEVl/pre与NO、8-isoprostane存在负相关性(r=-0.610,P<0.05;r=-0.545,P<0.05)。ACT与NO、8-isoprostane也呈现负相关(r=-0.533,P<0.05;r=-0.584,P<0.05)。结论 EBC中炎性标志物能反映出气道炎症程度,且与肺功能和ACT评估指标有较好的相关性。     

呼出气冷凝液中8-异前列腺素F2α的检测及其临床意义

8-异前列腺素F2α是目前研究比较多的一种呼出气中的标志物，反映了呼吸系统疾病炎症反应及氧化应激变化，有较好特异性及灵敏度。本文就呼出气冷凝液中8-异前列腺素F2α的来源、代谢、检测方法、影响呼出气中8-异前列腺素F2α水平的因素和临床意义等进行综述。     

哮喘患者呼出气冷凝液中TNF-α、8-isoPG检测的临床意义

目的了解哮喘患者呼出气冷凝液（EBC）中TNF-α、8-isoPG的含量,并观察激素治疗对其水平的影响。方法选择轻、中度哮喘患者38例和健康对照组25例,其中轻度哮喘组20例、中度哮喘组18例。轻度哮喘组予以吸入激素治疗一个月。采用ELISA双抗体夹心法测定EBC中TNF-α、8-isoPG的含量。结果哮喘组EBC中TNF-α、8-isoPG的含量显著高于对照组（P〈0.05）。结论哮喘患者EBC中TNF-α、8-isoPG的含量增高与哮喘严重程度有关,可作为检测哮喘气道炎症反应和氧化应激的客观指标。吸入糖皮质激素治疗后TNF-α、8-isoPG含量无显著变化,提示糖皮质激素不能完全有效控制哮喘患者气道炎症反应和氧化应激损伤。     

慢性阻塞性肺疾病患者呼出气冷凝液中检测一氧化氮、8-异前列腺素的临床意义

目的观察慢性阻塞性肺疾病（COPD）患者呼出气冷凝液（EBC）中一氧化氮（NO）、8-异前列腺素（8-isoPG）的变化及其临床意义。方法收集COPD急性发作期（AECOPD）、缓解期患者和正常对照组的EBC,用硝酸还原法检测NO的浓度,酶免疫法检测8-isoPG的浓度。结果①AECOPD组（19例）患者EBC中NO和8-isoPG的浓度显著高于正常对照组（12例）,NO测定值分别为（80．83±40．15）μmol／L和（36．95±22．47）μmol／L,8-isoPG测定值分别为（13．56±11．11）ng／L和（5．87±3．39）ng／L,P〈0．05;②10例COPD急性发作期患者EBC中NO和8-isoPG的浓度显著高于缓解期,NO测定值分别为（91．09±34．30）μmol／L和（29．65±11．76）μmol／L,8-isoPG测定值分别为（17．60±12．44）ng／L和（5．23±6．20）ng／L,P〈0．05;③AECOPD组NO测定值与FEV1呈负相关（r=0．565,P〈0．05）,与血白细胞计数呈正相关（r=0．746,P〈0．01）。结论COPD患者急性发作期气道炎症反应和氧化应激增强。     

检测呼出气冷凝液中一氧化氮和8-异前列腺素对慢性阻塞性肺疾病的临床意义

我们对慢性阻塞性肺疾病（COPD）患者呼出气中的标志物一氧化氮和8-异前列腺素进行了研究。 对象与方法 选择2005年8至12月住院的COPD急性发作期患者19例，平均年龄（71±12）岁，男：女为2．1：1，COPD急性发作期和缓解期诊断符合文献[1]的标准。对照组12名，为同期健康体检志愿者，平均年龄（66±5）岁，男：女为2：1。患者入院后给予抗感染、止咳化痰和平喘等处理，其中10例在缓解期收集冷凝液（EBC）复查检测指标。     

