成人哮喘中呼出氣體揮發性有機化合物：系統評價
Exhaled volatile organic compounds in adult asthma: a systematic review
Adnan Azim, Clair Barber, Paddy Dennison, John Riley, Peter Howarth
European Respiratory Journal 2019; DOI: 10.1183/.00056-2019
Abstract
The search for biomarkers that can guide precision medicine in asthma, particularly those that can be translated to the clinic, has seen recent interest in exhaled volatile organic compounds. Given the number of studies reporting “breathomics” findings and its growing integration in clinical trials, we performed a systematic review of the literature to summarise current evidence and understanding of breathomics technology in asthma.
A PRISMA-oriented systematic search was performed (CRD) of Medline, Embase and the Cochrane Databases to search for any reports that assessed exhaled volatile organic compounds in adult asthma patients, using the following terms (Asthma AND (Volatile Organic Compounds AND Exhaled) OR Breathomics).
Two authors independently determined the eligibility of 2957 unique records, from which 66 underwent full-text review. Data extraction and risk of bias assessment was performed on the 22 studies deemed to fulfil the search criteria. The studies are described in terms of methodology and the evidence narratively summarised under the following clinical headings: Diagnostics, Phenotyping, Treatment stratification, Treatment monitoring and Exacerbation Prediction/Assessment.
Our review found that most studies were designed to assess diagnostic potential rather than focus on underlying biology or treatable traits. Results are generally limited by a lack of methodological standardisation, external validation and insufficiently powered studies, but there is consistency across the literature that exhaled VOCs are sensitive to underlying inflammation. Modern studies are applying robust breath analysis workflows to large multi-centre study designs, which should unlock the full potential of measurement of exhaled volatile organic compounds in airways diseases such as asthma.
尋找可以指導哮喘精準醫學的生物標志物，特別是那些可以轉化為臨床的生物標志物，近對呼出的揮發性有機化合物感興趣。鑒于報告“呼吸系統”研究結果的研究數量及其在臨床試驗中的不斷整合，我們對文獻進行了系統評價，總結了目前對哮喘患者呼吸系統技術的依據和理解。
使用以下術語(哮喘和(揮發性有機化合物和呼出氣體)OR，對Medline，Embase和Cochrane數據庫進行PRISMA導向的系統檢索(CRD)，以搜索評估成人哮喘患者呼出的揮發性有機化合物的任何報告。 Breathomics)。
兩位作者獨立確定了2957份*記錄的資格，其中66份接受了全文審查。在被認為符合搜索標準的22項研究中進行數據提取和偏倚評估風險。這些研究以方法學和在以下臨床標題下敘述性總結的證據進行描述：診斷，表型分析，治療分層，治療監測和惡化預測/評估。
我們的綜述發現，大多數研究旨在評估診斷潛力，而不是關注潛在的生物學或可治療的特征。結果通常受到缺乏方法學標準化，外部驗證和研究不充分的限制，但文獻中一致認為呼出氣體的VOC對潛在的炎癥敏感。現代研究正在將強大的呼吸分析工作流程應用于大型多中心研究設計，這將充分發揮哮喘等氣道疾病中呼出的揮發性有機化合物測量的潛力
