The indicator with reactive protein is increased. C-reactive protein: definition of diseases by biochemical analysis of blood. CRP positive or negative - value in women
Often, a blood test is ordered when there is a suspicion of inflammatory processes in the body. In addition to increasing the number of leukocytes, doctors usually pay attention to such a parameter as the erythrocyte sedimentation rate (ESR). Recent studies may undermine confidence in the usefulness of ESR for the diagnosis of inflammation and pay attention to the content of C-reactive protein (CRP, pronounced as CRRP).
What is better for diagnosing inflammation - ESR or C-reactive protein?
What is blood?
Blood is a suspension (particles in a liquid) in which red blood cells (particles) are in a liquid (plasma). As sand settles to the bottom in a test tube with water under the action of gravity, so red blood cells eventually settle in the capillary. Of course, blood is a more complex substance in its composition, and contains, in addition to erythrocytes and plasma, a large number of various cells and molecules. But erythrocytes are the most numerous cell population, present at 10¹² per litre. Whereas there are three orders of magnitude less leukocytes - 109 per liter. Plasma occupies about 45-55% of the total blood volume. To prevent blood from clotting, sodium citrate is added to it. Thus, the blood retains its fluidity, and does not clot when settling.
Erythrocytes are living non-nuclear blood cells with a lifespan of about 120 days. They have their own surface charge. The vascular endothelium is also charged in the same way. Due to the same charge, erythrocytes are repelled from each other and from the walls of the endothelium. The charge of an erythrocyte is provided by membrane molecules, as well as plasma proteins, which are adsorbed on the surface of erythrocytes. When settling, erythrocytes settle down with the formation of "coin columns". A change in the erythrocyte membrane or plasma composition as a result of the synthesis of acute-phase proteins (fibrinogen, c-reactive protein, haptoglobin, alpha-1 - antitrypsin) entails a change in the cell charge.
What is SOE?
ESR is used as a screening parameter characterizing inflammation. However, an increase in ESR is also observed with:
- anemia (the number of erythrocytes per unit volume decreases, the sedimentation rate increases),
- autoimmune diseases, paraproteinemias (antibodies are adsorbed on the erythrocyte membrane),
- intoxications (damage to the erythrocyte membrane, decrease in charge),
- kidney diseases, for example, with nephrotic syndrome, the excretion of toxic molecules slows down,
- taking medications (estrogens, glucocorticoids, heparin, penicillin, vitamin A).
In addition, there have been cases of increased ESR without any reason. An increase in ESR in acute inflammatory and infectious processes is observed 24 hours after an increase in temperature and an increase in the number of leukocytes. In a chronic inflammatory process, ESR rises due to the growth of fibrinogen and an increase in antibody titer.
There are the following methods for determining ESR: the Panchenkov method and the Westergren method. The only difference is that when determining by the Panchenkov method, a capillary with a scale of 100 mm is used, and by the Westergren method - 200 mm. The measurement is taken into account in millimeters of erythrocyte sedimentation within an hour. In the range of normal values, the dataobtained by these two methods are the same. Only in the presence of severe pathology is the Westergren method more sensitive. Thus, the determination of ESR is the easiest to perform, the most common laboratory parameter that does not require large expenditures and special equipment. At the same time, ESR is not a specific marker of the inflammatory response and can increase for many reasons, in contrast to such a parameter as CRP.
What is C-reactive protein?
The C-reactive protein got its name from its ability to bind to the C-polysaccharides of pneumococci. CRP is a protein that is synthesized by the liver in response to inflammation, necrosis, or injury. It is a highly specific marker of inflammation. It rises after 4-6 hours from the onset of the inflammatory process, even before the growth of leukocytes. Its main target is bacteria, therefore, with viral infections, CBR increases slightly. Borderline values of CRP (close to normal) have great importance as a sign of the presence of chronic endogenous inflammation. For example, if the lower limit of CRP is 5 mg / ml, then a figure of 5 mg / ml or more indicates the presence of an inflammatory process, necrosis or injury. It is necessary to monitor the change in the amount of CRP over time. With a long-term increase in CRP in the range of 2-10 mg / ml, there is a risk of complications from of cardio-vascular system in the form of heart attacks and thromboembolism.
So what is more important for diagnosing inflammation - ESR or C-reactive protein?
As you understand, CRP is a more informative parameter of the inflammatory process. However, the determination of CRP requires special reagents and instruments, which makes the determination of this parameter more expensive.
If you have low ESR, and C-reactive protein is normal, then most likely you do not have inflammation, and the reason for the decrease in ESR lies in something else. If your ESR is elevated and your C-reactive protein is normal, it may be due to anemia, as anemia is one of the most common causes of elevated ESR listed above. In general, for the diagnosis of inflammation better analysis on CRP, not on ESR.
C-reactive protein is formed during the acute phase of the disease, thus it is also called "acute phase protein", or AP. In the case of the transition of the inflammatory process into a chronic form, it disappears from the blood and reappears in the acute stage.
Physiological role of CRP
C-reactive protein was isolated in the thirtieth year of the last century in the blood of pneumonia patients. It got its name because of its ability to bind and precipitate the C-polysaccharide of a microscopic organism called pneumococcus as one of the early signs of host defense against an infectious agent.
The completeness of the immune defense of the macroorganism depends on the rate of formation of this protein in the blood, because it activates complement, increases the rate of phagocytosis, increases the formation of interleukin, etc. Moreover, the stronger the pathological process develops, the more C-reactive protein (the norm in women and men the same) increased.
The norm of C-reactive protein in the blood in this state will be within 300 mg / l. That is, this protein is quite sensitive and serves as an early indicator of the inflammatory process. An increased content of C-reactive protein in the blood occurs within an hour from the onset of the inflammatory process and disappears during the healing process (convalescence).
Field of study
An increase in the concentration of C-reactive protein is an early sign of an infectious (bacterial, not viral) process in a macroorganism. The increase is manifested in the acute phase of rheumatism, rheumatoid arthrosis, cardioinfarction, acute inflammatory process in the pancreas (with necrotic phenomena), septic condition, and malignant neoplasms.
Additionally, the determination of this protein is used to assess the duration of antibiotic therapy. Its determination at the initial stage is carried out in the following patients: febrile patients with the assumption of an infectious disease and patients with inflammatory pathology in a chronic form. In the hospital, it is used for early diagnosis of complications in infections and for evaluating the effectiveness of antibiotic therapy. In favor of the occurrence of complications is the fact of an increase in concentration in dynamics in the next four to five days after surgery.
Subtleties of interpretation of reaction results
C-reactive protein (the norm in women and men is within 1 μg / ml) is formed in the liver and exists in the blood of almost all healthy individuals, provided there is no inflammation. Great care must be taken in interpreting the data, taking into account previously obtained values and serum levels of other indicators, as well as a full assessment of the patient's history.
So, although C-reactive protein is elevated (normal - within 1 μg / ml) in serum, however, this is not a characteristic symptom of any particular disease, it is an important marker of inflammation. The rate of C-reactive protein in the blood increases an hour after the onset of inflammation and reaches a maximum within three days, has a short life (1-2 days) and returns to normal within 5-10 days from the onset of the inflammatory reaction. Laboratories are encouraged to define their own reference values. They are associated with the patient population, but, given the published literature, C-reactive protein (the norm in adults and children is presented below) should be at the following level: in newborns - 0.01-0.35 mg / l; in adults - 0.068-8.2 mg / l.
When reading indicators, you can rely on the following data:
- with viral infections, metastasis, sluggish chronic processes and some rheumatic diseases, C-reactive protein increases, the norm of which in such ailments reaches mg / l;
- with a bacterial infection, exacerbation of diseases in a chronic form, surgical manipulation, cardioinfarction, C-reactive protein increases, the norm in this case varies from 40 mg / l to 200 mg / l;
- with generalized infections, burn lesions, septic condition, C-reactive protein increases, the norm of which in this case is over 300 mg / l.
Purpose and timing of the study
Indications for the study of C-reactive protein:
- Assessment of the risk of developing cardiovascular pathological processes in relatively healthy individuals, combining with other indicators.
