Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI
Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI
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DOI：
10.1056/nejmoa1916433
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发表时间：
2020-02-20
影响因子：
158.5
通讯作者：
Pirkle, James L.
中科院分区：
文献类型：
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作者：
Blount, Benjamin C.;Karwowski, Mateusz P.;Pirkle, James L.
背景目前全国范围内电子烟或电子烟产品使用相关肺损伤(EVALI)暴发的致病因素尚未确定。检测EVALI患者支气管肺泡灌洗液(BAL)中的毒物可以提供肺内暴露的直接信息。方法收集来自16个州的51名EVALI患者和99名健康参与者的BAL液，他们是2015年启动的一项正在进行的吸烟研究的一部分，该研究涉及非吸烟者、电子烟或蒸发产品的专用使用者和完全吸烟者。使用BAL液，我们进行了同位素稀释质谱仪检测几种优先毒性物质：维生素E醋酸酯、植物油、中链甘油三酯油、椰子油、石油馏分和稀释剂萜类。结果国家和地方卫生部门将EVALI病例列为25例确诊病例和26例可能病例。在16个状态的51例患者中，有48例(94%)的BAL液中检出维生素E醋酸酯，而健康对照组的BAL液中未检出维生素E醋酸酯。在病例患者和对照组的BAL液中没有发现其他优先毒物，除了椰子油和柠檬烯，分别在1名患者中发现。在有实验室或流行病学数据的病例患者中，50人中有47人(94%)在BAL液中检测到四氢大麻酚(THC)或其代谢物，或报告在发病前90天内蒸发THC产品。在47例患者中有30例检测到尼古丁或其代谢物(%)。结论在美国16个州51名患者的便利样本中发现维生素E醋酸酯与EVALI有关。(由国家癌症研究所和其他机构资助。)在一项涉及美国16个州51名与电子烟或电子烟产品使用相关的肺损伤患者的研究中，94%的患者的支气管肺泡灌洗液样本中检测到维生素E醋酸酯，而健康对照组的样本中没有检测到维生素E醋酸酯。
Background The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung.Methods BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes.Results State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%).Conclusions Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.)In a study involving 51 patients with electronic-cigarette, or vaping, product use-associated lung injury in 16 states across the United States, vitamin E acetate was detected in samples of bronchoalveolar-lavage fluid from 94% of the patients but not in samples from a healthy comparator group.