为了研究喉管切开术中存在严重吸入伤的患者呼出气凝结物（EBC）中多种细胞因子水平的变化和临床意义，进行了一项前瞻性研究。共招募了2021年5月至2022年8月期间入住南京医科大学附属苏州医院烧伤与整形外科科32例合并严重吸入伤的严重烧伤患者。同期选取了20名健康志愿者作为对照。收集了患者烧伤后12小时的呼出气凝结物（EBC）和健康对照样本。利用液相芯片技术测定EBC中27种细胞因子的水平，包括肿瘤坏死因子-α（TNF-α）和白细胞介素（IL-1β，IL-6，IL-8，IL-10和IL-17）。同时，收集了患者烧伤后12小时和志愿者血浆样本，并通过液相芯片技术检测炎症细胞因子水平，并分析血浆和EBC中水平之间的差异。收集了吸入伤患者烧伤后12小时和伤后3天、7天、14天和21天的血浆和EBC，通过酶联免疫吸附法（ELISA）检测TNF-α水平。最终，共纳入32例患者，总烧伤面积为（40±16）%。入院时间为受伤后（4.2±2.3）小时。(1)EBC中的27种细胞因子：与健康对照组相比，严重吸入伤患者中18种细胞因子的水平显著升高，包括巨噬细胞炎性蛋白-1β（MIP-1β）、IL-6、IL-5、IL-2、IL-1β、IL-8、IL-10、IL-15、IL-9、干扰素-γ（IFN-γ）、IL-1受体拮抗剂（IL-1ra）、TNF-α、象鼻虫趋化因子（Eotaxin）、碱性成纤维细胞生长因子（bFGF）、血小板来源生长因子-BB（PDGF-BB）、干扰素诱导蛋白-10（IP-10）和单核细胞趋化因子-1（MCP-1）、粒细胞集落刺激因子（G-CSF）。健康对照组EBC中未检测到Eotaxin。严重吸入伤患者EBC中未检测到巨噬细胞-巨噬细胞集落刺激因子（GM-CSF）、化学因子配体5（CCL5/RANTES）、IL-13、IL-4和MIP-1 α等5种细胞因子。严重吸入伤患者的EBC中血管内皮生长因子（VEGF）和IL-12 p70轻微降低，IL-7和IL-17略有增加，但差异无统计学意义。(2)血浆中的6种炎症细胞因子：严重吸入伤组的IL-6和IL-8水平明显升高，与健康对照组相比差异有统计学意义[IL-6（ng/L）：18.51（10.87，26.21）vs.0.22（0.10，0.36），IL-8（ng/L）：10.75（8.58，18.79）vs.1.06（0.81，2.14），P均<0.01]。与健康对照组相比，严重吸入伤患者的血浆TNF-α、IL-1β和IL-10水平略有升高，IL-17水平略有降低，但差异无统计学意义。在同一时期收集的EBC中，与健康对照组相比，严重吸入伤患者的TNF-α、IL-1β、IL-6、IL-8和IL-10等5种炎症细胞因子水平显著升高[TNF-α（ng/L）：16.42（12.57，19.21）vs.7.34（6.11，8.69），IL-1β（ng/L）：15.57（10.53，20.25）vs.0.99（0.67，1.41），IL-6（ng/L）：13.36（9.76，16.54）vs.0.70（0.42，0.85），IL-8（ng/L）：1,059.29（906.91，1,462.37）vs.10.36（8.40，12.37），IL-10（ng/L）：2.69（1.54，3.33）vs.1.54（1.18，2.06），P均<0.05]。(3)血浆和EBC中TNF-α的动态变化：严重吸入伤患者的EBC中TNF-α水平低于血浆中的水平。血浆TNF-α水平随时间延长逐渐升高，在受伤后第3天与健康对照组相比显著升高[ng/L：30.38（24.32，39.19）vs.22.94（17.15，30.74），P<0.05]，在第14天达到峰值，然后下降。受伤后12小时的EBC中的TNF-α水平显著高于健康对照组[ng/L：15.34（11.75，18.14）vs.6.99（6.53，7.84），P<0.01]，并在受伤后3天达到峰值，然后逐渐降低。严重吸入伤患者EBC中多种细胞因子的表达发生变化，包括TNF-α等多种炎症细胞因子的变化较血浆更为敏感，可用于监测和评估吸入伤患者的情况。

To investigate the changes and clinical significance of multiple cytokine levels in exhaled breath condensate (EBC) in patients undergoing tracheotomy with severe inhalation injury.A prospective study was conducted. A total of 32 patients with severe burn combined with severe inhalation injury admitted to the department of burns and plastic surgery of Affiliated Suzhou Hospital of Nanjing Medical University from May 2021 to August 2022 were enrolled. Twenty healthy volunteers from the same period were served as controls. EBC of patients at 12 hours after burn and the samples of healthy controls were collected. The levels of 27 cytokines in EBC, including tumor necrosis factor-α (TNF-α) and interleukins (IL-1β, IL-6, IL-8, IL-10, and IL-17), were determined by liquid phase chip technology. Meanwhile, plasma of patients at 12 hours after burn and the plasma of volunteers were collected, and the levels of inflammatory cytokines were detected by liquid chip technology, and the differences between the levels in plasma and those in EBC were analyzed. Plasma and EBC of patients with aspiration injury were collected at 12 hours and 3, 7, 14 and 21 days after burn, and TNF-α levels were determined by enzyme-linked immunosorbent assay (ELISA).Finally, 32 patients were enrolled, and the total burned area was (40±16)% of total body surface area (TBSA). The time of admission was (4.2±2.3) hours