Difference In The Level Of Prostaglandin D₂ In Serum Between Adult Patients With Bronchial Asthma And With Chronic Obstructive Pulmonary Disease And Its Clinical Significance

Objective:To investigate the difference of the level of serum prostaglandin D₂（PGD₂）in patients with bronchial asthma and patients with chronic obstructive pulmonary disease（COPD）of adults,as well as the potential clinical significance.Methods:A prospective study was performed on 50 patients admitted to Chengde Central Hospital of Hebei Province from March 2020 to February 2021 due to acute exacerbation of bronchial asthma and 50 patients admitted to the hospital due to acute exacerbation of COPD（AECOPD）and 50 physical examiners in corresponding period in the hospital.They were divided to asthma group,COPD group and control group.The general information such as gender,age,smoking index,allergies history,basic diseases history,and BMI of subjects were collected and the eosinophil（Eos）counts in blood,the level of serum PGD₂,immunoglobulin E（IgE）were determined when the p H,PaO₂,PaCO₂and Sa O₂of patients with bronchial asthma and patients with AECOPD were recorded.Meanwhile,checking the lung function,bronchial diastolic test and fractional exhaled nitric oxide（Fe NO）and recording the value of percentage of predicted forced expiratory volume in one second（FEV1%pred）,forced vital capacity（FVC）,forced expiratory volume in one second/forced vital capacity（FEV1/FVC）and Fe NO of subjects.All patients with acute exacerbation of asthma and patients with AECOPD were given standardized treatment after admission.Reexamining the level of serum PGD₂,FEV1%pred,FEV1/FVC,Fe NO concentration and the Eos counts of all patients when their respiratory system conditions were stable on the day of discharge.Observing the difference of the level of serum PGD₂in each group,the changes of the level of serum PGD₂before and after treatment in asthma group and COPD group,and the correlation of the level of serum PGD₂with each index.SPSS 26.0 software was adopted to process and analyze data.Differences of all the indicators were compared among three groups.Pearson and Spearman correlation analysis were used to evaluate the correlation between indicators and the level of serum PGD₂.ROC curve was used to evaluate the predictive value of serum PGD₂for asthma and AECOPD and search the best diagnostic threshold.P<0.05 was considered statistically significant.Results:1.Comparison of general clinical data of patients among three groups1.1 Comparison of basic data of patients among three groupsThere were 150 patients were selected in the study.There were 50patients（22 males）in asthma group and their average age was 53.52±13.81years.There were 50 patients（26 males）in COPD group and their average age was 68.38±8.15 years.There were 50 patients（29 males）in control group and their average age was 57.24±12.40 years.The ages and smoking index of patients in asthma group were lower than COPD group,showing significant differences（P<0.05）.The allergies history of patients in asthma group was higher than COPD group,showing significant difference（P<0.05）.There were no significant differences in gender,BMI,Hypertension history,and diabetes mellitus history of patients among three groups（P>0.05）.1.2 Comparison of FEV1%pred,FEV1/FVC%,Fe NO of subjects before treatment among three groupsAll variables showed significant differences（P<0.05）in FEV1%pred,FEV1/FVC%,Fe NO of patients among three groups.1.3 Comparison of eosinophil counts in blood,IgE content of patients before treatment among three groupsThe eosinophil counts in blood,IgE content of patients in asthma group had shown improvements,showing significant differences（P<0.05）.IgE content of patients in COPD group was higher than control group,showing significant differences（P<0.05）.There was no significant difference in eosinophil counts in blood between COPD group and control group（P>0.05）.2.Comparison of p H,PaCO₂,PaO₂,Sa O₂of patients between asthma group and COPD groupThere was significant difference in PaCO₂of patients between asthma group and COPD group（P<0.05）.There were no significant differences in p H,PaO₂,Sa O₂of patients between asthma group and COPD group（P>0.05）.3.Comparison of adjusted the level of serum PGD₂of subjects among the three groups3.1 Comparison of the level of serum PGD₂of subjects before treatment among the three groupsThere was significant difference