Efficacy and metabolomic analysis of the pneumonia compound formulation against community-acquired pneumonia: an observational controlled before-after clinical trial

BackgroundPneumonia Compound Formulation (PCF) is a traditional Chinese medicine (TCM) formula used for the clinical treatment of novel coronavirus pneumonia. However, its efficacy and mechanism of action for community-acquired pneumonia (CAP) are unknown. Therefore, the aim of this study was to evaluate the efficacy of PCF combined with antibiotics in the treatment of CAP and to explore its mechanism based on metabolomics.Patients and methodsThis prospective controlled study included 100 CAP patients from June to December 2023. Patients were randomized into an antibiotics-only group (NCM, n = 50) and a combined antibiotics and PCF treatment group (CM, n = 50). Clinical data were collected for all participants. The efficacy of the treatments was assessed by comparing traditional Chinese medicine syndrome scores and clinical parameters before and after treatment. Levels of inflammatory mediators (CRP, IL-6, TNF-alpha) and immunoglobulins (IgA, IgG, IgM) in the plasma were measured using ELISA. Plasma metabolomics analysis was conducted using ultra-performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS).ResultsBoth the NCM and CM group improved the clinical symptoms of CAP patients, with the CM group showing more significant improvements. Both groups effectively reduced the levels of the inflammatory mediators CRP, but had no significant impact on immunoglobulin levels. CM group using additional PCF significantly altered glycerophospholipid metabolism in patients, primarily characterized by increased levels of phosphatidylinositol, phosphatidylglycerol, and 1-acyl-sn-glycero-3-phosphoethanolamine, and decreased levels of phosphatidylcholine and phosphatidylethanolamine.ConclusionsPCF is an effective adjunct therapy to antibiotics for the treatment of CAP, enhancing clinical symptom improvement. Its mechanism may involve the regulation of glycerophospholipid metabolism levels in patients, providing a new theoretical basis for the application of PCF in the treatment of CAP.Trial registrationChiCTR2400086283 (2024-06-27).