SRB blood test - interpretation and norm. C-reactive protein (CRP): everything you need to know C reactive protein synthesis process

General information about the study

C-reactive protein is a glycoprotein produced by the liver and belongs to the acute phase proteins of inflammation. Under the influence of anti-inflammatory cytokines (interleukin-1, tumor necrosis factor alpha and especially interleukin-6), its synthesis increases within 6 hours, and its concentration in the blood increases 10-100 times within 24-48 hours after the onset of inflammation. The highest levels of CRP (more than 100 mg/l) are observed with bacterial infection. In case of a viral infection, the level of CRP, as a rule, does not exceed 20 mg/l. The concentration of CRP also increases with tissue necrosis (including myocardial infarction, tumor necrosis).

CRP is involved in the activation of complement (a group of proteins that are part of the immune system), monocytes, stimulation of the expression of adhesion molecules ICAM-1, VCAM-1, E-selectin on the surface of the endothelium (they ensure cell interaction), binding and modification of low-density lipids (LDL) , that is, contributes to the development of atherosclerosis. According to the results of recent studies, low-grade inflammation in the vascular wall plays a major role in the development of atherosclerosis, which, in turn, is associated with the occurrence of cardiovascular diseases. Damage to the vascular wall, inflammation and increased CRP are promoted by “classical” risk factors for cardiovascular diseases: smoking, obesity, decreased sensitivity of tissues to the action of insulin.

A slightly elevated baseline level of CRP, which can only be determined using highly sensitive analytical methods, reflects the activity of inflammation in the inner lining of blood vessels and is a reliable sign of atherosclerosis. Some studies indicate that patients with elevated CRP and normal LDL are at greater risk of developing cardiovascular disease than patients with normal CRP and high LDL. A relatively elevated level of CRP, even with normal cholesterol levels in practically healthy individuals, allows one to predict the risk of hypertension, myocardial infarction, stroke, sudden cardiac death, type 2 diabetes mellitus and obliterating atherosclerosis of peripheral vessels. In patients with coronary heart disease, excessive levels of CRP are a bad sign and indicate a high risk of recurrent heart attack, stroke, restenosis during angioplasty and complications after coronary artery bypass grafting.

The level of CRP in the blood is reduced by acetylsalicylic acid and statins, which reduce the activity of inflammation in the vascular wall and the course of atherosclerosis. Regular physical activity, moderation in alcohol consumption, and normalization of body weight lead to a decrease in the level of CRP and, accordingly, the risk of vascular complications.

As is known, among the causes of mortality in the adult population of developed countries, cardiovascular diseases and their complications occupy first place. Studies of CRP levels in combination with other indicators help to assess the likely risk of developing cardiovascular diseases in relatively healthy people, as well as to predict the course of the disease in cardiac patients, which can be used for preventive purposes and when planning treatment tactics.

What is the research used for?

• To assess the risk of developing cardiovascular diseases in apparently healthy individuals (along with other markers).
• To predict complications (myocardial infarction, stroke, sudden cardiac death) in persons with coronary heart disease and hypertension.
• To assess the effectiveness of prevention of cardiovascular diseases and their complications.

When is the study scheduled?

• During a comprehensive examination of practically healthy individuals of older age groups.
• When examining patients with coronary heart disease and hypertension.
• During the treatment and prevention of cardiovascular complications, while taking aspirin (acetylsalicylic acid) and statins in cardiac patients.
• After angioplasty in patients with exertional angina or acute coronary syndrome (to assess the risk of death, recurrent myocardial infarction, restenosis).
• After coronary bypass surgery (to identify early postoperative complications).

Early diagnosis of the tuberculosis process in HIV-infected patients significantly reduces mortality and improves the overall prognosis. At the same time, as is known, the diagnosis of tuberculosis (TB) is the weak link in anti-TB measures in general. It is especially difficult to make a timely diagnosis in patients with a negative sputum smear for TB. In countries with a high prevalence of HIV infection and TB, it is these patients who experience increased mortality, and its main reason is the late diagnosis of TB. There is an opinion that the level of C-reactive protein (CRP) can be one of the auxiliary methods for diagnosing TB in HIV-TB infected patients. South African scientists analyzed a large cohort of patients in order to confirm or refute this assumption.

