1.Variations of Chemical Components in Gardeniae Fructus Before and After Being Charred Analyzed by UPLC-Q-Orbitrap MS/MS
Lan LI ; Jie HONG ; Yanan SONG ; Yilan LI ; Yun WANG ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(4):175-182
ObjectiveTo investigate the changes in chemical components of Gardeniae Fructus(GF) before and after being charred, providing data support for research on the material basis of GF Carbonisata(GFC). MethodsUltra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry(UPLC-Q-Orbitrap MS/MS) was used to conduct a comprehensive analysis of the chemical components in GF and GFC under positive and negative ion modes with Compound Discoverer 3.3 software and online database. Then, principal component analysis and partial least squares-discriminant analysis in SIMCA14.1 software were used to analyze the MS data of each sample. Based on the principle of variable importance in the projection(VIP) value>1, differential secondary and primary metabolites before and after carbonization were screened. In addition, MetaboAnalyst website was used for pathway enrichment of Kyoto Encyclopedia of Genes and Genomes(KEGG), so as to provide a reference for clarifying the processing mechanism. ResultsA total of 185 components were identified, including 96 secondary metabolites and 89 primary metabolites. These components were classified into nine categories, primarily including iridoid glycosides, flavonoids, and terpenoids, their fragmentation pathways were also analyzed. Simultaneously, multivariate statistical analysis was performed on the secondary and primary metabolites, identifying 70 and 59 differential metabolites, respectively. The secondary metabolites were enriched in two metabolic pathways, including C5-branched dibasic acid metabolism and flavonoid and flavonol biosynthesis, while the primary differential metabolites were enriched in seven pathways such as linoleic acid metabolism and tyrosine metabolism. ConclusionThe chemical components of GF change significantly after carbonization, with a significant decrease in the contents of iridoid glycosides and terpenoids such as hydroxyisogeniposide, crocin Ⅱ, crocetin, and jasminoside B. while the contents of 4-hydroxycoumarin, geniposidic acid, gentiopicroside, and gardenoside methyl ester increase significantly. This change is presumed to be associated with the enhanced cooling and hemostatic effects of the processed products. The identified key components provide a basis for elucidating the material basis underlying the efficacy changes before and after carbonization.
2.Effects of Modified Buyang Huanwu Tang on Mice with Cerebral Ischemia-reperfusion Injury by Regulating PINK1/Parkin Signaling Pathway-mediated Mitochondrial Autophagy
Li GUO ; Hengwen CHEN ; Cun ZHAN ; Zhenzhen YING ; Zuomin WU ; Shaoju JIN ; Shangmei CAO ; Shengming HUANG ; Jin WANG ; Xiaotao YU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(11):34-43
ObjectiveTo investigate the effects of modified Buyang Huanwu Tang on cerebral ischemia-reperfusion injury (CI/RI) in mice via the PTEN-induced putative kinase 1/E3 ubiquitin ligase (PINK1/Parkin) signaling pathway-mediated mitophagy, and to explore the underlying mechanism by which modified Buyang Huanwu Tang improves CI/RI. MethodsSeventy-two male C57BL/6J mice were randomly divided into six groups (n = 12 per group): Sham-operated group, middle cerebral artery occlusion/reperfusion (MCAO/R) model group, low-, medium-, and high-dose modified Buyang Huanwu Tang groups (8.84, 17.68, 35.36 g·kg-1·d-1), and an aspirin group (13.00 mg·kg-1·d-1). Neurological deficit scores were assessed using the Zea-Longa method. Cerebral infarct volume ratio was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Histopathological changes and neuronal injury in brain tissues were observed using hematoxylin-eosin (HE) staining and Nissl staining. Apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Mitochondrial ultrastructure in brain tissue was observed by transmission electron microscopy (TEM). Serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were determined by enzyme-linked immunosorbent assay (ELISA). The mRNA and protein expression levels of PINK1, Parkin, microtubule-associated protein 1 light chain 3B (LC3B, LC3Ⅱ/Ⅰ), and p62 in brain tissues were detected by real-time quantitative