目的 探讨结直肠癌(CRC)患者血清中再生胰岛衍生蛋白1α(REG1α)和张力蛋白同源物4(Tensin4)的水平，并分析其对腹腔镜结直肠癌根治术后肝转移的预测价值。方法 选取2019年1月—2022年1月武汉市第三医院消化内科收治的接受腹腔镜结直肠癌根治术的CRC患者124例为CRC组，根据术后是否发生肝转移将CRC患者分为肝转移亚组45例和无肝转移亚组79例，另选取同期医院健康体检者60例为健康对照组。采用酶联免疫吸附试验检测血清REG1α和Tensin 4的表达水平，分析其与患者临床病理特征的相关性;多因素Logistic回归分析CRC患者术后肝转移的影响因素;受试者工作特征(ROC)曲线分析血清REG1α、Tensin 4水平对CRC患者术后肝转移的预测价值。结果 CRC组血清REG1α、Tensin 4水平高于健康对照组(t/P=30.118/<0.001、30.155/<0.001);TNM分期Ⅲ期、淋巴结转移CRC患者血清REG1α、Tensin 4水平高于TNM分期Ⅰ～Ⅱ期、无淋巴结转移的患者(REG1α:t/P=19.452/<0.001,20.884/<0.001; Tensin 4:t/P=25.004/<0.001,30.608/<0.001);肝转移亚组CRC患者血清REG1α、Tensin 4水平高于无肝转移亚组(t/P=16.472/<0.001,45.063/<0.001); TNM分期Ⅲ期、淋巴结转移、REG1α升高、Tensin 4升高是CRC患者术后肝转移的独立危险因素[OR(95%CI)=1.426(1.145～1.776),1.406(1.152～1.718),1.335(1.099～1.596),1.297(1.096～1.535)];血清REG1α、Tensin 4水平单独及二者联合评估CRC患者术后肝转移的曲线下面积(AUC)分别为0.841、0.833、0.915，二者联合的AUC高于单独预测(Z/P=4.410/<0.001、4.462/<0.001)。结论 CRC患者血清REG1α、Tensin 4水平升高，与肿瘤恶性进展密切相关，可作为CRC术后肝转移评估的潜在血清学标志物。

Objective To investigate the relationship between the expression of serum long non-coding RNA maternally expressed gene 3(lncRNA MEG3) and micro RNA-493-5p(miR-493-5p) in patients with aneurysmal subarachnoid hemorrhage(aSAH) and the degree of disease and prognosis. Methods The clinical data of 182 patients with a SAH(aSAH group) admitted to the Department of Neurosurgery, the First Hospital Affiliated to Hebei Northern University from January2023 to April 2025 were selected. The severity of a SAH patients was classified according to the World Federation of Neurosurgical Societies(WFNS) classification criteria on admission, including 112 cases in the mild subgroup(WFNS grade Ⅰ-Ⅲ)and 70 cases in the severe subgroup(WFNS grade Ⅳ-Ⅴ). In addition, 170 healthy volunteers who underwent physical examination in the hospital during the same period were set as the healthy control group. Clinical data of a SAH patients were collected, and serum levels of lnc RNA MEG3 and mi R-493-5p were detected by quantitative real-time PCR. Patients with a SAH were followed up for 6 months according to the Glasgow Outcome Scale(GOS) score, and were divided into a poor prognosis subgroup(GOS score 1-3, 61 cases) and a good prognosis subgroup(GOS score 4-5, 121 cases). Differences in serum lnc RNA MEG3 and mi R-493-5p levels and clinical data between the two subgroups were compared. Correlations of serum lnc RNA MEG3 and mi R-493-5p with disease severity and prognosis, factors affecting poor prognosis, and the predictive value of these two markers for poor prognosis were analyzed. Results Compared with the healthy control group, serum lnc RNA MEG3 level was significantly increased and mi R-493-5p level was significantly decreased in the a SAH group(t = 60.043,46.202, both P <0.001). Compared with the mild subgroup, the severe subgroup had significantly increased lnc RNA MEG3 and significantly decreased mi R-493-5p(t = 22.222, 20.157, both P <0.001). Compared with the good prognosis subgroup, the poor prognosis subgroup had a higher proportion of patients with a history of hypertension, modified Fisher scale score 3-4 at admission, Hunt-Hess scale score 3-5, WFNS grade Ⅳ-Ⅴ, aneurysm diameter ≥5 mm, cerebral vasospasm, and higher serum lnc RNA MEG3 levels, while mi R-493-5p levels were lower(χ2/t = 4.650, 99.688, 72.264, 79.006, 6.049, 39.729, 27.796,34.778;P = 0.031, <0.001, <0.001, <0.001, 0.014, <0.001, <0.001, <0.001). Serum lnc RNA MEG3 was negatively correlated with mi R-493-5p in a SAH patients(r =-0.617, P <0.001). lnc RNA MEG3 was positively correlated with WFNS grade and negatively correlated with GOS score(r = 0.723,-0.781, both P <0.001). mi R-493-5p was negatively correlated with WFNS grade and positively correlated with GOS score(r =-0.649, 