Objective To explore the correlation between the levels of nitrite / nitrate( NO2 /NO3) in exhaled breath condensate ( EBC) and pulmonary infection in mechanically ventilated patients. Methods The clinical data from ventilated patients in critical care units of Peking University People’s Hospital from November 2006 to August 2007 were collected and analyzed. The patients’clinical pulmonary index score ( CPIS) were calculated. EBC of those patients were collected via endotracheal tube or tracheostomy cannula,and the concentrations of NO2 /NO3 were assayed. The level of NO2 /NO3 in different CPIS patients in 24 hours’ventilation, weaning proportion in 3 days and mortality in different NO2 /NO3 level patients were compared. The correlation of the CPIS and level of NO2 /NO3 were explored between survival and non-survival patients. Results A total of 76 patients were enroled. The NO2 /NO3 levels in patients of CPIS≤3, CPIS 3-6 and CPIS gt;6 in 24 hours of ventilation were ( 23. 31 ±5. 79) , ( 28. 72 ±9. 10) and ( 35. 42 ±12. 10) μmol / L respectively, with significantly differences between each other ( P lt; 0. 01) . The lower the patients’concentration of NO2 /NO3 was, the earlier the weaning and the lower the mortality were. The NO2 /NO3 levels on 4th and 7th day were detected in 24 survival patients and 23 non-survival patients. The difference of NO2 /NO3 levels between the survival patients and non-survival patients became significant on 7th day [ ( 29. 32 ±9. 52) μmol / L vs. ( 37. 22 ±12. 03) μmol / L, P lt; 0. 01] . Linear correlation analysis showed that the NO2 /NO3 level was positively correlated with CPIS ( r = 0. 76, P lt; 0. 01) . Conclusions The NO2 /NO3 level of EBC in ventilated patients is positively correlated to the severity of pulmonary infection, thus may be used as a new predictor for weaning and prognosis.
Objective To invesitgate the relationship between 8-isoprostane ( 8-iso-PG) level in exhaled breath condensates ( EBCs) and severity of asthma and explore the role of 8-iso-PG in asthma evaluation and monitoring. Methods Fifty-nine patients with asthma were enrolled. In which 15 cases were acute exacerbation, 13 cases were mild intermittent, 15 cases were mild persistent, and 16 cases were moderate-to-severe persistent. Thirteen healthy volunteers were recruited as control. EBCs were collected using EcoScreen system. The 8-iso-PG levels in EBCs were measured by a specific enzyme immunoassay.The patients with mild intermittent asthma were treated with inhaled corticosteroid ( ICS) for one month and their EBCs were recollected for 8-iso-PG measurement. Results Exhaled 8-iso-PG levels were obviously increased in the patients with acute asthma compared with those chronic asthmatics [ ( 47. 2 ±6. 8) pg/mL vs ( 24. 5 ±12. 0) pg/mL, P lt; 0. 01] . In the chronic persistent asthma, the levels were significantly higher in patients with mild persistent and moderate-to-severe asthma [ ( 17. 9 ±1. 2) pg/mL and ( 39. 7 ±4. 0) pg/mL,P lt; 0. 01] . While 8-iso-PG level did not differ significantly in intermittent asthma [ ( 13. 5 ±1. 1) pg/mL]compared with the control subjects ( P gt; 0. 05 ) . After one-month ICS treatment the 8-iso-PG level in the patients with mild intermittent asthma did not change significantly although the ACT score improved. Conclusions 8-iso-PG levels in EBC are associated with the severity of asthma, implicating 8-iso-PG may be useful in monitoring airway oxidative stress in asthma. ICS treatment is incapable of decreasing the 8-iso-PG, suggesting the ICS has minor impact on oxidative stress.
Objective To examine the levels of nitrite /nitrate( NO2 /NO3 ) , IL-4 and IFN-γin exhaled breath condensates( EBCs) in patients with asthma, and to investigate the effect of corticosteroid treatment. Methods Forty patients diagnosed as mild to moderate asthma were recruited. Among them, twenty were newly diagnosed and steroid naive( non-treatment group) . The other 20 patients had been treated with corticosteroid treatment( treatment group) . Twenty healthy volunteers were enrolled as normal control.EBC samples were taken for measurement of NO2 /NO3, IL-4 and IFN-γlevels. Serum IL-4 and IFN-γ concentrations were also measured. Results NO2 /NO3 level in EBC of the non-treatment group was significantly higher than that of the normal controls and the treatment group[ ( 48. 55 ±27. 37) μmol / L vs( 24. 51 ±18. 22) μmol /L, ( 36. 06 ±25. 13) μmol /L, respectively, both P lt; 0. 05] , and no significant difference was found between the treatment group and the normal controls( P gt;0. 05) . The IL-4 and IFN-γ levels in both EBC and serum had no significant difference between the three groups ( all P gt; 0. 05) . Conclusion NO2 /NO3 in EBCs increases in asthmatic patients, and decreases after corticosteroid treatment. Whether IL-4 and IFN-γlevels can be used for reflecting airway inflammation need further study.