reverse transcription PCR (Real-time PCR) and Western blot, respectively. ResultsCompared with the sham-operated group, the MCAO/R model group showed significantly increased neurological deficit scores and cerebral infarct volume ratios (P<0.01). Severe cortical injury on the infarct side was observed, characterized by decreased neuronal density, cytoplasmic vacuolation, nuclear pyknosis, a marked reduction in Nissl bodies, dissolution of Nissl bodies in the cytoplasm of some pyramidal neurons, and blurred cellular boundaries. The number of TUNEL-positive cells increased significantly (P<0.01). Mitochondria exhibited cristae membrane rupture and matrix vacuolation, with rupture of the outer mitochondrial membrane and formation of autophagosomes, the number of which increased significantly. Serum SOD activity decreased significantly (P<0.01), while MDA content increased significantly (P<0.01). In infarcted brain tissues of model mice, the relative mRNA expression and protein levels of PINK1, Parkin and LC3B were significantly increased (P<0.05, P<0.01), whereas p62 mRNA and protein expression were significantly decreased (P<0.05, P<0.01), showing statistical significance. Compared with the model group, all treatment groups showed significantly decreased neurological deficit scores and cerebral infarct volume ratios (P<0.01). Neuronal density increased significantly, cytoplasmic vacuolation was alleviated, nuclear morphology tended to be more regular and clearer, Nissl body density increased significantly with reduced dissolution and improved contour clarity. The mitochondrial cristae structure was partially restored, with some mitochondria showing autophagosome encapsulation, and the degree of mitochondrial damage was alleviated. Serum SOD activity increased significantly (P<0.01), while MDA content decreased significantly. The mRNA and protein expression levels of PINK1, Parkin, and LC3Ⅱ/Ⅰ were significantly increased (P<0.05, P<0.01), while p62 mRNA and protein expression in the low- and medium-dose modified Buyang Huanwu Tang groups were significantly decreased (P<0.05, P<0.01), showing statistical significance. ConclusionModified Buyang Huanwu Tang can upregulate the protein expression levels of PINK1, Parkin, and LC3Ⅱ/Ⅰ and downregulate p62 protein expression, suggesting that it may improve CI/RI by regulating the expression of proteins related to the PINK1/Parkin signaling pathway. Regulation of the mitophagy pathway may be one of the mechanisms by which modified Buyang Huanwu Tang alleviates CI/RI in mice.
3.Genetic characteristics of VP1 region of Coxsackievirus A10 in Yunnan Province
Yihui CAO ; Bingjun TIAN ; Zhichao WANG ; Jianping CUN ; Xiaofang ZHOU ; Lili JIANG ; Enfa QIAO
Journal of Public Health and Preventive Medicine 2025;36(6):25-29
Objective To investigate the genetic characteristics of the VP1 region of Coxsackievirus A10 (CVA10) in Yunnan Province. Methods Fecal samples of suspected hand, foot and mouth disease (HFMD) were subjected to real-time fluorescent quantitative PCR for detection of enterovirus CVA10. Positive samples were subjected to VP1 gene sequence amplification and Sanger sequencing. Sequence splicing was performed with DNAstar7.1 Seqman software, and nucleotide sequence and amino acid site analysis were performed using Mega 6.0 software. Results The sequencing of VP1 gene of CVA10 obtained a sequence of 894 nucleotides, encoding 298 amino acids. Compared with the original strain, there were mainly three active amino acid mutation regions, 13-33, 141-142, and 283-285. The nucleotide difference rate between the Yunnan isolates and the reference strain ranged from 16.92% to 30.90%, and the amino acid difference rate ranged from 2.58% to 4.00%. C1 and C2 group nucleotide difference was 10.58%, and the amino acid difference rate was 1.80%. The VP1 150-176 region exhibited highly conserved characteristics. Six CVA10 strains and Sichuan strain MW178898 belonged to the C1 group of the C genotype. The other 14 CVA10 strains belonged to the C2 group. Conclusion VP1 gene mutation is active and CVA10 is an important pathogen of HFMD in Yunnan. C2 genotype of CVA10 is dominant in this study, and C1 and C2 have co-circulated in Yunnan. It is necessary to strengthen monitoring and develop multivalent vaccines containing CVA10 epidemic genotype.
