糖原合酶激酶-3β对脓毒症及相关急性肾损伤的诊断和预后评估价值研究

Evaluation of glycogen synthase kinase -3β in the diagnosis and prognosis of sepsis and related acute kidney injury

目的 分析糖原合酶激酶-3β（glycogen synthase kinase-3β， GSK-3β）在脓毒症及相关急性肾损伤（AKI）中的诊断价值，及其对患者预后的评估价值。方法 选取2016-09～2017-08我院收治的104例脓毒症患者为研究对象，根据患者病情将其分为严重脓毒症组（70例）和普通脓毒症组（34例），另选取同期体检健康者100例作为对照组，收集三组研究对象的临床资料，并于入组24 h内分别采集血液及尿液标本，应用ELISA法检测三组血、尿标本中GSK-3β水平。 结果 与对照组比较，严重脓毒症组和普通脓毒症组患者血、尿标本中GSK-3β基因相对表达量均较高（P＜0.05）；严重脓毒症组患者血标本中GSK-3β基因相对表达量高于普通脓毒症组（2.42±1.15 vs. 1.69±0.72，P＜0.05），但两组患者尿液标本中GSK-3β基因相对表达量比较差异无统计学意义（1.59±0.67 vs. 1.41±0.53,P＞0.05）。Pearson 结果显示，血GSK-3β表达量与尿GSK-3β表达量、白细胞计数及降钙素原呈正相关（P＜0.05）；尿GSK-3β表达量与肾小球滤过率呈正相关（P＜0.05），而与血肌酐及APACHEⅡ评分呈负相关（P＜0.05）。严重脓毒症恶化亚组患者血、尿标本中GSK-3β基因相对表达量高于好转亚组和对照组（P＜0.05）；AKI亚组和非AKI亚组患者血、尿标本中GSK-3β基因相对表达量均高于对照组（P＜0.05）；AKI亚组患者血标本中GSK-3β基因相对表达量高于非AKI亚组（P＜0.05）；AKI恶化亚组患者血、尿标本中GSK-3β基因相对表达量高于AKI好转亚组和对照组，且差异有统计学意义（P＜0.05）。结论 GSK-3β在脓毒症及相关AKI患者血、尿标本中呈高表达，其对临床评估脓毒症及相关AKI病情严重程度和患者预后具有重要作用。

Objective To evaluate the diagnostic value of glycogen synthase kinase - 3β （GSK- 3β） in sepsis and related acute kidney injury（AKI） and its prognostic value. Methods 104 patients with sepsis treated in our hospital from September 2016 to August 2017 were divided into two groups： severe sepsis group （70 cases） and normal sepsis group （34 cases） , and another 100 healthy subjects were selected as the control group during the same period. The clinical data of the three groups were collected. Blood and urine samples were collected within 24 hours after instillation. Serum and urinary GSK -3β levels were detected by sandwich enzyme immunoassay （ELISA）. Results Compared with the control group, the relative expression levels of GSK - 3β in serum and urine of patients with severe sepsis and normal sepsis was higher （ P 〈 0.05 ）. Severe sepsis patients showed higher serum level of GSK - 3β than sepsis patients （2.42 ± 1.15 vs. 1.69 ± 0.72,P 〈 0.05）. However, there was no significant difference in urine level of GSK - 3β in the two groups of patients （ 1.59 ± 0.67 vs. 1.41 ± 0.53, P 〉 0.05 ）. The Pearson results showed that the serum GSK- 3 β was positively correlated with urinary GSK- 3β, leukocyte count and procalcitonin （P 〈0.05 ）, while urine GSK- 3β was positively correlated with glomerular filtration rate （ P 〈 0.05 ）, but was negatively correlated with serum ereatinine and APACHE Ⅱ score （P 〈0.05 ）. The relative expression of GSK- 3β in serum and urine of patients with severe sepsis subgroup was higher than that of the improved subgroup and healthy control group （ P 〈 0.05 ）. The relative expression levels of GSK - 3 β in blood and urine samples of patients with AKI and non - AKI subgroup were higher than those of the control group （ P 〈 0.05 ）. The relative expression of blood GSK- 3β was higher in patients with severe AKI than that in patients with non -AKI（ P 〈 0.05 ）. The relative expression of GSK- 3β in blood and urine of patients with severe sepsis - aggravated AKI was higher than that of the improved subgroup and healthy control group （ P 〈 0.05 ） , and the difference was statistically significant （P 〈 0.05 ）. Conclusion GSK -3β is highly expressed in blood and urine samples of patients with sepsis and related AKI, which plays an important role in the clinical evaluation of the severity of the disease and the prognosis of patients with sepsis and related AKI.