Objective To explore the clinical significance of IL-6 and 8-isoprostane( 8-iso-PG) in exhaled breath condensate( EBC) in chronic obstructive pulmonary disease ( COPD) and smoking. Methods 17 patients with stable COPD and 30 healthy controls( 14 smokers and 16 non-smokers) were included in this study. EBC was collected in all subjects with a self-designed experimental device. The concentrations of 8-iso-PG and IL-6 in EBC were determined by enzyme-linked immunosorbent assay. Results Both8-iso-PG and IL-6 levels significantly increased in the COPD patients [ ( 8. 37±5. 09) pg/mL and ( 4. 62 ±1. 73) pg/mL, respectively] compared with the healthy non-smokers[ ( 5. 23 ±3. 08) pg/mL and ( 3. 09 ±1. 85) pg/mL, respectively] ( both P lt;0. 01) . There was no difference between the COPD patients and thehealthy smokers( both P gt; 0. 05) . The IL-6 level significantly increased in the healthy smokers compared with the non-smokers [ ( 4. 06 ±1. 59) pg/mL vs ( 3. 09 ±1. 85) pg/mL, P lt;0. 05] , but the 8-iso-PG level was similar in the non-smokers and smokers( P gt;0. 05) . Conclusion Airway inflammation and oxide stress are persistent in stable COPD patients and are aggravated by smoking.
Objective To investigate the feasibility of collecting exhaled breath condensate ( EBC)fromartificially ventilated patients with modified EcoScreen condenser. Methods ①In vitro test with lung simulator: the modified EcoScreen condenser was connected to lung simulator and mechanically ventilated for 60 min through three different types of connected tube as follows: dry ventilator pipe disconnected to humidifier, connected to the unheated humidifier, and connected to heated humidifier.Meanwhile, the changes of the peak pressure of inspiration ( PI) and tidal volume ( VT ) were observed. The volume of condensate was measured at last. ②In vivo test from artificially ventilated patients: 10 patients were artificially ventilated and their EBCs were collected with the modified EcoScreen condenser through dry pipe disconnected to humidifier for 20 min. The changes of PI, VT , respiratory frequency( f) , heart rate( HR) , mean arterial blood pressure ( MAP) , and blood oxygen saturation ( SpO2 ) were observed. Results ①In vitro test with lung simulator: At the end of the ventilating through the dry pipe disconnected to humidifier for 60 min,2. 2 mL condensate wascollected. Neither the change of PI or VT nor the obstruction of the collecting tube by iced condensate were observed. The ventilating through dry pipe connected to unheated humidifier had to stop at 50 min as the obstruction of the collecting tube caused by ice. 5 mL condensate was collected. It was observed that VTdecreased and PI increased. After ventilation through dry pipe connected to heated humidifier for 60 min,10. 5 mL condensate was collected while PI slightly increased and VT decreased. ② In vivo test from artificially ventilated patients: After ventilation through dry pipe disconnected to humidifier for 20 min, 2 mL EBC was collected without significance changes in PI, VT, f, HR, MAP, and SpO2 . Conclusions The modified EcoScreen condenser can be favourably applied to artificially ventilated patients for collecting EBC.It is recommended to performfor 20 min through the pipe disconnected to humidifier to obtain sufficient EBC without condensate dilution and airway obstruction. It is warranted more attention to the clinical and mechanical monitoring in this procedure.
Objective To observe the level of vascular endothelium growth factor A( VEGF-A) in exhaled breath condensate ( EBC) of patients with acute lung injury/acute respiratory distress syndrome ( ALI/ARDS) , and investigate its clinical significance. Methods EBC of 23 patients with ALI/ARDS by mechanical ventilation in intensive care unit ( ICU) were collected with improved EcoScreen condenser. EBC of 17 normal control subjects were collected with EcoScreen condensor. The level of VEGF-A was measured by ELISA in EBC and serum. The levels of VEGF-A in EBC of patients with different grades of lung injuries were compared, and the correlation was analyzed between the level of VEGF-A and clinical indicators. Results The level of VEGF-A in EBC was lower in the patients with ALI/ARDS than that of control subjects [ ( 49. 88 ±6. 32) ng/L vs. ( 56. 50 ±6. 323) ng/L, P lt;0. 01] , the level of VEGF-A was higher in the ALI patients than that of ARDS patients [ ( 53. 56 ±5. 56) ng/L vs. ( 45. 86 ±4. 45) ng/L, P lt;0. 01] ,and higher in the survival patients than that of the died patients [ ( 51. 92 ±6. 28) ng/L vs. ( 46. 05 ± 4. 58) ng/L, P lt;0. 05] . The level of VEGF-A in EBC was negatively correlated with lung injury score and A-aDO2 /PaO2 ( r = - 0. 426 and - 0. 510, respectively, P lt;0. 05) , and positively correlated with PaO2 /FiO2 and PaO2 ( r =0. 626 and 0. 655, respectively, P lt; 0. 05) . The level of VEGF-A in serum was not different between the ALI/ARDS patients and the control subjects, between the ALI and ARDS patients, or between the survival and the died patients ( all P gt;0. 05) . The level of VEGF-A in serumhad no correlation with lung injury score, A-aDO2 /PaO2 , PaO2 /FiO2 , or PaO2 ( all P gt;0. 05) . Conclusion The changes of VEGF-A in EBC of patients with ALI/ARDSmay serve as an indicator for severity and prognosis evaluation.