- To predict possible complications in people with coronary heart disease and arterial hypertension.
- To assess the effectiveness of the prevention of cardiovascular pathologies and their complications.
- To assess the completeness and effectiveness of antibacterial treatment.
- For diagnosing autoimmune diseases.
Research period:
- When examining patients with coronary artery disease, hypertension.
- During the period of therapy and prevention of cardiovascular complications while taking non-steroidal anti-inflammatory drugs (aspirin).
- In patients with ischemic heart disease after vascular plasty.
- In a comprehensive examination of healthy older people.
- After coronary bypass surgery (postoperative period) to control the dynamics.
ESR and CRP
There is a definite relationship between an increase in erythrocyte sedimentation rate and C-reactive protein. However, the latter is synthesized and disappears much earlier than the erythrocyte sedimentation rate changes. C-reactive protein is used in clinical diagnosis along with ESR as a marker of the inflammatory process.
In some cases, if the erythrocyte sedimentation rate is high, the C-reactive protein is higher than normal. The exceptions to this situation are:
- the concentration of CRP increases even as a result of a slight aseptic inflammation of the tissues, the ESR in this case remains within the limits of the normative indicators;
- ESR increases, and the protein level does not change with certain viral infections, severe intoxication, chronic arthritis.
It should be noted that the detection of C-reactive protein is a more reliable and sensitive marker of inflammation than the erythrocyte sedimentation rate (ESR).
The role of CRP in forecasting
This analysis plays a very important role in the diagnosis of many diseases. C-reactive protein (the norm in healthy people is up to 1 μg / ml) has a prognostic value in assessing the risk of cardiovascular pathologies and the development of their complications.
With myocardial infarction, the rate of C-reactive protein in the blood increases within hours from the onset of the disease, decreases by the twentieth day, and comes to normal indicators. With a second heart attack, CRP increases again.
In this case, ELISA is used for in vitro quantitation. Highly sensitive C-reactive protein is measured. The analysis can detect even a slight content of the mentioned protein in the serum (shows low inflammation during inner layer vascular wall) and gives grounds to preliminarily determine the risk of cardiovascular complications.
With myocardial infarction, aseptic inflammation is formed under the action of internal pathogens. In parallel, CRP is synthesized by hepatocytes, which promotes phagocytosis of the latter. The level of CRP in this pathology is interconnected with the size of the necrotic area in the heart muscle, with restenosis and complications in the postinfarction period.
Role in the development of cardiovascular diseases
Among the causes of mortality, cardiovascular pathologies and their complications are the most common. Determining the concentration of CRP in combination with other markers helps to assess the possible risk of developing such ailments in healthy people, as well as to predict cardiac diseases.
According to recent studies, flaccid inflammation in the intima of the vessel plays an important role in the occurrence of atherosclerosis, which is directly related to cardiovascular disease.
Certain studies show that patients with elevated CRP and normal low-density lipoproteins (LDL) are at greater risk of cardiovascular disease than those with normal CRP and high LDL. A slightly elevated CRP concentration with a normal cholesterol level makes it possible to predict the risk of developing hypertension, myocardial infarction, non-insulin-dependent diabetes mellitus, etc. In patients with coronary artery disease, elevated CRP is a negative indicator and indicates a risk of relapse.
Factors Affecting CRP
Causes of an increase in the level of C-reactive protein:
- infectious process in acute form;
- chronic inflammatory reactions in the acute stage;
- trauma, surgery, myocardial infarction;
- malignant tumor and metastasis;
- burn disease;
- septic condition;
- chronic inflammatory process sluggish with the risk of cardiovascular diseases and their complications;
- nicotine addiction;
- arterial hypertension;
- diabetes;
- decrease in lipoproteins high density, increased content of triglycerides and low density lipoproteins;
- an increase in estrogen and progesterone.
Factors that increase the content of C-reactive protein:
- pregnancy, significant physical activity;
- oral contraceptives, hormone therapy.
Factors that reduce the content of CRP:
- taking NSAIDs (acetylsalicylic acid, Analgin, Diclofenac, etc.), corticosteroids, statins, beta-blockers.
C-reactive protein. The norm in children
Normal serum levels of CRP in children are up to 10 mg/l.
Factors that increase the level of CRP in the child's body:
- infectious and inflammatory processes in the acute stage;
- rheumatoid diseases;
- ulcerative lesions of the large intestine;
- myocardial infarction;
- neoplasms in the stage of necrosis and metastasis;
- trauma;
- inflammatory ENT diseases, inflammation of the respiratory system, etc.;
- burn disease;
- liver transplant;
- tuberculosis;
- meningococcal infection;
- neonatal sepsis.
Possible fluctuations between 50 and 60 mg / l allow the pediatrician to determine the nature of the infectious process in the child, especially when it comes to respiratory pathology, such as pharyngitis, bronchitis or pneumonia. CRP can have high rates even if the child suffers from an inflammatory process in the appendix, an allergic reaction in case of any adenovirus or herpes infection, including mononucleosis.
Causes and signs of elevated blood c-reactive protein (CRP)
C-reactive protein, or CRP, is an important immunological laboratory test that can detect many pathological processes. He is the first to signal trouble and launches defense mechanisms.
Elevated c reactive protein in the blood is not specific for any disease, but the test itself is universal due to its high sensitivity.
In this article, you will learn about increased c-reactive protein in the blood, what it means, what are the causes and signs in adults and children.
What is CRP in a blood test
It is traditionally accepted that a blood test for C-reactive protein (CRP) is done to diagnose rheumatism. Indeed, it is included in the complex of immunological tests to detect the activity of rheumatism, but not only. This protein can be called a universal and very sensitive indicator of any inflammatory process in the body.
Modern medicine attaches more importance to the analysis of CRP than to the determination of ESR or the detection of leukocytosis in the diagnosis of the inflammatory process.
The reason for the inflammatory process is that the analysis for C-reactive protein is much more sensitive: literally a few hours after the onset of inflammation, the content of CRP in the blood increases, and as the process subsides, its level immediately decreases, which cannot be said about ESR or leukocytosis, which change their indicators are much slower, “late”.
The thing is that C-reactive protein is a product of the body's immune system, which is always on the alert, sends signals to the liver, it produces albumins, of which CRP is a representative. Normally, it is also produced in certain amounts and is involved in the utilization of fatty acids and phospholipids.
In addition, C-reactive protein reacts to the appearance of a malignant process in the body, its level increases many times with cancer, leukemia, lymphomas, as well as after injuries and operations, with diabetes.
Norm of C-reactive protein
The amount of CRP in the blood of a healthy person is negligible, regardless of age and gender. Therefore, when as a result of the analysis it is noted that CRP is negative, this does not mean at all that it is not there. Just a very small amount of it is not determined by the laboratory, but it is present in the amount that is necessary to participate in the metabolism of fats.
The exception is newborns, in whom CRP in the blood is increased to 15 mg/l, and it decreases in the first days of a child's life. If this does not happen, then neonatologists (pediatricians who deal with newborns) sound the alarm and examine the child for an inflammatory process, infection in the body.
Modern diagnostics is guided by the content of CRP in mg per 1 liter of blood serum, that is quantitative analysis, it is more accurate. C reactive protein is elevated during pregnancy if a woman takes hormonal contraceptives or smokes. When evaluating a blood test should be taken into account. Elevated CRP is the norm for pregnant women taking hormonal contraceptives and smokers.
Anti-inflammatory drugs, corticosteroids, beta-blockers high blood pressure) reduce protein concentration. Therefore, when diagnosing, all this must be taken into account.
You can learn more about C-reactive protein norms here.
Reasons for the elevated level
Since C-reactive protein in the blood is an almost universal indicator of trouble in the body, an increase in its content is characteristic of many diseases. The reason is that the function of the protein is to bind to the damaged cell membrane and protect it.
CRP is fixed to the shell of bacteria, viruses, marking them for the immune system. Therefore, in diseases that occur with damage to cell membranes and with the ingress of pathogens, the production of CRP in the liver increases.
What to do if an increase in CRP is detected in the blood? The analysis itself is not specific and cannot be the basis for a diagnosis.