阻塞性睡眠呼吸暂停低通气综合征患者治疗前后呼出气冷凝液中8-异前列腺素水平的变化

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者治疗前后氧化应激标记物的变化以及这些变化与病情严重程度的关系。方法68例OSAHS患者中40例接受治疗2个月,其中33例使用持续气道正压通气治疗（CPAP）、5例行外科手术、2例使用口矫器,28例未经任何治疗,随访2个月。所有患者分别于治疗前和治疗后2个月,于晨起空腹时收集呼出气冷凝液（EBC）,同时抽取静脉血5ml,应用酶联免疫吸附法（ELISA）测定EBC和血清中8．异前列腺素的含量,并进行统计学的处理。结果治疗后EBC和血清中8-异前列腺素的水平较治疗前明显降低,差异具有显著性[EBC：（19．9±2．9）pg／ml,（14．4±3．1）pg/ml,P〈0．001;血清：（29．9±5．7）pg／ml,（20．4±3．9）pg／ml,P〈0．001];EBC和血清中8-异前列腺素水平的绝对变化（治疗后．治疗前）与呼吸暂停低通气指数（AHI）和最长窒息时间的绝对变化呈正相关（EBC：r=0．69,r=0．50,P〈0．001;血清：r=0．72,r=0．46,P〈0．001）,与夜间最低SaO2的绝对变化呈负相关（EBC：r=-0．58,P〈0．001;血清：r=-0．53,P〈0．001）。结论EBC和血清中8-异前列腺素的水平能通过治疗有效降低,治疗前后的水平变化与病情的严重程度有关,可作为随访病情和反映治疗效果的指标。     

间歇性和持续性哮喘患者呼出气冷凝液中的白三烯C4、8-异前列腺素与硝酸盐检测的临床意义

目的探讨支气管哮喘（简称哮喘）患者治疗前后呼出气冷凝液（EBC）中白三烯c4（LTC4）、8-异前列腺素（8-ISO）、硝酸盐（NO。）水平及临床意义。方法酶法和比色法对30例哮喘患者EBC中LTC4、8-ISO、NO。进行检测,30例健康者作为对照。结果哮喘患者的LTC4比对照组显著升高（55．17ng／L比17．95ng／L,P〈0．01）,持续期比间歇期组显著升高（67．38ng／L比41．21ng／L,P〈0．01）,持续期比对照组显著升高（67．38ng／L比17．95ng／L,P〈0．01）,间歇期比对照组显著升高（41．21ng／L比17．95ng／L,P〈0．01）,患者组比治疗后组显著升高（55．17ng／L比38．36ng／L,P〈0．01）。哮喘患者的8-ISO比对照组显著升高（13．41ng／L比6．93ng／L,P〈0．01）,持续期组比对照组显著升高（14．29ng／L比6．93ng／L,P〈0．01）,间歇期比对照组显著升高（12．40ng／L比6．93ng／L,P〈0．05）。哮喘患者的NOx比对照组显著升高（4．17ng／L比3．20ng／L,P〈0．01）,持续期组比对照组显著升高（4．50ng／L比3．20ng／L,P〈0．01）。结论LTC4、8-ISO、NOx水平能够很好的体现出哮喘患者的气道炎症水平,而孟鲁斯特药物能够很好的控制气道炎症水平,缓解气道炎症。     

