Exhaled Acetone as a New Biomarker of Heart Failure Severity
Exhaled Acetone as a New Biomarker of Heart Failure Severity
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DOI：
10.1378/chest.11-2892
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发表时间：
2012-08-01
期刊：
影响因子：
9.6
通讯作者：
Bacal, Fernando
中科院分区：
文献类型：
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作者：
Marcondes-Braga, Fabiana G.;Gutz, Ivano G. R.;Bacal, Fernando
背景：心力衰竭（HF）与不良预后相关，识别其严重程度的生物标志物有助于其治疗。在一项试点研究中，我们观察到心力衰竭患者呼出气中丙酮含量很高。本研究旨在评估呼出丙酮作为心力衰竭诊断和心力衰竭严重程度的生物标志物。方法：在 2009 年 5 月至 2010 年 9 月期间评估的 235 名收缩功能障碍患者中，89 名患者（心力衰竭组）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。心力衰竭患者根据临床稳定性进行分组（急性失代偿性心力衰竭 [ADHF]，n = 59；慢性心力衰竭，n = 30）并接受呼出气收集。通过气相色谱-质谱法鉴定化学物质并通过分光光度法定量。排除糖尿病患者。结果：HF组呼出气丙酮（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 < .001）， ADHF 组（中位数，7.8 μg/L；IQR，3.6-15.2 μg/L）高于慢性 HF 组（中位数，1.22 μg/L；IQR，0.68-2.19 P < .001）。该方法诊断心力衰竭和ADHF的准确性和敏感性约为85%，与B型钠尿肽（BNP）的诊断结果相似。 EBA 水平随心力衰竭严重程度的不同而存在显着差异（纽约心脏协会分类，P < .001）。 EBA 与 BNP 呈正相关（r = 0.772，P < .001）。结论：EBA 不仅是一种有前途的心力衰竭无创诊断方法，其准确度与 BNP 相当，而且还是一种新的心力衰竭严重程度的生物标志物。胸部 2012； 142(2):457-466
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 mu g/L; interquartile range [IQR], 1.69-10.45 mu g/L) than in the control group (median, 0.39 mu g/L; IQR, 0.30-0.79 mu g/L; P < .001) and higher in the ADHF group (median, 7.8 mu g/L; IQR, 3.6-15.2 mu g/L) than in the chronic HF group (median, 1.22 mu g/L; IQR, 0.68-2.19 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. CHEST 2012; 142(2):457-466