Methods and progress of the study

The study took place in the KwaZulu Nathan province (South Africa), where the prevalence of HIV infection among patients in public outpatient clinics is 40.4%. The prospective study included patients with suspected tuberculosis and a double negative sputum smear for M. Tuberculosis and patients from whom it was impossible to collect sputum for testing. Patients with TB, Karnofsky score > 40, Pneumocystis pneumonia, anti-tuberculosis therapy for a week or more, and antiretroviral therapy were excluded< 3 месяцев.

Patients were carefully examined upon inclusion in the study. The study included radiological techniques, sputum culture and CRP levels. At the discretion of the attending physician, some patients were immediately prescribed anti-tuberculosis therapy. Patients were observed for 8 weeks and during this time either a diagnosis of TB (confirmed or possible) was made or removed. TB was considered confirmed if the sputum culture was positive and possible if the culture result was negative but progressed during anti-tuberculosis therapy.

To assess the diagnostic value of the CRP analysis, the CRP coefficient was used, which was calculated by dividing its absolute value by the upper limit of normal for CRP. That is, for example, when the level of CRP increased two times above the upper limit of normal, the coefficient was equal to two.

results

The analysis included 364 patients with suspected TB. Of these, 255 (55.5%) were HIV positive, 39 (11%) did not have HIV, and 125 (34%) refused HIV testing. The median CD4 cells in HIV-infected patients was 143 cells/µl.

During observation, TB was confirmed in 135 (37%) patients, in 114 (39%) the diagnosis of TB remained “possible”, and in 115 (24%) the suspicion of TB was removed.

The median CRP coefficient was equal to 15.4 (interquartile range [IQR] 7.2; 23.3) in patients with confirmed TB, equal to 5.8 (IQR 1.4; 16.0) in patients with possible TB and equal to 0 .7 (IQR 0.2; 2.2) in patients without TB.

In order to evaluate the diagnostic value of CRP, the researchers compared its performance in a group of patients with confirmed TB and a group of patients without TB. They determined that an elevated CRP ratio had a sensitivity of 0.98 (95% CI 0.94–0.99), specificity of 0.59 (95% CI 0.5–0.68), positive predictive value of 0.74 (95 % CI 0.67-0.80), negative predictive value 0.96 (95% CI 0.88-0.99). Patients with an increased CRP coefficient had a several tens of times increased risk of being infected with TB (odds ratio 63.7, 95% CI 19.1-212). A higher CRP ratio had higher specificity but lower sensitivity (see table).

CRP quotation	Sensitivity	Specificity	Positive likelihood ratio	Negative likelihood ratio	Diagnostic odds ratio	Positive predictive value	Negative predictive value
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
>1×ULN	0.90	0.59	2.19	0.18	12.4	0.83	0.72
	(0.85;0.93)	(0.50; 0.68)	(2.1; 2.3)	(0.16; 0.19)	(7.1; 21.5)	(0.77; 0.87)	(0.62; 0.81)
≥2.5×ULN	0.81	0.77	3.59	0.24	14.7	0.89	0.65
	(0.76; 0.86)	(0.69; 0.85)	(3.32; 3.88)	(0.23; 0.25)	(8.6; 25.2)	(0.84; 0.92)	(0.57; 0.73)
≥5×ULN	0.71	0.85	4.84	0.33	14.4	0.91	0.58
	(0.65; 0.77)	(0.77; 0.91)	(4.29; 5.45)	(0.32; 0.34)	(8.1; 25.9)	(0.86; 0.95)	(0.50; 0.65)
≥10 uULN	0.53	0.93	7.56	0.51	14.8	0.94	0.48
	(0.46; 0.59)	(0.87; 0.97)	(5.84; 9.79)	(0.50; 0.52)	(6.9; 31.7)	(0.89; 0.97)	(0.41; 0.54)

Performance of CRP as a screening test: Combined group of confirmed or possible tuberculosis vs. those with no tuberculosis (n=364).