0.695, both P <0.001). A history of hypertension, modified Fisher scale score 3-4 at admission, Hunt-Hess scale score 3-5, WFNS grade Ⅳ-Ⅴ, aneurysm diameter ≥5 mm, cerebral vasospasm,and high lnc RNA MEG3 level were independent risk factors for poor prognosis in a SAH patients, while high mi R-493-5p level was an independent protective factor [OR(95%CI) = 1.874(1.146-3.065), 2.863(1.541-5.319), 2.667(1.461-4.868), 4.047(1.844-8.881), 1.514(0.904-2.536), 2.442(1.397-4.270), 2.255(1.318-3.858), 0.398(0.188-0.839)]. The areas under the curve(AUC) for serum lnc RNA MEG3, mi R-493-5p, and their combination in predicting poor prognosis in a SAH patients were 0.796, 0.781, and 0.878, respectively. The AUC of the combination was significantly greater than that of either marker alone(Z = 1.968, 2.058; P = 0.043, 0.040). Conclusion In a SAH patients, serum lnc RNA MEG3 is highly expressed while mi R-493-5p is lowly expressed; these changes are more pronounced in patients with more severe conditions. The combination of lnc RNA MEG3 and mi R-493-5p has a favorable predictive effect on poor prognosis in a SAH patients.

Objective To investigate the application value of combined detection of serum cyclic guanosine monophosphate-adenosine monophosphate(cGAMP) and high-temperature requirement protein A2(HtrA2) levels in patients with severe pneumonia(SP) complicated by myocardial injury(MI). Methods A total of 102 patients with SP admitted to the Intensive Care Unit of Yulin Hospital, the First Affiliated Hospital of Xi' an Jiaotong University from January 2022 to January2025 were prospectively selected as the SP group, and 102 healthy volunteers were selected as the healthy control group at a1 ∶1 ratio. Serum c GAMP and HtrA2 levels were detected by enzyme-linked immunosorbent assay. SP patients were divided into a critical SP subgroup(48 cases) and a non-critical SP subgroup(54 cases) according to disease severity. The correlation between serum c GAMP and HtrA2 levels and disease severity was analyzed by point-biserial correlation. SP patients were further divided into an MI subgroup and a non-MI subgroup based on whether MI occurred within 28 days after admission. Factors influencing MI in SP patients and the predictive efficacy of serum c GAMP and HtrA2 levels were analyzed. Results Compared with the healthy control group, serum levels of c GAMP and HtrA2 were significantly increased in the SP group(t =14.512, 14.231, both P <0.001). Compared with the non-critical SP subgroup, serum levels of c GAMP and HtrA2 were significantly increased in the critical SP subgroup(t = 4.334, 4.363, both P <0.001). Serum c GAMP and HtrA2 levels in SP patients were positively correlated with disease severity(r = 0.498, 0.500, both P <0.001). The incidence of MI among the 102 SP patients was 50.98%(52/102). Compared with the non-MI subgroup, the MI subgroup had significantly higher levels of cardiac troponin I(cTnI), creatine kinase isoenzyme MB(CK-MB), c GAMP, and HtrA2(t = 3.444, 3.270, 5.926, 6.310; P = 0.001,0.001, <0.001, <0.001). Elevated c Tn I, elevated CK-MB, elevated c GAMP, and elevated HtrA2 were independent risk factors for MI in SP patients [OR(95%CI) = 2.326(1.270-4.260), 1.117(1.002-1.246), 2.054(1.390-3.034), 1.263(1.116-1.429)].The AUCs of serum c GAMP, HtrA2, and their combination in predicting MI in SP patients were 0.789, 0.800, and 0.912, respectively. The combined detection was superior to either marker alone(Z = 3.484, 3.132;P = 0.001, 0.002). Conclusion Elevated serum c GAMP and HtrA2 levels in SP patients are associated with increased disease severity and the occurrence of MI.Their combination demonstrates high predictive efficacy for MI.

