目的 探讨预后营养指数（PNI）对脓毒症合并心力衰竭患者发生谵妄的预测价值，并评估其在指导护理风险分层中的作用。方法 采用回顾性队列研究，纳入2022年2月—2024年9月广东省第二中医院收治的162例脓毒症合并心力衰竭患者。通过ROC曲线确定PNI预测谵妄的最佳截断值，并以此将患者分为高低PNI组。比较两组基线特征，采用Kaplan-Meier曲线分析谵妄累积发生率和28天院内死亡率，通过Cox比例风险模型评估PNI与谵妄及预后的独立关联，并利用ROC曲线评价其预测性能。最后利用亚组分析技术进一步评估PNI预测价值的普适性。结果 低PNI（≤35.72）是谵妄发生的独立危险因素。竞争风险模型显示，低PNI组10 d谵妄累积发生率达37.8%，高于高PNI组的10.0%。多因素分析表明，PNI每降低一个单位，谵妄风险增加约17.2%。限制性立方样条分析提示PNI与谵妄风险呈线性负相关。ROC曲线分析显示PNI预测谵妄的AUC为0.721，其预测效能优于白蛋白和SOFA评分。亚组分析进一步证实PNI的保护效应在不同临床特征患者中具有一致性。结论 PNI是脓毒症合并心力衰竭患者谵妄风险的独立预测指标，其预测效能优于传统单一指标。基于PNI的风险分层有助于早期识别谵妄高危患者，为实现精准护理干预提供重要依据。

      Objective To explore the predictive value of the prognostic nutritional index（PNI）for delirium in patients with sepsis complicated by heart failure，and to evaluate its role in guiding nursing risk stratification．Methods A retrospective cohort study was conducted，including 162 patients with sepsis and heart failure admitted to Guangdong Provincial Second Hospital of Traditional Chinese Medicine between February 2022 and September 2024．The optimal PNI cut-off value for predicting delirium was determined using ROC curve analysis，and patients were divided into high and low PNI groups accordingly．Baseline characteristics of the two groups were compared．Kaplan-Meier curves were used to analyze the cumulative incidence of delirium and 28-day in-hospital mortality．Cox proportional hazards models were employed to assess the independent association between PNI and delirium as well as prognosis，and ROC curves were used to evaluate its predictive performance．Subgroup analysis was further utilized to assess the generalizability of PNI’s predictive value．Results A low PNI（≤35.72）is an independent risk factor for delirium．The competing risk model showed that the cumulative incidence of delirium in the low PNI group was 37.8% at 10 days，significantly higher than the 10.0% in the high PNI group．Multivariate analysis indicated that for each unit decrease in PNI，the risk of delirium increased by 17.2% approximately．Restricted cubic spline analysis suggested a linear negative correlation between PNI and delirium risk．ROC curve analysis demonstrated that the AUC of PNI for predicting delirium was 0.721，with its predictive performance surpassing that of albumin and SOFA score．Subgroup analysis further confirmed that the protective effect of PNI was consistent across patients with different clinical characteristics．Conclusions PNI is an independent predictor of delirium risk in patients with sepsis and heart failure，with superior predictive performance compared to traditional single indicators．Risk stratification based on PNI aids in the early identification of patients at high risk for delirium，providing an important basis for precise nursing interventions．

      目的   免疫球蛋白A肾病（IgAN）与炎症性肠病（IBD）的相互作用机制尚未阐明。本研究旨在解析IBD与IgAN共病的关键特征基因及核心信号通路，以揭示肠－肾轴的分子调控网络。方法   于GEO数据库获取IBD（GSE75214）和IgAN（GSE93798）基因表达谱，筛选差异表达基因（DEGs）。通过蛋白互作网络（PPI）和拓扑算法（MCC、MNC、Degree、EPC等）识别核心特征基因，并结合公共数据库（CTD、DISEASES和GeneCards）和单细胞转录组测序（GSE171314）进行验证。通过Nephroseq数据库验证基因表达与临床表型的相关性。结果   共筛选出17个IBD-IgAN共病DEGs，PPI网络分析等确定以FOS、EGR1、CXCL2和JUNB为核心特征基因。功能富集分析显示白细胞介素-17（IL-17）信号通路显著激活。单细胞测序验证FOS、EGR1、CXCL2和JUNB基因在IgAN特异性高表达，并通过Nephroseq数据库验证其与尿蛋白和估算的肾小球滤过率下降（eGFR）显著相关。结论  本研究揭示IBD与IgAN共享IL-17通路异常激活及FOS、EGR1、CXCL2和JUNB的基因网络，为开发基于肠－肾轴调控的靶向治疗策略提供理论依据。

