Objective To analyze the effect of human serum albumin combined with targeted fluid infusion on septic shock patients with acute respiratory distress syndrome(ARDS).Methods From February 2020 to October 2021, 76 patients with septic shock and ARDS diagnosed and treated by the Department of Severe Medicine of Hainan Cancer Hospital were selected. They were randomly divided into control group and observation group with 38 patients in each group. Routine intervention was carried out in both groups, in which target oriented fluid infusion was used in the control group, and human serum albumin was infused in the observation group on the basis of the control group. The time spent in intensive care unit(ICU), mechanical ventilation time, norepinephrine dosage and fluid infusion volume of the two groups were counted; The fluid balance volume, blood gas status [arterial partial pressure of oxygen(PaO2), oxygenation index(OI)], hemodynamic changes(heart rate, mean arterial pressure, central venous pressure) and fluid negative balance time were recorded at 6 h, 12 h and 24 h after treatment. Serum albumin level, inflammatory index [C-reactive protein(CRP), procalcitonin(PCT)] and alveolar lavage fluid albumin level were measured before and 24 hours after treatment, and the mortality of the two groups was compared one month later.Results The time of mechanical ventilation and the amount of fluid infusion in the observation group were significantly lower than those in the control group(t/P=6.801/< 0.001, 17.383/< 0.001). There was no significant difference between the two groups in the time spent in the ICU and the amount of norepinephrine(P>0.05); The fluid balance in both groups was positive at 6 h, increased at 12 h, decreased significantly at 24 h(F/P=46.986/< 0.001, 39.492/< 0.001), and the fluid balance in the observation group was lower than that in the control group(t/P=6.608/<0.001), and the time of negative fluid balance was shorter than that in the control group(t/P=5.406/< 0.001); After 24 hours of treatment, the serum albumin in the observation group was higher than that in the control group(t/P=5.314/<0.001), and the levels of albumin in alveolar lavage fluid, CRP and PCT in serum were lower than those in the control group(t/P=3.485/0.001, 2.288/0.025, 2.361/0.021); At 6,12 and 24 hours after treatment, the heart rate of the two groups continued to decrease, and PaO2, OI, mean arterial pressure and central venous pressure increased on average(P<0.01). After 24 h treatment, the heart rate of the observation group was lower than that of the control group, and the levels of PaO2, OI, mean arterial pressure and central venous pressure were higher than those of the control group(t/P=3.351/0.001, 2.678/0.009, 2.409/0.018,3.929/<0.001,3.443/0.001); There was no significant difference in mortality between the two groups(P=1.000).Conclusion The combination of human serum albumin and targeted fluid infusion in the treatment of septic shock with ARDS can shorten the time of mechanical ventilation and liquid negative balance, increase the level of serum albumin, reduce protein leakage, improve hemodynamics and blood gas status, and reduce inflammatory reaction, which has clinical application value.

Objective To explore the predictive value of systemic inflammatory factors in type 2 diabetes based on decision curve. Methods From January 2021 to January 2022, 63 patients with type 2 diabetes newly diagnosed by the Endocrinology Department of Xinjiang Uygur Autonomous Region Maternal and Child Health Hospital were selected as the type 2 diabetes group, and 51 patients with hospital health examination at the same time were selected as the healthy control group. The clinical data and serum systemic inflammatory factors [C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6), IL-8, IL-1 β, monocyte chemoattractant protein-1(MCP-1)]of the two groups were compared.Multivariate logistic regression analysis was used to analyze the independent risk factors affecting type 2 diabetes mellitus, and the value of serum systemic inflammatory factors in predicting type 2 diabetes mellitus was analyzed by the subject's work characteristic curve(ROC). Draw decision curve, analyze independent prediction index and joint prediction model to predict the net income of type 2 diabetes. Results Body mass index(BMI), waist circumference, insulin resistance index(HOMA-IR), glycosylated hemoglobin(HbA1 c) and triacylglycerol(TG) in patients with type 2 diabetes were significantly higher than those in healthy controls [t(χ2)/P=2.765/0.013,2.858/0.011,4.566/<0.001,3.675/<0.001,2.178/0.024],The expression levels of serum CRP, TNF-α,IL-6, IL-8 and MCP-1 in patients with type 2 diabetes mellitus were significantly higher than those in the healthy control group(t/P=4.513/<0.001, 4.789/<0.001, 5.698/<0.001, 2.453/0.017, 2.378/0.019); The results of multifactor logistic regression analysis showed that CRP and TNF-α, the increase of IL-6 was an independent risk factor for type 2 diabetes mellitus [OR(95%CI)=2.543(1.345-3.789), 2.167(1.145-3.578), 2.645(1.256-4.527)]; ROC curve analysis results show that the area under the curve(AUC) of CRP, TNF-α,IL-6 and the three combined predictors of type 2 diabetes mellitus was 0.784, 0.743, 0.846, 0.947, which was higher than that of single indicator(Z=10.234, 12.992, 13.455,P<0.001); The analysis results of the decision curve show that within most reasonable threshold probabilities, CRP and TNF-α, IL-6 and their combined prediction have good net benefits for type 2 diabetes.Conclusion Serum CRP, TNF-α, IL-6 has a high clinical value and net income in predicting newly diagnosed type 2 diabetes mellitus, and the value of joint prediction is the highest.

