血清HIF-1α、DcR3与老年慢性阻塞性肺疾病急性加重期伴呼吸衰竭患者临床预后的相关性OA

Objective To analyze the correlation between serum hypoxia-inducible factor-1α(HIF-1α),decoy receptor-3(DcR3),and clinical prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by respiratory failure.Methods In total,125 patients with AECOPD accompanied by respiratory failure admitted to the 960th Hospital of the Joint Logistics Support Force of the PLA from June 2021 to June 2023 were selected as the study group,and 125 AECOPD patients without respiratory failure collected in a 1∶1 ratio during the same period were selected as the control group.All patients received standardized treatment(including non-invasive mechanical ventilation)upon admission,and serum levels of HIF-1α and DcR3 were measured using enzyme-linked immunosorbent assay(ELISA).The study group was divided into a weaning failure group(n=25)and a weaning success group(n=100)based on the outcome of the first weaning attempt during treatment.Pearson correlation analysis was used to examine the correlation between serum HIF-1α,DcR3 and weaning failure in elderly AECOPD patients with respiratory failure.Multivariate logistic regression analysis was conducted to identify the factors affecting the clinical prognosis in AECOPD patients with respiratory failure.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum HIF-1α and DcR3 for the clinical prognosis of AECOPD patients with respiratory failure.Results The serum levels of HIF-1α and DcR3 in the study group were higher than those in the control group(P＜0.01).Among the 125 patients,25 patients experienced the first weaning failure(weaning failure group),with a failure rate of 20.00％.The serum HIF-1α,DcR3,Acute Physiology and Chronic Health Assessment Ⅱ(APACHE Ⅱ)score,and partial pressure of carbon dioxide(PaCO2)in the weaning failure group were higher than those in the weaning success group,while the blood oxygen partial pressure(PaO2)was lower than that in the weaning success group(P＜0.01).Multivariate logistic regression analysis showed that serum HIF-1α,DcR3,APACHE Ⅱ score,PaCO2,and PaO2 were related factors affecting the clinical prognosis of elderly AECOPD patients with respiratory failure(P＜0.05,P＜0.01).Pearson correlation analysis showed a positive correlation between serum HIF-1α,DcR3 and weaning failure in elderly AECOPD patients with respiratory failure(r=0.387,0.386,P＜0.01).ROC curve analysis showed that the area under the curve(AUC)of serum HIF-1 α combined with DcR3 in predicting weaning failure was significantly higher than each indicator alone(P＜0.01).Conclusion Compared with AECOPD patients without respiratory failure,patients with AECOPD complicated by respiratory failure have higher levels of serum HIF-1α and DcR3,which are closely related to the clinical prognosis of AECOPD complicated by respiratory failure.Upon admission,testing of the above two indicators may be considered for preliminary prediction of the patient's clinical prognosis,in order to facilitate implementation of more targeted treatment regimens.