Therefore, deviations from the norm of C-reactive protein are evaluated taking into account other blood parameters, patient complaints, examination results and additional studies. All this is within the competence of a doctor who will prescribe an examination and give a correct assessment.
Features of an increased level in children
It is acceptable to increase CRP in newborns domg / l. This is due to the fact that in the baby's body there is still a high concentration of hormones transferred to him by the mother through the placenta. As they are removed, CRP will also decrease. If it does not fall to the norm (5 mg / l), or rises, this indicates the development of an inflammatory process in the child's body and requires treatment.
In acute childhood infections (measles, chickenpox, rubella), it can reach 100 mg / l, and this deviation appears on the first day of an increase in body temperature. If it does not decrease within 4-5 days, this indicates the development of complications, which are often given by the same scarlet fever, measles, and rubella.
CRP in children is also always prescribed for acute bacterial infections, pneumonia, meningitis, septic condition to control treatment and monitor the dynamics of inflammation. A decrease in protein levels indicates recovery.
signs
How to find out about an increase in the level of CRP in the blood, by what symptoms and signs? The fact is that this marker protein (indicator) in itself is a symptom or sign of many diseases. And its increase will be manifested by the symptoms of the disease, as a result of which the protein content increased.
For example, heat, rash on the body, headache, cough, runny nose, bloating and loose stools, swollen lymph nodes and other symptoms are always accompanied by an increase in CRP, are its companions, but not signs.
Indications for the appointment of a blood test for C-reactive protein are:
- Suspicion of the presence in the body of an infectious, inflammatory process.
- Treatment of acute and chronic inflammation - to control the effectiveness.
- Tumors, leukemia - to monitor the effectiveness of treatment.
- Endocrine disorders (increased blood sugar, signs of Itsenko-Cushing's syndrome).
- Systemic autoimmune diseases - rheumatism, lupus, rheumatoid arthritis.
- vascular atherosclerosis.
- Hypertonic disease.
- Cardiac ischemia.
- Injuries and surgical interventions.
Due to the fact that heart disease can be determined from CRP fluctuations, it is increasingly used in cardiology.
Also, an analysis of C-reactive protein is included in the program of medical examinations of the elderly for the early detection of atherosclerosis or cancer.
Treatment
How can the CRP content be reduced, are there any treatment methods? Of course, it is quite possible to normalize the level of this marker protein, and there are enough various therapeutic agents for this in the arsenal of medicine. Only there is no single prescription and no single treatment program, because CRP is not a diagnosis.
Only then is treatment possible. If it is an infectious or inflammatory process, antibiotic therapy, anti-inflammatory and immunomodulating agents are prescribed. If the cause is a malignant process, complex anticancer therapy is prescribed, and if vascular sclerosis progresses, agents are prescribed that improve fat metabolism, blood circulation, and so on.
In a word, there is no single prescription for treatment, it is individual in each case. And if the treatment is carried out adequately, then the C-reactive protein will quickly respond to it with a decrease and normalization of the level, and will return to its physiological "duties" - participation in metabolic processes.
As for the patient himself, he can also contribute to the reduction of CRP levels by parting with addiction to tobacco, adjusting the diet and following medical recommendations.
Now you know everything about CRP, why the reactive protein is elevated in a biochemical analysis, the causes of high concentration in children or a small child, as well as treatment methods.
C-reactive protein (CRP)
C-reactive protein appears during the acute period of the disease, therefore it is sometimes called acute phase protein (APP). With the transition to the chronic phase of the disease, C-reactive protein disappears from the blood and reappears during an exacerbation of the process. The appearance of this protein is the most early sign diseases. C-reactive protein stimulates protective reactions, activates the immune system.
C-reactive protein normal
CRP is synthesized in the liver and is contained in the blood serum of a healthy person in minimal amounts. Serum (plasma) levels of CRP are not affected by hormones, including during pregnancy, sex, age, medication, etc.
The norm of C-reactive protein in both children and adults is less than 5 mg / l (or 0.5 mg / dl).
For CRP analysis, blood is taken from a vein in the morning, on an empty stomach. If you need to donate blood at another time, you need to refrain from eating for 4-6 hours.
C-reactive protein (CRP)
Causes of an increase in C-reactive protein
C-reactive protein is elevated
During inflammation, the concentration of CRP in the blood plasma increases very quickly (in the first 6-8 hours) and very significantly by 10–100 times, and there is a direct relationship between the change in the level of CRP and the severity and dynamics of the clinical manifestations of inflammation. The higher the concentration of CRP, the higher the severity of the inflammatory process and vice versa. That is why the measurement of its concentration is widely used to monitor and control the effectiveness of the treatment of bacterial and viral infections.
Different causes of inflammation increase CRP levels in different ways:
With viral infections of sluggish chronic and some systemic rheumatic diseases, CRP rises to 10-30 mg / l. The level of CRP during a viral infection increases slightly, therefore, in the absence of injury, its high values in serum indicate the presence of a bacterial infection, which is used to differentiate a viral infection from a bacterial one.
If neonatal sepsis is suspected, a CRP level of more than 12 mg / l is an indication for the immediate initiation of antimicrobial therapy (in some newborns, a bacterial infection may not increase CRP).
With bacterial infections, exacerbation of some chronic inflammatory diseases, as well as tissue damage (surgery, acute myocardial infarction), the highest levels of dog / l are observed. With effective therapy, the concentration of CRP decreases the very next day, and if this does not happen, taking into account changes in CRP levels, the question of choosing another antibacterial treatment is decided. If within 4-5 days after the operation CRP continues to remain high (or increases), this is an indication of the development of complications (pneumonia, thrombophlebitis, wound abscess). After the operation, the level of CRP will be the higher, the more difficult the past operation, the more traumatic it is.
In myocardial infarction, the protein increases 18-36 hours after the onset of the disease, decreases by the 18-20th day, and returns to normal by the 30-40th day. With recurrences of a heart attack, CRP rises again. With angina pectoris, it remains within the normal range.
An increase in the level of CRP is observed in tumors of various localizations: in cancer of the lung, prostate, stomach, ovaries and other tumors and can serve as a test for assessing tumor progression and disease recurrence.
Severe generalized infections, burns, sepsis increase CRP almost prohibitively - up to 300 g / l or more. In any disease, the addition of a bacterial infection increases CRP by more than 100 mg / l.
With successful treatment, the level of C-reactive protein decreases over the next days, usually returning to normal on days 6-10.
C-reactive protein is elevated in the blood: causes
Often, pathological proteins are found in the blood serum, which are indicators of various diseases. One of them is C-reactive protein, and if it is elevated in the blood, it means that there is an acute inflammatory process in the body, and its causes can be very diverse. To find out what the increase in its concentration in the blood signals, let's figure out what kind of protein it is and why it begins to be synthesized.
What is C-reactive protein for?
This peptide belongs to the "acute phase" proteins. This means that CRP is one of the first to be synthesized in the liver in response to tissue damage and performs the following functions:
- activates immune responses;
- promotes phagocytosis;
- increases the mobility of leukocytes;
- enhances the functional activity of T-lymphocytes;
- binds to C-polysaccharides of bacteria and phospholipids of damaged tissues.
In fact, he takes an active part in immune defense. Its concentration in the blood increases significantly during the first days after the onset of inflammation, and decreases as it recovers. It is produced in response to the appearance of bacterial polysaccharides in the body. It is because of its ability to precipitate with the C-polysaccharide of the shell of pneumococci that it got its name. In addition, CRP is synthesized if there are necrotic processes in the body, because it reacts to phospholipids of damaged tissues.
An increase in CRP is an early sign:
Not only C-reactive protein is an indicator of an acute inflammatory process. Evidence of the same pathologies and ESR. Both of these indicators suddenly increase as soon as the disease occurs, but they also have differences:
- CRP appears much earlier and then disappears faster than ESR changes. That is, in the early stages of diagnosis, the detection of C-reactive protein is much more effective.
- If the therapy is effective, this can be determined by CRP on days 6-10 (its level will decrease significantly). The erythrocyte sedimentation rate decreases after 2-4 weeks.