Objective To observe the effect of dulaglutide combined with dagelin on urinary protein excretion rate and serum inflammatory factors in patients with early diabetic nephropathy. Methods From January to October 2021, 120 patients with early diabetic nephropathy diagnosed and treated by the Department of Endocrinology of the Fifth People's Hospital of Datong, Shanxi Province, were selected and divided into the control group and the observation group according to the random number table method, with 60 patients in each group. The patients in the control group were treated with daggligin combined with telmisartan, and the patients in the observation group were treated with dulaglutide on the basis of the control group. The renal function [glomerular filtration rate(GFR), urea nitrogen(BUN), uric acid(UA) and urinary protein excretion rate] and the level of inflammatory factors [transforming growth factor-β1(TGF-β1), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)],Blood glucose level(2 h postprandial blood glucose, fasting blood glucose, glycosylated hemoglobin), blood lipid level [total cholesterol(TC), triacylglycerol(TG), low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C)]were compared between the two groups before and after treatment, and the incidence of adverse reactions. Results Compared with that before treatment, the excretion rates of BUN, UA, GFR and urinary protein in the two groups decreased after treatment, but the excretion rates of BUN, UA and urinary protein in the observation group were lower than those in the control group, and GFR was higher than those in the control group(t=6.215, 20.742, 8.955,12.431,P<0.001). Serum TGF-β1,IL-6,TNF-α of the two groups after treatment was lower in the observation group than in the control group(t=12.139, 18.351, 13.889,P<0.001). After treatment, the levels of blood glucose, fasting blood glucose and glycosylated hemoglobin at 2 h after meal in both groups decreased, and those in the observation group were lower than those in the control group(t=6.835, 8.849, 5.425,P<0.001). After treatment, serum TC, TG, LDL-C in both groups decreased, HDL-C in the observation group increased, and the improvement in the observation group was better than that in the control group(t=4.225, 15.746, 4.243, 4.121,P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion On the basis of treatment with dagelin combined with telmisartan, the addition of dulaglutide can effectively reduce the level of serum inflammatory factors and urinary protein excretion rate in patients with early diabetic nephropathy, reduce inflammatory reaction, improve renal function, regulate blood sugar, and is safe and effective.

Objective To investigate the relationship between serum levels of long chain non coding RNA MEG3(lncRNA MEG3), microRNA-223(miR-223) and abdominal aortic calcification(AAC) in peritoneal dialysis patients. Methods From September 2020 to September 2021, 100 peritoneal dialysis patients admitted to the Department of Nephrology of Xiaogan Hospital affiliated to Wuhan University of Science and Technology were selected as the research objects. According to the results of abdominal CT, they were divided into 52 AAC patients and 48 non AAC patients. At the same time, the patients in AAC group were divided into mild AAC subgroup(31 cases) and severe AAC subgroup(21 cases). The expression of serum lncRNA MEG3 and miR-223 in the two groups was detected by real-time fluorescent quantitative PCR. The correlation between serum lncRNA MEG3 and miR-223 in peritoneal dialysis patients with AAC and general data and biochemical indicators was evaluated by Pearson or Spearman methods. The predictive value of serum lncRNA MEG3 and miR-223 in peritoneal dialysis patients with AAC was evaluated by ROC curve; Logistic regression was used to analyze the influencing factors of AAC in peritoneal dialysis patients. Results Age, diabetes ratio, phosphorus(P), abdominal aortic calcification score and serum lncRNA MEG3 in AAC group were higher than those in non AAC group [t(χ2)/P=6.465/<0.001, 5.364/0.021, 2.639/0.010, 31.766/<0.001, 8.428/<0.001], 25 hydroxyvitamin D3 and serum miR-223 were lower than those in non AAC