Predictive Efficacy of Peripheral Blood TLR7/IL-23/IL-17 Signaling Pathway-related Factors in Acute Exacerbation Risk in Patients with Chro-nic Obstructive Pulmonary Disease

DAI Fangfang; DENG Dingding; GE Min; ZHANG Xiaotao; PENG Wenbin

doi:10.3969/j.issn.2095-3097.2023.06.007

Abstract：Objective To investigate the predictive efficacy of toll-like receptor 7(TLR7)/interleukin-23(IL-23)/interleukin-17(IL-17)signaling pathway-related factors in peripheral blood on the risk of acute exacerbation in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 115 patients with COPD were selected from June 2019 to June 2022.According to whether acute exacerbation occurred within 6 months of follow-up,they were divided into acute ex-acerbation group(n =28)and stable group(n =87).Peripheral blood TLR7,IL-23 and IL-17 were compared between the two groups and among patients with different severities of COPD,and the correlation between peripheral blood indicators and severity of COPD patients was analyzed,as well as the value of predicting the risk of acute exacerbation in COPD patients.The impact of peripheral blood indicators on the risk of acute exacerbation in COPD patients was analyzed with the optimal cut-off value.Results Peripheral blood TLR7,IL-23 and IL-17 in acute exacerbation group were higher than those in stable group.The levels of TLR7,IL-23 and IL-17 in peripheral blood of patients with COPD quality of life assessment questionnaire(CAT)score≥20 were higher than those of patients with CAT score<20.The levels of TLR7,IL-23,and IL-17 in periph-eral blood of patients with COPD Global Initiative(GOLD)grade 3 to 4 were the highest,followed by patients with grade 2 and patients with grade 1(P<0.01).TLR7,IL-23 and IL-17 in peripheral blood of COPD patients were positively correlated with CAT score and GOLD classification of lung function(P<0.01).The area under the curve(AUC)of TLR7 and IL-23 and IL-17 in peripheral blood to predict the risk of acute exacerbation in COPD patients was 0.801,0.710 and 0.801,re-spectively.The optimal cut-off value was 58.79,35.95 and 47.66 ng/mL,respectively,the sensitivity was 78.57%,57.14%and 60.71%,respectively,and the specificity was 72.41%,83.91%and 83.91%,respectively.The AUC of the combination of the three indicators to predict the risk of acute exacerbation in COPD patients was 0.915,with sensitivity of 85.71%and specificity 86.21%,which were better than those predicted by each indicator alone(P<0.05).The optimal cutoff values of TLR7,IL-23 and IL-17 in peripheral blood were divided into positive and negative expressions.After CAT score and GOLD classification of lung function were excluded,the positive expression of TLR7,IL-23 and IL-17 in peripheral blood was an independent risk factor for acute exacerbation of COPD(P<0.01).Conclusion Peripheral blood TLR7/IL-23/IL-17 signaling pathway-related factors are independent predictive efficacy of risk of acute exacerbation of COPD,and the combined detection of the three indicators is a reliable predictive efficacy of acute exacerbation of COPD.