after injury. (1) Twenty-seven cytokines in EBC: 18 kinds of cytokines including macrophage inflammatory protein-1β (MIP-1β), IL-6, IL-5, IL-2, IL-1β, IL-8, IL-10, IL-15, IL-9, interferon-γ (IFN-γ), IL-1 receptor antagonist (IL-1ra), TNF-α, chemotactic factor for eosinophil (Eotaxin), basic fibroblast growth factor (bFGF), platelet derived growth factor-BB (PDGF-BB), interferon-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), granulocyte colony-stimulating factor (G-CSF) were significantly increased in patients with severe aspiration injury compared with health controls. Eotaxin was not detected in EBC of healthy controls. Five cytokines, granulocyte-macrophage colony-stimulating factor (GM-CSF), chemokine ligand 5 (CCL5/RANTES), IL-13, IL-4 and MIP-1α, were not detected in EBC of severe inhalation injury patients and healthy controls. Vascular endothelial growth factor (VEGF) and IL-12 p70 in EBC of severe aspiration injury patients were slightly decreased as compared with healthy controls, while IL-7 and IL-17 were slightly increased, but the differences were not statistically significant. (2) Six inflammatory cytokines in plasma: the levels of IL-6 and IL-8 in the severe aspiration injury group were significantly increased as compared with healthy controls [IL-6 (ng/L): 18.51 (10.87, 26.21) vs. 0.22 (0.10, 0.36), IL-8 (ng/L): 10.75 (8.58, 18.79) vs. 1.06 (0.81, 2.14), both P < 0.01]. The plasma levels of TNF-α, IL-1β and IL-10 were slightly increased in patients with severe aspiration injury as compared with healthy controls, and IL-17 was slightly decreased, but the difference was not statistically significant. In the EBC collected during the same period, five inflammatory cytokines, including TNF-α, IL-1β, IL-6, IL-8 and IL-10, in patients with severe inhalation injury were significantly increased as compared with healthy controls [TNF-α (ng/L): 16.42 (12.57, 19.21) vs. 7.34 (6.11, 8.69), IL-1β (ng/L): 15.57 (10.53, 20.25) vs. 0.99 (0.67, 1.41), IL-6 (ng/L): 13.36 (9.76, 16.54) vs. 0.70 (0.42, 0.85), IL-8 (ng/L): 1 059.29 (906.91, 1 462.37) vs. 10.36 (8.40, 12.37), IL-10 (ng/L): 2.69 (1.54, 3.33) vs. 1.54 (1.18, 2.06), all P < 0.05]. (3) Dynamic changes of TNF-α in plasma and EBC: the level of TNF-α in EBC of patients with severe aspiration injury was lower than that in plasma. Plasma TNF-α level was increased gradually with the extension of time after injury, and was significantly higher than that of healthy controls on day 3 [ng/L: 30.38 (24.32, 39.19) vs. 22.94 (17.15, 30.74), P < 0.05], and reached the peak on day 14, then fell back. The level of TNF-α in EBC at 12 hours after injury was significantly higher than that in healthy controls [ng/L: 15.34 (11.75, 18.14) vs. 6.99 (6.53, 7.84), P < 0.01], and reached the peak on 3 days after injury, and then gradually decreased.There are changes in the expression of multiple cytokines in EBC of patients with severe inhalation injury, and the changes of many inflammatory cytokines including TNF-α are more sensitive than those in plasma, which can be used to monitor and evaluate the condition of patients with inhalation injury.