Objective To investigate the relationship between serum Meteorin-like protein(Metrnl) and growth differentiation factor 11(GDF11) expression levels with lower extremity vascular disease(LEVD) and prognosis in patients with diabetic foot(DF) infection. Methods A total of 97 DF infection patients admitted to the Department of Endocrinology, Shangluo Central Hospital, from January 2022 to December 2023 were selected as the DF group, and 97 patients with type 2 diabetes mellitus(T2DM) alone were selected as the T2DM group. DF infection patients were further divided into the LEVD subgroup(n=73) and the non-LEVD subgroup(n=24) based on the presence of LEVD. After a 6-month follow-up(with 2 lost to follow-up), DF infection patients were categorized into the poor prognosis subgroup(n=30) and the good prognosis subgroup(n=65). Additionally, 97 healthy individuals undergoing physical examinations during the same period were included as the healthy control group. Serum Metrnl and GDF11 levels were measured using enzyme-linked immunosorbent assay(ELISA). Multivariate logistic regression analysis was performed to identify factors influencing poor prognosis in DF infection patients. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive value of serum Metrnl and GDF11 levels for poor prognosis in DF infection patients. Results Serum Metrnl and GDF11 levels followed the order: DF group < T2DM group < healthy control group(F/P=2 058.898/<0.001, 139.757/<0.001). The LEVD subgroup exhibited lower serum Metrnl and GDF11 levels compared to the non-LEVD subgroup(t/P=4.165/<0.001, 6.469/<0.001). After 6 months of follow-up(with 2 lost), the incidence of poor prognosis was 31.58%(30/95). The poor prognosis subgroup had longer T2DM and DF duration, higher proportions of LEVD, higher HbA1clevels, and lower serum Metrnl and GDF11 levels compared to the good prognosis subgroup(t/P=6.603/<0.001, 11.567/<0.001, 5.410/0.020, 7.832/<0.001, 3.891/<0.001, 4.983/<0.001). Multivariate logistic regression analysis showed that LEVD and high HbA1c levels were independent risk factors for poor prognosis [OR(95%CI)=2.297(1.145-4.599), 1.881(1.043-3.394)], while high serum Metrnl and GDF11 levels were independent protective factors [OR(95%CI)=0.656(0.488-0.882), 0.680(0.519-0.892)]. The area under the curve(AUC) for predicting poor prognosis using serum Metrnl, GDF11, and their combination was 0.774, 0.737, and 0.902, respectively. The combined AUC was significantly higher than individual predictions(Z/P=2.239/0.002, 2.836/<0.001). Conclusion Serum Metrnl and GDF11 levels are decreased in DF infection patients and are associated with LEVD. Combined detection of serum Metrnl and GDF11 levels has high predictive value for poor prognosis in DF infection patients.

Objective To investigate the correlation between serum silent information regulator factor 6(SIRT6), solute carrier family 7 member 11(SLC7A11), and type 2 diabetes mellitus(T2DM) combined with non-alcoholic fatty liver disease(NAFLD). Methods A total of 90 patients with T2DM complicated with NAFLD, who were admitted to the Department of Endocrinology at Harbin Second Hospital from January 2022 to March 2024, were enrolled in the NAFLD group. Another 90 T2DM patients without NAFLD were selected in a 1:1 ratio as the non-NAFLD group. Serum SIRT6 and SLC7A11 levels were detected using enzyme-linked immunosorbent assay. Multivariate logistic regression was performed to analyze the influencing factors of T2DM complicated with NAFLD. Receiver operating