Objective To investigate the correlation of serum levels of soluble programmed death ligand 1(sPD-L1),tumor necrosis factor-associated apoptosis-inducing ligand(TRAIL)and fibroblast growth factor 23(FGF-23)with risk stratification and death in patients with acute pulmonary embolism(APE).Methods A total of 113 pa-tients with APE admitted to the hospital from January 2022 to January 2024 were selected as APE group,and 50 healthy subjects were selected as control group.The 113 patients with APE were divided into high risk group(39 cases),medium risk group(45 cases)and low risk group(29 cases)by risk stratification.Accord-ing to the death of APE patients,they were divided into survival group(83 cases)and death group(30 cases).The levels of serum sPD-L1,TRAIL and FGF-23 were measured by enzyme-linked immunosorbent assay(ELISA).Multiple Logistic regression was used to analyze the risk factors affecting death of APE patients.Receiver operating characteristic(ROC)curve was drawn to analyze the value of serum sPD-L1,TRAIL and FGF-23 levels in evaluating mortality in APE patients.Pearson correlation analysis was used to investigate the correlation between serum sPD-L1,TRAIL and FGF-23 levels and cardiac function indicators in APE patients.Results The levels of serum sPD-L1,TRAILand FGF-23 in the APE group were significantly higher than those in the control group(P＜0.001).The serum sPD-L1,TRAIL and FGF-23 levels in the death group were significantly higher than those in the survival group(P＜0.001).The levels of serum sPD-L1,TRAIL and FGF-23 in the high-risk group were higher than those in the medium and low-risk groups,and the medium risk group was higher than the low-risk group,and the differences were statistically significant(P＜0.001).Multiple Logistic regression analysis showed that elevated levels of cardiac troponin Ⅰ(cTnⅠ),B type brain na-triuretic peptide(BNP),sPD-L1,TRAIL and FGF-23 were risk factors for mortality in APE patients(P＜0.05).ROC curve analysis showed that the combination of sPD-L1,TRAIL and FGF-23 had the largest area under curve for predicting death in APE patients,which was 0.924(95％CI:0.861-0.986),with a sensitivity of 96.8％and a specificity of 81.2％.Correlation analysis showed that the levels of serum sPD-L1,TRAIL and FGF-23 were positively correlated with cTnⅠ and BNP in APE patients(P＜0.001).Conclusion The lev-els of serum sPD-L1,TRAIL and FGF-23 are significantly elevated in APE patients,and their high expression is associated with high-risk stratification and mortality.The combination of these three indexes has good eval-uation value for APE patient mortality.

Objective To investigate the relationship between plasma metalloproteinase-tissue inhibitor 1 (TIMP-1),vascular endothelial growth factor (VEGF) and potentially transforming growth factor binding protein 2 (LTBP-2) levels and risk stratification and death in patients with acute pulmonary embolism (APE). Methods A toral of 110 APE patients admitted to the Third People's Hospital of Haikou from January 2022 to January 2024 were selected for risk stratification,and they were divided into low-risk group(n=28),medium-risk group(n=43) and high-risk groups(n=39). According to the occurrence of death in APE patients,they were divided into a survival group (n=79)and a death group(n=31). Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of plasma TIMP-1,VEGF and LTBP-2. Applying multiple Logistic regression analysis to identify risk factors affecting the mortality of APE patients and plotting ROC curve to analyze the predictive value of plasma TIMP-1,VEGF and LTBP-2 levels for APE patients mortality and. Pearson correlation analysis was used to analyze the correlation between plasma levels of TIMP-1,VEGF and LTBP-2 and clinical indexes in APE patients. Results The heart rate,B-type brain natriuretic peptide (BNP),D-dimer,TIMP-1(207.15±62.84pg/ml vs 152.48±41.62pg/ml),VEGF (726.35±190.46pg/ml vs 419.27±115.28pg/ml) and LTBP-2(29.17±6.38ng/ml vs 13.26±3.70ng/ml) levels in the death group were significantly higher than those in the survival group,the difference were statistically significant (t=5.386～21.194,all P<0.05). The levels of plasma TIMP-1(204.15±60.17 pg/ml,178.18±51.30pg/ml vs 148.20±34.80pg/ml),VEGF(720.83±204.18pg/ml,580.16±158.37pg/ml vs 412.15±109.26pg/ml) and LTBP-2(28.40±6.41ng/ml,21.37±5.26ng/ml vs 12.84±3.12ng/ml) in high-risk and medium-risk groups were significantly higher than those in the low-risk group(t=8.417～19.850),and those in the high-risk group were higher than those in the medium-risk group(t=7.964,9.381,11.470),the differences were statistically significant (all P<0.05),respectively. Multiple Logistic regression analysis showed that increased plasma BNP,D-dimer,TIMP-1,VEGF and LTBP-2 levels were risk factors for death in APE patients (all P<0.05). ROC curve analysis showed that TIMP-1,VEGF and LTBP-2 combined predicted the highest AUC(95％CI) of death in APE patients[0.938(0.881～0.997)],with an accuracy of 88.2％. Pearson correlation analysis showed that the levels of plasma TIMP-1,VEGF and LTBP-2 in APE patients were positively correlated with BNP and D-dimer (r=0.416～0.753,all P<0.05). Conclusion Elevated levels of plasma TIMP-1,VEGF and LTBP-2 are associated with high risk and mortality in APE,and the combination of these three factors has good predictive value for mortality in APE patients.

