目的：研究血浆蛋白C活性（ PC∶A）测定对支气管哮喘患者病情和预后的评估价值。方法回顾性队列分析研究。选择天津医科大学总医院于2010年至2012年间收治的支气管哮喘患者202例，男77例，女125例，年龄（41.2±11.4）岁。采用IL ACL TOP 700型血液凝固仪测定PC∶A。采用ROC评价PC∶A的诊断性能。利用χ2检验对PC∶A和临床病理因素进行关联性分析。用Cox回归模型对预后影响因素进行分析。用Kaplan-Meier曲线进行生存分析。结果 PC∶A测定结果分别为健康对照组（102.2±13.6）％、间歇发作组（104.8±11.9）％、轻度持续组（136.3±15.8）％、中度持续组（129.0±13.5）％、重度持续组（126.8±14.7）％，各组间PC∶A水平差异有统计学意义（F＝7.15，P＜0.01）。轻度、中度和重度持续组PC∶A水平均高于健康对照组（q值分别为16.83、19.94、11.37）和间歇发作组（q值分别为15.54、12.15、10.66），差异均有统计学意义（P＜0.05）。中度持续组和重度持续组PC∶A水平均显著低于轻度持续组（ q值分别为3.82和4.30，P＜0.05）。在接受6个月的规则治疗后，部分控制组和未控制组的PC∶A水平均显著高于控制组（ q值分别为12.45和9.91，P＜0.05）。 PC∶A评价哮喘患者接受治疗6个月后病情未得到完全控制的临界值为118.0％时，曲线下面积为0.892（95％CI：0.851～0.936）。χ2检验分析显示，PC∶A与嗜酸性粒细胞数量、血清总IgE、合并过敏性鼻炎和肺功能（ FEV1％）有关联性（ P＜0.01）。 Cox回归模型和生存分析显示，在接受6个月规则治疗后的血浆PC∶A是哮喘患者第7～12个月内哮喘急性发作风险的独立预后评价指标，血浆PC∶A高于临界值的哮喘患者的急性发作风险增加。结论哮喘患者血浆PC∶A水平显著增高，并与患者病情严重程度、哮喘控制水平和哮喘严重发作风险相关，可作为评价患者病情发展和哮喘控制的有效指标。%Objective To study the assessment value of serum protein C activity ( PC∶A) test in the patient′s condition and prognosis in bronchial asthma.Methods 202 bronchial asthma patients were selected from the Tianjin medical university general hospital from 2010 to 2012 for this retrospective cohort study, 77 males and 125 females with a mean age of 41.2 ±11.4 years.the level of PC∶A were analysed by IL ACL TOP 700 coagulation analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnosis performance of PC∶A, χ2 test was used to analyze the relevance between PC∶A and clinical pathological factors , Cox regression analysis model was used to evaluate the effect on prognosis , Kaplan-Meier curve to implement survival analysis.Results The elevels of PC∶A were:control group ( 102.2 ± 13.6)%, intermittent attack group (104.8 ±11.9)%, mild persistent group (136.3 ±15.8)%, moderate persistent group ( 129.0 ±13.5 )% and severe persistent ( 126.8 ±14.7 )% respectively , and there was significantly difference among the all groups ( F =7.15, P <0.01 ).Compared the control group and intermittent attack group with other groups , the PC∶A level was higher in mild persistent group ( q=16.83, q=15.54, P<0.05), moderate persistent group (q=19.94,q=12.15, P<0.05), and severe persistent group(q=11.37,q=10.66, P<0.05).The PC∶A level was lower in moderate and severe persistent group than mild persistent group ( q =3.82, q =4.30, P <0.05 ).After undergoing regular treatment for six months, the PC∶A level was higher in partly controlled group and uncontrolled group than complete controlled group (q=12.45, q=9.91,P<0.05).The optimum cut-off point of PC∶A (after undergoing regular treatment for six months ) for asthma condition with uncontrolled was 118.0%, the area under ROC curve was 0.892 ( 95% confidence interval:0.851-0.936 ).The χ2 test results showed that there was the relevance between the serum PC∶A level and the eosinocyte , total serum IgE , complicated allergic rhinitis and lung function ( FEV1%) ( P<0.01 ).The Cox analysis and survival analysis showed that the serum PC∶A level ( after undergoing regular treatment for six months ) was the independent assessment parameter for asthma acute attack in 7th-12th month, the cumulative probability of acute attack was increased obviously in the patients who with PC∶A level over the cut-off value.Conclusions The serum PC∶A level was increased obviously in asthma patients , and was related to patient′s condition, level of asthma control and severe attacks risk , which could be used as an effective indicator for assessment of disease progression and asthma control in asthma patients.
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