乳腺癌患者呼气中挥发性标志物的筛选与定量分析

Screening and quantitative analysis of volatile markers in the breath of patients with breast cancer

目的探讨乳腺癌患者呼出气体中挥发性有机化合物成分在临床诊断中的价值。方法用Tedlar(袋收集36例正常人、27例乳腺腺病及33例乳腺癌术前患者的呼气样本,经固相微萃取浓缩后经气相色谱/质谱对呼气中的挥发性有机化合物(VOCs)进行检测,筛选出乳腺癌的挥发性标志物,以标准曲线法定量,并通过受试者工作曲线(ROC)评估它们用于乳腺癌诊断的价值。结果在乳腺癌患者呼气标本中筛选出两种挥发性标志物,分别为苯乙酮和十六烷。在健康人与乳腺癌患者中,苯乙酮和十六烷浓度差异均有统计学意义(P<0.05),苯乙酮用于乳腺癌的诊断敏感性和特异性分别为97.0%和50.0%,十六烷为75.8%和61.1%;在乳腺腺病和乳腺癌患者中,两种VOCs差异无统计学意义(P>0.05);在乳腺腺病患者和健康人中,苯乙酮浓度差异有统计学意义(P<0.05),十六烷浓度差异无统计学意义(P>0.05)。结论苯乙酮和十六烷可能作为乳腺癌患者呼气中的标志物,两者都不能正确区分乳腺癌和乳腺腺病,但苯乙酮可能对鉴别健康人与乳腺腺病有帮助。

Objective To explore the volatile organic compounds（VOCs）in breath of normal human,breast adenosis and breast cancer patients with the methodology of gas chromatography（GC）/mass spectrometry（MS）coupled with solid phase microextraction（SPME）and assess their diagnostic value of breast cancer.Methods The breath samples were collected from 36 normal human,27 breast adenosis and 33 breast cancer patients using Tedlar bags.The VOCs were extracted with SPME and analyzed by GC/MS.The concentrations of selected VOCs were calculated using standard curve method.Receiver operating characteristic curves（ROC）were used to assess the diagnostic value of these markers.Results Two kinds of VOCs were selected as potential markers,including phenylethylketone and hexadecane.The concentrations of acetophenone and hexadecane were significantly different between breast cancer patients and normal human（P〈0.05）.The diagnostic sensitivity and specificity of phenylethylketone for the breast cancer diagnostic sensitivity and specificity were 97.0% and 50.0%,hexadecane were 75.8% and 61.1%.It had no significant differences for these VOCs between the breast adenosis and breast cancer patients（P〈0.05）.Between the breast adenosis patients and normal human,the concentrations of acetophenone were significantly different（P〉0.05）,on the contrary for hexadecane（P〈0.05）.Conclusions Phenylethylketone and hexadecane may be used as breath markers of breast cancer,which can not correctly distinguish breast cancer and breast adenosis,but acetophenone may identify normal human and the breast adenosis paitients.