- CRP does not depend on gender, time of day, erythrocyte count, plasma composition, and these factors have a significant effect on ESR.
That is why the level of CRP in the blood is an important diagnostic criterion in establishing the cause of the disease. Determining its concentration is the most sensitive method for assessing the activity of chronic and acute inflammatory processes. It is examined if various diseases are suspected, and by how much the level of CRP in the blood has increased, the specialist will make a timely and accurate diagnosis.
Causes of an increase in C-reactive protein
Laboratories use different methods of determination. Determine the concentration of CRP using:
If you take a blood test in different diagnostic centers, then the final figures may differ slightly. That is why it is better to take a second test in the same laboratory as the first one.
If there is an inflammatory process, in the first hours of the disease, the concentration of this protein begins to increase. Its amount exceeds the norm by 100 times or more and is constantly growing. A day later, its maximum concentration is reached.
Its amount in the blood increases due to major operations. After transplantation, an increase in protein concentration indicates graft rejection.
By examining the amount of CRP in the blood, the doctor determines the effectiveness of therapy. If its level is significantly increased, then the prognosis for the course of the disease is unfavorable. And he points to such diseases:
The expediency of studying the level of C-reactive protein will be determined only by a doctor. After all, the diagnosis of diseases by elevated levels of CRP has many features. For example:
- An increase in C-reactive protein is accompanied by rheumatoid arthritis. Determining the level of CRP is recommended not only for diagnosing this disease, but also for monitoring the effectiveness of treatment. However, by this indicator alone, it is impossible to distinguish rheumatoid arthritis from rheumatoid arthritis.
- The amount of CRP depends on the activity of ankylosing spondylitis.
- In systemic lupus erythematosus (SLE), if there is no serositis, its level will be within the normal range.
- In SLE patients, an increase in the concentration of C-reactive protein indicates the development of arterial thrombosis.
- Myocardial infarction is accompanied by an increase in CRP after hours. Its level begins to decrease from the day and after a month and a half returns to normal. With relapse, a surge of C-reactive protein occurs.
- Its level often increases in patients with unstable angina pectoris. And with stable - this figure is within the normal range.
- The synthesis of CRP is increased due to malignant tumors. And since this “acute phase” protein is nonspecific, for accurate diagnosis it is studied in combination with other tumor markers.
- With a bacterial infection, the concentration of C-reactive protein is significantly higher than with diseases provoked by viruses.
CRP is intensively synthesized in the following chronic diseases:
In these diseases, the protein concentration depends on the activity of the process, so the study of its amount is necessary to monitor the effectiveness of treatment. A persistent increase indicates a poor prognosis. And in myocardial infarction, the activity of C-reactive protein is associated with a high probability of death.
A number of scientific studies have shown that even a slight increase in CRP to 10 mg / l indicates the risk of:
But for the diagnosis of chronic diseases, the indicators of C-reactive protein are unreliable. In addition, its excessive amount is fixed in various autoimmune, infectious, allergic diseases, necrotic processes, after injuries, burns, surgical operations. Therefore, the doctor will make an accurate diagnosis based on the increase in CRP in the blood by conducting additional examinations.
Conclusion
Since C-reactive protein is synthesized in response to necrotic changes in tissues, the occurrence infectious disease, then its determination is necessary for accurate early diagnosis. Study it and to monitor how successful the therapy is. It is better not to make a diagnosis of an increase in the level of C-reactive protein in the blood on your own, but to entrust it to specialists - a rheumatologist, cardiologist, oncologist, surgeon. Indeed, to determine the cause of the disease, accompanied by an increase in the concentration of CRP, it is necessary to carry out additional examination patient.
Erythrocyte sedimentation rate (ESR) - the norm of the indicator and the reasons for the increase
The erythrocyte sedimentation rate (ESR) is an indicator that is obtained from a general clinical blood test. It should be noted right away that it is not considered separately - only in combination with other indicators. About what ESR is, what causes it to increase, and what is the rate of ESR in the blood of children will be discussed further.
What is SOE?
The erythrocyte sedimentation rate (ESR) measures how quickly red blood cells stick together in the blood. In scientific terms, the process is as follows. The specific mass of erythrocytes in the blood exceeds the specific mass of its plasma. Therefore, in a test tube, erythrocytes slowly settle to the bottom. If, for some reason, erythrocytes stick together, then their volume increases and, accordingly, the sedimentation rate increases. The process of adhesion of erythrocytes depends on the protein composition of the blood and their electrical properties.
The reasons causing an increase or decrease in ESR are very numerous, which is why it cannot be considered separately from other indicators. Only in their totality the doctor can draw a conclusion about the root cause.
The norm of ESR in the blood in children and adults
The ESR norm varies depending on gender and age. For example, in infants, the erythrocyte sedimentation rate is very small, a maximum of 2 mm / h, in boys - from 1 to 8 mm / h, in men - from 1 to 10. For more information on the norms of ESR in the blood of children and adults, see the following table.
It is also worth noting that ESR changes during pregnancy and in the first few weeks after childbirth. All these changes associated with age and pregnancy are physiological norm, but changes in the pathological nature must be evaluated in conjunction with other indicators. Unfortunately, a lot of doctors, seeing an increased content in the blood, immediately conclude that there is an inflammatory process and prescribe antibiotics. If you encounter such a doctor, immediately leave him and do not drink prescribed medications. Experienced and good doctor be sure to first find the cause of the increased rate and only then decide which treatment course to prescribe. Because elevated ESR is not a disease, it is only an indicator that something is wrong in the body.
Causes of changes in ESR in the blood
Above, we indicated that the aggregation of erythrocytes can be caused by an increase in the protein content in the blood, and this occurs due to inflammation, tissue destruction, immune disorders, etc.
Analysis of a person who becomes ill with an acute viral infection, shows a slow increase in ESR in the first couple of days after infection. It reaches its maximum value relatively late. A repeated increase in the indicator during the illness or a long stay of the indicator at a high level indicates complications.
In most cases, an elevated ESR in a child indicates an infectious and inflammatory process, allergies, and intoxication.
It is also observed in the following pathologies:
- Rheumatism in the active phase;
- Hepatitis;
- kidney disease;
- myocardial infarction;
- Lupus erythematosus;
- Leukocytosis;
- Diabetes;
- Anemia etc.
When it comes to allergies or infections, it is not so difficult to guess, because they will be accompanied by the corresponding symptoms. It is much more difficult to understand the problem when the child feels good, but the tests are bad. But here, too, you should not panic ahead of time, since sometimes the ESR indicator increases for harmless reasons, for example, when you violate the diet, helminthiasis, taking certain medications, during teething and with a lack of vitamins.
When successful treatment begins, the increased ESR in the child will gradually fall down. But, it is very important to remember that this process can take some time. Full normalization of the analysis occurs only after 1-1.5 months. But during treatment, as well as after it, doctors monitor the dynamics, therefore, as a rule, repeated tests are given every 2-3 weeks.
Analysis for C-reactive protein
This is a more modern express analysis. It is used in most paid clinics.
C-reactive protein is a blood plasma protein, by its concentration one can easily determine the presence of an inflammatory process in the body.
An analysis for C-reactive protein can be done after a course of treatment, and then you do not have to re-take an ESR test and wait for normalization within a month - this analysis can immediately show how the inflammatory process in the body is.
C-reactive protein in the blood: the norm in the tests, why it rises, the role in diagnosis
C-reactive protein (CRP, C-Reactives protein - CRP) is a rather old laboratory test, which, like ESR, shows that there is an acute inflammatory process in the body. It is not possible to detect CRP by conventional methods; in a biochemical blood test, an increase in its concentration is manifested by an increase in α-globulins, which it, along with other acute-phase proteins, represents.
The main reason for the appearance and increase in the concentration of C-reactive protein is acute inflammatory diseases, which give a multiple (up to 100 times) increase in this acute phase protein within hours from the start of the process.
