糖尿病足溃疡合并铜绿假单胞菌感染PI3K-Akt-mTOR信号通路表达与预后

Correlation between expression of PI3K-Akt-mTOR signaling pathway and prognosis of diabetic foot ulcer patients complicated with Pseudomonas aeruginosa infection

目的探讨磷脂酰肌醇-3-激酶/丝氨酸激酶/哺乳动物雷帕霉素靶蛋白(PI3K/Akt/mTOR)信号通路在糖尿病足溃疡(DFU)合并铜绿假单胞菌(PA)感染患者中的表达及其与预后的关系。方法选取2017年1月-2020年12月自贡市第四人民医院收治的DFU合并PA感染患者120例为DFU-PA组,未合并PA感染患者108例为DFU-noPA组,分析两组患者临床资料,观察溃疡创面渗出液中磷酸化PI3K(p-PI3K)、磷酸化Akt(p-Akt)和磷酸化mTOR(p-mTOR)表达及其与预后的关系。结果DFU-PA组患者p-PI3K、p-Akt、p-mTOR水平均低于DFU-noPA组(P<0.05);DFU-PA组重度感染患者上述指标水平均低于轻度感染患者(P<0.05);预后不良患者上述指标水平均低于预后良好患者(P<0.05);受试者工作特征(ROC)曲线分析显示,p-PI3K、p-Akt、p-mTOR联合检测预测DFU-PA患者预后的曲线下面积(AUC)为0.869(95%CI:0.801~0.937)、敏感度为80.60%、特异度为79.80%。结论p-PI3K、p-Akt、p-mTOR在DFU-PA患者中呈低表达,且与患者感染严重程度存在关系,对DFU-PA患者预后有良好的预测效能。

OBJECTIVE To explore the relationship between expression of phosphatidylinositol-3-kinase/serine threonine kinase/mammalian target of rapamycin(PI3 K/Akt/mTOR)signaling pathway and prognosis of the diabetic foot ulcer(DFU)patients complicated with Pseudomonas aeruginosa infection.METHODS A total of 120 DFU patients complicated with P.aeruginosa infection who were treated in the Fourth People′s Hospital of Zigong City from Jan 2017 to Dec 2020 were assigned as the DFU-PA group,and 108 DFU patients who were not complicated with P.aeruginosa infection were chosen as the DFU-noPA group.The clinical data of the two groups of patients were analyzed,and the correlation the expression of phosphorylated PI3 K(p-PI3 K),phosphorylated Akt(p-Akt)and phosphorylated mTOR(p-mTOR)in ulcer wound exudates and the prognosis was observed.RESULTS The levels of p-PI3 K,p-Akt and p-mTOR of the DFU-PA group were significantly lower than those of the DFU-noPA group (P<0.05).In the DFU-PA group,the levels of above indexes of the patients with severe infection were significantly lower than those of the patients with mild infection(P<0.05);the levels of above indexes of the patients with poor prognosis were significantly lower than those of the patients with favorable prognosis(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of the joint detection of p-PI3 K,p-Akt and p-mTOR was 0.869(95%CI:0.801-0.937)in prediction of prognosis of the DFU-PA patients,the sensitivity 80.60%,the specificity 79.80%.CONCLUSION The DFU-PA patients show low expression of p-PI3 K,p-Akt and p-mTOR,the indexes are associated with the severity of infection and have high efficiency in prediction of prognosis of the DFU-PA patients.