Pneumoconiosis is the most prevalent occupational disease in China, with coal worker pneumoconiosis (CWP) demonstrating the highest incidence. Studies have indicated that phospholipids may be associated with CWP. In this study, serum was obtained from 62 patients with pneumoconiosis, 105 coal dust-exposed workers, and 50 healthy individuals and analyzed via targeted lipidomics using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). After initially identifying phospholipids with significant differences through univariate and multivariate statistical analyses, receiver operating characteristic (ROC) analysis was performed. The differential phospholipids identified in patient samples were then integrated to assess their diagnostic potential for CWP using a support vector machine (SVM). Compared with healthy subjects, the levels of Lyso-PS (18:0) were decreased, while PC (16:0), PC (18:0), PC (16:0/18:1), PI (16:0/18:1), PS (18:1), PG (16:0), and PG (18:0/18:1) were significantly increased in the pneumoconiosis group, with an area under the curve (AUC)>0.7. Moreover, compared with the dust-exposed group, Lyso-PC (16:0), PC (16:0), PC (16:0/18:1), PI (16:0/18:1), and PG (16:0) were significantly elevated in the pneumoconiosis group, with an AUC>0.7. The diagnostic model, including PC (16:0), PC (16:0/18:1), PI (16:0/18:1), and PG (16:0), demonstrated excellent performance with an AUC of 0.956. The serum phospholipid profiles of patients with pneumoconiosis differed significantly from those of controls, including differences in PC, Lyso-PC, PI, PS, Lyso-PS, and PG. Among these, a diagnostic model incorporating PC (16:0), PC (16:0/18:1), PI (16:0/18:1), and PG (16:0) demonstrated superior screening efficiency.
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