CRP in the blood and a single protein molecule
In addition to the high sensitivity of CRP to various events occurring in the body, changes for better or worse, it responds well to therapeutic measures, so it can be used to control the course and treat various pathological conditions accompanied by an increase in this indicator. All this explains the high interest of clinicians, who called this acute phase protein a “gold marker” and designated it as a central component of the acute phase of the inflammatory process. However, the detection of CRP in the patient's blood at the end of the last century was associated with certain difficulties.
Problems of the last century
The detection of C-reactive protein until the end of the last century was problematic, due to the fact that CRP was not amenable to traditional laboratory tests that make up a biochemical blood test. The semi-quantitative method of capillary ring precipitation using antiserum was rather qualitative, as it was expressed in "pluses" depending on the amount (in millimeters) of precipitated flakes (precipitates). The biggest drawback of the analysis was the time spent on obtaining the results - the answer was ready only after a day and could have the following values:
- No sediment - the result is negative;
- 1mm sediment - + (weakly positive reaction);
- 2 mm - ++ (positive reaction);
- 3mm - +++ (very positive);
- 4 mm - ++++ (strongly positive reaction).
Of course, waiting for such an important analysis for 24 hours was extremely inconvenient, because in a day a lot could change in the patient's condition and often not for the better, so doctors most often had to rely primarily on ESR. The erythrocyte sedimentation rate, which is also a non-specific indicator of inflammation, unlike CRP, was determined in an hour.
Currently, the described laboratory criterion is valued higher than both ESR and leukocytes - indicators of a general blood test. C-reactive protein, which appears before the increase in ESR, disappears as soon as the process subsides or the treatment has its effect (after 1–1.5 weeks), while the erythrocyte sedimentation rate will be above normal values even up to a month.
How is CRP determined in the laboratory and what do cardiologists need?
C-reactive protein is one of the most important diagnostic criteria, therefore, the development of new methods for its determination has never faded into the background, and at present, tests to detect CRP have ceased to be a problem.
C-reactive protein, which is not included in a biochemical blood test, is easy to determine with latex test kits based on latex agglutination (qualitative and semi-quantitative analysis). Thanks to this technique, even half an hour will not pass, as the answer, which is so important to the doctor, will be ready. Such a rapid study has proven itself as the very initial stage of the diagnostic search for acute conditions, the technique correlates well with turbidimetric and nephelometric methods, therefore it is suitable not only for screening, but also for the final decision regarding the diagnosis and choice of treatment tactics.
The concentration of this laboratory indicator is recognized using highly sensitive latex-enhanced turbidimetry, enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay methods.
It should be noted that the described criterion is often used to diagnose pathological conditions of the cardiovascular system, where CRP helps to identify possible risks of complications, monitor the course of the process and the effectiveness of the measures taken. It is known that CRP itself is involved in the formation of atherosclerosis, even at relatively low values of the indicator (we will return to the question of how this happens). To solve such problems, traditional methods of laboratory diagnostics of cardiologists do not satisfy, therefore, in these cases, high-precision measurement of hsCRP in combination with a lipid spectrum is used.
In addition, this analysis is used to calculate the risk of developing cardiovascular pathology in diabetes mellitus, diseases of the excretory system, and unfavorable pregnancy.
SRP norm? One for all, but...
In the blood of a healthy person, the level of CRP is very low or this protein is completely absent (in a laboratory study, but this does not mean that it does not exist at all - the test simply does not capture scanty amounts).
The following ranges of values are accepted as the norm, moreover, they do not depend on age and gender: in children, men and women it is one - up to 5 mg / l, the only exception is newborn children - they are allowed to have up to 15 mg / l of this acute phase protein (as evidenced by reference literature). However, the situation changes when sepsis is suspected: neonatologists begin urgent measures (antibiotic therapy) when the child's CRP rises to 12 mg/l, while doctors note that a bacterial infection in the first days of life may not give a sharp increase in this protein.
A laboratory test is prescribed to detect C-Reactives protein in the case of many pathological conditions accompanied by inflammation, the cause of which was an infection or destruction of the normal structure (destruction) of tissues:
- Acute period of various inflammatory processes;
- Activation of chronic inflammatory diseases;
- Infections of viral and bacterial origin;
- Allergic reactions of the body;
- Active phase of rheumatism;
- Myocardial infarction.
In order to better understand the diagnostic value of this analysis, it is necessary to understand what acute phase proteins are, to learn about the reasons for their appearance in the patient's blood, and to consider in more detail the mechanism of immunological reactions in an acute inflammatory process. Which is what we will try to do in the next section.
How and why does C-reactive protein appear during inflammation?
CRP and its binding to the cell membrane in case of its damage (for example, during inflammation)
CRP, participating in acute immunological processes, promote phagocytosis at the first stage of the body's response (cellular immunity) and are one of the key components of the second phase of the immune response - humoral immunity. It happens like this:
- The destruction of cell membranes by a pathogen or other factor leads to the destruction of the cells themselves, which does not go unnoticed by the body. Signals sent from the pathogen or from leukocytes located near the site of the “accident” attract phagocytic elements to the affected area, capable of absorbing and digesting particles foreign to the body (bacteria and the remains of dead cells).
- The local response to the removal of dead cells causes an inflammatory response. Neutrophils with the highest phagocytic ability rush to the scene from the peripheral blood. A little later, monocytes (macrophages) arrive there to help with the formation of mediators that stimulate the production of acute phase proteins (CRP), if necessary, and to perform the function of a kind of “janitors” when it is necessary to “clean up” the focus of inflammation (macrophages are able to absorb particles larger than themselves).
- To carry out the processes of absorption and digestion of foreign factors in the focus of inflammation, the production of its own proteins (C-reactive protein and other acute phase proteins) is stimulated, which are able to withstand an invisible enemy, enhancing the phagocytic activity of leukocyte cells and attracting new components of immunity to fight infection . The role of inducers of this stimulation is taken by substances (mediators) synthesized by macrophages "ready for battle" located in the focus and arriving in the inflammation zone. In addition, other regulators of the synthesis of acute-phase proteins (cytokines, glucocorticoids, anaphylotoxins, mediators formed by activated lymphocytes) also participate in the formation of CRP. CRP is produced mainly by liver cells (hepatocytes).
- Macrophages, after performing the main tasks in the area of inflammation, leaving, capture the foreign antigen and go to the lymph nodes to present it there (antigen presentation) to immunocompetent cells - T-lymphocytes (helpers), which recognize it and give the command to B-cells to start antibody production (humoral immunity). In the presence of C-reactive protein, the activity of lymphocytes with cytotoxic abilities increases markedly. From the beginning of the process and at all its stages, CRP itself is actively involved in the recognition and presentation of the antigen, which is possible due to other factors of immunity with which it is in close relationship.
- In less than half a day (up to approximately 12 hours) from the onset of cell destruction, the concentration of serum C-reactive protein will increase many times over. This gives grounds to consider it one of the two main proteins of the acute phase (the second is serum amyloid protein A), which have the main anti-inflammatory and protective functions (other acute phase proteins perform mainly regulatory tasks during inflammation).
In this way, elevated level CRP indicates the onset of the infectious process at the earliest stage of its development, and the use of antibacterial and anti-inflammatory drugs, on the contrary, reduces its concentration, which makes it possible to give this laboratory indicator a special diagnostic significance, calling it the "gold marker" of clinical laboratory diagnostics.
Cause and investigation
Due to the qualities that ensure the performance of numerous functions, C-reactive protein has been nicknamed the "two-faced Janus" by the researcher-wit. The nickname turned out to be apt for a protein that performs a lot of tasks in the body. Its versatility lies in the roles it plays in the development of inflammatory, autoimmune, and necrotic processes: in the ability to bind to many ligands, recognize foreign agents, and timely engage the body's defenses in the destruction of the "enemy".
Probably, each of us has ever experienced an acute phase of an inflammatory disease, where the central place is given to C-reactive protein. Even without knowing all the mechanisms of CRP formation, one can independently suspect that the whole organism is involved in the process: the heart, blood vessels, head, endocrine system (the temperature rises, the body “aches”, the head hurts, the heartbeat quickens). Indeed, the fever itself already indicates that the process has begun, and changes in metabolic processes in various organs and entire systems have begun in the body, due to an increase in the concentration of acute-phase markers, activation of the immune system, and a decrease in the permeability of the vascular walls. These events are not visible to the eye, but are determined using laboratory parameters (CRP, ESR).