The researchers set the task of assessing the impact of HIV infection on the value of the CRP coefficient in patients with suspected TB. They determined that CRP was significantly higher in patients with HIV-TB co-infection compared with patients with severe HIV infection but without TB.

conclusions

The researchers believe that CRP may play a significant supporting role in the initial diagnosis of pulmonary TB in patients with clinical symptoms suggestive of the disease and a negative sputum smear. They believe that the high negative predictive value of an elevated CRP ratio in patients with TB allows one to rule out TB in patients with normal CRP levels.

Wilson D, Badri M, Maartens G. Performance of serum C-reactive protein as a screening test for smear-negative tuberculosis in an ambulatory high HIV prevalence population. PLoS One. 2011 Jan 10;6(1):e15248.

http://www.ncbi.nlm.nih.gov/pubmed/21249220

http://www.medicusamicus.com

The doctor often looks at C-reactive protein in blood tests together with ESR to determine the possibility of an inflammatory process in the body in the acute phase. Analysis of the presence of C-reactive protein in the blood began to be used back in the 30s of the twentieth century. A distinctive feature of this protein is its rapid response to the onset of the disease. The level increases within 6 to 12 hours after the onset of the disease, when there are still no symptoms.

“Golden marker” is what clinicians call C-reactive protein for its ability to detect the acute phase of the inflammatory process. To the delight of those same clinicians, test results can now be obtained in half an hour (in some cases in an hour) instead of 24 hours due to the introduction of modern techniques. With this speed of blood test processing, in addition to diagnosing the disease, it is also possible to monitor the treatment process.

CRP (CRP is an abbreviation for C-Reactives protein) is a protein found in blood plasma and produced in the liver. It belongs to the indicators of the acute phase of inflammation.

The synthesis of C-reactive protein is activated during the development of an inflammatory process of any localization in the human body. The main mechanism of action of this marker is the precipitation reaction with C-polysaccharide of pneumococci and other bacteria and fungi already at the earliest stages of the pathological condition.

The main characteristics of DRR are:

• Higher sensitivity to inflammation as opposed to erythrocyte sedimentation rate.
• It reacts within 4–6 hours after exposure to a pathogen or the development of a pathological condition (meaning conditions of non-infectious origin).
• Changes in indicators can be diagnosed within the first day of the disease.

Modern medical literature provides evidence that there are two types of C-reactive protein:

• Native (pentameric, consists of 5 subunits) protein is this marker, which is known to everyone as CRP itself.
• The new protein (monomeric, consists of 1 subunit) is characterized by faster mobility, reduced platelet aggregation time, and the ability to activate and synthesize biological substances.

Monomeric protein antigens are located on the surface of lymphocyte and plasma cells, killer cells. With the acute development of inflammation, the usual C-reactive protein is transformed into a monomeric one, which already produces all the effects inherent in CRP.

For reference. In the body of a healthy and sick person, such an inflammatory trigger and its concentrations are responsible for the most important functions of the immune system.

Functions of C-reactive protein

Since this marker is included in the complex of main acute-phase indicators of inflammation, it is characterized by the following functions:

• The most important responsibility of CRP is to participate in the implementation of humoral innate immunity. This effect is realized through complex sequential immune reactions, which ensures a strong connection between innate and acquired immunity:
  • Destruction of the membranes of healthy cells by a pathogen or other pathological factor. This leads to cell death. Leukocytes and phagocytes migrate to such foci.
  • Now a local reaction begins to dispose of dead cells, which causes an inflammatory reaction. At the sites of such reactions, first neutrophils accumulate, then monocytes, in order to absorb foreign elements and promote the synthesis of mediators, with the help of which CRP begins to be intensively produced.
  • After this, the accelerated formation of all acute-phase components begins.
  • At this stage, T-lymphocytes react, which, in response to the delivery of antigens by macrophages to the lymph nodes, recognize antigenic structures and transmit information to B-lymphocytes. It is from this moment that the active formation of antibodies begins, which is a key link in humoral immunity. At all these stages, C-reactive protein takes part in the reactions.
  • Within 10–12 hours, CRP levels in the blood are rapidly increasing, which confirms its main functions – anti-inflammatory and protective.
• It has properties similar to immunoglobulin G, which is manifested by the ability to activate the complement system with platelet aggregation.
• Causes hemolysis of red blood cells during inflammation, which are associated with pathological units.
• At the source of the infectious process, the effect of decay products of pathogens is inhibited.

