Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Chest. 2014 Mar 1;145(3):551-558. doi: 10.1378/chest.13-1363.
Pulmonary arterial hypertension (PAH) is a progressive and devastating condition characterized by vascular cell proliferation and is associated with several metabolic derangements. We hypothesized that metabolic derangements in PAH can be detected by measuring metabolic by-products in exhaled breath.
We collected breath and blood samples from patients with PAH at the time of right-sided heart catheterization (n=31) and from healthy control subjects (n=34). Breath was analyzed by selected ion flow tube-mass spectrometry in predetermined training and validation cohorts.
Patients with PAH were 51.5±14 years old, and 27 were women (85%). Control subjects were 38±13 years old, and 22 were women (65%). Discriminant analysis in the training set identified three ion peaks (H3O+29+, NO+56+, and O2+98+) and the variable age that correctly classified 88.9% of the individuals. In an independent validation cohort, 82.8% of the individuals were classified correctly. The concentrations of the volatile organic compounds 2-propanol, acetaldehyde, ammonia, ethanol, pentane, 1-decene, 1-octene, and 2-nonene were different in patients with PAH compared with control subjects. Exhaled ammonia was higher in patients with PAH (median [interquartile range]: 94.7 parts per billion (ppb) [70-129 ppb] vs 60.9 ppb [46-77 ppb], P<.001) and was associated with right atrial pressure (ρ=0.57, P<.001), mean pulmonary artery pressure (ρ=0.43, P=.015), cardiac index by thermodilution (ρ=-0.39, P=.03), pulmonary vascular resistance (ρ=0.40, P=.04), mixed venous oxygen (ρ=-0.59, P<.001), and right ventricular dilation (ρ=0.42, P=.03).
Breathprint is different between patients with PAH and healthy control subjects. Several specific compounds, including ammonia, were elevated in the breath of patients with PAH. Exhaled ammonia levels correlated with severity of disease.
肺动脉高压（PAH）是一种以血管细胞增殖为特征的进行性和破坏性疾病，与多种代谢紊乱有关。我们假设 PAH 中的代谢紊乱可以通过测量呼气中的代谢副产物来检测。
我们在右心导管检查时（n=31）收集了 PAH 患者和健康对照者（n=34）的呼吸和血液样本。呼吸样本通过预定的训练和验证队列中的选择离子流管-质谱进行分析。
PAH 患者的年龄为 51.5±14 岁，其中 27 名女性（85%）。对照组的年龄为 38±13 岁，其中 22 名女性（65%）。在训练集中的判别分析确定了三个离子峰（H3O+29+、NO+56+和 O2+98+）和变量年龄，它们正确地对 88.9%的个体进行了分类。在一个独立的验证队列中，82.8%的个体被正确分类。与对照组相比，PAH 患者的挥发性有机化合物 2-丙醇、乙醛、氨、乙醇、戊烷、1-癸烯、1-辛烯和 2-壬烯的浓度不同。PAH 患者呼气中的氨浓度较高（中位数[四分位间距]：94.7 皮克/每十亿（ppb）[70-129 ppb]比 60.9 ppb [46-77 ppb]，P<.001），并与右心房压力（ρ=0.57，P<.001）、平均肺动脉压（ρ=0.43，P=.015）、热稀释法测定的心指数（ρ=-0.39，P=.03）、肺血管阻力（ρ=0.40，P=.04）、混合静脉血氧（ρ=-0.59，P<.001）和右心室扩张（ρ=0.42，P=.03）相关。
PAH 患者和健康对照者的呼吸图谱不同。PAH 患者的呼吸中几种特定的化合物，包括氨，浓度升高。呼气中的氨水平与疾病的严重程度相关。