C-reactive protein will be increased already in the first 6-8 hours from the onset of the disease, and its values will correspond to the severity of the process (the more severe the course, the higher the CRP). Such properties of CRP allow it to be used as an indicator at the onset or occurrence of various inflammatory and necrotic processes, which will be the reasons for the increase in the indicator:
- Bacterial and viral infections;
- Acute cardiac pathology (myocardial infarction);
- Oncological diseases (including metastasis of tumors);
- Chronic inflammatory processes localized in various organs;
- Surgical interventions (violation of tissue integrity);
- Injuries and burns;
- Complications of the postoperative period;
- Gynecological pathology;
- Generalized infection, sepsis.
Elevated CRP often occurs with:
It should be noted that the values of the indicator for different groups diseases can vary significantly, for example:
- Viral infection, tumor metastases, rheumatic diseases that proceed sluggishly, without severe symptoms, give a moderate increase in the concentration of CRP - up to 30 mg / l;
- Exacerbation of chronic inflammatory processes, infections caused by bacterial flora, surgical interventions, acute myocardial infarction can increase the level of the acute-phase marker by 20 or even 40 times, but in most cases, such conditions can be expected to increase in concentration to 40-100 mg / l ;
- Severe generalized infections, extensive burns, septic conditions can very unpleasantly surprise clinicians with numbers indicating the content of C-reactive protein, they can reach exorbitant values (300 mg / l and much higher).
And one more thing: not having the desire to scare anyone, I would like to raise a very important issue regarding the increased amount of CRP in healthy people. A high concentration of C-reactive protein with external complete well-being and the absence of signs of at least some kind of pathology suggests the development of an oncological process. Such patients should undergo a thorough examination!
but on the other hand
In general, in terms of its properties and abilities, CRP is very similar to immunoglobulins: it “can distinguish between “self-foe”, bind to the components of a bacterial cell, to ligands of the complement system, and nuclear antigens. But to date, two types of C-reactive protein are known and how they differ from each other, thereby adding new functions of C-Reactives protein, can show a good example:
- The native (pentameric) acute phase protein, discovered in 1930 and consisting of 5 interconnected circular subunits located on the same surface (therefore, it was called pentameric and assigned to the pentraxin family) is the CRP that we know and talk about. Pentraxins consist of two sections responsible for certain tasks: one recognizes a “stranger”, for example, an antigen of a bacterial cell, the other “calls for help” those substances that have the ability to destroy the “enemy”, since CRP itself does not have such abilities;
- "New" (neoCRP), represented by free monomers (monomeric CRP, which is called mCRP), which has other properties that are not characteristic of the native variant (rapid mobility, low solubility, acceleration of platelet aggregation, stimulation of production and synthesis of biologically active substances). New form C-reactive protein was discovered in 1983.
A detailed study of the new acute phase protein revealed that its antigens are present on the surface of lymphocytes circulating in the blood, killer cells and plasma cells, and it is obtained (mCRP) from the transition of a pentameric protein to a monomeric protein during the rapid development of the inflammatory process. However, the most important thing that scientists have learned about the monomeric variant is that the "new" C-reactive protein contributes to the formation of cardiovascular disease. How does this happen?
Elevated CRP is involved in the formation of atherosclerosis
The body's response to the inflammatory process sharply increases the concentration of CRP, which is accompanied by an enhanced transition of the pentameric form of C-reactive protein to the monomeric form - this is necessary to induce the reverse (anti-inflammatory) process. An increased level of mCRP leads to the production of inflammatory mediators (cytokines), adherence of neutrophils to the vascular wall, activation of the endothelium with the release of factors that cause spasm, the formation of microthrombi and impaired blood circulation in the microcirculatory bed, that is, the formation of atherosclerosis of arterial vessels.
This should be taken into account in the latent course of chronic diseases with a slight increase in the level of CRP (domg / l). The person continues to consider himself healthy, and the process slowly develops, which can lead first to atherosclerosis, and then to myocardial infarction (first) or other thromboembolic complications. Can you imagine how much a patient is at risk, having high concentrations of C-reactive protein in the blood test, the predominance of the low-density lipoprotein fraction in the lipid spectrum and high values of the atherogenic coefficient (CA)?
In order to prevent sad consequences, patients at risk should not forget to take the necessary tests for themselves, moreover, their CRP is measured by highly sensitive methods, and LDL is examined in the lipid spectrum with the calculation of the atherogenic coefficient.
The main tasks of the SRB are determined by its “diversity”
It is possible that the reader has not received answers to all his questions regarding the central component of the acute phase - the C reactive protein. Considering that complex immunological reactions of stimulation, regulation of CRP synthesis and its interaction with other immunity factors can hardly be of interest to a person who is far from these scientific and incomprehensible terms, the article focused on the properties and important role of this acute phase protein in practical medicine.
And the importance of CRP is really difficult to overestimate: it is indispensable in monitoring the course of the disease and the effectiveness of therapeutic measures, as well as in the diagnosis of acute inflammatory conditions and necrotic processes, where it exhibits high specificity. At the same time, it, like other acute-phase proteins, is also characterized by non-specificity (a variety of reasons for the increase in CRP, the multifunctionality of C-reactive protein due to the ability to bind to many ligands), which does not allow using this indicator to differentiate various conditions and establish an accurate diagnosis ( No wonder they called him "two-faced Janus"?). And then it turns out that he takes part in the formation of atherosclerosis ...
On the other hand, many laboratory tests and instrumental diagnostic methods are involved in the diagnostic search, which will help CRP, and the disease will be established.
There is a protein in blood plasma called C-reactive (CRP). It responds most quickly to the appearance of inflammatory processes. The protein belongs to the acute phase glycoproteins. Its concentration rises sharply when tissues are damaged in the body.
The importance of C-reactive protein for the body
CRP is the dominant protein that activates the immune system to respond to tissue damage (muscle, nerve or epithelial). Therefore, the level of CRP along with ESR is used in diagnostics as an indicator of inflammation.
In violation of the structure and integrity of tissues, an inflammatory process is triggered. White blood cells begin to secrete interleukins, which are part of the immune system. They stimulate the synthesis of CRP in the liver. Further, the protein performs the following functions:
- CRP attaches to the surface of pathogens, as if marking them. Pathogens become more "visible" to the immune system.
- Thanks to the C-reactive protein, its successive reactions are launched, contributing to the fastest elimination of the pathogen.
- In the focus of inflammation, CRP binds to decay products and protects the body from their negative effects. Thus, phagocytosis is activated - the process of absorption and elimination of pathogens.
Four hours after the onset of inflammation, the concentration of CRP increases several times. And after two days, CRP exceeds the norm by one thousand times.
The results of the analysis tell the doctor in time whether it is necessary to prescribe antibiotics. If CRP is elevated, then the answer is yes. Otherwise, these drugs are not used.
Causes of an increase in C-reactive protein
The highest CRP is observed with the penetration of bacterial infections. When they invade the body, the protein content increases tenfold. At a rate of 5 mg / l, its amount can jump up to 100 mg / liter.
In addition to bacterial infections, there are other reasons for the growth of CRP. Its level increases with the development in the body:
- viral infections. The content of CRP can jump up to 20 mg/l;
- necrosis and tissue damage as a result of: myocardial infarction, decay of tumors, injuries, burns, frostbite;
- atherosclerotic vascular lesions. Slow inflammation in their walls contributes to the development of the disease;
- rheumatoid and psoriatic arthritis;
- polymyalgia rheumatica - chronic muscle pain;
- neoplasms;
- atherogenic dyslipidemia, including a triad of metabolic disorders;
- arterial hypertension;
- diabetes;
- hormonal disorders, when the content of estrogen and progesterone exceeds the optimal number;
- diseases of the gastrointestinal tract;
- viral, bacterial or tuberculous meningitis;
- bronchial asthma in case of damage to the respiratory system.
