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首页> 外文期刊>The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation >Heart allograft rejection: detection with breath alkanes in low levels (the HARDBALL study).
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Heart allograft rejection: detection with breath alkanes in low levels (the HARDBALL study).

机译：心脏同种异体移植排斥：低水平检测呼吸道烷烃（HARDBALL研究）。

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BACKGROUND: We evaluated a new marker of heart transplant rejection, the breath methylated alkane contour (BMAC). Rejection is accompanied by oxidative stress that degrades membrane polyunsaturated fatty acids, evolving alkanes and methylalkanes, which are excreted in the breath as volatile organic compounds (VOCs). METHODS: Breath VOC samples (n = 1,061) were collected from 539 heart transplant recipients before scheduled endomyocardial biopsy. Breath VOCs were analyzed by gas chromatography and mass spectroscopy, and BMAC was derived from the abundance of C4-C20 alkanes and monomethylalkanes. The "gold standard" of rejection was the concordant set of International Society for Heart and Lung Transplantation (ISHLT) grades in biopsies read by 2 reviewers. RESULTS: Concordant biopsies were: Grade 0, 645 of 1,061 (60.8%); 1A, 197 (18.6%); 1B, 84 (7.9%); 2, 93 (8.8%); and 3A, 42 (4.0%). A combination of 9 VOCs in the BMAC identified Grade 3 rejection (sensitivity 78.6%, specificity 62.4%, cross-validated sensitivity 59.5%, cross-validated specificity 58.8%, positive predictive value 5.6%, negative predictive value 97.2%). Site pathologists identified the same cases with sensitivity of 42.4%, specificity 97.0%, positive predictive value 45.2% and negative predictive value 96.7%. CONCLUSIONS: A breath test for markers of oxidative stress was more sensitive and less specific for Grade 3 heart transplant rejection than a biopsy reading by a site pathologist, but the negative predictive values of the 2 tests were similar. A screening breath test could potentially identify transplant recipients at low risk of Grade 3 rejection and reduce the number of endomyocardial biopsies.
机译：背景：我们评估了心脏移植排斥反应的新标志，即呼吸甲基化烷烃轮廓（BMAC）。排斥反应伴随着氧化应激，氧化应激会降解膜多不饱和脂肪酸，不断发展的烷烃和甲基烷烃，它们以挥发性有机化合物（VOC）的形式在呼吸中排出。方法：在预定的心内膜活检之前，从539名心脏移植受者中收集了呼吸VOC样品（n = 1,061）。通过气相色谱法和质谱法分析呼吸中的挥发性有机化合物，BMAC来源于丰富的C4-C20烷烃和单甲基烷烃。拒绝的“金标准”是由2位审阅者阅读的符合国际心肺移植学会（ISHLT）等级的活检标本集。结果：一致的活组织检查为：0，1,645级，1,061（60.8％）; 1A，197（18.6％）; 1B，84（7.9％）; 2，93（8.8％）;和3A，42（4.0％）。 BMAC中9种VOC的组合确定了3级排斥反应（敏感性78.6％，特异性62.4％，交叉验证的敏感性59.5％，交叉验证的特异性58.8％，阳性预测值5.6％，阴性预测值97.2％）。现场病理学家鉴定出相同病例，敏感性为42.4％，特异性为97.0％，阳性预测值为45.2％，阴性预测值为96.7％。结论：氧化应激标志物的呼气试验比3级心脏移植排斥反应的敏感性更高，比部位病理学家的活检读数特异性更低，但是这两种试验的阴性预测值相似。呼吸筛查可以潜在地识别出三级排斥风险低的移植接受者，并减少心内膜活检的数量。

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