Abstract:

Objective To discuss the changes of the levels of phosphatidylinositol 3-kinase （PI3K） and protein kinase B （Akt） in serum of the patients with Sj?gren’s syndrome （SS）， and to clarify their relationships with thrombocytopenia （TP） in the SS patients. Methods A total of 198 SS patients admitted to our hospital from January 2022 to December 2024 were selected. According to the platelet （PLT） count levels， they were divided into SS-TP group （n=51） and SS-non-TP （NTP） group （n=147）. The clinical data of the patients in two groups were collected； Pearson correlation analysis was used to analyze the correlations between the serum levels of PI3K and Akt and PLT count in the SS patients； χ2 test and independent sample t test were used to analyze the relationships between the clinical data of the SS patients and TP； multivariate Logistic regression analysis was used to screen the independent predictors for the risk of TP in the SS patients； receiver operating characteristic （ROC） curve was drawn to evaluate the predictive efficacy of the predictors； decision curve was used to assess the clinical utility of the predictors. Results Among the 198 SS patients， 51 patients （25.76%） complicated with TP were included as SS-TP group， and the remaining patients were included as SS-NTP group. Compared with SS-NTP group， the serum levels of PI3K and Akt of the patients in SS-TP group were significantly decreased （P<0.05）. The serum levels of PI3K （r=0.416， P<0.001） and Akt （r=0.425， P<0.001） of the SS patients were positively correlated with PLT count. Compared with SS-NTP group， the percentage of lymphadenectasis of the patients in SS-TP group was significantly increased （P<0.05）， and the lymphocyte count and hemoglobin level were significantly decreased （P<0.05）. The Logistic regression analysis results showed that the concurrent TP in the SS patients was associated with the decrease in the lymphocyte count， hemoglobin level， and serum levels of PI3K and Akt （P<0.05 or P<0.01）. The area under curve （AUC） value of serum PI3K level for predicting concurrent TP in the SS patients was 0.770， the AUC value of serum Akt level for predicting concurrent TP in the SS patients was 0.763， and the AUC value of the combined prediction of the two was 0.853. The efficacy of the combined prediction of serum PI3K level and serum Akt level for concurrent TP in the SS patients was better than that of either alone （combined prediction-serum PI3K level： Z=2.779， P=0.006； combined prediction-serum Akt level： Z=2.907， P=0.004）. Within the threshold range of 0.10-0.82， the net benefit rate of the combined prediction of serum PI3K and Akt levels for the risk of concurrent TP in the SS patients was higher than that of the separate assessment of serum PI3K or Akt levels. Conclusion The decrease of serum PI3K and Akt levels are associated with the risk of concurrent TP in SS patients， and the combined assessment of the two has a high predictive value for the occurrence of TP.

Key words: Sj?gren’s syndrome, Phosphatidylinositol 3-kinase, Protein kinase B, Thrombocytopenia, Lymphocyte, Hemoglobin