Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD.
Crit Care Resusc. 2009 Dec;11(4):305-9.
A high serum cholesterol level is a risk factor for cardiovascular disease and has commonly been linked with worse outcomes. It is now well recognised that, in many critically ill patients, the opposite is true, with hypocholesterolaemia being associated with poor outcomes. In critical illness, particularly sepsis, total and high-density lipoprotein (HDL) cholesterol levels are commonly decreased, with varying changes in triglyceride levels. The magnitude of the changes seems to reflect the severity of inflammation. Plausible biological explanations exist to explain these associations, including an interaction of lipoproteins with endotoxin and the regulation of cytokine production. It remains unclear whether these observed alterations in lipid profile are a consequence of the physiological disturbance or whether they have a more causative role, worsening organ dysfunction or predisposing to infection. Lipid emulsions provide a vehicle for drug delivery, have become an important part of nutrition, and are emerging as a therapy for specific intoxications. The nature, dietary source and amount of lipid provided to critically ill patients may be enormously important and warrant more rigorous investigation. Further understanding of the alterations in lipid metabolism may have therapeutic implications in treatment of sepsis with specific compounds that manipulate lipid profiles, such as fibrates, statins, niacin and even reconstituted HDL.
血清胆固醇水平高是心血管疾病的一个风险因素，通常与预后较差有关。现在人们已经充分认识到，在许多重症患者中，情况恰恰相反，低胆固醇血症与不良预后相关。在重症疾病中，特别是脓毒症中，总胆固醇和高密度脂蛋白（HDL）胆固醇水平通常降低，甘油三酯水平也有不同程度的变化。这些变化的程度似乎反映了炎症的严重程度。存在合理的生物学解释来解释这些关联，包括脂蛋白与内毒素的相互作用以及细胞因子产生的调节。目前尚不清楚这些观察到的脂质谱变化是生理紊乱的结果，还是它们具有更具因果关系的作用，使器官功能恶化或易感染。脂质乳剂为药物输送提供了载体，已成为营养的重要组成部分，并作为特定中毒的治疗方法出现。为重症患者提供的脂质的性质、饮食来源和数量可能非常重要，值得更严格的研究。进一步了解脂质代谢的变化可能对使用特定化合物治疗脓毒症具有治疗意义，这些化合物可以通过操纵脂质谱来治疗脓毒症，如贝特类药物、他汀类药物、烟酸，甚至重组 HDL。
