Wang Zhennan, Wang Chuji
Department of Physics and Astronomy, Mississippi State University, Starkville, MS 39759, USA.
J Breath Res. 2013 Sep;7(3):037109. doi: 10.1088/1752-7155/7/3/037109. Epub 2013 Aug 20.
Since the ancient discovery of the 'sweet odor' in human breath gas, pursuits of the breath analysis-based disease diagnostics have never stopped. Actually, the 'smell' of the breath, as one of three key disease diagnostic techniques, has been used in Eastern-Medicine for more than three thousand years. With advancement of measuring technologies in sensitivity and selectivity, more specific breath gas species have been identified and established as a biomarker of a particular disease. Acetone is one of the breath gases and its concentration in exhaled breath can now be determined with high accuracy using various techniques and methods. With the worldwide prevalence of diabetes that is typically diagnosed through blood testing, human desire to achieve non-blood based diabetic diagnostics and monitoring has never been quenched. Questions, such as is breath acetone a biomarker of diabetes and how is the breath acetone related to the blood glucose (BG) level (the golden criterion currently used in clinic for diabetes diagnostic, monitoring, and management), remain to be answered. A majority of current research efforts in breath acetone measurements and its technology developments focus on addressing the first question. The effort to tackle the second question has begun recently. The earliest breath acetone measurement in clearly defined diabetic patients was reported more than 60 years ago. For more than a half-century, as reviewed in this paper, there have been more than 41 independent studies of breath acetone using various techniques and methods, and more than 3211 human subjects, including 1581 healthy people, 242 Type 1 diabetic patients, 384 Type 2 diabetic patients, 174 unspecified diabetic patients, and 830 non-diabetic patients or healthy subjects who are under various physiological conditions, have been used in the studies. The results of the breath acetone measurements collected in this review support that many conditions might cause changes to breath acetone concentrations; however, the results from the six independent studies using clearly-defined Type 1 and Type 2 diabetic patients unanimously support that an elevated mean breath acetone concentration exists in Type 1 diabetes. Note that there is some overlap between the ranges of breath acetone concentration in individual T1D patients and healthy subjects; this reminds one to be careful when using an acetone breath test on T1D diagnostics. Comparatively, it is too early to draw a general conclusion on the relationship between a breath acetone level and a BG level from the very limited data in the literature.
自从古代发现人类呼出气体中有“甜味”以来，基于呼吸分析的疾病诊断研究就从未停止过。实际上，作为三种关键疾病诊断技术之一的呼吸“气味”，在东方医学中已被使用了三千多年。随着测量技术在灵敏度和选择性方面的进步，越来越多特定的呼出气体成分被识别出来，并被确立为特定疾病的生物标志物。丙酮是呼出气体中的一种，现在可以使用各种技术和方法高精度地测定其在呼出气体中的浓度。鉴于糖尿病在全球范围内的普遍存在，通常通过血液检测来诊断，人们对实现非血液检测的糖尿病诊断和监测的渴望从未停止。诸如呼出气体中的丙酮是否为糖尿病的生物标志物，以及呼出气体中的丙酮与血糖（BG）水平（目前临床上用于糖尿病诊断、监测和管理的金标准）有何关系等问题，仍有待解答。目前大多数关于呼出气体中丙酮测量及其技术发展的研究工作都集中在回答第一个问题上。解决第二个问题的努力最近才开始。60多年前就有关于明确诊断的糖尿病患者呼出气体中丙酮测量的最早报道。在本文回顾的半个多世纪里，已经有超过41项使用各种技术和方法对呼出气体中丙酮进行的独立研究，参与研究的人类受试者超过3211名，其中包括1581名健康人、242名1型糖尿病患者、384名2型糖尿病患者、174名未明确类型的糖尿病患者，以及830名处于各种生理状况下的非糖尿病患者或健康受试者。本次综述收集的呼出气体中丙酮测量结果表明，许多情况可能会导致呼出气体中丙酮浓度的变化；然而，六项使用明确诊断的1型和2型糖尿病患者的独立研究结果一致表明，1型糖尿病患者呼出气体中丙酮的平均浓度升高。需要注意的是，个别1型糖尿病患者呼出气体中丙酮浓度范围与健康受试者的有一定重叠；这提醒人们在使用丙酮呼气试验进行1型糖尿病诊断时要谨慎。相比之下，从文献中非常有限的数据得出呼出气体中丙酮水平与血糖水平之间关系的一般性结论还为时过早。
