What your breath could reveal about your health | Julian Burschka

Translator: Joseph Geni Reviewer: Camille Martínez

翻译人员: Hanlin Wang 校对人员: Lipeng Chen

I have a tendency to assume the worst,

我倾向于把事情往坏了想，

and once in a while, this habit plays tricks on me.

而这种想法偶尔会把我弄糊涂。

For example, if I feel unexpected pain in my body

举例来说，如果我的身体 突然感到疼痛，

that I have not experienced before and that I cannot attribute,

这种疼痛前所未有，并且我不清楚病因，

then all of a sudden, my mind might turn a tense back into heart disease

那么我会突然认为背部剧痛 是由心脏病所致，

或者因为小腿肌肉疼痛 而怀疑自己有了深部静脉血栓。

or calf muscle pain into deep vein thrombosis.

But so far, I haven't been diagnosed with any deadly or incurable disease.

但至今为止，我还没被确诊 患有任何致命或者难以治愈的疾病。

Sometimes things just hurt for no clear reason.

有时这种事实会毫无缘由地使我伤心。

But not everyone is as lucky as me.

但并不是所有人都像我这么幸运。

Every year, more than 50 million people die worldwide.

每年，世界上都有超过五千万人死去。

Especially in high-income economies like ours,

尤其像我们这种高收入经济体里，

a large fraction of deaths is caused by slowly progressing diseases:

慢性病致死占了很大一部分：

heart disease, chronic lung disease, cancer, Alzheimer's, diabetes,

心脏病，慢性肺病，癌症， 阿尔兹海默症，糖尿病，

just to name a few.

这些只是其中一小部分例子。

Now, humanity has made tremendous progress in diagnosing and treating many of these.

如今，人类已经在慢性病确诊 和治疗上取得了显著进展。

But we are at a stage where further advancement in health

但就现阶段而言，医学上的进一步突破

cannot be achieved only by developing new treatments.

不能只依赖于研发新的治疗方法。

And this becomes evident when we look at one aspect

而当我们观察所有 这些疾病的一个共同点时，

that many of these diseases have in common:

这一点就变得尤为明显：

the probability for successful treatment

治疗的成功率

strongly depends on when treatment is started.

很大程度上取决于何时开展治疗。

But a disease is typically only detected once symptoms occur.

但是一般来说，疾病只有 在症状显现后才会被确诊。

The problem here is that, in fact, many diseases can remain asymptomatic,

这里的问题在于，实际上， 很多疾病一直没有临床症状，

hence undetected, for a long period of time.

所以很长一段时间都不会被检测出来。

Because of this, there is a persisting need for new ways

因此，在远早于症状显现出来前，

of detecting disease at early stage,

便能检测出早期疾病的新治疗方法

way before any symptoms occur.

变得极为需要。

In health care, this is called screening.

在医疗保健上，这被称为筛检。

And as defined by the World Health Organization,

根据世界卫生组织（WHO）的定义，

screening is "the presumptive identification of unrecognized disease

筛检意为“在看似健康的人身上，

in an apparently healthy person,

通过快速简单的...多种检测手段...

by means of tests ... that can be applied rapidly and easily ..."

得出的未确诊疾病的假定诊断。”

That's a long definition, so let me repeat it:

这段定义非常长，所以我再重复一遍：

identification of unrecognized disease

在看似健康的人身上，

in an apparently healthy person

通过多种快速简单的检测手段

by means of tests that can be applied both rapidly and easily.

得出的未确诊疾病的假定诊断。

And I want to put special emphasis on the words "rapidly" and "easily"

我想着重强调“快速”和“简单”这两个词，

because many of the existing screening methods

因为现阶段的很多筛检方法

are exactly the opposite.

并没做到这两点。

And those of you who have undergone colonoscopy

而在座的观众中做过 直肠癌筛检程序之一，

as part of a screening program for colorectal cancer

即结肠镜检查的人

will know what I mean.

将会明白我的话中之意。

Obviously, there's a variety of medical tools available

显而易见，目前有许许多多

to perform screening tests.

可应用于筛检的医学手段。

This ranges from imaging techniques such as radiography

其中包括X射线放射成像、

磁共振成像、

or magnetic resonance imaging

to the analysis of blood or tissue.

还有血液和组织分析。

We have all had such tests.

我们一直都拥有这些技术。

But there's one medium that for long has been overlooked:

但有一个长期被忽视的媒介：

a medium that is easily accessible,

一个可轻易接触到的，

basically nondepletable,

基本无损耗的，

and it holds tremendous promise for medical analysis.