4.Analysis on Dynamic Change of Stir-fried Glycyrrhizae Radix et Rhizoma Quality Based on "Exterior-interior Correlation"
Yue XU ; Zhe JIA ; Yun WANG ; Bing LI ; Deling WU ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(5):194-202
ObjectiveIn order to provide a reference for the optimization of preparation process of stir-fried Glycyrrhizae Radix et Rhizoma(sf-GRR), the quality changes during the processing was studied. MethodsGlycyrrhizae Radix et Rhizoma was processed by stir-frying for 17 min, and samples were collected every 1 min during the processing. The appearance color of the samples was determined by visual analysis technology, the moisture and extract of the process samples were detected by the drying method and the hot extraction method of alcohol-soluble extract in the general rules of the 2020 edition of Chinese Pharmacopoeia(part Ⅳ), and the contents of liquiritin apioside, liquiritin, isoliquiritin apioside, isoliquiritin, licoricesaponin G2 and glycyrrhizic acid in the process samples were determined by high performance liquid chromatography(HPLC). Then principal component analysis(PCA), partial least squares-discriminant analysis(PLS-DA) and Spearman correlation analysis were used for clustering, discrimination and correlation analysis of the appearance color, moisture, extract and the contents of six internal components. Based on artificial neural network and random forest algorithm, the prediction model of processing degree of sf-GRR was established. On this basis, based on the five principles of quality marker(Q-Maker), explore the monitoring Q-Maker of sf-GRR. ResultsThe color of Glycyrrhizae Radix et Rhizoma deepened after stir-frying, and the appearance color of the sample changed from light yellow to dark yellow during processing. During the stir-frying process, the moisture content showed a decreasing trend with the extension of processing time, while the extract content showed an increasing trend with the extension of processing time. After stir-frying, the contents of liquiritin apioside, liquiritin and licoricesaponin G2 showed an overall decreasing trend, while the contents of isoliquiritin apioside and isoliquiritin increased, and the content of glycyrrhizic acid increased slightly. The correlation analysis showed that moisture was positively correlated with brightness(L*) and red/green value(a*), and negatively correlated with yellow/blue value(b*) and total color difference(E*ab). Isoliquiritin apioside and isoliquiritin had negative correlation with L* and a*, and positive correlation with b* and E*ab. The processing process of sf-GRR could be divided into two stages of the early stage(0-14 min) and the late stage(15-17 min), and could be divided into three stages of the early stage(0-6 min), the middle stage(7-14 min) and the late stage(15-17 min) by combining the moisture, extract, the contents of 6 components and color values. Based on artificial neural network analysis and random forest algorithm, isoliquiritin apioside, isoliquiritin, liquiritin and glycyrrhizic acid were selected as monitoring markers for sf-GRR. ConclusionBased on the analysis of the exterior-interior indicators of process samples of sf-GRR, this paper ultimately identifies four processing monitoring markers, which can provide a basis for optimizing the processing technology of sf-GRR.
5.Processing History and Modern Research of Jianghuanglian: A Review
Ying LI ; Yun WANG ; Zhe JIA ; Lin YAN ; Min JIN ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(6):275-282
Jianghuanglian is one of the representative processed products of Coptidis Rhizoma for treating cold syndrome with drugs of heat nature, and ginger is used to restrict the bitter cold of Coptidis Rhizoma, which can be traced back to Bojifang, and it is suitable for stagnation of damp-heat in middle-jiao, cold-heat mutual knots and other symptoms. Jianghuanglian retains the alkaloids, phenylpropanoids and flavonoids of Coptidis Rhizoma, and also introduces gingerol components such as 6-gingerol in ginger, which has pharmacological activities such as anti-inflammatory, antibacterial, anti-tumor, and improving gastrointestinal function. The 2020 edition of Chinese Pharmacopoeia and many local processing specifications have included the traditional processing process and quality standards of Jianghuanglian, but the specific process parameters and quality standards are incomplete, which limits the production and clinical application of this processed product. By summarizing the processing history, process research, quality evaluation, pharmacodynamic and medicinal property changes and application of Jianghuanglian in the past 20 years, there are differences in the processing methods and standards in various provinces and cities, which are mainly reflected in the preparation method, dosage, processing process and quantitative standards of ginger juice. In addition, there are also certain differences in the changes of the main components of Jianghuanglian prepared from ginger or dried ginger, as well as their efficacy and medicinal properties. The research on the processing process of Jianghuanglian plays an important role in improving its quality standards, and this review can provide a reference for improving the quality evaluation system of Jianghuanglian.