How is the analysis carried out?

To assess the severity of inflammation, it is necessary to collect venous blood in the morning on an empty stomach, in the serum of which C-reactive protein is determined during a biochemical study.

For reference. The main method for determining C-reactive protein is immunoturbodimetry, which can be used to detect even those values ​​whose concentration is below 0.5 mg/l.

It should be noted that a blood test to determine CRP is not mandatory for everyone. This test is carried out for certain indications.

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Indications for analysis

As with each marker, the determination of CRP is characterized by its own conditions in which research is necessary:

• Assessment of the risk of cardiovascular system pathology in healthy and sick people.
• If patients have coronary heart disease or arterial hypertension, the prognosis of complications such as sudden cardiac death, acute coronary syndrome, myocardial infarction, and stroke is assessed.
• Assessment of the extent of ischemia and necrosis during infarction.
• Analysis of treatment effectiveness.
• Prevention of complications.
• Diagnosis of acute infections.
• Control of the development of graft-versus-host disease.
• Diagnosis of neoplasms.
• Determination of complications in the postoperative period.
• Monitoring the dynamics of diffuse connective tissue diseases and evaluating their treatment.
• Differential diagnosis between viral and bacterial lesions.
• For complaints of prolonged pain in the joints, elevated body temperature, pain in the back, muscles, as well as enlarged lymph nodes.

When assessing the data obtained, it is necessary to start from the norm values ​​for different categories of persons.

In a healthy adult, C-reactive protein is not detected in the blood during a biochemical blood test or it is allowed
indicator no more than 5 – 10 mg/l (according to various sources).

To correctly interpret the data obtained, the following factors must be taken into account:

• Age.
• Physiological state of a person.
• Presence of diseases.

Norm. Currently, the following are considered normal indicators:

• Adult men and women – no more than 10 mg/l.
• Pregnant women – no more than 20 mg/l.
• Newborns - the level should not exceed 15 mg/l
• Children – up to 10 mg/l.
• Smokers – concentration up to 20 mg/l.
• Athletes, especially after severe physical activity – no more than 60 mg/l.

In addition to taking into account the normal test numbers, it is necessary to take into account some reasons that could affect the analysis data.

Factors influencing CRP levels

There are a number of circumstances under which the picture of the data obtained changes.
That is why, before taking the test, it is necessary to inform the attending physician about the reasons that may affect the outcome of the study:

• Use of contraceptives.
• Treatment with hormonal drugs.
• Pregnancy.
• Intense physical activity.
• Age.

Since C-reactive protein is an indicator of the acute phase of inflammation and pathological disorders in the body, it is necessary to identify the source that caused the change in test levels.

Content

Thanks to the developments of scientists, doctors have a unique opportunity to determine the development of inflammation at the very beginning of their formation. A blood test for CRP instantly gives a conclusion that pathologies have appeared in the body. This helps to start timely treatment and avoid dangerous complications. It is useful to understand this important indicator in the analyzes.

C-reactive protein - what is it?

In extremely low concentrations, this substance is invariably produced by the liver. Of all the proteins found in the body, this protein is the most highly sensitive. When several hours pass from the moment of inflammation, a sharp increase in its quantitative composition occurs tens of times. This shows the beginning of an acute process. Even a disease that has just begun will be reflected in the results of blood plasma tests by increased levels of CRP protein. With treatment and progression of the disease into the chronic phase, the values ​​decrease.

C-reactive protein is a substance that:

• reacts with polysaccharides, binds and precipitates them;
• removes fatty acids formed when cell membranes are damaged with the onset of inflammation;
• recognizes and destroys microbes;
• stimulates defensive reactions;
• helps wound healing;
• promotes the production of leukocytes that create a barrier to infection;
• activates the immune system.

DRR analysis

Laboratory testing is carried out by collecting venous blood on an empty stomach. The assay is performed using protein-sensitive reagents. The correctness of the results is affected by the use of hormonal drugs, contraceptives, and non-steroidal anti-inflammatory drugs. To take the test, you need to prepare:

• stop taking medications, alcohol, fatty, spicy foods one day before;
• do not eat 12 hours before the procedure;
• exclude physical activity;
• to be in a complacent state;
• no smoking in an hour.