An increase in the level of C-reactive protein is also possible:
- in the postoperative period. Its growth signals the development of complications;
- in pregnant women, when the threat of premature birth looms.
There are also subjective factors:
- significant physical activity immediately before the test;
- taking hormonal contraceptives;
- obesity;
- adherence to a diet with a significant amount of protein (most often, this applies to athletes);
- depression and sleep problems;
- addiction to smoking.
It should also be taken into account that there are drugs that artificially reduce the amount of C-reactive protein, which is actually elevated. These include:
- anti-inflammatory nonsteroidal drugs;
- glucocorticoid hormones (glucocorticosteroids).
Separately, it is worth highlighting the reasons for the growth of C-reactive protein in children.
Features of elevated C-reactive protein in children
In a baby who has just been born, the amount of C-reactive protein may not increase even with sepsis. The reason lies in the fact that the liver of the crumbs is not yet working at full capacity.
When an increase in CRP is nevertheless recorded in the blood of infants, antimicrobial treatment should be carried out immediately.
Sometimes an increase in the concentration of this type of protein may be the only sign of infection entering the child's body after any surgical intervention.
The level of CRP increases with the development of such childhood ailments:
- chickenpox;
- rubella;
- measles.
The amount of CRP jumps up in the first days of the disease, when the child is feverish from a change in body temperature. After recovery, the protein concentration also quickly decreases to a normal level.
Signs of elevated C-reactive protein and test indications
The following indirect symptoms indicate an increase in the level of CRP:
- temperature rise;
- slight chills;
- periodic cough and shortness of breath;
- increased general sweating;
- in the general blood test, an increase in ESR and the number of leukocytes is recorded.
More recently, a C-reactive protein test has been prescribed in order to reveal hidden inflammatory processes. Today, it can be used to assess the risk of cardiovascular diseases in people who are practically healthy. First of all, this applies to elderly patients.
The main indications for the study are as follows:
- The development of coronary heart disease and other ailments that develop against the background of atherosclerosis.
- Timely fixation of exacerbations after surgical operations, such as bypass surgery or angioplasty.
- Identification of the risk of a second heart attack or stroke.
- Evaluation of the level of effectiveness of treatment with antibacterial drugs for a bacterial infection.
- The period of treatment of cardiovascular diseases.
- Suspicion of the presence of neoplasms.
- The appearance of signs of lupus erythematosus.
- Diagnosis of Crohn's disease and ulcerative colitis.
To ensure the reliability of the results, the test is carried out in the morning. In addition, you should not eat 12 hours before the procedure, temporarily give up physical activity and avoid stress.
Having fixed an increased level of protein and excluding the influence of subjective factors on the indicator, the doctor determines the therapy.
Taking drugs can blur the reliability of the obtained data on the level of CRP. To ensure the accuracy of the results, the test must be done again after fourteen days.
C-reactive protein elevated: therapy
An increased amount of CRP is not a disease, but an indirect sign of a possible pathology. Its exact name is determined by the doctor after an additional examination. It is the identified ailment that needs to be treated.
If therapy is prescribed correctly, then the CRP level returns to normal in a day. When this does not happen, treatment needs to be adjusted.
In the case of an increase in the amount of CRP and the absence of signs of infection in the body, a consultation with an oncologist is necessary.
In order to make therapy more effective, it does not hurt to follow these recommendations:
- work on lowering cholesterol levels;
- do not forget about physical activity and maintain normal weight;
- prevent the growth of sugar in the blood;
- convince yourself of the dangers of smoking and alcohol, reducing their consumption to a minimum;
- follow the dietary advice.
These are the standard rules for all those who want to stay healthy longer and high quality life.
It is advisable to evaluate the concentration of C-reactive protein no earlier than two weeks after the symptoms of any acute illness or exacerbation disappear. chronic illness. With an increase in the number of CRP two times or more, it is necessary to undergo an additional examination to clarify possible reasons start of the inflammatory process.
Synonyms: C-reactive protein, CRP, CRP
C-reactive protein is a blood component that provides the body's primary response to tissue damage and inflammation. This is a fast phase protein, it only stimulates the immune response to the pathological process. Therefore, CRP is usually not detected in the blood of a healthy person.
A blood test for CRP allows you to establish the presence of the disease and determine the stage and severity of its course. Also, according to the results of this study, specialists evaluate the effectiveness of the prescribed course of therapy, which makes it possible (in the absence of positive dynamics) to change the treatment regimen in a timely manner.
General information
CRP is produced in liver cells (hepatocytes) immediately after damage has occurred, the provoking factors of which can be bacteria, fungi, antigens, various immune complexes, etc.
The level of C-reactive protein directly depends on the type, form (acute, chronic), stage and activity of the disease. In the first 4-6 hours after cell damage, active synthesis of CRP begins, and a day later its density increases exponentially.
With early diagnosis of the disease and timely treatment, after a few days, the analysis will show a decrease in the concentration of CRP. The indicator will be completely reset only 1-2 weeks after the start of conservative therapy.
Chronic pathologies are characterized by an undulating course, respectively, and CRP will increase during an exacerbation and decrease independently during remission (subsidence of clinical symptoms).
CRP analysis plays an important role in the diagnosis of atherosclerosis. If the level of protein in the plasma rises, then we can talk about the pathology of the vascular walls and the beginning of the inflammatory process. Additional diagnostics will reveal which disease is developing: stroke or heart attack, ischemic disease, hypertension, atherosclerosis, etc.
In newborns, liver function is insufficient, so the level of C-reactive protein may not increase even with acute inflammatory processes and sepsis (blood infection). Antibacterial treatment of infants should be started when the concentration of CRP is more than 12 mg / l.
Indications
A referral for the determination of C-reactive protein can be carried out by an immunologist, an infectious disease specialist, a general practitioner, a pediatrician, or a general practitioner.
Norm for C-reactive protein
- Normally, the concentration of CRP in a healthy person varies between 0-5 mg / l.
The following values can be used to assess the risk of developing cardiovascular pathologies:
Interpretation of results
Normally, in the blood of a healthy person, C-reactive protein is completely absent or is in a negligible concentration.
Exceeding the norm of CRP may indicate the following pathologies:
- bacterial diseases in an acute form (sepsis in newborns, tuberculosis);
- meningitis (inflammation of the soft tissues around the brain);
- postoperative complications (wound infection, sepsis);
- neutropenia (decrease in the concentration of neutrophils in the blood);
- tissue damage as a result of trauma, surgery, burns;
- acute myocardial infarction;
- malignant processes in the body with metastasis;
- hypertensive crisis (a sharp increase in pressure to individually high numbers);
- diabetes mellitus (increased blood glucose);
- hormonal disruptions (increased levels of the hormones estrogen or progesterone);
- systemic rheumatic pathologies;
- atherogenic dyslipidemia (decreased concentration of "normal" cholesterol with an increase in triglyceride levels);
- chronic cardiovascular pathologies (ischemic heart disease, angina pectoris);
- recurrence of infectious and inflammatory processes;
- rejection reaction of the transplanted graft;
- secondary amyloidosis (impaired protein metabolism).
It should be borne in mind that the concentration of C-reactive protein for various diseases differs significantly.
- With viral pathologies, metastatic cancer (stage 4), as well as indolent rheumatic diseases, the protein level can be increased moderately - up to 30 mg / l;
- In recurrent chronic inflammatory diseases, bacterial infection, acute myocardial infarction, the concentration of C-reactive protein can be in the range of 40-100 mg / l. The same values are observed in patients in the postoperative period;
- Generalized infections, extensive burns, sepsis and other conditions threatening human life and health can give ultra-high values - more than 300 mg / l;
An increased concentration of CRP in healthy people in the absence of complaints and clinical symptoms may indicate the development of oncology.
Preparation for analysis
The material for the study is venous blood. Biomaterial sampling is carried out by venipuncture strictly on an empty stomach and in the morning (the last meal should be taken at least 8-10 hours before the manipulation).
The rest of the training requirements are standard for all similar procedures.