拥有巨大前景的医学分析媒介。

And that is our breath.

这便是我们的呼气。

Human breath is essentially composed of five components:

人类呼出的气体基本由五个部分组成：

nitrogen, oxygen, carbon dioxide, water and argon.

氮、氧、二氧化碳、水和氩。

But besides these five, there are hundreds of other components

除此之外，还有其它上百种

that are present in very low quantity.

含量极低的成分。

These are called volatile organic compounds,

它们是挥发性有机物质，

and we release hundreds, even thousands of them

而我们每次呼气都会释放

every time we exhale.

成百甚至上千种有机物质。

The analysis of these volatile organic compounds in our breath

以这些挥发性有机物为对象的分析

is called breath analysis.

被称为呼气分析。

In fact, I believe that many of you have already experienced breath analysis.

事实上，我相信在座的许多人 都已经做过呼气分析。

Imagine: you're driving home late at night,

试想一下：你在深夜开车回家，

when suddenly, there's a friendly police officer

突然这时，有位亲切的警官，

who asks you kindly but firmly

和善却态度坚决地要求你

to pull over and blow into a device like this one.

靠边停车，并朝这个仪器里呼气。

This is an alcohol breath tester

这是酒精呼气检测仪，

that is used to measure the ethanol concentration in your breath

用于测量呼出气体中的酒精含量

and determine whether driving in your condition is a clever idea.

以评估你此时的身体条件 是否允许开车。

Now, I'd say my driving was pretty good,

我觉得我的驾驶水平很不错，

but let me check.

但让我现在检测一下。

(Beep)

（响声）

0.0, so nothing to worry about, all fine.

0.0，所以没什么好担心的，一切正常。

(Laughter)

（笑声）

Now imagine a device like this one,

现在试想这样一台仪器，

that does not only measure alcohol levels in your breath,

它不仅可以检测呼气中的酒精含量，

but that detects diseases like the ones I've shown you

还可以检测出像我 刚刚介绍过的那样的疾病，

and potentially many more.

甚至可能检测出更多种。

The concept of correlating the smell of a person's breath

这种将人类呼气中的气味 和他的某种健康状况

with certain medical conditions,

所联系起来的概念，

in fact, dates back to Ancient Greece.

实际上起源于古希腊。

But only recently, research efforts on breath analysis have skyrocketed,

但直到最近，关于呼气分析的 研究成果才有了飞跃性的进展，

and what once was a dream is now becoming reality.

曾经只存在于想象中的事物 如今变成了事实。

And let me pull up this list again that I showed you earlier.

我现在再展示一下刚才的那张单子。

For the majority of diseases listed here,

有大量证据表明，

there's substantial scientific evidence

这张单子中的大部分疾病，

suggesting that the disease could be detected by breath analysis.

可以通过呼气分析检测到。

But how does it work, exactly?

但呼气分析到底是如何检测的？

The essential part is a sensor device

分析仪器里必不可缺的部分是

that detects the volatile organic compounds in our breath.

可以检测呼气中挥发性有机物的感应器。

Simply put: when exposed to a breath sample,

简单地说，当把此装置置于呼气样本中，

the sensor outputs a complex signature

它便会输出复杂的信号，

这些信号便是来源于 我们呼气中的挥发性有机物。

that results from the mixture of volatile organic compounds that we exhale.

Now, this signature represents a fingerprint of your metabolism,

而这些信号就好比你体内的新陈代谢，

your microbiome

微生物菌群，

and the biochemical processes that occur in your body.

以及生化过程的“指纹”。

If you have a disease,

如果你患有某种疾病，

your organism will change,

你的机体会产生变化，

and so will the composition of your exhaled breath.

这也包括了呼出气体的成分。

And then the only thing that is left to do is to correlate a certain signature

接下来该做的，便是把某个信号

with the presence or absence of certain medical conditions.

与某项身体状况的存在与否给联系起来。

The technology promises several undeniable benefits.

这项技术具备一些不可忽视的优点。

Firstly, the sensor can be miniaturized

首先，感应器可以微型化，

and integrated into small, handheld devices

并被整合进小型便携设备，

like this alcohol breath tester.

比如酒精呼气检测仪。

This would allow the test to be used in many different settings

这使得测试可在很多不同情境下，

and even at home,

甚至在家里完成，

so that a visit at the doctor's office

如此一来，每次检测

is not needed each time a test shall be performed.