呼出气一氧化氮检测对咳嗽变异性哮喘的诊断价值

目的 探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)检测在咳嗽变异性哮喘(cough variant asthma,CVA)诊断中的应用价值.方法 回顾性研究分析2015年1月至2015年12月我院呼吸科门诊及住院,因慢性咳嗽同时行支气管激发试验(bronchial provocation test,BPT)检查及FeNO检测的患者共989例.以BPT阳性作为诊断CVA的金标准,记录患者病史及FeNO水平;绘制受试者工作特征(ROC)曲线,探讨诊断CVA的FeNO阈值.结果 989例被纳入研究的患者中,120例BPT阳性者诊断为哮喘组,869例BPT阴性者诊断为非哮喘组.哮喘组患者FeNO水平[(61.28±41.24) ppb]明显高于非哮喘组[(25.43±24.87) ppb],差异有统计学意义(P＜0.01).诊断CVA的FeNO阈值为30.00 ppb,ROC曲线下面积为0.804,其约登指数为0.505 2,灵敏度为72.50％,特异度为78.02％,阳性预测值为31.29％,阴性预测值为95.36％,准确度为77.35％.结论 FeNO检测诊断CVA具有较高的特异度和阴性预测值,且安全性好,在临床上有较高的诊断价值.     

阻塞性睡眠呼吸暂停低通气综合征呼出气冷凝液8-异前列烷的昼夜变化及其意义

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者呼出气冷凝液(exhaled breath condensate,EBC)8-异前列烷(8-isoprostane,8-isoPG)的昼夜变化及其意义.方法 采用德国JAEGER公司的呼出气收集器.收集40例OSAHS患者和30名正常对照者睡眠监测前后的EBC,同时采集睡眠监测后的血清,采用酶联免疫技术测定EBC及血清中8-isoPG的含量,并与睡眠监测指标进行相关性分析.结果 OSAHS组EBC中8-isoPG睡眠监测前为(13.08±1.42)ng/L、睡眠临测后为(14.93±1.39)ng/L(P<0.01).正常对照组EBC中8-isoPG睡眠监测前为(11.06±0.72)ng/L、睡眠监测后为(10.97±0.70)ng/L(P>0.05).OSAHS组睡眠监测后EBC及血清中8-isoPG比正常对照组升高,P<0.01.OSAHS患者睡眠监测后EBC 8-isoPG与血清8-isoPG呈正相关(r=0.685,P<0.01),与AHI呈正相关(r=0.650,P<0.05),与睡眠中最低血氧饱和度、基础血氧饱和度和平均血氧饱和度呈负相关(r=-0.406,-0.439,-0.454,P值均<0.05).结论 OSAHS患者存在夜间氧化应激反应增强,OSAHS患者早晨EBC中8-isoPG可以作为评价患者氧化应激状态和估计病情严重程度的较好指标.     

Variability of exhaled breath condensate leukotriene B4 and 8-isoprostane in COPD patients

The reproducibility of exhaled breath condensate (EBC) mediators is not well documented in chronic obstructive pulmonary disease (COPD). This study assessed within assay (WA), within (WD) and between day (BD) reproducibility of EBC leukotriene B₄ (LTB₄) and 8-isoprostane. Three EBC samples were collected from 24 COPD patients separated by 1 h and 1 wk, to assess WD and BD reproducibility. WA reproducibility was assessed by sample analysis by enzyme immunoassay in triplicate. WA coefficient of variation for LTB₄ and 8-isoprostane (18.2% and 29.2%, respectively) was lower than corresponding values for WD (47.7% and 65.3%, respectively) and BD (75.7% and 79.1%, respectively). Repeatability coefficient for 8-isoprostane and LTB₄ assays were 18.6 pg/ml and 13.2 pg/ml, respectively. Group mean differences for WD and BD were small and statistically nonsignificant. Using the Bland Altman method, there were wide limits of agreement for WD (−51.6 to 47.2 for 8-isoprostane and −31.8 to 31.4 for LTB₄) and BD reproducibility (−61.4 to 75.7 for 8-isoprostane and −29.3 to 38.6 for LTB₄). This is the first study to fully report the variability of EBC 8-isoprostane and LTB₄ in COPD. WA variability and group mean changes were small. However, we observed considerable WD and BD variability for these biomarkers.     

