近日，美国疾病控制和预防中心Benjamin C. Blount及其研究小组发现，支气管肺泡灌洗液中的维生素E醋酸酯与EVALI相关。2019年12月20日，国际知名学术期刊《新英格兰医学杂志》发表了这一成果。

目前尚未确定全美范围内电子烟或蒸汽烟相关性肺损伤（EVALI）爆发的原因。EVALI患者支气管肺泡灌洗液（BAL）中毒物的检测可提供肺部暴露的直接信息。

从2015年起，研究组收集了16个州51名EVALI患者和99名健康参与者的BAL液体，采用同位素稀释质谱法对几种主要有毒物质：维生素E醋酸酯、植物油、中链甘油三酯油、椰子油等进行检测。

这51名EVALI患者中有25名确诊，26名疑似。共有48例（94%）患者的BAL液中发现了维生素E醋酸盐，健康对照组的BAL液中未发现。除1例患者的BAL液中发现椰子油和柠檬烯之外，其他病例和健康对照组中均未发现其他有毒物质。

50例患者中有47例（94%）在BAL液中检测到四氢大麻酚（THC）或其代谢物，或在发病前90天内报告曾吸入THC产物。47例患者中有30例（64%）检测到尼古丁及其代谢物。

总之，对美国16个州51名患者的简便样本进行检测，发现维生素E醋酸盐与EVALI显著相关。

附：英文原文

Title: Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI

Author: Benjamin C. Blount, Ph.D.,, Mateusz P. Karwowski, M.D., M.P.H.,, Peter G. Shields, M.D.,, Maria Morel-Espinosa, Ph.D.,, Liza Valentin-Blasini, Ph.D.,, Michael Gardner, M.S.,, Martha Braselton, B.S.,, Christina R. Brosius, M.P.H.,, Kevin T. Caron, B.S.,, David Chambers, Ph.D.,, Joseph Corstvet, B.S.,, Elizabeth Cowan, Ph.D.,, Víctor R. De Jesús, Ph.D.,, Paul Espinosa, B.S.,, Carolina Fernandez, M.P.H.,, Cory Holder, M.S.,, Zsuzsanna Kuklenyik, Ph.D.,, Jennifer D. Kusovschi, B.S.,, Cody Newman, B.S.,, Gregory B. Reis, B.S.,, Jon Rees, Ph.D.,, Chris Reese, B.S.,, Lalith Silva, Ph.D.,, Tiffany Seyler, Ph.D.,, Min-Ae Song, Ph.D.,, Connie Sosnoff, M.A.,, C.R. Spitzer, M.D.,, Denise Tevis, M.S.,, Lanqing Wang, Ph.D.,, Cliff Watson, Ph.D.,, Mark D. Wewers, M.D.,, Baoyun Xia, Ph.D.,, Douglas T. Heitkemper, Ph.D.,, Isaac Ghinai, M.B., B.S.,, Jennifer Layden, M.D., Ph.D.,, Peter Briss, M.D.,, Brian A. King, Ph.D.,, Lisa J. Delaney, M.S.,, Christopher M. Jones, Pharm.D., Dr.P.H.,, Grant T. Baldwin, Ph.D.,, Anita Patel, Pharm.D.,, Dana Meaney-Delman, M.D.,, Dale Rose, Ph.D.,, Vikram Krishnasamy, M.D.,, John R. Barr, Ph.D.,, Jerry Thomas, M.D.,, and James L. Pirkle, M.D., Ph.D.

Issue&Volume: 2019-12-20

Abstract: 

BACKGROUND
The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use–associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung.

METHODS
BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes.

RESULTS
State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%).

CONCLUSIONS
Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States.

DOI: 10.1056/NEJMoa1916433

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1916433