When is it prescribed to determine CRP parameters in a biochemical blood test? This is done if necessary:

• examinations of hypertensive patients;
• performing diagnostics;
• assessing the effect of treatment;
• prognosis of tumor development;
• control over the progress of treatment;
• prognosis of cardiovascular system anomalies;
• performing a tumor test;
• assessing the severity of infection;
• identifying postoperative problems;
• monitoring the survival rate of transplanted organs;
• analysis of the use of antimicrobial drugs.

The values ​​of the indicators reflect the course of inflammatory processes in association with diseases:

• maximum 30 mg/l – tumor metastases, viral diseases, rheumatic pathologies;
• from 40 to 95 – operations, bacterial infections, acute myocardial infarction, worsening chronic processes;
• over 295 mg/l – sepsis, major burns, severe infections, cancer.

A very important role is given to analysis as a means of preventing atherosclerosis and the development of thromboembolism. If indicators change, treatment is promptly prescribed to save the patient’s life. The diseases are inflammatory in nature and have deadly consequences - stroke, heart attack. If a vessel is destroyed:

• cholesterol attaches to the crack;
• a loose plaque appears;
• it can come off;
• the blood clot will block the vessel.

C-reactive protein is normal

Throughout a person’s life, CRP levels in a healthy body remain normal. Whether it is a woman, a man or a child, young or old, does not matter. The only exception is newborn babies, in whom the indicator should not show a value higher than 1.6 mg/l. The normal level of C-reactive protein in the blood is considered to be no more than 0.49 mg/l. Increased values ​​are a signal of the onset of acute inflammation. To reduce them, it is necessary to carry out additional diagnostics and treatment - the analysis does not indicate the exact location of the anomaly.

C-reactive protein is normal in women

Researchers have discovered a pattern: an adult woman will have lower CRP levels if her mother breastfed her as a child. In addition to inflammation, test results are affected by taking hormonal medications, including oral contraceptives, menopause, and excess weight. When a biochemical analysis reveals that a woman’s CRP is elevated, this may mean thyroid disease or toxicosis of pregnancy. The normal level of C-reactive protein in women, when they are healthy, cannot exceed 0.49 mg/l. High values ​​can be reduced with timely treatment.

C-reactive protein is normal in men

There is a peculiarity in the male body. If C-reactive protein remains above 1.8 mg/l for a long time, then there is a high probability of developing a depressive state. The normal level of C-reactive protein in men cannot exceed 0.49 mg/l. The deviation of indicators to large numbers is influenced by:

• alcohol abuse;
• stress;
• excess weight;
• taking anabolic steroids;
• smoking;
• increased stress – physical and emotional.

C-reactive protein is normal in children

The first determination of CRP indicators is carried out in the child in the maternity hospital, blood for laboratory testing is taken from the umbilical cord. This is necessary to exclude sepsis. In a newborn child, the values ​​of indicators are increased to 1.6 mg/l. Fluctuations from the standards are caused by chronic benign agranulocytosis, which goes away without treatment by three years. The normal level of C-reactive protein in children is similar to that of adults. Elevated values ​​may indicate the presence of diseases:

• meningitis;
• systemic lupus erythematosus;
• chickenpox;
• flu;
• rubella;
• measles.

C-reactive protein is elevated - reasons

The following diseases are the basis for abnormal values ​​of CRP protein:

The analysis is interpreted by the attending physician, who determines the reasons for the increase in C-reactive protein in the blood. These include violations of tissue integrity observed as a result of:

• getting injured;
• significant burns;
• carrying out surgical intervention;
• organ transplants;
• bypass operations;
• rupture of the amniotic sac - a threat to premature birth.

The reasons for the increase in CRP results in the analysis include low-grade inflammation, which provokes the risk of an increase in cardiovascular pathologies. An important role is played by the exacerbation of chronic infectious diseases. Indicators are increased if:

• Cushing's disease - pathology of the pituitary gland;
• thromboembolism;
• tuberculosis;
• jade;
• diabetes mellitus;
• obesity;
• hormonal imbalance;
• atherosclerosis;
• malignant neoplasms;
• gynecological pathologies;
• apoplexy;
• lymphogranulomatosis;
• viral infections;
• allergies.