group(t/P=14.847/<0.001, 8.461/<0.001); Serum lncRNA MEG3 and abdominal aortic calcification scores in severe AAC subgroup were higher than those in mild AAC subgroup, and serum miR-223 was lower than those in mild AAC subgroup(t=5.728, 19.959, 6.934,P<0.001); There was a negative correlation between serum lncRNA MEG3 and miR-223 levels in AAC patients undergoing peritoneal dialysis(r=-0.552,P<0.001). Age, diabetes, P, abdominal aortic calcification score of AAC patients undergoing peritoneal dialysis were positively correlated with lncRNA MEG3(r/P=0.513/0.004, 0.496/0.010, 0.504/0.008, 0.522/0.001), and negatively correlated with miR-223(r/P=-0.502/0.006,-0.495/0.010,-0.491/0.009,-0.514/0.003); 25 hydroxyvitamin D3 was negatively correlated with serum lncRNA MEG3(r/P=-0.512/0.008) and positively correlated with miR-223(r/P=0.514/0.006). The area under the curve(AUC) of serum lncRNA MEG3, miR-223 and their combination in predicting AAC in peritoneal dialysis patients were 0.898, 0.823 and 0.942, respectively. The combined predictive value of the two was higher than that of single prediction(Z/P=1.667/0.048, 2.441/0.007); The elevated level of serum lncRNA MEG3 is an independent risk factor for AAC in peritoneal dialysis patients [OR(95%CI)=2.648(1.445-4.852)], and the elevated level of miR-223 is a protective factor [OR(95%CI)=0.884(0.830-0.941)].Conclusion LncRNA MEG3 and miR-223 are independent influencing factors of AAC in peritoneal dialysis patients respectively. Detection of the changes of these two indicators can help predict the occurrence and severity of AAC in peritoneal dialysis patients.

Objective To explore the correlation between serum microRNA-301 a(miR-301 a), miR-197 and inflammatory cytokines in patients with gestational diabetes(GDM), and to analyze the receiver operating characteristic curve(ROC) that predicts pregnancy outcome.Methods From January 2020 to January 2021, 45 pregnant women with GDM who were diagnosed and delivered in the Obstetrics Department of the Second Affiliated Hospital of Hainan Medical College were selected as the observation group, and were divided into 25 good subgroups and 20 bad subgroups according to pregnancy outcomes. Another 45 healthy pregnant women who were delivered in the hospital during the same period were selected as the control group. White blood cell count(WBC), serum miR-301 a, miR-197, interleukin-1(IL-1), IL-6, and tumor necrosis factor were detected in the two groups of pregnant women-α(TNF-α), C-reactive protein(CRP) level, serum miR-301 a, miR-197 and WBC, IL-1, IL-6, TNF-α were analyzed by Pearson method, Correlation of CRP, logistic regression analysis of the risk factors affecting the pregnancy outcome of GDM patients, and ROC curve analysis of the predictive value of serum miR-301 a and miR-197 on the pregnancy outcome of GDM patients. Results The serum miR-301 a in the observation group was higher than that in the control group, and miR-197 was lower than that in the control group(t=16.542, 75.445,P<0.001). WBC and serum IL-1, IL-6, TNF-α, CRP levels were higher than those in the control group(t=9.297, 40.910, 31.633, 14.860, 12.258,P<0.001). Serum miR-301 a and WBC, IL-1, IL-6, TNF-α, CRP level was positively correlated(r/P=0.523/< 0.001, 0.542/< 0.001, 0.325/0.009, 0.196/0.002, 0.145/0.034). Serum miR-197 was associated with WBC, IL-1, IL-6, TNF-α, CRP levels were negatively correlated(r=-0.251,-0.673,-0.374,-0.258,-0.546,P<0.001). High expression of miR-301 a and low expression of miR-197 in serum are independent risk factors affecting pregnancy outcome of GDM patients [OR(95%CI)=22.692(2.056-250.385),12.833(1.143-144.119)].The AUC of serum miR-301 a, miR-197 and their combination in predicting the pregnancy outcome of GDM patients were 0.785, 0.804 and 0.954, respectively. The AUC of their combination was higher than that of single detection(Z=5.239, 4.263,P<0.001).Conclusion The abnormal expression of serum miR-301 a and miR-197 is related to the occurrence and development of gestational diabetes. The combined detection of miR-301 a and miR-197 is of high value in predicting pregnancy outcome, and can be used as an important target for the treatment of gestational diabetes.