Inflammatory markers in exhaled breath condensate from patients with asthma

Background and objective:   Evaluation of airway inflammation is important for the diagnosis and treatment of asthma. Exhaled breath condensate (EBC) is a minimally invasive method for assessing inflammation and may be useful for monitoring airway inflammation in asthma. The aims of this study were to establish an EBC collection method, to assess biomarkers reflecting asthmatic airway inflammation, and to determine the relationship of these biomarkers with asthma severity and lung function.
Methods:   Fifty-eight non-smoking healthy subjects, seven asymptomatic smokers, nine subjects with common cold and 55 asthmatics with disease severity ranging from mild intermittent to severe persistent were studied. The efficacy of a pipette method was compared with that of a commercial collecting device. pH, CRP, albumin, hydrogen peroxide (H₂O₂) and nitrite/nitrate levels were measured in EBC.
Results:   Except for the quantity of EBC collected and albumin levels, there were no differences between the commercial method and the pipette method in levels of biomarkers measured. Levels of CRP, H₂O₂ and nitrite/nitrate were significantly higher in the asthma group than that in the control group. In terms of asthma severity, pH and levels of CRP, H₂O₂ and nitrate were significantly higher in the mild persistent group than that in the other groups. In addition, H₂O₂ levels in EBC correlated significantly with the level of nitrite/nitrate. FEV₁ and PEF showed significant negative correlations with H₂O₂ and nitrite/nitrate levels.
Conclusion:   Measurement of EBC biomarkers is a non-invasive and useful way to evaluate airway inflammation in patients with asthma.     

Clinical and technical factors affecting pH and other biomarkers in exhaled breath condensate

Exhaled breath condensate (EBC) pH appears to be a robust measure of asthma. However, the association between EBC pH and clinical factors and airway inflammatory markers remains unclear. The objectives of this study were to investigate the factors determining EBC pH in asthmatic children, and the reproducibility and effects of collection devices on EBC pH in nine healthy, nonsmoking adults. EBC was collected once from asthmatic children using EcoScreen, and from adults over 3 consecutive days using both RTubes and EcoScreen. EBC pH was measured immediately in non-deaerated samples by microelectrode pH meter. Concentrations of 8-isoprostane, cysteinyl leukotrienes (cys-LT), and leukotriene B4 (LTB4) were measured using enzyme immunoassay. Exhaled nitric oxide concentration (FeNO) was measured by chemiluminescence. Fifty-eight asthmatics (16 intermittent, 12 mild persistent, and 30 moderate-to-severe persistent) were recruited. EBC pH was lower among patients with moderate-to-severe persistent than intermittent asthma (P = 0.046). This marker correlated inversely with disease severity score (rho = -0.276, P = 0.036), but not FeNO or other EBC biomarkers. Bland-Altman analyses found pH but not other EBC biomarkers to be reproducible, which were confirmed by its low coefficient of variation (2.7%; range, 0.4-5.2%). There was poor correlation between pH in EBC collected by RTube and EcoScreen (rho = 0.059, P = 0.784). Factor analysis selected four factors that explained 67.5% of the total variance, and EBC pH clustered with both cys-LT and LTB4. In conclusion, our results suggest that pH in non-deaerated EBC is influenced by asthma severity in children. EBC pH measurement is reproducible, but is dependent on the collection devices used.     

Exercise increases exhaled breath condensate cysteinyl leukotriene concentration in asthmatic patients

