The relationship between the changes of inflammatory factors and dietary inflammatory index in elderly diabetic pa-tients with COPD and the acute exacerbation of COPD

Bai Weijuan; Zhang Bozhi; Shen Zhifen

doi:10.3969/j.issn.1671-6450.2025.01.009

Abstract：Objective To analyze the relationship between the changes of inflammatory factors and dietary inflam-matory index(DII)in elderly patients with diabetes mellitus complicated with chronic obstructive pulmonary disease(COPD)and the acute attack of COPD.Methods From October 2021 to October 2023,110 elderly patients with diabetes mellitus and COPD admitted to the First Department of the Cadre Ward of the 980th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army were selected as the research objects.According to whether acute exacerbation of COPD occurred,the patients were divided into acute exacerbation group(48 cases)and stable group(62 cases).The levels of serum inflammatory factors[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)]were measured by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation between serum inflammatory factor levels and lung function.Multivariate Logistic regression analysis was used to analyze the influencing factors of acute exac-erbation of COPD in elderly diabetic patients with COPD.R software was used to construct a nomogram model for predic-ting acute exacerbation of COPD in elderly diabetic patients with COPD.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the nomogram model for acute exacerbation of COPD in elderly diabetic pa-tients with COPD,and the calibration curve was used to evaluate the consistency of the model.Results The levels of ser-um TNF-α,CRP and DII score in the acute exacerbation group were higher than those in the stable group(t=5.482,4.603,4.588,all P＜0.01).The levels of FPG,2 hPGand HbA1c in the acute exacerbation group were higher than those in the stable group,and the levels of FVC and FEV1 were lower than those in the stable group(t=4.481,5.984,4.465,4.710,4.208,all P＜0.01).Pearson correlation analysis showed that serum TNF-α and CRP levels were negatively correlated with FVC and FEV1 in diabetic patients with COPD(r=-0247,-0260,-0.191,-0.255,P=0.009,0.003,0.045,0.007).Multivariate Logistic regres-sion analysis showed that TNF-α,DII score,2 hPG and HbA1c were increased.The decrease of FVC and FEV1 was an inde-pendent risk factor for acute exacerbation of COPD in diabetic patients with COPD[OR(95％CI)=1.459(1.011-2.104),22.687(1.524-337.648),12.500(2.465-63.389),30.593(2.086-448.593),120.662(9.724-1497.195),19.862(4.644-84.950)],and a nomo-gram prediction model was constructed.ROC curve was used to verify the nomogram model.The area under the curve(AUC)of the nomogram model for predicting acute exacerbation of COPD in diabetic patients with COPD was 0.984(95％CI=0.966-1.000).Bootstrap was used to verify the nomogram model.The results showed that the C-index value was 0.954,and the calibration curves were in good agreement with the ideal curve fitting.Conclusion The levels of serum TNF-α,CRP and DII score increased with the aggravation of the disease in elderly diabetic patients with COPD.The increase of TNF-α,DII score,2 hPG and HbA1c,and the decrease of FVC and FEV 1 were independent risk factors for acute exacerba-tion of COPD in elderly diabetic patients with COPD.The decision tree model based on the above factors had good clinical predictive efficacy.