呼气丙酮作为心力衰竭严重程度的新生物标志物。

Exhaled acetone as a new biomaker of heart failure severity.

机构信息

Laboratory of Heart Failure, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Chemistry Institute, University of São Paulo, São Paulo, Brazil.

出版信息

Chest. 2012 Aug;142(2):457-466. doi: 10.1378/chest.11-2892.

DOI:10.1378/chest.11-2892

PMID:22345382

Abstract

BACKGROUND

Heart failure (HF) is associated with poor prognosis, and the identification of biomarkers of its severity could help in its treatment. In a pilot study, we observed high levels of acetone in the exhaled breath of patients with HF. The present study was designed to evaluate exhaled acetone as a biomarker of HF diagnosis and HF severity.

METHODS

Of 235 patients with systolic dysfunction evaluated between May 2009 and September 2010, 89 patients (HF group) fulfilled inclusion criteria and were compared with sex- and age-matched healthy subjects (control group, n = 20). Patients with HF were grouped according to clinical stability (acute decompensated HF [ADHF], n = 59; chronic HF, n = 30) and submitted to exhaled breath collection. Identification of chemical species was done by gas chromatography-mass spectrometry and quantification by spectrophotometry. Patients with diabetes were excluded.

RESULTS

The concentration of exhaled breath acetone (EBA) was higher in the HF group (median, 3.7 μg/L; interquartile range [IQR], 1.69-10.45 μg/L) than in the control group (median, 0.39 μg/L; IQR, 0.30-0.79 μg/L; P < .001) and higher in the ADHF group (median, 7.8 μg/L; IQR, 3.6-15.2 μg/L) than in the chronic HF group (median, 1.22 μg/L; IQR, 0.68-2.19 μg/L; P < .001). The accuracy and sensitivity of this method in the diagnosis of HF and ADHF were about 85%, a value similar to that obtained with B-type natriuretic peptide (BNP). EBA levels differed significantly as a function of severity of HF (New York Heart Association classification, P < .001). There was a positive correlation between EBA and BNP (r = 0.772, P < .001).

CONCLUSIONS

EBA not only is a promising noninvasive diagnostic method of HF with an accuracy equivalent to BNP but also a new biomarker of HF severity.

摘要

背景

心力衰竭（HF）与预后不良相关，识别其严重程度的生物标志物有助于其治疗。在一项初步研究中，我们观察到 HF 患者呼气中丙酮水平升高。本研究旨在评估呼气丙酮作为 HF 诊断和 HF 严重程度的生物标志物。

方法

在 2009 年 5 月至 2010 年 9 月间评估的 235 例收缩功能障碍患者中，89 例（HF 组）符合纳入标准，并与性别和年龄匹配的健康受试者（对照组，n = 20）进行比较。根据临床稳定性（急性失代偿性 HF [ADHF]，n = 59；慢性 HF，n = 30）将 HF 患者分组，并进行呼气采集。通过气相色谱-质谱联用仪鉴定化学物质种类，通过分光光度法进行定量。排除糖尿病患者。

结果

HF 组呼气丙酮（EBA）浓度（中位数，3.7μg/L；四分位距[IQR]，1.69-10.45μg/L）高于对照组（中位数，0.39μg/L；IQR，0.30-0.79μg/L；P<0.001），ADHF 组（中位数，7.8μg/L；IQR，3.6-15.2μg/L）高于慢性 HF 组（中位数，1.22μg/L；IQR，0.68-2.19μg/L；P<0.001）。该方法在 HF 和 ADHF 诊断中的准确性和灵敏度约为 85%，与 B 型利钠肽（BNP）相当。EBA 水平随 HF 严重程度显著变化（纽约心脏协会分类，P<0.001）。EBA 与 BNP 呈正相关（r = 0.772，P<0.001）。