       Objective  The complex interplay between immunoglobulin A nephropathy（IgAN）and inflammatory bowel disease（IBD）remains poorly understood．This  study  aimed to identify  key  cross-talk  genes  and  pivotal  signaling pathways shared between IBD and IgAN，thereby elucidating the molecular regulatory network underlying the gut-kidney axis．Methods  Transcriptomic datasets for IBD（GSE75214）and IgAN（GSE93798）were retrieved from the GEO database．Differentially expressed genes（DEGs）were screened，and shared DEGs were intersected．Protein-protein interaction（PPI）networks were constructed using STRING and Cytoscape，with topological algorithms applied to identify hub genes．Gene expression profiles were validated through（CTD，DISEASES and GeneCards）and single-cell RNA sequencing（GSE171314）and the Nephroseq database，focusing on clinical correlations with proteinuria and estimated glomerular filtration rate（eGFR）．Results  Seventeen shared DEGs were identified between IBD and IgAN．PPI network analysis revealed FOS，EGR1，CXCL2 and JUNB as core hub genes．Functional enrichment analysis demonstrated significant activation of the interleukin-17（IL-17）signaling pathway．Single-cell sequencing confirmed the specific upregulation of these genes in renal tubular epithelial cells of IgAN patients，which was further validated to correlate with proteinuria and eGFR decline．Conclusions  IBD and  IgAN share aberrant activation of the IL-17 pathway and a co-regulatory gene network involving FOS，EGR1，CXCL2 and JUNB，providing a theoretical foundation for developing therapeutic strategies centered on the gut-kidney axis．

目的 探究老年脑梗死患者抑郁与共病之间的相关性。方法 选择2021年9月—2023年7月于开封市第五人民医院接受治疗的80例老年脑梗死康复期患者,均使用老年抑郁量表（GDS）对其进行评测,按照评测结果将患者区分为无抑郁组（n=39,GDS≤10分）和抑郁组（n=41,GDS>10分）,并按照受试者是否存在共病区分为不同亚组（如并消化系统疾患、并发循环系统疾患等）,对比不同亚组患者占比差异,并采用Pearson相关性分析的方式,分析入组80例老年脑梗死患者GDS评分与其Charlson共病指数（CCI）评分的相关性。结果 80例患者中抑郁占比为51.25%,对比显示共病循环系统、内分泌系统以及运动系统疾病的老年脑梗死患者抑郁发生率明显更高（P<0.05）;Pearson相关性分析显示老年脑梗死患者GDS评分与其CCI评分呈正相关（r=0.180,P<0.001）。结论 老年脑梗死患者抑郁发生率较高,对并发循环系统疾病、内分泌系统疾病、运动系统疾病的老年脑梗死患者应予以更多关注,预防抑郁的发生。

Objective To explore the correlation between depression and comorbidity in elderly patients with cerebral infarction．Methods A total of 80 elderly patients treated from September 2021 to July 2023 were selected．The patients were evaluated using the Geriatric Depression Scale（GDS）,patients were divided into the non-depression group（n=39,GDS≤10 points）and the depression group（n=41,GDS>10 points）,and they were divided into different subgroups（such as concurrent digestive disorders,concurrent circulatory disorders,etc.）．Comparing the differences in patient proportions in different subgroups,and the correlation between the GDS score and its Charlson comorbidity index（CCI）score in 80 elderly patients with cerebral infarction was analyzed with Pearson correlation analysis．Results The proportion of depression in 80 patients was 51.25%,showing a significantly higher incidence of depression in elderly patients with a comorbid circulatory system,endocrine system and motor system disease（P<0.05）;Pearson correlation analysis showed that GDS score in elderly patients with a cerebral infarction was positively correlated with their CCI score（r=0.180,P<0.001）．Conclusions The incidence of depression in elderly patients with cerebral infarction is relatively high,and more attention should be paid to elderly patients with concurrent circulatory system diseases,endocrine system diseases and motor system diseases to prevent the occurrence of depression．