AECOPD合并2型糖尿病患者发生呼吸衰竭时诱骗受体3水平与预后的相关性分析OA

Objective To investigate the relationship between decoy receptor 3(DcR3)levels and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with type 2 diabetes mellitus(T2DM)who develop respiratory failure.Methods A total of 128 AECOPD patients with T2DM and respiratory failure admitted to the Traditional Chinese Medicine Hospital Affiliated to Guangzhou Medical University from December 2021 to December 2023 were retrospectively enrolled.The patients were stratified into quartile groups(Q1-Q4)based on DcR3 levels,and the general data of the four groups were compared.Logistic regression model was used to gradually exclude confounding factors with collinearity,and the correlation between DcR3 level and the risk of poor prognosis was analyzed.Sensitivity was tested using the correlation E-value method.LOWESS method was used to analyze the relationship between DcR3 and glucose metabolism levels.According to the prognosis,the patients were divided into good prognosis group(n=81)and poor prognosis group(n=47).The general data were compared between the two groups,as was the prognosis of patients with different DcR3 and glucose metabolism levels.Unconditional logistic regression model was used to analyze the multiplicative interaction between DcR3 level and glucose metabolism indicators on prognosis,while an additive interaction was assessed using an interaction analysis table.The correlation between DcR3 level and poor prognosis was analyzed using restricted cubic splines and threshold effect analysis.Results Levels of fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2hPG),glycosylated hemoglobin(HbA1c),procalcitonin(PCT),D-dimer(D-D),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)were significantly different among patients with different DcR3 levels(P<0.05).After stepwise elimination of confounding factors by logistic regression model,DcR3 level was independently correlated with the risk of poor prognosis.LOWESS analysis revealed a nonlinear relationship between DcR3 and FPG,2hPG and HbA1c.Stratified analysis showed significant differences in poor prognosis rate among patients with different DcR3 levels within the high-level subgroup of FPG,2hPG and HbA1c(P<0.05).Specifically,in Q4 group(DcR3>6.32 ng/ml),the incidence of poor prognosis was the highest when FPG≥10mmol/L,2hPG of 9-14 mmol/L and HbA1c≥10%,which were 64.71%,58.82%and 52.94%,respectively.After adjusting for confounding factors,interaction analysis results showed that there was an interaction between FPG,2hPG,HbA1c and DcR3 levels on patient prognosis in the additive model and multiplicative model.Restricted cubic spline results showed a nonlinear relationship between DcR3 level and prognosis(nonlinear test P<0.001).Threshold effect analysis showed that DcR3 level was significantly positively correlated with the risk of poor prognosis;specifically,when DcR3>6.00 ng/ml,the risk of poor prognosis increased significantly with further rises in DcR3 level.Conclusion In AECOPD patients with T2DM who develop respiratory failure,peripheral blood DcR3 level is associated with glucose metabolism levels and prognosis.