便没必要去医生办公室才能完成了。

Secondly, breath analysis is noninvasive

其次，呼气分析是无创的，

and can be as simple as blowing into an alcohol breath tester.

就像朝酒精检测仪里吹气那样简单。

Such simplicity and ease of use would reduce patient burden

此种简单且易操作的特点 可以减轻病人的负担，

and provide an incentive for broad adoption of the technology.

还可以促进这项技术的推广。

And thirdly, the technology is so flexible

另外，这项技术的灵活性

that the same device could be used

使得仪器能被应用于

to detect a broad range of medical conditions.

检测很多方面的身体状况。

Breath analysis could be used to screen for multiple diseases at the same time.

呼气检测可以同时筛检多种疾病。

Nowadays, each disease typically requires a different medical tool

如今，每种疾病的筛检

to perform a screening test.

需要用到不同医疗仪器。

But this means you can only find what you're looking for.

但这意味这你只能 有目的的进行疾病监测。

With all of these features, breath analysis is predestined

有了这些特点，呼气分析就、

to deliver what many traditional screening tests are lacking.

就可以弥补传统筛检里的不足。

And most importantly,

而最重要的是，

all of these features should eventually provide us

所有这些特点最终可提供

with a platform for medical analysis

一个平均花费相当低的

that can operate at attractively low cost per test.

医疗分析平台。

On the contrary, existing medical tools

相较之下，现在的医疗仪器

often lead to rather high cost per test.

常常意味着高昂的成本。

Then, in order to keep costs down,

为了降低成本，

the number of tests needs to be restricted,

检测的数量便被限制，

and this means (a) that the tests can only be performed

这说明：(a) 检测只能提供给

on a narrow part of the population, for example, the high-risk population;

一小部分人，比如高危人群；

and (b) that the number of tests per person needs to be kept at a minimum.

(b) 每人的检测数要被控制在最少。

But wouldn't it actually be beneficial

但如果这些检测被提供给

if the test was performed on a larger group of people,

更多的人，甚至长此以往 提供给每一个人，

and more often and over a longer period of time for each individual?

这样岂不是更有益？

Especially the latter would give access to something very valuable

尤其是后一种情况，将会在最后

that is called longitudinal data.

提供一种名为“纵向数据”的宝贵数据。

Longitudinal data is a data set that tracks the same patient

纵向数据是一种跟踪记录同一个病人

over the course of many months or years.

在数月或数年内情况的数据组。

Nowadays, medical decisions are often based on a limited data set,

如今，医疗上的决策 常受有限数据组限制，

where only a glimpse of a patient's medical history

仅仅只有病人的一部分病史

is available for decision-making.

对决策有帮助。

In such a case,

在这种情况下，

abnormalities are typically detected

病人身体的异常一般是通过

by comparing a patient's health profile

将病人的健康概貌

to the average health profile of a reference population.

和参考组的平均健康概貌作比较。

Longitudinal data would open up a new dimension

纵向数据将会开拓出新的维度，

and allow abnormalities to be detected

并以病人自己的病史为依据

based on a patient's own medical history.

检测出身体异常。

This will pave the way for personalized treatment.

这将会为个性化治疗开辟道路。

Sounds pretty great, right?

这听起来很棒，对吧？

Now you will certainly have a question that is something like,

现在，你肯定会冒出一个问题：

"If the technology is as great as he says, then why aren't we using it today?"

“如果这项技术真的有他说得那么好， 为什么现在还没被应用呢？”

我能给出的唯一答复是：

And the only answer I can give you is:

not everything is as easy as it sounds.

并不是所有事情都像听起来那么简单。

There are technical challenges, for example.

比如，现阶段还存在着技术上的难关。

There's the need for extremely reliable sensors

我们需要非常可靠的感应器，

that can detect mixtures of volatile organic compounds

可靠到以足够的再现性

with sufficient reproducibility.

检测到挥发性有机混合气体。

And another technical challenge is this:

另一个技术难关是这个：

How do you sample a person's breath in a very defined manner

要如何明确清楚地抽样调查 一个人呼出的气体，

so that the sampling process itself

以保证抽样过程本身

does not alter the result of the analysis?

不会改变分析结果呢？

And there's the need for data.

另外，我们还需要数据。

Breath analysis needs to be validated in clinical trials,

呼气分析需在医疗测试中进行验证，

and enough data needs to be collected

同时需要收集足够的数据，

so that individual conditions can be measured against baselines.

以保证个体的身体状况 可通过对比基准线来检测。

Breath analysis can only succeed

呼气分析只有在

if a large enough data set can be generated

能生成大量的数据组

and made available for broad use.