6.Distribution Tendency of Traditional Chinese Medicine Syndromes in Chronic Persistent Immunoglobulin A Nephropathy and Its Relationship with Prognosis
Kang ZHANG ; Long TANG ; Cun SHEN ; Mengdi WANG ; Yuan MENG ; Wenjing ZHAO
Journal of Guangzhou University of Traditional Chinese Medicine 2025;42(5):1052-1059
Objective To investigate the distribution of traditional Chinese medicine(TCM)syndromes in chronic persistent immunoglobulin A nephropathy(IgAN)and to explore the relationship between TCM syndromes and prognosis based on real-world research.Methods From January 2018 to January 2024,a total of 80 patients with chronic persistent IgAN who were admitted to Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University were included.The clinical baseline data and prognosis-related information were collected.The main outcome indicators were defined as renal failure events of glomerular filtration rate(eGFR)decreased by>50%,serum creatinine doubled or end-stage renal disease(ESRD).The distribution of TCM syndromes in chronic persistent IgAN and the relationship between different deficiency syndromes and prognosis were preliminarily discussed.Results(1)Among the 80 patients with chronic persistent IgAN,the syndrome manifestations with an occurrence frequency of more than 30%in descending order were foamy urine(75.00%),fatigue and lassitude(71.25%),waist ache(61.25%),dry mouth(31.25%),lower extremity edema(31.25%),aversion to cold and cold limbs(30.00%),and insomnia(30.00%).(2)The commonly-seen root-deficiency syndrome in patients with chronic persistent IgAN was qi and yin deficiency syndrome,with a total of 28 cases(35.00%).And other root-deficiency syndromes were spleen and kidney yang deficiency syndrome in 22 cases(27.50%),lung and spleen qi deficiency syndrome in 15 cases(18.75%),and liver and kidney yin deficiency syndrome in 15 cases(18.75%).The commonly-seen complicated syndrome was water-damp syndrome,with a total of 17 cases(21.25%).The other complicated syndromes were damp-heat syndrome in 15 cases(18.75%),blood-stasis syndrome in 9 cases(11.25%),phlegm-damp syndrome in 7 cases(8.75%),turbidity-toxin syndrome in 5 cases(6.25%),liver depression syndrome in 3 cases(3.75%),and cold-damp syndrome in 1 case(1.25%).(3)Among the 80 patients with chronic persistent IgAN,21 cases(26.25%)had renal failure events,and their syndrome types were lung and spleen qi deficiency syndrome in 9 cases(60.00%),qi and yin deficiency syndrome in 3 cases(10.71%),liver and kidney yin deficiency syndrome in 3 cases(20.00%),and spleen and kidney yang deficiency syndrome in 6 cases(27.27%).The incidence of renal failure events in patients with lung and spleen qi deficiency syndrome was significantly higher than that in the other three syndrome types,and the chi-square test showed that the difference was statistically significant(P<0.05).(4)Kaplan-Meier survival analysis showed that the cumulative incidence of 2-year and 5-year endpoint events in patients with lung and spleen qi deficiency syndrome was 23.10%and 46.20%,respectively,and the final incidence was 85.00%.The cumulative incidence of 2-year and 5-year endpoint events in patients with other deficiency syndromes was 4.50%and 19.70%,respectively,and the final incidence was 71.60%.The intergroup comparison(tested by Log-rank)showed that the incidence of renal failure events in patients with lung and spleen qi deficiency syndrome was significantly higher than that in patients with other root-deficiency syndromes,and the difference was statistically significant(P<0.05).(5)COX proportional hazard regression analysis showed that lung and spleen qi deficiency syndrome(HR=7.755,95%CI 1.631-36.874,P<0.05)and anemia(HR=8.205,95%CI 1.007-66.857,P<0.05)were the independent risk factors for renal failure events in patients with chronic persistent IgAN.Conclusion Qi and yin deficiency syndrome is the most common syndrome in the patients with chronic persistent IgAN,and lung and spleen qi deficiency syndrome and anemia are the independent risk factors for renal failure events in IgAN.
