Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom; and.
Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
Am J Respir Crit Care Med. 2022 Feb 15;205(4):388-396. doi: 10.1164/rccm.202105-1197TR.
The biological functions of cholesterol are diverse, ranging from cell membrane integrity, cell membrane signaling, and immunity to the synthesis of steroid and sex hormones, vitamin D, bile acids, and oxysterols. Multiple studies have demonstrated hypocholesterolemia in sepsis, the degree of which is an excellent prognosticator of poor outcomes. However, the clinical significance of hypocholesterolemia has been largely unrecognized. We undertook a detailed review of the biological roles of cholesterol, the impact of sepsis, its reliability as a prognosticator in sepsis, and the potential utility of cholesterol as a treatment. Sepsis affects cholesterol synthesis, transport, and metabolism. This likely impacts its biological functions, including immunity, hormone and vitamin production, and cell membrane receptor sensitivity. Early preclinical studies show promise for cholesterol as a pleiotropic therapeutic agent. Hypocholesterolemia is a frequent condition in sepsis and an important early prognosticator. Low plasma concentrations are associated with wider changes in cholesterol metabolism and its functional roles, and these appear to play a significant role in sepsis pathophysiology. The therapeutic impact of cholesterol elevation warrants further investigation.
胆固醇的生物学功能多种多样，从细胞膜完整性、细胞膜信号传递和免疫到类固醇和性激素、维生素 D、胆汁酸和氧化固醇的合成。多项研究表明，败血症患者存在胆固醇水平降低，其降低程度是预后不良的极佳预测指标。然而，低胆固醇血症的临床意义在很大程度上尚未被认识。我们详细回顾了胆固醇的生物学作用、败血症的影响、其作为败血症预后指标的可靠性以及胆固醇作为治疗药物的潜在用途。败血症会影响胆固醇的合成、转运和代谢。这可能会影响其生物学功能，包括免疫、激素和维生素的产生以及细胞膜受体的敏感性。早期的临床前研究表明，胆固醇作为一种多效治疗药物具有前景。败血症患者常出现胆固醇水平降低，这是一个重要的早期预后指标。低血浆浓度与胆固醇代谢及其功能作用的广泛变化相关，这些变化似乎在败血症病理生理学中发挥了重要作用。胆固醇升高的治疗效果值得进一步研究。