in the level of serum PGD₂of patients among the three groups（P<0.05）.The level of serum PGD₂was higher of patients before treatment in asthma group than COPD group and control group,showing significant differences（P<0.05）.The level of serum PGD₂of patients before treatment in COPD group was higher than control group,showing significant difference（P<0.05）.3.2 Comparison of the level of serum PGD₂of patients after treatment among the three groupsThe level of serum PGD₂of patients after treatment in asthma group was higher than control group,showing significant difference（P<0.05）.There were no significant differences in the level of serum PGD₂of patients between asthma group and COPD group,and that between COPD group and control group（P>0.05）.3.3 Comparison of the level of serum PGD₂of patients between before treatment and after treatment in asthma group and COPD groupThere was significant difference in the level of serum PGD₂of patients between before treatment and after treatment in asthma group（P<0.05）.There was no significant difference in the level of serum PGD₂of patients between before treatment and after treatment in COPD group（P>0.05）.4.Comparison of Eos counts in blood,Fe NO,FEV1%pred,FEV1/FVC between before treatment and after treatment in asthma group and COPD group4.1 The comparison of indicators of patients between before treatment and after treatment in asthma groupThere were significant differences in Eos counts in blood,Fe NO,FEV1%pred,FEV1/FVC between before treatment and after treatment in asthma group（P<0.05）.4.2 The comparison of indicators of patients in COPD group between before treatment and after treatmentThere was significant difference in Fe NO between before treatment and after treatment in COPD group（P<0.05）.There were no statistically significant differences in Eos counts in blood,FEV1%pred and FEV1/FVC between before treatment and after treatment in COPD group（P>0.05）.5.Correlation analysis of Eos counts in blood,Fe NO,FEV1%pred,FEV1/FVC,IgE with the level of serum PGD₂in asthma group and COPD group5.1 Correlation analysis of the indicators with the level of serum PGD₂in asthma groupPearson correlation analysis showed that Eos counts（r=0.395,P=0.005）was positively correlation with the level of serum PGD₂,and FEV1%pred（r=-0.639,P<0.001）was negatively associated with the level of serum PGD₂.Spearman correlation analysis showed that Fe NO（r=0.553,P<0.001）was positively correlation with serum PGD₂while FEV1/FVC（r=0.110,P=0.447）and IgE（r=-0.267,P=0.06）existed no correlations with the level of serum PGD₂.5.2 Correlation analysis the indicators with serum PGD₂in asthma group after treatmentSpearman correlation analysis showed that Fe NO（r=0.281,P=0.048）was positively correlation with the level of serum PGD₂after treatment.Eos counts,FEV1%pred and FEV1/FVC were not significantly related to the level of serum PGD₂in asthma group after treatment（P>0.05）.5.3 Correlation analysis the indicators with the level of serum PGD₂in COPD groupPearson correlation analysis showed that Eos counts,FEV1%pred were not significantly related to the level of serum PGD₂in COPD group（P>0.05）.Spearman correlation analysis showed that Fe NO,FEV1/FVC and IgE were not significantly related to the level of serum PGD₂in COPD group（P>0.05）.6.The predictive value of serum PGD₂for acute exacerbation of asthma and AECOPDThe area under the ROC curve for the level of serum PGD₂to evaluate the acute exacerbation of asthma was 0.859（95%CI:0.788-0.930,P<0.001）,and the best threshold was 340.550pg/m L（sensibility was 70%,specificity was 86%）.The area under the ROC curve for the level of serum PGD₂to evaluate the AECOPD was 0.645（95%CI:0.536-0.753,P=0.013）,and the best threshold was 266.70pg/m L（sensibility was 74%,specificity was 58%）.Conclusion:1.The level of serum PGD₂could reflect the level of airway inflammation in patients with acute exacerbation of asthma,and related to the severity of airflow restriction of patients with acute exacerbation of asthma.2.The level of serum PGD2 could be used to evaluate the level of airway inflammation in patients with acute exacerbation of asthma after hospitalization,and be used for monitoring the severity of acute exacerbation of asthma.3.PGD₂was involved in the pathogenesis of acute exacerbation of asthma and AECOPD.In contrast to AECOPD,the predictive value of the level of serum PGD₂for acute exacerbation of asthma was higher.