Background. Although the importance of cysteinyl leukotrienes (Cys-LTs) in exercise-induced bronchoconstriction (EIB) is supported by various sources of evidence, how the concentration of these mediators change during the development of EIB has not been investigated. Objectives. Our goal was to determine the effect of exercise on the concentration of airway Cys-LT in asthmatic patients by measuring Cys-LT in exhaled breath condensate (EBC). Methods. Seventeen atopic asthmatic patients with a previous history of EIB and six healthy volunteers were studied. Before and two times within 10 minutes after exercise challenge, FEV₁ was measured and EBC was collected for Cys-LT measurement. Exhaled nitric oxide level, a marker of airway inflammation, was also determined at baseline. Results. Baseline Cys-LT level was higher in the asthmatic group versus healthy subjects (168 pg/mL /112–223/ vs. 77 pg/mL /36–119/, p = .03). EBC Cys-LT concentration increased in all asthmatic patients post-exercise (n = 17, p = .03), with the increase significantly greater in patients developing exercise-induced bronchospasm (n = 7, p = .03), whereas no change was observed in healthy controls (p = .59). The exercise-induced fall in FEV₁ in asthmatics was related to the increase in EBC Cys-LT concentration (r = ?0.40, p = .03). Conclusions. Our study shows that Cys-LT concentration of EBC is elevated minutes after physical exercise in asthmatic patients and strongly supports the concept that the release of this mediator is involved in the development of EIB.     

非小细胞肺癌患者呼出气冷凝液中CEA检测的临床意义

目的研究非小细胞肺癌（NSCLC）患者呼出气冷凝液（EBC）中癌胚抗原（CEA）检测的临床意义。方法采用德国JAEGER公司的EBC收集器，收集NSCLC组和正常对照组的EBC，所有对象同时抽血留血清待测。采用非平衡放射免疫分析法（R1A）测定EBC和血清中CEA。结果①肺癌组CEA检测值，EBC为4．52±2．44mg／L，血清为7．73±3．19mg／L；正常对照组CEA检测值，EBC为1．62±1．30mg／L，血清为2．28±1．30mg／L，两组比较有显著统计学意义（P〈0．01）；②腺癌组EBC和血清标本中CEA水平分别为（4．91±2．56mg／L）和（9．17±3．75mg／L），高于正常对照组（P〈0．05）；③Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期NSCLC患者EBC中CEA水平分别为3．32±1.58mg／L、4．11±2．45mg／L、4．75±2．50mg／L、5．48±2．41mg／L，TNM分期越高，EBC中CEA的水平越高，F=3．12，P〈0．05；④肺癌组EBC和血清CEA检测值呈线性正相关，回归方程=1．61x-1．51，相关系数（r）=0．8615，P〈0．05；⑤肺癌组EBC中CEA检测的敏感性和特异性为51．5％和93．3％，血清中为60．6％和91．1％。肺癌组同时进行EBC和血清中CEA检测，联合敏感性为80．9％，联合特异性85．0％。结论在EBC中检测CEA水平有助于肺癌的早期诊断和临床分期的判断。     

呼出气一氧化氮对慢性咳嗽人群中咳嗽变异型哮喘的诊断价值:Meta分析

目的 咳嗽变异型哮喘(cough variant asthma,CVA)是慢性咳嗽的常见病因.本研究旨在应用Meta分析的方法评价呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)检测对慢性咳嗽人群CVA诊断的有效性和准确性.方法 检索Embase、PubMed、Medline、Cochrane library、Web of science、百度学术、中国期刊网和万方数据库,全面收集FeNO在慢性咳嗽人群对CVA诊断的文献,检索时限均从建库至2016年8月.根据QUADAS-2量表的评价标准对文献进行质量评价.用Stata 14.0、RevMan 5.0软件对文献进行异质性分析,并计算合并的敏感性、特异性、阳性似然比、阴性似然比、诊断优势比和SROC曲线下面积.结果 共纳入文献5篇,涉及慢性咳嗽患者704例.FeNO检测诊断CVA合并的敏感度、特异度、阳性似然比、阴性似然比、诊断优势比、SROC曲线下面积分别为0.74 [95％可信区间(CI):0.69～0.79],0.85 (95％ CI:0.81～0.88),4.73 (95％CI:3.70～6.05),0.31 (95％ CI:0.26～0.38),14.84 (95％CI:10.11～21.79)和0.87 (95％CI:0.84～0.89).结论 FeNO对慢性咳嗽人群中CVA的诊断有较好的敏感度和特异度,可作为重要的诊断指标.