Osei-Bimpong A, Meek J H, Lewis S M
Department of Haematology, Hammersmith Hospital, London, UK.
Hematology. 2007 Aug;12(4):353-7. doi: 10.1080/10245330701340734.
To review the normal reference values for erythrocyte sedimentation rate (ESR) and the significance of high values in the elderly, to re-examine the correlation, if any, between ESR and C-reactive protein (CRP) and to compare their utility and limitations for both health screening and clinical management of patients.
CRP and ESR were measured in 295 blood samples from male and female subjects in whom their family doctors had found no clinically significant symptoms nor abnormal physical sign and in whom all other pathology tests gave normal results. None had been hospitalised during at least a six-week period prior to the study.
The results showed a mean ESR of 10 mm/1 h (range 0-25) in both males and females below the age of 40 yrs; this increased with age, to a mean of 18 mm (range 0-35) by 60 yrs in both men and women. In the CRP test, 95% of the samples in the >40 yrs group had CRP range of 0-18 mg/l compared with 0-10 mg/l in the younger subjects. The distribution plot of CRP results showed a left skew with mode at about 2 mg/l, whereas the equivalent ESR distribution shows a broad plateau with less skew. Thus, there was more overlapping of the numerical values for ESR and CRP in subjects younger than 40 yrs, as compared with those over 40 yrs old in whom the two sets of measurements were well separated. The relative utility of the two tests in clinical management of patients was also discussed. Different rates of increase and subsequent fall in the test results were shown over several weeks on a patient with an acute infection. Initially, both tests were increased, but after antibiotic therapy the CRP returned to normal indicating that remission had occurred, whereas the ESR remained high, indicating persistence of the infection. A subsequent dramatic increase in CRP to 180 mg/l confirmed the re-infection that had been indicated earlier by the ESR. After further antibiotic therapy CRP fell to normal, followed later by a slower reduction in ESR to a normal value for the patient's age.
This study confirms that after the age of 40, there is an age-related elevation of ESR, increasing steadily, especially after age 60 yrs. CRP is also affected by age, but to a much less extent. ESR and CRP appear to be equally useful and reliable as a screening test. Accordingly, in deciding which test should be carried out account must be taken of their relative convenience and cost. However, when required as a clinical test in the management of patients with specific diseases both tests should be carried out in tandem.
回顾红细胞沉降率（ESR）的正常参考值及其在老年人中升高的意义，重新审视ESR与C反应蛋白（CRP）之间是否存在相关性，并比较它们在健康筛查和患者临床管理中的效用及局限性。
对295份血液样本进行CRP和ESR检测，这些样本来自其家庭医生未发现临床显著症状或异常体征且所有其他病理检查结果均正常的男性和女性受试者。在研究前至少六周内，所有受试者均未住院。
结果显示，40岁以下男性和女性的ESR平均值为10毫米/1小时（范围0 - 25）；随着年龄增长，60岁时男性和女性的ESR平均值增至18毫米（范围0 - 35）。在CRP检测中，40岁以上组95%的样本CRP范围为0 - 18毫克/升，而较年轻受试者的范围为0 - 10毫克/升。CRP结果的分布曲线呈左偏态，众数约为2毫克/升，而ESR的等效分布呈较宽的平台状，偏态较小。因此，与40岁以上两组测量值区分明显的受试者相比，40岁以下受试者的ESR和CRP数值重叠更多。还讨论了这两项检测在患者临床管理中的相对效用。在一名急性感染患者中，数周内两项检测结果显示出不同的升高和随后下降速率。最初，两项检测结果均升高，但抗生素治疗后CRP恢复正常，表明病情缓解，而ESR仍高，表明感染持续存在。随后CRP急剧升至180毫克/升，证实了ESR earlier所显示的再次感染。进一步抗生素治疗后CRP降至正常，随后ESR较慢降至该患者年龄对应的正常值。
本研究证实，40岁以后，ESR随年龄升高，且稳步增加，尤其是60岁以后。CRP也受年龄影响，但程度小得多。ESR和CRP作为筛查检测似乎同样有用且可靠。因此，在决定进行哪项检测时，必须考虑它们的相对便利性和成本。然而，当作为特定疾病患者管理中的临床检测时，两项检测应同时进行。
