Internal Medicine Department, Quiron Salud Hospital, Barcelona, Spain.
Research Group of Autoimmunity, Infection and Thrombosis (GRAIIT), Pere Virgili for Health Research Institute (IISPV), Rovira and Virgili University (URV), Reus, Spain; Internal Medicine Department, "Sant Joan" University Hospital, Reus, Spain.
J Lipid Res. 2024 Sep;65(9):100622. doi: 10.1016/j.jlr.2024.100622. Epub 2024 Aug 21.
This prospective observational study compared the 1H NMR blood lipidomes and metabolomes of 71 patients with community-acquired pneumonia (CAP), 75 patients with COVID-19 pneumonia, and 75 healthy controls (matched by age and sex) to identify potential biomarkers and pathways associated with respiratory infections. Both pneumonia groups had comparable severity indices, including mortality, invasive mechanical ventilation, and intensive care unit admission rates. Patients with COVID-19 pneumonia exhibited more pronounced hypolipidemia, with significantly lower levels of total cholesterol and LDL-c compared to patients with CAP. Atherogenic lipoprotein subclasses (VLDL-cholesterol, IDL-cholesterol, IDL-triglyceride, and LDL-triglyceride/LDL-cholesterol) were significantly increased in severe cases of both pneumonia types, while lower HDL-c and small, dense HDL particles were associated with more severe illness. Both infected groups showed decreased esterified cholesterol and increased triglycerides, along with reduced phosphatidylcholine, lysophosphatidylcholine, PUFA, omega-3 fatty acids, and DHA. Additionally, infected patients had elevated levels of glucose, lactate, 3-hydroxybutyrate, and acetone, which are linked to inflammation, hypoxemia, and sepsis. Increased levels of branched-chain amino acids, alanine, glycine, and creatine, which are involved in energy metabolism and protein catabolism, were also observed. Neurotransmitter synthesis metabolites like histidine and glutamate were higher in infected patients, especially those with COVID-19. Notably, severe infections showed a significant decrease in glutamine, essential for lymphocyte and macrophage energy. The severity of COVID-19 pneumonia was also associated with elevated glycoprotein levels (glycoprotein A, glycoprotein B, and glycoprotein F), indicating an inflammatory state. These findings suggest that metabolomic and lipidomic changes in pneumonia are connected to bioenergetic pathways regulating the immune response.
这项前瞻性观察研究比较了 71 例社区获得性肺炎（CAP）患者、75 例 COVID-19 肺炎患者和 75 名健康对照者（按年龄和性别匹配）的 1H NMR 血脂组和代谢组，以确定与呼吸道感染相关的潜在生物标志物和途径。两组肺炎患者的严重程度指数相当，包括死亡率、有创机械通气和入住重症监护病房的比例。COVID-19 肺炎患者表现出更为明显的血脂降低，总胆固醇和 LDL-c 水平明显低于 CAP 患者。两种类型肺炎的严重病例中，致动脉粥样硬化脂蛋白亚类（VLDL-胆固醇、IDL-胆固醇、IDL-甘油三酯和 LDL-甘油三酯/LDL-胆固醇）显著增加，而 HDL-c 和小而密的 HDL 颗粒减少与疾病更严重相关。两组感染患者的酯化胆固醇和甘油三酯降低，同时磷脂酰胆碱、溶血磷脂酰胆碱、多不饱和脂肪酸、ω-3 脂肪酸和 DHA 减少。此外，感染患者的葡萄糖、乳酸、3-羟丁酸和丙酮水平升高，这些与炎症、低氧血症和败血症有关。还观察到支链氨基酸、丙氨酸、甘氨酸和肌酸等参与能量代谢和蛋白质分解代谢的氨基酸水平升高。与感染相关的神经递质合成代谢物如组氨酸和谷氨酸水平也较高，尤其是 COVID-19 感染患者。值得注意的是，严重感染导致淋巴细胞和巨噬细胞能量所必需的谷氨酰胺显著减少。COVID-19 肺炎的严重程度也与糖蛋白水平升高（糖蛋白 A、糖蛋白 B 和糖蛋白 F）相关，表明存在炎症状态。这些发现表明，肺炎中的代谢组和脂质组变化与调节免疫反应的生物能量途径有关。