7.Thoughts on Development Path of Traditional Chinese Medicine Processing Technology from Perspective of Traditional Medicine and Techniques
Ying LIU ; Yun WANG ; Zhe JIA ; Peng ZHANG ; Jie ZOU ; Cun ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(20):233-240
As an important part of Chinese traditional culture, the processing technology of traditional Chinese medicine(TCM) carries the wisdom of TCM for thousands of years, and its process is complex and rigorous. With the popularization of modern production technology, traditional processing techiques are facing the dual pressures from technological innovation and production standardization under the perspective of intangible cultural heritage. The modernization of TCM processing technology is an inevitable trend for industrial upgrading, but it cannot be separated from the foundation of traditional skills and ignore the core concepts and cultural values it embodies. Therefore, by analyzing the core characteristics of TCM processing technology and its differences with modern production, this paper discusses the establishment of a synergistic innovation mechanism between traditional techniques and modern technologies, the promotion of joint research and development between scientific research institutes and the industry, the strengthening of standardization of processing techniques, and the enhancement of social education and industry training to improve the recognition and inheritance of processing techniques in order to achieve the goal of innovation and protection of TCM processing technologies in the context of modernization, and to promote the high-quality development of the TCM processing industry.
8.Mechanism of Huazhuo Jiedu Prescription in Alleviating Renal Fibrosis in 5/6 Nephrectomy Rats Based on AMPK/mTOR Pathway
Wanqing WANG ; Yashi WANG ; Hui GAO ; Linlin ZHENG ; Dong BIAN ; Cun FENG ; Xiaona WEI
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(22):90-97
ObjectiveBased on the AMP-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) signaling pathway, this study aimed to observe the effect of the Huazhuo Jiedu prescription on renal fibrosis in 5/6 nephrectomy rats and explore its underlying mechanism. MethodsA total of 67 SPF-grade male SD rats were used, of which 11 were randomly selected as the normal group. A chronic renal failure (CRF) model was established using 5/6 nephrectomy. The successfully modeled rats were randomly assigned to the model group, losartan potassium group (4.5 mg·kg-1), and low- (1.175 g·kg-1), medium- (2.35 g·kg-1) and high-dose (4.7 g·kg-1) Huazhuo Jiedu prescription groups, with 9 rats per group. Each group received an equivalent volume of saline or the corresponding concentration of Huazhuo Jiedu prescription by gavage once daily for 8 weeks. Hematoxylin-eosin (HE) and Masson staining were used to observe renal tissue pathological changes. Transmission electron microscopy examined renal ultrastructure. Immunohistochemistry (IHC) detected expressions of α-smooth muscle actin (α-SMA) and transforming growth factor-β1 (TGF-β1). Western blot analyzed expression levels of microtubule-associated protein Ⅰ light chain 3Ⅱ (LC3Ⅱ), Beclin1, p62, AMPK, phosphorylated AMPK (p-AMPK), mTOR, and phosphorylated mTOR (p-mTOR). ResultsCompared with the normal group, the model group exhibited glomerular shrinkage, mesangial and interstitial thickening, and tubular vacuolar degeneration, with no evident autophagosomes or autophagolysosome structures. Expression levels of α-SMA and TGF-β1 were significantly increased (P0.01), while p-AMPK/AMPK, Beclin1, and LC3Ⅱ were significantly decreased (P0.01), and p-mTOR/mTOR and p62 were significantly increased (P0.01). Compared with the model group, the medium- and high-dose Huazhuo Jiedu prescription groups and the losartan potassium group showed varying degrees of pathological improvement. Autophagosomes with double- or multiple-layer membranes and autophagolysosomes with monolayer membranes containing undegraded organelles were observed. Renal α-SMA and TGF-β1 protein expression levels were markedly reduced (P0.05, P0.01), p-mTOR/mTOR and p62 were significantly decreased (P0.05, P0.01), and p-AMPK/AMPK, Beclin1, and LC3Ⅱ expression levels were significantly increased (P0.05, P0.01). ConclusionHuazhuo Jiedu prescription may improve renal fibrosis in 5/6 nephrectomy rats by regulating the AMPK/mTOR signaling pathway and enhancing autophagy.