C-reactive protein in oncology

A test for possible cancer development is a CRP test. To specify the diagnosis, special studies using tumor markers, ultrasound, and computed tomography are required. The appearance of metastases is characterized by CRP readings in the range of 10-31 mg/l. This analysis helps monitor the progression of the tumor and the dynamics of its growth. With its help, the doctor gives a prognosis of the condition and life expectancy. If C-reactive protein is elevated in oncology, this is characteristic of cancer:

• prostate;
• endometrium;
• cervix;
• ovaries;
• stomach;
• lungs.

C-reactive protein in rheumatoid arthritis

This blood test method is very sensitive to inflammatory processes that begin in joints and bones. This helps to make an early diagnosis and begin treatment, which is effective at this stage. C-reactive protein in rheumatoid arthritis rises tenfold if the cause of inflammation is bacterial. The viral source of the disease does not give high readings. When the process develops into the chronic phase, the normal level of CRP in the blood is observed. This means that during this period the analysis is not relevant.

C-reactive protein during pregnancy

For a woman expecting a baby, elevated CRP levels are not dangerous if other tests are normal. Otherwise, it is necessary to look for the cause of the inflammatory process. Indications may increase to 115 mg/l with toxicosis. When they increase to 8 mg/l from 5 to 19 weeks, there is a risk of miscarriage. C-reactive protein in pregnant women is checked regularly, because diseases of the mother can affect the development of the unborn child. The reasons for the increase are:

• viral infections, if the level is up to 19 mg/l;
• bacterial causes when it is more than 180 mg/l.

Video: C-reactive protein in the blood

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Changes in the levels of cardiovascular disease markers when switching from boosted protease inhibitors to raltegravir

Background: Switching from boosted protease inhibitors (PI/r) to raltegravir (RAL) results in a better plasma lipid profile than continuing PI/r. Whether this strategy affects plasma biomarkers associated with atherosclerosis is unknown.

Methods: We appreciated 48-week changes in fasting lipids and several biomarkers including serum high-sensitivity C-reactive protein (hsCRP), monocyte chemoattractant protein 1 (MCP-1), osteoprotegerin, interleukin (IL) 6, IL-10, tumor necrosis factor alpha (TNF-α), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), E-selectin and P-selectin, adiponectin, insulin, and D-dimer in otherwise healthy, virologically suppressed HIV-infected patients treated with PI/r who randomly switched from PI/r to RAL or continued with PI/r in the SPIRAL trial. Biomarkers and lipids at baseline and 48-week changes between both study arms were compared. Correlations between changes in biomarkers and changes in lipids were also evaluated.

Results: Of 273 patients initiating study drugs in the SPIRAL trial, 233 (119 RAL, 114 PI/r) remained on allocated therapy for 48 weeks and had sera available for the purpose of this substudy. Triglycerides (−28%, P

C-reactive protein in HIV

CHANGES IN C-REACTIVE PROTEIN LEVEL DURING HIV INFECTION AND HIV/HCV CO-INFECTION

Topic: Elevated D-dimer and C-reactive protein levels are associated with risk of femoral head necrosis in HIV-infected adults

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Elevated D-dimer and C-reactive protein levels are associated with risk of femoral head necrosis in HIV-infected adults

Background: A high incidence of nontraumatic osteonecrosis has been reported in HIV-infected patients. We investigated the levels of D-dimer and C-reactive protein (CRP) in a cohort of HIV-infected adults with and without osteonecrosis of the femoral head.

Methods: Forty-three HIV-infected patients with osteonecrosis of the femoral head and a comparison group of 50 HIV-infected patients with negative MRI of the hips and for whom serial plasma samples were available were included. D-dimer and CRP levels were measured prior to and at the time of diagnosis for osteonecrosis patients, at the time of negative MRI of the hips for controls, and at least 6 months later for both groups.