The day before:
- obligatory adherence to a diet that excludes the use of spicy, fatty, fried, smoked foods and alcoholic / tonic drinks;
- a strict ban on:
- any physical and emotional overload;
- overheating and hypothermia of the body.
On the day of the procedure (from the morning until the moment of blood sampling):
- you can not take any medicines, drink tea / coffee, juices, etc. Only pure non-carbonated water is allowed for consumption;
- you can not drink alcohol and energy drinks, as well as smoke and use nicotine substitutes.
Additional terms:
- a blood test is prescribed before the start of drug therapy or 2 weeks after its cancellation/completion;
- venipuncture is carried out before other scheduled examinations (ultrasound, x-ray, fluorography, etc.).
Other rheumatology screening tests
When conducting a biochemical study, in some cases CRP may be detected in the blood - what it is is not known to all patients. This is the designation of C-reactive protein - a sensitive element of the blood, which appears when the tissues of the body are damaged, the development of inflammatory processes, the penetration of foreign organisms.
What is SRB?
C-reactive protein is a special structure of the blood that instantly reacts to the appearance of inflammation in the body. This substance is a kind of marker that allows doctors to determine the presence in the body of even sluggish pathological processes that do not appear externally. The protein consists of five separate subunits connected to each other in the form of a pentahedron. They are connected to each other by covalent bonds.
C-reactive protein is present in the body in a small concentration, but its volume increases significantly with the development of pathologies affecting such internal organs:
- liver;
- kidneys.
Determination of C-reactive protein
CRP in a biochemical blood test is determined by counting the number of mg of this protein per 1 liter of biological fluid. As a sample, blood obtained from the patient's cubital vein is used. Subsequently, the resulting biological fluid is sent to the laboratory for a complete microscopic examination. The results of the analysis are known on the same day. They are evaluated by a doctor who has information from the patient's history and the results of other laboratory and hardware studies. The values of the norm of CRP in the blood (what it is indicated above) are variable and depend on:
- gender of the patient;
- age.
What does a blood test for CRP show?
Patients who are scheduled for an examination often have no idea what C-reactive protein shows and what it is set for. The main purpose of the study is to confirm the presence of pathology in the body, which is not always manifested. If there is an incubation period, doctors may become aware of infection as early as 4 to 6 hours after infection.
This allows you to quickly respond and start therapy at an early stage, reducing the treatment period and preventing possible complications. In addition, the study helps to determine the transition of the disease from the acute to the chronic phase, when the symptoms subside, but recovery does not occur.
Blood test for CRP - preparation
In order for a C-reactive protein blood test to show an objective result, doctors warn patients about the need to prepare for the study. It consists in limiting food intake 12 hours before the study. At this time, it is necessary to completely exclude fatty and fried foods, alcohol from the diet. The last meal before blood sampling should occur no later than 8 hours before the expected time of analysis.
At this time, only drinking is allowed: ordinary water without gas. Juices, tea and coffee are excluded before analysis. Smoking is prohibited 30 minutes before the examination. In order to obtain objective results and avoid the need for a second study, doctors recommend that on the eve of the analysis, beware of stressful situations, overvoltage, physical exertion.
How to take an analysis for CRP?
CRP blood biochemistry is no different from conventional venous blood sampling. The procedure is optimally carried out between 8-11 hours. The fence is made from the cubital vein of the patient. In this case, the laboratory assistant uses a disposable syringe or a special vacuum system. For analysis, 5-10 ml of blood is needed. After receiving the material, it is placed in a dry sterile test tube, which is labeled in a special way. The applied code contains information about the patient, which is then taken into account when interpreting the results of the analysis.
CRP blood test - transcript
Only a specialist can determine whether the concentration of C-reactive protein in the blood is normal. When evaluating the result obtained, not only the numerical value of the indicator is taken into account, but also the overall clinical picture, the patient's condition and the time of the study. In some cases, a slight increase in protein concentration may be recorded a short time after the examination. In addition, an increase in the level of this compound can be observed during the transition of a previously identified pathology from the chronic stage to the acute one.
C-reactive protein is normal
Having found out why the concentration of CRP in the blood is set, what kind of substance it is, it is necessary to name the normal indicators. Depending on the methods of analysis, the reagents used and the units of measurement, the results of the study in different laboratories may vary. In this case, the difference is insignificant, but it may be present. When evaluating the results of the examination, doctors must take into account the patient's gender and age.
In some cases, there may be a slight presence of CRP in the blood, the rate of which is set to 5 mg / l. This value applies to both women and men. However, when evaluating the results, physiological factors are also taken into account, which can provoke a slight increase in CRP in the bloodstream of women.
Doctors are more likely to interpret the results as follows:
- up to 1 mg / l - the likelihood of inflammatory diseases and complications is low;
- 1-3 mg / ml - an increased risk of developing pathologies, the presence of chronic pathologies in the body;
- above 5 mg / l - there is inflammation in the body in the acute stage.
The norm of CRP in the blood of women
Slight, temporary fluctuations in the level of CRP in the blood in women (what it is, described above) are a variant of the norm. They are often associated with cyclical changes occurring in the body of women of reproductive age. Menstrual flow is always the period when there is a decrease in the body's defenses. As a result, there is a risk of developing a disease or exacerbating a chronic infection in the body. As a result of such changes, the growth of C-reactive protein is possible.
CRP is also elevated during pregnancy. At this time, this indicator can briefly reach a value of 20 mg / l. This is observed at short gestation periods, when the girl may still not know about the conception that has occurred. The immune system initially reacts to the fetal egg as a foreign agent. As a result, there is an increase in the concentration of C-reactive protein, which is of a short-term nature.
CRP is the norm in men
In males, the norm of CRP in the blood is the same 5 mg / l. However, unlike women, fluctuations in the values of this parameter are practically not observed. The interpretation of the results of the analysis for C-reactive protein in the blood, the norm of indicators, can be carried out as follows:
- less than 1 mg / l - a result close to normal, there is no risk of onset of vascular diseases;
- 1-3 mg / l - an increased value, indicating a high probability of heart damage;
- 3-5 mg / l - exacerbation of a chronic disease;
- more than 5 mg / l - an acute stage of inflammation, requiring additional examination.
CRP is normal in children
Due to the stress and heavy loads that the baby experiences when passing through the birth canal, C-reactive protein is present in his blood. So, the rate of CRP in the blood of newborns is set at around 0.6 mg / l. Over time, the concentration of this substance gradually increases. Neonatologists associate this phenomenon with the period of active adaptation of a small organism to changing environmental conditions. So, in babies, after a week of life, CRP reaches 1.6 mg / l, which is a variant of the norm. An increase in the indicator can be recorded in older children.
Elevated CRP in the blood - what does it mean?
In itself, an increase in the concentration of this protein in the blood is only a symptom of a possible disorder and is not considered as a sign of pathology. In order to establish what specifically caused the appearance of C-reactive protein in the bloodstream, an additional comprehensive examination is required. Fixation of high values of CRP is an indication for re-analysis. As the observations of specialists show, C-reactive protein is increased with:
- inflammation;
- pregnancy;
- exacerbation of chronic diseases;
- injuries;
- smoking.
Increased CRP in the blood - causes
If C-reactive protein is significantly elevated in the bloodstream, doctors prescribe a set of diagnostic measures aimed at determining the exact cause. Often, the patient will have a dozen examinations before receiving the final conclusion. Why C-reactive protein is elevated, which means it can be established only after receiving the results of all tests. Among the main pathologies in which CRP is detected in the blood (we figured out what it is), it is necessary to highlight:
- diseases of the gastrointestinal tract;
- cancer of any localization;
- tuberculosis;
- neonatal sepsis.
Increased CRP - what to do?
High C-reactive protein is an indication for a complete examination of the patient. Features of therapy and its duration are completely determined by the type of pathological process. At the same time, doctors try to exclude all foci of chronic infection in the body. The presence of this protein indicates a high risk of heart attacks and strokes. When the main cause of the increase in protein is eliminated, its concentration returns to normal on its own.
To avoid an increase in C-reactive protein, doctors recommend:
- Timely undergo preventive examinations.
- Get tested for markers of inflammation.
- Fully comply with the prescribed treatment.