低氧气味:在高海拔地区使用电子鼻,并证明其在急性高山病的预测和诊断中的作用

the smell of hypoxia: using an electronic nose at altitude and proof of concept of its role in the prediction and diagnosis of acute mountain sickness
低氧气味:在高海拔地区使用电子鼻,并证明其在急性高山病的预测和诊断中的作用
jonathan r. n. lacey carlos kidel jildou m. van der kaaij paul brinkman edward t. gilbert‐kawai michael p. w. grocott michael g. mythen daniel s. martin for the xtreme everest 2 research group
abstract
electronic nose (e‐nose) devices may be used to identify volatile organic compounds (vocs) in exhaled breath. vocs generated via metabolic processes are candidate biomarkers of (patho)physiological pathways. we explored the feasibility of using an e‐nose to generate human “breathprints” at high altitude. furthermore, we explored the hypothesis that pathophysiological processes involved in the development of acute mountain sickness (ams) would manifest as altered voc profiles. breath analysis was performed on sherpa and lowlander trekkers at high altitude (3500 m). the lake louise scoring (lls) system was used to diagnose ams. raw data were reduced by principal component (pc) analysis (pca). cross validated linear discriminant analysis (cv‐lda) and receiver‐operating characteristic area under curve (roc‐auc) assessed discriminative function. breathprints suitable for analysis were obtained from 58% (37/64) of samples. pca showed significant differences between breathprints from participants with, and without, ams; cv‐lda showed correct classification of 83.8%, roc‐auc 0.86; pc 1 correlated with ams severity. there were significant differences between breathprints of participants who remained ams negative and those whom later developed ams (cv‐lda 68.8%, roc‐auc 0.76). pca demonstrated discrimination between sherpas and lowlanders (cv‐lda 89.2%, roc‐auc 0.936). this study demonstrated the feasibility of breath analysis for vocs using an e‐nose at high altitude. furthermore, it provided proof‐of‐concept data supporting e‐nose utility as an objective tool in the prediction and diagnosis of ams. e‐nose technology may have substantial utility both in altitude medicine and under other circumstances where (mal)adaptation to hypoxia may be important (e.g., critically ill patients).
电子鼻(e-nose)装置可用于识别呼出气体中的挥发性有机化合物(voc)。通过代谢过程产生的voc是(病理)生理途径的候选生物标志物。我们探讨了在高空使用电子鼻产生人类“呼吸印记”的可行性。此外,我们还探讨了一种假说,即参与急性山病(ams)发展的病理生理过程表现为voc图谱的改变。对海拔3500米的夏尔巴和低地徒步者进行呼吸分析。路易斯湖评分(lls)系统用于诊断ams。通过主成分分析(pca)减少原始数据。交叉验证线性鉴别分析(cv-lda)和曲线下接收器操作特征面积(roc-auc)评估了鉴别功能。从58%(37/64)的样本中获得适合分析的呼吸图。患有和不患有ams的参与者的呼吸图pca显示出显著差异;cv-lda显示出83.8%的正确分类,roc-auc 0.86;pc 1与ams严重程度相关。仍为ams阴性的受试者和后来发展为ams的受试者的呼吸图存在显著差异(cv-lda 68.8%,roc-auc 0.76)。pca显示夏尔巴人和低地人之间存在歧视(cv-lda 89.2%,roc-auc 0.936)。本研究证明了在高空使用电子鼻进行挥发性有机化合物呼吸分析的可行性。此外,它还提供了概念验证数据,支持电子鼻作为预测和诊断ams的客观工具。电子鼻技术在高原医学和其他对低氧适应很重要的情况下(如危重病患者)都有很大的实用性。
figure 1. photograph of e-nose (cyranose 320) and breath analysis apparatus.

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