目的 基于炎性相关指标与凝血标志物构建慢性阻塞性肺疾病(COPD)合并肺动脉高压患者预后的列线图模型，并验证其预测效能。方法 回顾性选取2023年1月—2025年5月山西白求恩医院呼吸与危重症医学科收治的COPD合并肺动脉高压患者296例临床资料，以7∶3比例分为训练集(n=207)与验证集(n=89)，根据治疗1周时预后情况将训练集患者分为预后良好亚组(n=156)与预后不良亚组(n=51);采用多因素Logistic回归分析COPD合并肺动脉高压患者预后的影响因素，并构建列线图模型;使用受试者工作特征(ROC)曲线、校准曲线、决策曲线评估模型的预测效能与临床效用。结果 预后不良亚组肺动脉高压分级Ⅲ级、合并高血压占比及NOD样受体家族蛋白3(NLRP3)、高迁移率族蛋白B1(HMGB1)、血管性血友病因子(v WF)水平高于预后良好亚组，治疗1周时格拉斯哥预后评分(GOS)低于预后良好亚组(χ2/P=4.823/0.028、4.356/0.037,t/P=5.760/<0.001、2.975/0.003、6.867/<0.001、4.017/<0.001);预后不良亚组C反应蛋白(CRP)、NEU与LYM比值(NLR)、PLT与LYM比值(PLR)、D二聚体(D-D)、纤维蛋白原(Fib)高于预后良好亚组，抗凝血酶Ⅲ(AT-Ⅲ)水平低于预后良好亚组(t/P=3.431/0.001、5.267/<0.001、5.320/<0.001、4.628/<0.001、4.527/<0.001、5.152/<0.001);合并高血压、PLR、NLRP3、HMGB1、D-D、v WF水平升高均是COPD合并肺动脉高压患者预后不良的独立危险因素[OR(95%CI)=4.016(1.119～14.412)、1.037(1.010～1.066)、1.069(1.023～1.118)、1.710(1.015～2.880)、9.679(1.038～90.243)、1.054(1.023～1.086)],AT-Ⅲ水平升高、治疗1周时GOS评分高是独立保护因素[OR(95%CI)=0.918(0.851～0.989)、0.184(0.041～0.824)];ROC曲线显示，基于炎性相关指标与凝血标志物构建的列线图模型在训练集与验证集中的曲线下面积分别为0.937(95%CI 0.903～0.970)、0.938(95%CI 0.883～0.993);校准曲线显示，模型在训练集与验证集中的预测风险与实际风险一致性良好;决策曲线提示，训练集与验证集中风险阈值概率范围分别在0.01～0.89、0.01～1.00时，模型可产生较高的临床净受益率，最大净受益率分别为0.229、0.240;训练集与验证集中列线图模型预测患者预后的曲线下面积均大于GOS评分预测(Z/P=3.573/<0.001、4.108/<0.001)。结论 基于炎性相关指标与凝血标志物构建的列线图模型对COPD合并肺动脉高压患者预后具有较好预测效能与实用性。

目的 探讨血清血小板反应蛋白-4(TSP-4)、足萼糖蛋白(Podxl)在糖尿病下肢动脉硬化闭塞症(LEASO)中的表达及与病情程度的相关性。方法 选取2021年1月—2024年9月青海省中医院内分泌科收治的糖尿病LEASO患者100例(LEASO组)，按照1∶1比例选取同期收治的单纯糖尿病患者100例(非LEASO组)，根据Fontaine分期将糖尿病LEASO患者分为Fontaine分期Ⅰ～Ⅱ期亚组(58例)和Ⅲ～Ⅳ期亚组(42例)。采用酶联免疫吸附法检测血清TSP-4、Podxl水平;多因素Logistic回归分析糖尿病LEASO患者病情程度的影响因素;受试者工作特征(ROC)曲线分析血清TSP-4、Podxl水平对糖尿病LEASO患者的诊断价值及对Fontaine分期Ⅲ～Ⅳ期的预测价值。结果 LEASO组血清TSP-4、Podxl水平高于非LEASO组(t/P=9.657/<0.001、11.720/<0.001); Fontaine分期Ⅲ～Ⅳ期亚组血清TSP-4、Podxl水平高于Ⅰ～Ⅱ期亚组(t/P=5.346/<0.001、6.256/<0.001);多因素Logistic回归分析显示，Hb A1c高、TSP-4高、Podxl高为糖尿病LEASO患者Fontaine分期Ⅲ～Ⅳ期的独立危险因素[OR(95%CI)=3.066(1.313～7.159)、3.251(1.425～7.416)、1.112(1.049～1.180)]，踝肱指数(ABI)高为独立保护因素[OR(95%CI)=0.451(0.282～0.722)]; ROC曲线分析显示，血清TSP-4、Podxl及二者联合诊断糖尿病LEASO的曲线下面积(AUC)分别为0.833、0.841、0.935，二者联合优于各自单独诊断(Z/P=4.372/<0.001、3.778/<0.001);血清TSP-4、Podxl水平及二者联合预测糖尿病LEASO患者Fontaine分期Ⅲ～Ⅳ期的AUC分别为0.788、0.798、0.877，二者联合优于各自单独预测(Z/P=2.450/0.015、1.996/0.047)。结论 糖尿病LEASO患者血清TSP-4、Podxl水平升高，且与病情程度加重有关，血清TSP-4、Podxl水平联合检测对糖尿病LEASO诊断和病情评估具有较高价值。