Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Handb Exp Pharmacol. 2023;277:367-384. doi: 10.1007/164_2022_622.
Critical illness is associated with dramatic changes in metabolism driven by immune, endocrine, and adrenergic mediators. These changes involve early activation of catabolic processes leading to increased energetic substrate availability; later on, they are followed by a hypometabolic phase characterized by deranged mitochondrial function. In sepsis and ARDS, these rapid clinical changes are reflected in metabolomic profiles of plasma and other fluids, suggesting that metabolomics could one day be used to assist in the diagnosis and prognostication of these syndromes. Some metabolites, such as lactate, are already in clinical use and define patients with septic shock, a high-mortality subtype of sepsis. Larger-scale metabolomic profiling may ultimately offer a tool to identify subgroups of critically ill patients who may respond to therapy, but further work is needed before this type of precision medicine is readily employed in the clinical setting.
危重病与由免疫、内分泌和肾上腺素能介质驱动的代谢急剧变化有关。这些变化涉及到早期分解代谢过程的激活，导致能量底物的可用性增加；之后，它们会被代谢功能紊乱的低代谢阶段所跟随。在脓毒症和 ARDS 中，这些快速的临床变化反映在血浆和其他体液的代谢组学特征中，这表明代谢组学有朝一日可能被用于辅助这些综合征的诊断和预后。一些代谢物，如乳酸，已经在临床中使用，并定义了患有败血症性休克的患者，这是一种高死亡率的败血症亚型。更大规模的代谢组学分析最终可能提供一种工具来识别可能对治疗有反应的危重症患者亚组，但在这种精准医学在临床环境中得到广泛应用之前，还需要做更多的工作。