characteristic(ROC) curves were plotted to evaluate the diagnostic efficiency of serum SIRT6 and SLC7A11 levels for T2DM complicated with NAFLD. Results Serum SIRT6 and SLC7A11 levels were significantly lower in the NAFLD group compared to the non-NAFLD group(t/P=7.892/<0.001, 7.643/<0.001). The alkaline phosphatase(ALP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), and triglyceride(TG) levels were higher in the NAFLD group than in the non-NAFLD group(t/P=2.953/0.004, 3.764/<0.001, 4.729/<0.001, 4.862/<0.001). Body mass index(BMI), hypertension, ALP, AST, ALT, and TG were independent risk factors for T2DM complicated with NAFLD, while high SIRT6 and SLC7A11 levels were independent protective factors[OR(95%CI)=1.279(1.044-1.569), 2.342(1.096-5.005), 1.026(1.001-1.052), 1.038(1.003-1.074), 1.026(1.001-1.052), 2.524(1.307-4.874), 0.782(0.692-0.882), 0.987(0.981-0.994)]. The area under the curve(AUC) for serum SIRT6, SLC7A11, and their combination for diagnosing T2DM complicated with NAFLD were 0.791, 0.787, and 0.876, respectively. The combined diagnosis of serum SIRT6 and SLC7A11 for T2DM complicated with NAFLD showed an AUC greater than the individual diagnosis by SIRT6 and SLC7A11(Z/P=2.217/0.027, 2.041/0.041). Conclusion The decrease in serum SIRT6 and SLC7A11 levels in T2DM patients is closely related to T2DM complicated with NAFLD. The combination of serum SIRT6 and SLC7A11 levels has high diagnostic efficiency for T2DM complicated with NAFLD.

目的探讨司美格鲁肽联合达格列净对2型糖尿病(T2DM)合并代谢综合征(MS)患者腹部脂肪分布及血清白脂素(Asprosin)、Spexin水平的影响。方法选取2022年1月—2024年1月新疆克拉玛依市中西医结合医院(市人民医院)内分泌肾病科诊治T2DM合并MS患者104例，按治疗方案不同分为2组。以接受达格列净治疗的患者52例为对照组，以接受司美格鲁肽联合达格列净治疗的患者52例为观察组，均治疗3个月，比较2组治疗前后糖代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)]、胰岛功能相关指标[胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)]、脂代谢指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、体质量、内脏脂肪面积(VFA)、皮下脂肪面积(SFA)、血清Asprosin与Spexin水平及不良反应发生率。结果与治疗前比较，治疗3个月后2组FPG、HbA1c降低，且观察组低于对照组(t/P=4.579/<0.001,4.714/<0.001);2组HOMA-IR较治疗前降低，HOMA-β较治疗前升高，且观察组降低/升高幅度大于对照组(t/P=6.109/<0.001,6.771/<0.001);2组TC、TG、LDL-C较治疗前降低，HDL-C较治疗前升高，且观察组降低/升高幅度大于对照组(t/P=4.725/<0.001,7.748/<0.001,4.647/<0.001,6.596/<0.001);2组体质量、VFA及SFA较治疗前降低，且观察组低于对照组(t/P=2.363/0.020,6.089/<0.001,4.116/<0.001);2组血清Asprosin水平较治疗前降低，血清Spexin水平较治疗前升高，且观察组降低/升高大于对照组(t/P=6.111/<0.001,5.007/<0.001);2组不良反应发生率比较，差异无统计学意义(P>0.05)。结论司美格鲁肽联合达格列净治疗T2DM合并MS患者，可调节血清Asprosin、Spexin水平，改善糖脂代谢及胰岛素抵抗，同时可以降低体质量及VFA、SFA,且安全性高。

Objective To investigate the predictive value of serum acyl-CoA synthetase long-chain family member 4(ACSL4) and systemic immune-inflammation index(SII) levels for no-reflow phenomenon during percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction(ASTEMI) complicated by heart failure with preserved ejection fraction(HFpEF). Methods This study included 135 ASTEMI patients with HFpEF(observation group) who underwent PCI at The Second Affiliated Hospital of Anhui Medical University from October 2019 to June 2024, and 70 healthy volunteers(control group). The ASTEMI patients were further divided into no-reflow subgroup(n=33) and reflow subgroup(n=102) based on coronary flow during PCI. Serum ACSL4 and SII levels were compared among groups. Multivariate unconditional Logistic regression was used to identify risk factors for no-reflow. Receiver operating characteristic(ROC) curve analysis was performed to evaluate the predictive value of serum ACSL4 and SII levels for no-reflow.Results Compared with controls, the observation group showed higher serum