Objective To investigate the relationship between plasma metalloproteinase-tissue inhibitor 1 (TIMP-1),vascular endothelial growth factor (VEGF) and potentially transforming growth factor binding protein 2 (LTBP-2) levels and risk stratification and death in patients with acute pulmonary embolism (APE). Methods A toral of 110 APE patients admitted to the Third People's Hospital of Haikou from January 2022 to January 2024 were selected for risk stratification,and they were divided into low-risk group(n=28),medium-risk group(n=43) and high-risk groups(n=39). According to the occurrence of death in APE patients,they were divided into a survival group (n=79)and a death group(n=31). Enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of plasma TIMP-1,VEGF and LTBP-2. Applying multiple Logistic regression analysis to identify risk factors affecting the mortality of APE patients and plotting ROC curve to analyze the predictive value of plasma TIMP-1,VEGF and LTBP-2 levels for APE patients mortality and. Pearson correlation analysis was used to analyze the correlation between plasma levels of TIMP-1,VEGF and LTBP-2 and clinical indexes in APE patients. Results The heart rate,B-type brain natriuretic peptide (BNP),D-dimer,TIMP-1(207.15±62.84pg/ml vs 152.48±41.62pg/ml),VEGF (726.35±190.46pg/ml vs 419.27±115.28pg/ml) and LTBP-2(29.17±6.38ng/ml vs 13.26±3.70ng/ml) levels in the death group were significantly higher than those in the survival group,the difference were statistically significant (t=5.386～21.194,all P<0.05). The levels of plasma TIMP-1(204.15±60.17 pg/ml,178.18±51.30pg/ml vs 148.20±34.80pg/ml),VEGF(720.83±204.18pg/ml,580.16±158.37pg/ml vs 412.15±109.26pg/ml) and LTBP-2(28.40±6.41ng/ml,21.37±5.26ng/ml vs 12.84±3.12ng/ml) in high-risk and medium-risk groups were significantly higher than those in the low-risk group(t=8.417～19.850),and those in the high-risk group were higher than those in the medium-risk group(t=7.964,9.381,11.470),the differences were statistically significant (all P<0.05),respectively. Multiple Logistic regression analysis showed that increased plasma BNP,D-dimer,TIMP-1,VEGF and LTBP-2 levels were risk factors for death in APE patients (all P<0.05). ROC curve analysis showed that TIMP-1,VEGF and LTBP-2 combined predicted the highest AUC(95％CI) of death in APE patients[0.938(0.881～0.997)],with an accuracy of 88.2％. Pearson correlation analysis showed that the levels of plasma TIMP-1,VEGF and LTBP-2 in APE patients were positively correlated with BNP and D-dimer (r=0.416～0.753,all P<0.05). Conclusion Elevated levels of plasma TIMP-1,VEGF and LTBP-2 are associated with high risk and mortality in APE,and the combination of these three factors has good predictive value for mortality in APE patients.

Objective To investigate the prognostic value of microRNA-122 (miR-122) combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ) score in patient with acute respiratory distress syndrome (ARDS), and to provide evidence for the diagnosis and treatment of ARDS. Methods ARDS patients admitted to the Third People's Hospital of Haikou City from January 2016 to December 2018 were enrolled. The general data, serum miR-122 expression level and APACHEⅡ score within 24 hours were collected. The patients were divided into survival group and death group according to the survival status of ARDS patients. ARDS patients were divided into low-risk group ( < 10 scores), medium-risk group (10-20 scores) and high-risk group ( > 20 scores) according to APACHEⅡ score. Predictive values of miR-122 and APACHEⅡ scores on prognosis in ARDS patients were evaluated by the receiver operating characteristic (ROC) curve. The correlation between the serum miR-122 expression and APACHEⅡscore in patients with ARDS was calculated by Pearson correlation analysis. Results A total of 142 ARDS patients were selected, 94 male and 48 female; with age (56.80±11.30) years old; 55 deaths and 87 survivors; 67 of high-risk, 48 of medium-risk and 27 of low-risk. The expression of serum miR-122 and APACHEⅡ score in the death group were significantly higher than those in the survival group [miR-122 (2-ΔΔCt): 0.26±0.12 vs. 0.07±0.03, APACHEⅡ:31.84±4.25 vs. 15.30±2.60, both P < 0.01]. With the severity increase of the disease, the serum miR-122 expression level, APACHEⅡ score, and mortality rate of ARDS patients gradually elevated, and the difference between the two groups was significant in the low-risk group, medium-risk group, and high-risk group [miR-122 (2-ΔΔCt):0.05±0.02, 0.14±0.06, 0.23±0.09; APACHEⅡ: 12.30±2.15, 20.62±3.40, 28.90±3.60; mortality rate: 11.1%, 31.2%, 55.2%, respectively, all P < 0.05]. ROC curve analysis showed that miR-122 and APACHEⅡ score could predict the death of ARDS patients, and the area under the ROC curve (AUC) was 0.835 [95% confidence interval (95%CI) = 0.776-0.893] and 0.790 (95%CI = 0.732-0.854); the predicted value of the miR-122 combined with APACHEⅡscore (AUC = 0.918, 95%CI = 0.857-0.972) was higher than the single miR-122 and APACHEⅡscore (both P < 0.05), with sensitivity and specificity were 91.3% and 86.4% respectively. The correlation analysis showed that the expression of serum miR-122 was positively correlated with APACHEⅡscore in death patient with ARDS (r = 0.825, P < 0.01). Conclusion Elevated serum miR-122 expression level is associated with disease severity and prognosis of ARDS patients; miR-122 combination with APACHEⅡ score has a high evaluation value on prognosis of ARDS patients.