当风湿科医生在查C反应蛋白的的时候，他们在想什么？

2022-02-22 从医路漫漫 MedSci原创

当风湿科医生在谈论C反应蛋白的时候，他们在谈什么？

什么是C反应蛋白？

C-反应蛋白(C-reactive protein ,CRP)是在机体受到感染或组织损伤时血浆中一些急剧上升的蛋白质(急性蛋白)，激活补体和加强吞噬细胞的吞噬而起调理作用，清除入侵机体的病原微生物和损伤，坏死，凋亡的组织细胞。

CRP作为急性时相反应的一个极灵敏的指标，血浆中CRP浓度在急性心肌梗死、创伤、感染、炎症、外科手术、肿癌浸润时迅速显著地增高，可达正常水平的2000倍。而风湿病的发病机制大都涉及自身免疫功能紊乱及炎性反应, 故血清CRP多呈阳性反应, 比如类风湿关节炎、风湿热、结节性多动脉炎、强直性脊柱炎、SLE等。

参考范围

CRP	参考值
成人和儿童	0.068-8.2mg/L
新生儿，脐血	≤0.6mg/L
出生后第4天至1个月的婴儿	≤1.6mg/L
分娩母亲	≤40mg/L

用于诊断和鉴别

CRP在细菌感染后6-8h开始升高，24-48h达到高峰，在感染消除后急骤下降，一周内即可恢复正常。

结缔组织病如系统性红斑狼疮、多发性肌炎及系统性硬化症，CRP反应并不明显, 甚至在疾病的活动期也很不明显, 因此, 检测CRP水平有助于区分结缔组织病与其他风湿性疾病。

G^-感染	CRP可达较高水平，有时高达500mg/L
G⁺感染及寄生虫感染	可引起中等水平增高，多在100mg/L左右
病毒感染	反应最轻，通常≤50mg/L
倾向于支持系统性红斑狼疮与骨关节炎的诊断	CRP<10 mg/L
更支持类风湿性关节炎和系统性硬化症等疾病的诊断	CRP>10 mg/L

评估疗效及病情监测

CRP还可用来判断风湿病的活动性、严重性及预后。如RA患者的CRP水平与类风湿性关节炎的活动性与严重程度密切相关。在RA活动期中, 98%的患者CRP升高, 而缓解期92%的患者CRP恢复正常;轻度RA关节炎症患者的CRP通常不超过50 mg/L，如果CRP高达100 mg/L则表明疾病较严重。

RA患者

CRP水平	意义
＜10mg/L	无炎症或窗口期
10-50mg/L	轻度炎症或疾病恢复期
50-100mg/L	较严重疾病或疾病进展期
＞100mg/L	病情严重合并细菌感染

检测治疗结果，指导用药

CRP水平	意义
＜10mg/L	无细菌感染，不使用抗生素
＞50mg/L	细菌感染，建议使用抗生素
每日降幅≥30%	疗效显著，建议继续原方案
每日降幅≤20%	疗效较差，建议药物加量或更换方案

风湿疾病相关的CRP水平

类风湿关节炎（RA）分类标准涵盖了CRP和/或ESR水平异常这一项。CRP>10mg/L常见于未经治疗的新发RA患者。
在成人Still病、系统性血管炎、反应性关节炎或伴全身症状及急剧进展的关节软骨破坏的类风湿关节炎疾病中,CRP会显著增高
在多发性大动脉炎中,CRP会中等程度升高
在皮肌炎、系统性红斑狼疮、硬皮病中,CRP会轻度升高甚至不升高
大部分系统性红斑狼疮活动期患者的CRP为正常水平，仅有少数患者会轻度升高，即便患者病情严重时，其CRP升高的程度也比类风湿关节炎患者低
当CRP>60mg/L时,可怀疑患者为狼疮合并感染。
小关节受累时,其C反应蛋白的水平常较以大关节受累为主要表现的患者低

参考文献

[1]Enocsson H,Karlsson J,Li HY,et al.The Complex Role of C-Reactive Protein in Systemic Lupus Erythematosus.J Clin Med 2021 Dec 13;10(24)

[2]于峰.C反应蛋白与血沉在类风湿性关节炎中的应用价值[J].中国现代药物应用,2017,11(01):67-68.

[3] 邹光美,黄朝任,陈武,吴博文.血清RF、抗CCP抗体、CRP及免疫球蛋白联合检测在类风湿性关节炎的诊断价值[J].世界复合医学,2017,3(04):30-33.

[4] 高学祥,汪六庆. 血清抗CCP抗体、RF、CRP、ESR水平联合检测在类风湿性关节炎患者早期诊断中的应用价值[J]. 检验医学与临床,2018,15(14):2156-2159.

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#插入话题

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2022-02-24 JR19860219

#C反应蛋白#

77 0
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2022-02-23 ms1000001892479970

写的很详细

86 0
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2022-02-22 ms2000001545439177

受益匪浅

85 0
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2022-02-22 ms8000000018254969

学习

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