Objective To study the serum levels of CD59 and Gremlin-1 in patients with acute exacerbation of idiopathic interstitial pneumonia(IIP) and their correlation with recent prognosis.Method Ninety patients with acute exacerbation stage IIP diagnosed and treated in the Respiratory Department of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from March 2020 to February 2022 were selected as the research subjects(acute exacerbation stage group). 60 stable stage IIP patients diagnosed and treated at the same time were selected as the stable stage group, and 60 healthy individuals examined at the same time were selected as the healthy control group. According to the 3-month follow-up survival status of patients with acute exacerbation stage IIP, they were divided into survival subgroup(n=59) and death subgroup(n=31). Enzyme linked immunosorbent assay was used to detect serum levels of CD59 and Gremlin-1. Pearson correlation analysis of the correlation between serum CD59, Gremlin-1 and clinical indicators in patients with acute exacerbation of IIP. Multivariate logistic regression analysis of factors affecting the prognosis of death in patients with acute exacerbation of IIP. The predictive value of serum CD59 and Gremlin-1 in predicting the prognosis of death in patients with acute exacerbation of IIP by analyzing the working characteristic curve of subjects. Results The levels of serum CD59 and Gremlin-1 in the acute exacerbation group were higher than those in the stable stage group and the healthy control group(t=30.916, 47.431, 34.379, 54.420, P<0.001). The ESR and HRCT scores, serum CD59 and Gremlin-1 levels in the death subgroup were significantly higher than those in the survival subgroup(t/P=2.580/0.012、4.546/<0.001、26.388/<0.001、20.842/<0.001). The levels of serum CD59 and Gremlin-1 in patients with acute exacerbation of IIP were positively correlated with ESR and HRCT scores(r=0.621, 0.736, 0.705, 0.689, all P<0.001). HRCT score, CD59, and Gremlin-1 are high risk factors for mortality prognosis in patients with acute exacerbation of IIP [OR(95%CI)=1.589(1.258-2.006), 1.593(1.252-2.028), 1.733(1.249-2.404)]. The AUC of HRCT score, serum CD59, Gremlin-1, and combined detection for evaluating the prognosis of acute exacerbation stage IIP patients were 0.807, 0.779, 0.752, and 0.867, respectively. The AUC of combined detection was the highest(Z=5.183, 4.349, 5.127, P<0.001). Conclusion The elevated levels of serum CD59 and Gremlin-1 in patients with acute exacerbation of IIP are influencing factors for the prognosis of death in patients with acute exacerbation. The combined detection of HRCT score, serum CD59, and Gremlin-1 has high evaluation value for the prognosis of death in patients with acute exacerbation of IIP.

Objective To explore the changes in serum immune status and predictive value of prognosis in elderly patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary infection. Methods One hundred and twenty elderly COPD patients with pulmonary infection admitted to the Department of Respiratory and Critical Care Medicine at Yangguang Ronghe Hospital in Weifang City from June 2021 to June 2022 were selected. They were divided into a survival group of 100 patients and a death group of 20 patients based on their prognosis after one year of treatment. Compare the levels of CD3+, natural killer(NK) cells, CD4+/CD8+, and their correlation with lung function indicators and COPD grading between two groups of patients. Application of multivariate logistic regression analysis to analyze the risk factors of pulmonary infection in elderly COPD patients; Draw ROC curves to evaluate the predictive value of CD4+/CD8+, CD3+, and NK cells in elderly COPD patients with pulmonary infection. Results Compared with the survival group, the levels of CD3+, NK cells, and CD4+/CD8+ in the death group decreased(t/P=12.552/<0.001, 8.132/<0.001, 5.779/<0.001). Comparison of serum CD3+, NK cells, and CD4+/CD8+ levels in patients with different grades of COPD: Grade Ⅰ>Grade Ⅱ>Grade Ⅲ(F/P=82.514/<0.001, 35.529/<0.001, 19.657/<0.001). The expression of CD3+, NK cells, CD4+/CD8+was positively correlated with FEV1/FVC, FEV1% pred, and negatively correlated with COPD grading(r=0.556, 0.560,-0.550, 0.545, 0.539,-0.567, 0.572, 0.587,-0.605, P<0.001). Older age, longer disease course, higher proportion of COPD grade Ⅲ, are risk factors for prognosis in elderly COPD patients with pulmonary infection [OR(95%CI)=1.369(1.194～1.571), 5.239(2.506～10.951),1.114(1.016～1.212)],higher FEV1/FVC, higher FEV1% pred, higher CD3+, higher NK cells, and higher CD4+/CD8+ are protective factors[OR(95%CI)=0.697(0.593～0.821), 0.622(0.493～0.786), 0.478(0.331～0.689), 0.633(0.523～0.766), 0.023(0.004～0.124)]. The AUC of CD3+, NK cells, CD4+/CD8+, and the three combined tests for predicting the prognosis of elderly COPD with pulmonary infection were 0.640, 0.637, 0.840, and 0.935, respectively. The AUC of the three combined tests was greater than that of the individual predictors(P=0.001). Conclusion The expression of serum CD3+, NK cells, and CD4+/CD8+in elderly COPD patients with pulmonary infection decreases, and is related to lung function indicators and COPD grading. The combined detection of these three factors can effectively improve the predictive value of elderly COPD patients with pulmonary infection.