ACSL4 and SII levels(t/P=21.858/<0.001, 13.649/<0.001). The no-reflow rate during PCI was 24.44%(33/135). The no-reflow subgroup had higher ACSL4 and SII levels than the reflow subgroup(t/P=5.877/<0.001, 5.324/<0.001). Patients in no-reflow subgroup were older, with higher proportions of KILLIP class IV, NT-proBNP and LDL-C levels(χ2/t/P=3.610/<0.001, 2.993/0.003, 3.782/0.005, 2.109/0.037). Advanced age, high ACSL4, and high SII were independent risk factors for no-reflow [OR(95%CI)=1.123(1.022-1.243), 1.207(1.082-1.346), 1.003(1.002-1.005)]. The AUC values for predicting no-reflow using ACSL4, SII, and their combination were 0.786, 0.797, and 0.879 respectively, with combined detection showing superior predictive value(Z/P=2.474/0.010, 2.726/0.004). Conclusion Elevated serum ACSL4 and SII levels are closely associated with no-reflow during PCI in ASTEMI patients with HFpEF. Combined detection of these biomarkers shows high predictive value.

Objective To investigate the clinical value of serum levels of human beta-defensin-2(hBD-2), Periostin, and thrombospondin-1(TSP-1) in the diagnosis and prognosis evaluation of acute stroke(AS) complicated with pulmonary infection. Methods A total of 102 AS patients with lung infection admitted to the Respiratory and Critical Care Department of Xi 'an Ninth Hospital from September 2021 to September 2023 were selected AS the infection group, and another 102 AS patients without lung infection during the same period were selected as the non-infection group. Enzyme linked immunosorbent assay was applied to detect serum levels of hBD-2, Periostin, and TSP-1. ROC curve was applied to evaluate the diagnostic value of serum hBD-2, Periostin, and TSP-1 for AS complicated with pulmonary infection, and their predictive value for prognosis. Logistic regression analysis was applied to analyze the influencing factors of pulmonary infection in AS patients. Results The proportion of patients under went invasive procedures with dysphagia, and the levels of serum hBD-2, Periostin, TSP-1 in the infection group were higher than those in non-infection group(t/P=10.242/<0.001,4.819/<0.001,12.246/<0.001). The levels of serum hBD-2, Periostin and TSP-1 in the poor prognosis subgroup were higher than those in the good prognosis subgroup(t/P=4.335/<0.001,6.571/<0.001,5.441/<0.001). Invasive operation, dysphagia, high hBD-2, high Periostin, and high TSP-1 levels were all influencing factors of AS combined with pulmonary infection[OR(95%CI)=2.839(1.501-5.368),3.229(1.557-6.695).4.209(1.886-9.494),3.823(1.592-9.181),3.924(1.915-8.040)]. The AUC of serum hBD-2, Periostin, TSP-1 and their combination in predicting AS with pulmonary infection were 0.735, 0.782, 0.781, and 0.878, and the AUC of the combined use of the three markers was larger than that of the individual prediction(Z/P=2.788/0.005, 2.807/0.005, 2.049/0.040). The AUC of serum hBD-2, Periostin, TSP-1, and their combined use in predicting the prognosis of pulmonary infection in AS were 0.790, 0.785, 0.782, and 0.861, and the AUC of the combined use of the three markers was not significantly different from those of hBD-2, Periostin, and TSP-1 used alone(Z/P=1.258/0.209, 1.580/0.114, 1.416/0.157).Conclusion The serum levels of hBD-2, Periostin, and TSP-1 are high in patients with AS complicated with pulmonary infection, which are closely related to prognosis. Moreover, the combined diagnosis of these three factors has high clinical value in the diagnosis of AS complicated with pulmonary infection.