Results: Biomarker levels were elevated at the time of diagnosis in the osteonecrosis cohort compared with controls. Median D-dimer value was 0.32 μg/ml in the osteonecrosis group compared with less than 0.22 μg/ml in the control group (P = 0.016). For CRP, the corresponding values ​​were 2.52 mg/l and 1.23 mg/l (P = 0.003). Postdiagnosis, D-dimer and CRP levels were also elevated in the osteonecrosis patients compared with controls. Linear regression demonstrated a rise in D-dimer levels from prediagnosis to diagnosis in the osteonecrosis patients whereas CRP levels did not change significantly over time.

Conclusion: Compared to controls, patients who developed osteonecrosis had elevated levels of D-dimer and CRP at diagnosis. D-dimer levels increased whereas CRP levels did not change significantly from prediagnosis to diagnosis. These data suggest that patients with higher levels of inflammation are at an increased risk of osteonecrosis.

Rationale. There is an increased incidence of osteonecrosis of the femoral head in people infected with HIV. The levels of D-dimer and C-reactive protein were determined in a group of HIV patients with and without necrosis of the femoral head.

Methods. The study included 43 HIV-infected people with necrosis of the femoral head and 50 HIV-infected people from the comparison group with a negative MRI result of the femur; blood plasma samples were also taken from all participants for research. Levels of D-dimer and CRP were measured both before diagnosis of osteonecrosis and after diagnosis (in the control group and after receiving a negative MRI result), as well as after 6 months. (in both groups).

results. At the time of diagnosis, the level of markers in the group with osteonecrosis was increased compared to the control group. The median D-dimer level was 0.32 µg/ml in the group with necrosis of the femoral head and less than 0.22 µg/ml in the control group (p=0.016), and the median CRP was 2.52 mg/l in the osteonecrosis group and 1.23 mg/l in control group (p=0.003). After diagnosis, D-dimer and CRP levels remained elevated in the osteonecrosis group compared with the control group. Data analysis using linear regression showed an increase in D-dimer levels in the period before diagnosis, while the CRP level did not change significantly over time.

conclusions. Patients with osteonecrosis have elevated D-dimer and CRP levels at diagnosis compared to controls. D-dimer levels increased in the period before diagnosis, but CRP levels did not change statistically significantly. These data suggest that patients with higher inflammatory activity are at increased risk of femoral head necrosis.

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AIDS (233 messages)

Eric, please tell me what is the time frame for the appearance of AT for third generation tests that only determine AT. And in what time frame do you need to take these tests from the moment... open

The terms are exactly the same (6 and 12 weeks). It’s just that the reliability in the early stages (before 6 weeks) will be slightly lower than for the at+ag ELISA. look

Eric good afternoon. please tell me after 13 weeks the test for antigen and antibody is negative, can it be that at this period there is no antigen or antibody? and tell me... open

Hello. That's impossible. I consider your result reliable. look

Hello. I wanted to ask you. My husband has been sick with HIV for a year now. For six months, almost every month, ulcers have been appearing in the mouth, herpes on the lips, a month ago on the body... open

They won’t appoint you anyway, bastards. only when it reaches 250 will they appoint it, and even then, reluctantly to watch

angelina, hello. Yes, you need to insist on starting therapy yourself. IS 350, high VL and any clinical manifestations of immunodeficiency are indications for starting therapy... see

in general it’s a situation:
gp160+
gp110,120+
p68+
p55-
p52+
gp41+
p40-
p34+
p25-
p18-
what to do? open (1 more message)

Is your analysis positive? look

Sogdiana...,
Did you submit anonymously? look

It is up to the laboratory that performed the blot to interpret the result. As far as I can tell, this is a positive blot. look

invitro, ay! why do you use such a set of proteins? look

Sogdiana...,
Sorry for the dumb question, but what time do you have to watch?