Objective To explore the application value of cardiopulmonary ultrasound indicators and weaning cardiopulmonary ultrasound scores in distinguishing cardiogenic factors of weaning failure in severe mechanical ventilation patients.Method Four-eight patients who underwent mechanical ventilation at the Intensive Care Unit(ICU) of Hebei Provincial People's Hospital from July 2019 to May 2021 and experienced weaning failure were selected. According to the age stratification threshold of N-terminal B-type natriuretic peptide precursor(NT proBNP), weaning failure patients were divided into a cardiogenic weaning failure group(cardiogenic group) of 22 cases and a non cardiogenic weaning failure group(non cardiogenic group) of 26 cases. At the beginning of the weaning trial(0 min), bedside ultrasound was used to measure the patient's right ventricular end diastolic diameter(RVEDD), left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), inferior vena cava diameter(IVCD), early diastolic blood flow peak velocity(E) of the mitral valve, and early diastolic tissue velocity(e ') of the mitral annulus/left ventricular sidewall, and E/e' was calculated. At the 0th and 15th minutes of the withdrawal test, lung ultrasound was used to observe the changes in the number of B-lines in the anterior chest wall of both lungs, and each indicator was converted into a binary variable. Using a binary logistic regression model to screen for independent influencing factors. According to partial regression coefficients β Value is used as a weight to assign a score. Use the total score as the withdrawal cardiopulmonary ultrasound score. Use ROC curves to evaluate the predictive value of each parameter.Results The proportion of LVEF<50%, E/e '>14, IVCD ≥ 20 mm, and an increase of ≥ 6 B-lines in pulmonary ultrasound in the cardiogenic group were higher than those in the non cardiogenic group(χ2/P=11.679/0.001, 16.121/< 0.001, 11.679/0.001, 13.890/< 0.001); Logistic regression analysis showed that LVEF<50%, E/e '>14, and an increase of ≥ 6 B-lines in pulmonary ultrasound were independent risk factors for cardiac factor weaning failure [OR(95% CI)=21.119(1.411-316.056), 18.119(1.089-46.615), 7.126(2.839-115.642)]; ROC curve analysis showed that the area under the curve(AUC) for predicting cardiogenic factors of weaning failure by weaning cardiopulmonary ultrasound score was 0.913, which was higher than that predicted by LVEF and IVCD alone(Z/P=0.015/0.044, 2.352/0.019), and there was no statistically significant difference in predicting changes in E/e and the number of pulmonary ultrasound B-lines(Z/P=0.928/0.353, 1.558/0.119).Conclusion Cardiopulmonary ultrasound technology has high application value in identifying withdrawal failures caused by cardiogenic factors, with the highest predictive value of withdrawal cardiopulmonary ultrasound scores.

