The Correlation Analysis Of Serum Nets And VD Levels In Patients With COPD In Stable Stage And Their Correlation With Pulmonary Function

Objective: Vitamin D(VD)was used to intervene patients with chronic obstructive pulmonary disease(COPD)in stable stage,and the changes of serum neutrophil extracellular snare net(NETs)in patients with COPD in stable stage were observed before and after use,so as to provide theoretical basis for VD and NETs in clinical diagnosis and treatment of COPD.Methods: 72 patients with COPD in stable period who were admitted to our hospital from June 2021 to October 2022 were selected as the experimental group,including 43 males and 29 females,aged 55-84 years,with an average age of 70.29±8.14 years.According to the peripheral blood eosinophil(EOS)count and the frequency and severity of acute attacks in the past year,the patients were divided into non-EOS frequently aggravated phenotype(41 cases),EOS frequently aggravated phenotype(14 cases)and infrequently aggravated phenotype(17 cases),and 15 healthy people were selected as the control group.Patients with VD ddecrease/deficiency were treated with VD drugs for one month.Serum levels of 25-OH-VD and specific indexes of NETs(cit rulline histone 3(Cit H3)and myeloperoxidase DNA(MPO-DNA))of all subjects were detected by enzyme-linked immunosorbent assay(ELISA),and lung function of the enrolled patients was also detected.To analyze the differences of serum NETs,VD levels and lung function in patients with COPD in stable stage.To compare the serum NETs levels of COPD patients before and after VD drug intervention,in order to explore the significance of VD and NETs in the prevention,diagnosis and treatment of COPD.To explore the correlation between serum VD level NETs level in patients with COPD in stable stage.Results:(1)Comparing the variables among the four groups,there was no significant difference in gender,age and smoking between the experimental groups and the control group(P>0.05).There were significant differences in 25-OH-VD,NETs(Cit H3,MPO-DNA)and lung function(FVC%pred,FEV1%pred,FEV1/FVC,LCO%pred)(P<0.01).The level of serum 25-OH-VD FVC%pred FEV1%pred and FEV1/FVC of the experimental groups were all lower than those of the control group(P<0.05),but Cit H3 and MPO-DNA were all higher than those of the control group(P<0.05).The level of serum 25-OH-VD in non-EOS frequently aggravated phenotype was lower than that in EOS frequently aggravated phenotype and infrequently aggravated phenotype(P<0.05),and there was no significant difference between EOS frequently aggravated phenotype and infrequently aggravated phenotype(P>0.05).The level of serum Cit H3 in EOS frequently aggravated phenotype was lower than that of non-EOS frequently aggravated phenotype and infrequently aggravated phenotype(P<0.05),and there was no significant difference between non-EOS frequently aggravated phenotype and infrequently aggravated phenotype(P>0.05).The level of serum MPO-DNA in non-EOS frequently aggravated phenotype was higher than that of EOS frequently aggravated phenotype(P<0.05),and there was no significant difference between non-EOS frequently aggravated phenotype and EOS frequently aggravated phenotype(P>0.05).On lung function,FEV1%pred and FEV1/FVC in the experimental group were all lower than those in the control group(P<0.05).Among them,there were significant differences in FEV1%pred,FEV1/FVC between non-EOS frequently aggravated phenotype and infrequently aggravated phenotype(P<0.05).On FVC%pred and DLCO%pred,there was significant difference between non-EOS frequently aggravated phenotype and control group(P<0.05),but there was no significant difference between experimental groups(P>0.05).(2)According to the references,72 patients were divided into mild,moderate,severe and extremely severe.With the increase of GOLD grade,the serum level of 25-OH-VD decreased,and the differences among the groups were statistically significant(P<0.05).At the same time,the levels of serum Cit H3 and MPO-DNA increased,and there was a significant difference among the groups(P<0.05).(3)The serum level of 25-OH-VD in COPD patients in stable stage after VD drug intervention was higher than that before intervention,and the difference was statistically significant(P<0.001).The serum levels of Cit H3 and MPO-DNA were lower than before intervention,and the difference was statistically significant(P<0.001).(4)Pearson correlation analysis showed that the serum level of Cit H3 and MPO-DNA were negatively correlated with the serum level of 25-OH-VD.In the analysis between experimental groups,Cit H3 and MPO-DNA of non-EOS frequently aggravated phenotype were negatively correlated with 25-OH-VD(P<0.001),Cit H3 and MPO-DNA of infrequently aggravated phenotype were negatively correlated with 25-OH-VD(P<0.001),and EOS frequently aggravated phenotype Cit H3 and MPO-DNA.There is no correlation between Cit H3,MPO-DNA and 25-OH-VD in EOS frequently aggravated phenotype.(5)The Serum level of 25-OH-VD,Cit H3,MPO-DNA were correlated with FVC%pred,FEV1%pred and FEV1/FVC in COPD patients in stable stage,and the results showed that 25-OH-VD was positiveiy correlated with FVC%pred,FEV1%pred and FEV1/FVC(P<0.001),the Cit H3 and MPO-DNA were negatively correlated with FVC%pred,FEV1%pred and FEV1/FVC(P<0.001).(6)Correlation analysis of 25-OH-VD,Cit H3,MPO-DNA and DLCO%pred showed that DLCO%pred was positively correlated with 25-OH-VD(P<0.01),and negatively correlated with Cit H3 and MPO-DNA(P<0.01).(7)ROC curve analysis showed that AUC of 25-OH-VD,Cit H3 and MPO-DNA in predicting COPD was 0.8005,0.7556 and 0.7088,respectively.Logistic regression analysis showed that 25-OH-VD might be an independent risk factor for COPD(P<0.05),while Cit H3 and MPO-DNA were not independent risk factors for COPD(P>0.05).Conclusion:1.The serum vitamin D level of EOS frequently aggravated phenotype in COPD patients in stable stage is higher than that of non-EOS frequently aggravated phenotype.The serum NETs level of non-EOS frequently aggravated phenotype is higher than that of EOS frequently aggravated phenotype.2.Vitamin D may improve the level of NETs in stable COPD,but there is no difference in the effects on each phenotype.3.The serum NETs level is negatively correlated with all indexes of lung function,and positively correlated with the severity of the disease,suggesting that NETs can be used as an index to evaluate the severity of the patient’s disease.4.Vitamin D may be a protective factor for COPD.