Hello! I don’t know how to tell my husband about my HIV status! I recently discovered this fact myself! open

Katya, hello. There are no universal tips here, because it completely depends on how your relationship is. look

Say that there is a suspicion of HIV and convince him to take the test, and if it also turns out to be positive, throw a tantrum with tears and accuse him of having had a lot of fun... watch

Eric, I want to thank you so much for being so understanding about the questions! Thank you and good health to you! open

Please, glad to be of assistance. Thank you for your wishes! 🙂
Do not be ill! look

Hello Dear medical staff. I have this situation. always when I had sex, all the time and always protected myself with condoms, but yesterday there was... open

Hello. Because in fact, the contact was unprotected, then we can assume some risk for STDs and HIV in particular. look

Hello, a friend has been living with an HIV-infected person for 9 years. She gave birth to 2 children during this time. But she and the children are healthy. No antiviral drugs during pregnancy or… open

Victoria, hello. This is possible if the HIV-infected partner has a low viral load, which happens when taking HAART. In this case, the risk of HIV transmission to sexual... see

Hello. My C-reactive protein is two times too high. c-reactive protein, quantitative (highly sensitive method) 2.38 (reference values ​​0.00 -1.00)… open

Hello. By itself, without other data, this doesn't say much. look

Erik, tell me, does this mean that I have HIV? or is this a different analysis? look

C-reactive protein has nothing to do with HIV. You wrote an affirmative sentence “I am sick with HIV,” so I took it from the fact that you have already been diagnosed... see

Good evening, please advise me on the risk. There was contact with the tear fluid of an HIV-infected patient (she did not take therapy), the HIV load cannot be judged... open

Hello. HIV is not transmitted through tears. There was no risk. look

C-reactive protein in HIV

SRB– fast phase protein, produced in the liver, plays an important role in inflammation, protection against foreign agents and in autoimmune processes.

In what cases does a doctor prescribe a blood test for CRP?:

1. Preventive examination of elderly patients.
2. Determination of the likelihood of cardiovascular complications in patients with diabetes mellitus and atherosclerosis.
3. Patients with hypertension, coronary heart disease, to prevent possible complications: sudden cardiac death, myocardial infarction, stroke.
4. Monitoring the effectiveness of prevention and treatment of cardiovascular complications using statins and aspirin in cardiac patients.
5. Collagenosis (to determine the effectiveness of therapy and the reactivity of the process).
6. Monitoring the effectiveness of treatment of bacterial infections with antibiotics.
7. Neoplasms.
8. Acute infectious diseases.

Preparing for analysis:

Venous blood is donated for analysis on an empty stomach. The day before, you should refrain from drinking alcohol, fatty and fried foods, and try to avoid physical and emotional stress. You should not smoke 30 minutes before donating blood.

Diagnostic value of SRP.

Normally, CRP is negative. However, reference values ​​are accepted (0-1.0 mg/l).

For acute diseases:

Bacterial infection accompanied by the highest levels of CRP (100 mg/l and above). With effective therapy, the concentration of CRP decreases the very next day. If this does not happen, the choice of the necessary antibacterial treatment should be decided taking into account changes in CRP levels.

Viral infection. In such diseases, CRP increases slightly (less than 20 mg/l), which is used to differentiate a viral infection from a bacterial one.

Neutropenia. A CRP level of more than 10 mg/l with neutropenia in an adult patient may be the only objective indication of the presence of a bacterial infection and the need for antibiotics.

Postoperative complications. If CRP remains high (or increases) within 4-5 days after surgery, this indicates the development of complications

Associated bacterial infections. In any disease, or after surgery, the addition of a bacterial infection is accompanied by an increase in acute phase proteins, the concentration of CRP becomes more than 100 mg/l
Tissue necrosis- causes an acute-phase response, similar to what occurs during a bacterial infection. An acute-phase response is possible in myocardial infarction, tumor necrosis of kidney and lung tissue.

Measurements of baseline CRP concentrations have prognostic value in cardiovascular diseases, which allows you to assess the degree of risk of developing: acute myocardial infarction, cerebral stroke, sudden cardiac death in people suffering from cardiovascular diseases.

At baseline SRP concentrations (mg/l):

• less than 1.0 mg/l – the risk of vascular complications (AMI, stroke) is minimal,
• at 1.1-1.9 mg/l – low risk,
• with more than 3 mg/l – high risk.

The greatest prognostic significance is the joint determination of CRP and the atherogenic index (total cholesterol/high-density cholesterol).

You can always undergo an examination and take a biochemical blood test for SRP at the State Health Institution “LOCPBS and IZ”. In our laboratory, CRP is determined by a highly sensitive latex-enhanced immunoturbidimetric method.