Objective To investigate the correlation between phosphatidylserine(PS) eversion and oxidative stress levels, as well as vascular endothelial damage in patients with chronic kidney disease(CKD) at different stages.Methods Select 88 patients with CKD in stages 2-5 who were admitted to Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital from January 2019 to December 2021. According to the CKD staging, there were 20 cases of mild(2-3 stages), 15 cases of moderate(4 stages), and 53 cases of severe(5 stages) in three groups. Clinical data were compared, and the expression levels of blood PS, superoxide dismutase(SOD), malondialdehyde(MDA), glutathione peroxidase(GPx), endothelial nitric oxide synthase(eNOS), and vascular endothelial growth factor(VEGF) were measured. The differences in the expression levels of the above indicators were analyzed among the three groups of patients, and analyze the correlation among them; Another 40 venous blood vessel specimens were selected, 30 CKD5 patients underwent autologous arteriovenous fistula(AVF), and 10 normal patients underwent limb trauma surgery. Immunohistochemical staining was performed on vascular endothelial cells to observe the expression of superoxide dismutase 1(SOD-1), GPx, VEGF, and vascular endothelial growth factor receptor 2(VEGFR2) in venous endothelial cells. Results The serum levels of SCr, BUN, and UA in three groups of CKD patients increased with the worsening of the condition(F=61.316, 43.258, 5.044, P<0.001). The levels of serum MDA and eNOS increase with the aggravation of the condition, while the expressions of SOD and GPx decrease with the aggravation of the condition(F/P=6.984/0.030, 4.155/0.020, 14.937/<0.001, 3.172/<0.001). The expression of serum VEGF and PS increases with the aggravation of the disease(F/P=29.871/<0.001, 10.286/<0.001). The levels of PS and VEGF in CKD5 patients were negatively correlated with the expression of SOD and GPx(P<0.01), and positively correlated with the expression of MDA and eNOS(P<0.01). The exposure level of PS was positively correlated with the expression of VEGF(P<0.01). The receiver operating characteristic(ROC) curve shows that the areas under the curve predicted by SOD, GPx, MDA, eNOS, and VEGF for PS eversion are 0.819, 0.818, 0.735, 0.824, and 0.892. SOD-1, GPx, VEGF, and VEGFR2 are highly expressed in venous tissues of CKD patients undergoing AVF surgery. Conclusion Oxidative stress can exacerbate vascular endothelial injury and PS valgus in patients, thereby exacerbating the condition of CKD stage 5 patients. Vascular endothelial injury indicators have predictive value for PS valgus, and PS valgus is expected to become a new target for CKD treatment.

Objective To investigate the expression and significance of microRNAs miR-155 and miR-182 in serum of hemodialysis patients with end-stage renal disease. Methods A total of 112 patients with end-stage renal disease who received diagnosis and treatment and underwent hemodialysis in the 971st Navy Hospital, Qingdao Municipal Hospital, and Qingdao Haici Hospital from May 2019 to May 2022 were collected as the end-stage renal disease group, and 112 healthy patients who underwent physical examination during the same period were selected as the healthy control group. Real-time quantitative PCR(qRT-PCR) was used to detect the expression of serum miR-155 and miR-182. Pearson method was used to analyze the correlation between serum miR-155 and miR-182 levels in patients with end-end renal disease. Logistic regression analysis was performed to analyze the influencing factors of the prognosis of dialysis patients with end-end renal disease. The receiver operating characteristic(ROC) curve was used to analyze the predictive value of serum miR-155 and miR-182 expression levels in the prognosis of hemodialysis patients with end-stage renal disease. Results The serum expression levels of miR-155 and miR-182 in the end-renal disease group were significantly higher than those in the healthy control group(t/P=12.719/<0.001, 27.901/<0.001). there="" were="" no="" significant="" differences="" in="" the="" ratio="" of="" males="" and="" proportion="" primary="" dialysis="" serum="" total="" high-density="" lipoprotein="" low-density="" between="" two="" p="">0.05), and compared with the survival subgroup, the hemoglobin(Hb) and albumin(Alb) of the death subgroup were significantly reduced(t/P=15.069/<0.001, 9.629/<0.001), serum calcium(Ca) and high-sensitivity C-reactive protein(hs-CRP) and serum miR-155 and miR-182 were increased(t/P=21.174/<0.001, 40.68/<0.001, 6.629/<0.001, 8.497/<0.001). The serum expressions of miR-155 and miR-182 in hemodialysis patients with end-end renal disease were positively correlated(r=0.516, P<0.001). Low Hb, high serum Ca, high hs-CRP, high Alb, high miR-155, and high miR-182 were independent risk factors for the prognosis of dialysis patients with end-renal disease [OR(95%CI)=3.189(1.052-9.670), 4.387(1.175-16.375), 5.527(1.220-25.048), 2.058(1.251-3.386), 5.561(2.413-12.817), 3.189(1.052-9.670)]; The area under the curve(AUC) of serum miR-155 and miR-182 and their combination were 0.827, 0.793 and 0.956, respectively, which were better than those predicted by serum miR-155 and miR-182 separately(Z/P=2.251/0.024, 2.797/0.005). Conclusion The serum expression levels of miR-155 and miR-182 in hemodialysis patients with end-stage renal disease are elevated, and the combination of miR-155 and miR-182 may better predict the prognosis of hemodialysis patients with end-stage renal disease.