9.Protective effects of paeonol on human neuroblastoma cells in Parkinson's disease model and its underlying mechanism
Sheng-Nan SUN ; Lu-Lu HE ; Shao-Chen QIN ; Lei XU ; Li-Ran WANG ; Bao-Feng YU ; Cun-Gen MA ; Hui-Jie FAN ; Zhi CHAI
Medical Journal of Chinese People's Liberation Army 2025;50(1):69-75
Objective To investigate the protective effects of paeonol(PAE)on autophagy in human neuroblastoma cells(SH-SY5Y)induced by overexpression of α-synuclein(α-Syn),and to explore its related mechanism.Methods SH-SY5Y cells served as control group,while those induced with A53T-α-Syn mutation were used as model group.Additional groups included PAE(150 μg/ml)group,3-MA(1 mmol/L)group,and PAE(150 μg/ml)+3-MA(1 mmol/L)group.Cell viability was assessed using CCK-8 method,cell morphology was observed under an optical microscope,and protein expressions of α-Syn,LC3-Ⅱ,p62,Beclin-1,phosphorylated c-Jun N-terminal kinase(p-JNK),and p-Bcl-2 were determined by Western blotting.Results Compared with control group,model control exhibited decreased cell survival(P<0.01),increased α-Syn expression(P<0.001),reduced expression of autophagy-related proteins LC3-Ⅱ and Beclin-1(P<0.01,P<0.05),elevated autophagy substrate protein p62(P<0.05),and decreased expression of autophagy pathway-related proteins p-JNK and Bcl-2(P<0.05,P<0.01).Compared with model group,PAE group showed increased cell survival(P<0.01),decreased α-Syn and p62 protein expression(P<0.01,P<0.05),and increased expression of LC3-Ⅱ,Beclin-1,p-JNK and Bcl-2(P<0.05).Compared with PAE group,3-MA+PAE group demonstrated increased α-Syn expression(P<0.05).Conclusions PAE could attenuate the injury of SH-SY5Y cells induced by A53T-α-Syn and eliminate over-expressed α-Syn by activating autophagy pathway,which may be associated with the upregulation of JNK/Bcl-2 mediated autophagy pathway.
10.Construction and validation of a risk prediction model for 28-day mortality in patients with sepsis-associated acute kidney injury
Jiang-Ming ZHANG ; Ze-Qian WANG ; Cun-Lian XU ; Pai DENG ; Yang WU ; Min-Jun QI ; Lu-Mei MA ; Wei-Qing YAO ; Dong LIU ; Dong-Mei LIU
Medical Journal of Chinese People's Liberation Army 2025;50(8):935-942
Objective To explore the risk factors for 28-day mortality of sepsis-associated acute kidney injury(SA-AKI)patients and to develop a nomogram risk prediction model.Methods A retrospective cohort study was conducted,involving 184 patients with SA-AKI admitted to the intensive care unit(ICU)of the 940th Hospital of Joint Logistic Support Force of PLA between January 2017 and December 2022.Patients were categorized into survival(n=135)and non-survival(n=49)groups based on 28-day mortality.Clinical data were collected,and statistically significant risk factors were preliminarily screened.Multivariate stepwise logistic regression analysis was performed to identify independent risk factors for 28-day mortality of SA-AKI patients.A nomogram predictive model was constructed using these factors,and internally validated with the Bootstrap method.The receiver operating characteristic curve(ROC curve)was drawn,and the area under the ROC curve(AUC)was calculated to verify the predictive value and accuracy of the model.Results The 28-day mortality rate among 184 SA-AKI patients was 26.6%(49/184).Multivariate stepwise logistic regression analysis identified multiple organ dysfunction syndrome(MODS)(OR=16.393,95%CI 4.317-62.254,P<0.001),high acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score(OR=1.097,95%CI 1.036-1.161,P=0.002),low oxygenation index(OR=0.992,95%CI 0.986-0.998,P=0.015),low neutrophil count(OR=0.912,95%CI 0.860-0.968,P=0.002)and low fibrinogen concentration(OR=0.733,95%CI 0.549-0.978,P=0.034)as independent risk factors.The prediction model equation was P=1/1+e-logit(P),logit(P)=-1.626+2.797×MODS+0.092×AP ACHE Ⅱ+(-0.311)×fibrinogen+(-0.092)×neutrophil count+(-0.008)×oxygenation index.Internal validation with 1000 Bootstrap resamples showed high consistency between predicted and actual values.ROC analysis showed an AUC of 0.911(95%CI 0.868-0.955,P<0.05)for the model,with 93.9%sensitivity and 78.5%specificity at a cut-off of 0.194.The Hosmer-Lemeshow test confirmed good calibration(P=0.62),and decision-making curve analysis demonstrated clinical utility within the high-risk threshold range(0.1-0.9).Conclusions MODS,high APACHE Ⅱ score,low oxygenation index,low neutrophil count,and low fibrinogen concentration are independent risk factors for 28-day mortality in SA-AKI patients.The developed nomogram risk prediction model may provide important guidance for predicting 28-day mortality in SA-AKI patients.


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