并广泛应用的情况下才能成功。

If breath analysis holds up to its promises,

如果呼气分析有望成功，

this is a technology that could truly aid us

这将会成为能真正帮助我们

to transform our health care system --

改革医疗系统的技术——

transform it from a reactive system

从一个只有在病症显现时

where treatment is triggered by symptoms of disease

才能给出治疗的应激系统，

to a proactive system,

转变成主动出击的系统，

where disease detection, diagnosis and treatment

而在这个系统里， 疾病的检测、诊断和治疗

can happen at early stage,

可在疾病早期就被应用，

way before any symptoms occur.

远早于病症显现之时。

Now this brings me to my last point, and it's a fundamental one.

这便让我将演讲引向最后一点， 也是最基础的一点。

What exactly is a disease?

疾病到底是什么？

Imagine that breath analysis can be commercialized as I describe it,

想象一下，呼吸分析 就像我描述的那样被商业化，

and early detection becomes routine.

早期检测成为常规流程。

A problem that remains is, in fact, a problem

还留有的一个问题，实际上，

that any screening activity has to face

是任何筛检手段都需要面对的问题，

because, for many diseases,

因为，对于大多数疾病而言，

it is often impossible to predict with sufficient certainty

想要以足够的肯定性来检测

whether the disease would ever cause any symptoms

此种疾病是否会显现症状，

或使病人命悬一线， 通常是不可能的。

or put a person's life at risk.

This is called overdiagnosis,

这被称为“过度诊断”，

and it leads to a dilemma.

而它会将我们置于困境。

If a disease is identified,

如果某种疾病被检测出来，

你可以决定不去治疗它，

you could decide not to treat it

because there's a certain probability that you would never suffer from it.

因为有可能病人 从不会因这疾病而受煎熬。

But how much would you suffer

但如果你只知道可能得了绝症，

just from knowing that you have a potentially deadly disease?

这又会让你受到何种程度的煎熬呢？

And wouldn't you actually regret that the disease was detected

你会不会因为疾病 从一开始就被检测出来

in the first place?

而感到后悔呢？

Your second option is to undergo early treatment

你的第二种选择是 抱着能够被治好的希望

with the hope for curing it.

去接受早期治疗。

But often, this would not come without side effects.

但是，这经常会带来副作用。

To be precise:

准确地来说：

the bigger problem is not overdiagnosis,

更大的问题并不是过度诊断，

it's overtreatment,

而是过度治疗，

because not every disease has to be treated immediately

因为并不是仅因为 这种疾病有治疗方法

just because a treatment is available.

就要去马上接受治疗。

The increasing adoption of routine screening

频繁进行常规筛检

will raise the question:

会引发一个问题：

What do we call a disease that can rationalize treatment,

我们该如何判断 某种疾病是需要治疗，

and what is just an abnormality that should not be a source of concern?

还是视它为不需要担心的身体异常？

My hopes are that routine screening using breath analysis

我希望应用呼气分析的常规筛检

can provide enough data and insight

可以提供充足的数据和见解，

so that at some point, we'll be able to break this dilemma

能让我们以后打破僵局，

and predict with sufficient certainty

有充分的把握来预测

whether and when to treat at early stage.

此疾病是否需要在早期进行治疗。

Our breath and the mixture of volatile organic compounds that we exhale

我们的呼气和其中包含的挥发性有机物

hold tremendous amounts of information on our physiological condition.

蕴含着透露我们身体状况的丰富信息。

With what we know today, we have only scratched the surface.

我们目前的认识只是九牛一毛。

As we collect more and more data and breath profiles across the population,

随着我们在人群中收集到 越来越多的数据和呼吸信息，

including all varieties of gender, age, origin and lifestyle,

包括各种性别、年龄、种族和生活方式，

the power of breath analysis should increase.

呼气分析的权威性将会增强。

And eventually, breath analysis should provide us with a powerful tool

最终，呼气分析将成为强有力的工具，

not only to proactively detect specific diseases

它不仅能尽早检测出某种疾病，

but to predict and ultimately prevent them.

还可以预测和最终预防疾病。

And this should be enough motivation

这应该能敦促我们

to embrace the opportunities and challenges

接受呼气分析所带来的

that breath analysis can provide,

机遇和挑战，

even for people that are not part-time hypochondriacs like me.

甚至包括不同于我种 偶发疑病症患者的人。

Thank you.

谢谢。

(Applause)

（掌声）