Objective To investigate the concentration of 8-isoprostaglandin ( 8-iso-PG) in exhaled breath condensate ( EBC) of patients with acute lung injury/acute respiratory distress syndrome ( ALI/ ARDS) , and evaluate its clinical significance. Methods Thirty-one ALI/ARDS patients who received mechanical ventilation were recruited as an experimental group, and EBC was collected with improved EcoScreen condenser, while thirty normal subjects were recruited as a control group. The 8-iso-PG level in EBC was analyzed by ELISA. The ALI/ARDS patients were subdivided into a continuous ALI group ( n=10) , a continuous ARDS group ( n=9) , a worsening group ( n=6) , and a remission group ( n=6) by state of illness on 1st day and 5th day. The 8-iso-PG level in EBC of the ALI/ARDS patients with different severity and different prognosis were compared, and the correlation were analyzed between the 8-iso-PG level and clinical indicators. Results The 8-iso-PG levels in EBC of the ALI/ARDS patients on 1st day and 5th day were higher than those in the control subjects respectively [ ( 45.53 ±14.37) ng/L and ( 45.31 ±12.42) ng/L vs. ( 19.47 ±4.06) ng/L, Plt;0.001] . The 8-iso-PG level was higher in the worsening group than the remission group, higher in the continuous ARDS group than the continuous ALI group, and higher in the nonsurvival group than the survival group ( Plt;0.05) . The 8-iso-PG level in EBC was positively correlated with white blood cell count in peripheral blood, lung injury score, X-ray score, AaDO2 /PaO2 , AaDO2 , VT , VE and MEWS score, and negatively correlated with PaO2 /PAO2 and PaO2 /FiO2 . Conclusion The 8-iso-PG level in EBC of ALI/ARDS patients has reference value for judging severity and prognosis of ALI/ARDS.
0bjective To investigate the prevalence of gastroesophageal reflux(GER)in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and to explore the influence of GER on the acidity of airway and pulmonary ventilation function in AECOPD patients．Methods Sixty-five hospitalized AECOPD patients and 20 healthy volunteers were enrolled in this study．According to “GER survey”questionnaire，AECOPD patients were allocated into GER group and non-GER group and expired breath condensate(EBC)pH and pulmonary ventilation function were detected．Breath condensate samples were collected using a specially designed condensing chamber(EcoScreen，Germany)．Results About 30.8％ (20／65)AECOPD patients were complicated with GER．EBC pH was lowest in GER group，middle in non-GER group and highest in the control group[6.oo±0.75 VS 6.76±0.77 and 7.97±0.12，both Plt;0.05)．The pulmonary ventilation function(FEV1、FEV1％pred)in AECOPD patients with GER were lower than those without GER(both Plt;0.05)．Conclusions There iS a high prevalence of GER in AECOPD patients．And the airway pH is reduced in AECOPD patients，especially when complicated with GER，which may play an important role in the development of COPD．
ObjectiveTo monitor the airway inflammatory factors in exhaled breath condensate(EBC) of severe stable COPD patients during salmeterol/fluticasone (50/500μg, bid) treatment, and explore their clinical significance. MethodsTwenty-four sever stable COPD patients and 18 healthy controls were included in the study. EBC was collected from COPD patients before treatment (day 0) and 14 days, 28 days, 90 days after treatment. Meanwhile lung function test and SGRQ score were measured.Concentrations of IL-6 and IL-10 were measured by liquid chip and 8-isoprostane by enzyme-linked immunosorbent assay. ResultsLevels of 8-isoprostane, IL-6 and IL-10 in EBC were significantly higher in the sever stable COPD patients before treatment compared with the healthy controls. 8-isoprostane was decreased significantly at day 14 compared with day 0[(11.59±4.12) pg/mL vs. (14.17±4.66) pg/mL, P < 0.05], and kept in low level till day 90 (P > 0.05). IL-6 was significantly decreased at day 28 compared with day 0[(1.46±0.19) pg/mL vs. (1.59±0.19) pg/mL, P < 0.05], but did not change significantly till day 90. IL-10 was in low level but showed increase at day 90 compared with day 28[(1.72±0.19) pg/mL vs. (1.62±0.12) pg/mL, P < 0.05]. FEV1 and FEV1/FVC were improved and SGRQ score was decreased after 90 days treatment (P < 0.05). FEV1 was not correlated with 8-isoprostane, IL-6 or IL-10 level. ConclusionsDynamic observation of EBC 8-isoprostane level in severe COPD patients can help in evaluating drug efficacy. IL-10 may play a role in airway anti-inflammation.