Interaction between IL-23/Th17 immune inflammatory axis and intestinal flora in gastric mucosal atrophy caused by Helicobacter pylori infection in the elderly.

OBJECTIVE

To explore the interactive effects of the interleukin-23 (IL-23)/Th17 immune-inflammatory axis and gut microbiota in gastric mucosal atrophy among elderly patients with Helicobacter pylori (HP) infection.

METHODS

A total of 210 elderly patients with HP infection from Lishui Second People's Hospital between January 2023 and June 2024 were selected as the study group, and 210 healthy volunteers during the same period served as the control group. The IL-23/Th17 immune-inflammatory axis factors [IL-23, interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-2 (IL-2)], and gut microbiota were compared between the study and control groups. The study group was further divided into an atrophy subgroup (101 cases) and a non-atrophy subgroup (109 cases) based on the presence of gastric mucosal atrophy. Clinical data, IL-23/Th17 immune-inflammatory axis factors, and gut microbiota characteristics were compared between the two subgroups. Logistic regression analysis was used to investigate the influencing factors of gastric mucosal atrophy in elderly patients with HP infection and the interactive effects of the IL-23/Th17 immune-inflammatory axis and gut microbiota. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were performed to assess the predictive value of the IL-23/Th17 immune-inflammatory axis and gut microbiota for gastric mucosal atrophy in elderly patients with HP infection.

RESULTS

The study group had higher serum levels of IL-23, IL-17, TNF-α, IL-6, IL-2, and a higher count of Lactobacillus acidophilus, but lower counts of Bifidobacterium and Lactobacillus compared to the control group (P < 0.05). Within the study group, the atrophy subgroup showed more pronounced differences in these immunological and microbiological parameters compared to the non-atrophy subgroup (all P < 0.05). Logistic regression identified all measured immune factors and gut microbiota as independent influencing factors for gastric mucosal atrophy (all P < 0.05). Significant interactive effects were observed between the IL-23/Th17 axis factors and gut microbiota (all P < 0.05). The combined ROC model incorporating these factors achieved an AUC of 0.908 for predicting gastric mucosal atrophy, significantly outperforming individual predictors (all P < 0.001).

CONCLUSION

There are significant interactive effects between the IL-23/Th17 immune-inflammatory axis and gut microbiota in gastric mucosal atrophy among elderly patients with HP infection, and the combined predictive value is reliable.