合并T2DM的老年COPD患者IL-10/IL-17比值、IL-4/IL-13比值特征与急性加重风险的相关性OA

Objective To investigate the association between interleukin IL-10/IL-17 and IL-4/IL-13 rati-os and the risk of acute exacerbations in elderly patients with chronic obstructive pulmonary disease(COPD)complicated by type 2 diabetes mellitus(T2DM).Methods This prospective observational study included 212 elderly patients with stable COPD and comorbid T2DM treated between April 2022 and April 2024.Patients were categorized into a frequent ex-acerbation group and a non-frequent exacerbation group based on the number of COPD exacerbations within one year.Baseline clinical characteristics and serum cytokine levels were compared between groups.Spearman correlation analysis and multivariate logistic regression were used to identify factors associated with frequent exacerbations.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of IL-10/IL-17 and IL-4/IL-13 ratios,alone and in combination.Results The mean age of participants was(69.77±3.83)years.A total of 96 pa-tients(45.3％)were classified as frequent exacerbators and 116(54.7％)as non-frequent exacerbators.Compared with the non-frequent group,patients in the frequent exacerbation group had higher age,longer disease duration of COPD and T2DM,a higher proportion of GOLD stage Ⅲ-Ⅳ,and elevated serum levels of IL-4,IL-13,IL-17,and IL-4/IL-13 ratio,while IL-10 levels and IL-10/IL-17 ratio were significantly lower(P＜0.05).Spearman analysis showed that the number of exacerbations was positively correlated with IL-4,IL-13,IL-17,and IL-4/IL-13 ratio,and negatively correlated with IL-10 and IL-10/IL-17 ratio(all P＜0.05).Multivariate logistic regression identified higher IL-4(OR=1.058,95％CI:1.013-1.104),IL-13(OR=1.052,95％CI:1.007-1.098),IL-17(OR=1.081,95％CI:1.027-1.137),and IL-4/IL-13 ratio(OR=5.758,95％CI:2.124-15.621),as well as lower IL-10(OR=0.909,95％CI:0.866-0.955)and IL-10/IL-17 ratio(OR=0.281,95％CI:0.128-0.620),as independent factors associated with frequent exacerbations(P＜0.05).ROC analysis showed that the AUC(95％CI)for IL-10/IL-17 ratio,IL-4/IL-13 ratio,and their combination were 0.704(0.631-0.776),0.707(0.635-0.780),and 0.803(0.742-0.863),respectively.Conclusion Both IL-10/IL-17 and IL-4/IL-13 ratios are significantly associated with the risk of acute exacerbations in elderly patients with COPD and T2DM.These ratios may serve as useful biomarkers for risk stratification and early identification of high-risk individuals in clinical practice.