Costenbader K H, Chibnik L B, Schur P H
Division of Rheumatology, Immunology, and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Clin Exp Rheumatol. 2007 Sep-Oct;25(5):746-9.
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are common measures of systemic inflammation. Our goal was to identify clinical factors associated with CRP/ESR discordance.
We identified patients with ESR and CRP results at our academic hospital over six months. We matched individuals with discordant results (one measure in highest tertile, other in lowest), by age and sex to those with non-discordant results, and reviewed medical records for laboratory and clinical factors. We employed analysis of variance (ANOVA) and Chi squared tests to compare these variables in discordant and non-discordant subjects. We used conditional logistic regression to estimate the relative risk of CRP/ESR discordance associated with each variable.
2,069 patients had CRP and ESR measured on the same day; 87 had discordant results, 55 (2.6%) with elevated ESR/low CRP, 32 (1.5%) with elevated CRP/ low ESR. Underlying infection was associated with > 14 fold risk of elevated ESR/low CRP discordance (p < 0.001). Renal insufficiency was associated with increased risk of elevated ESR/low CRP discordance, (p = 0.003). RA patients were slightly less likely to have elevated ESR/low CRP, (p = 0.008, NS after Bonferroni correction). Low serum albumin was associated with both kinds discordance.
Infection, renal insufficiency, and low albumin were associated with having elevated ESR/low CRP; low albumin predicted elevated CRP/low ESR and elevated ESR/low CRP discordance. RA patients were less likely to have elevated ESR/depressed CRP. ESR as a measure inflammation in systemic rheumatic disease may be limited in settings of infection, renal insufficiency, and low albumin.
C反应蛋白（CRP）和红细胞沉降率（ESR）是全身性炎症的常用指标。我们的目标是确定与CRP/ESR不一致相关的临床因素。
我们在一家学术医院识别了六个月内有ESR和CRP检测结果的患者。我们将结果不一致（一项指标处于最高三分位数，另一项处于最低三分位数）的个体按年龄和性别与结果一致的个体进行匹配，并查阅病历以获取实验室和临床因素。我们采用方差分析（ANOVA）和卡方检验来比较不一致和一致受试者的这些变量。我们使用条件逻辑回归来估计与每个变量相关的CRP/ESR不一致的相对风险。
2069名患者在同一天进行了CRP和ESR检测；87名结果不一致，55名（2.6%）ESR升高/CRP降低，32名（1.5%）CRP升高/ESR降低。潜在感染与ESR升高/CRP降低不一致的风险增加14倍以上相关（p<0.001）。肾功能不全与ESR升高/CRP降低不一致的风险增加相关（p=0.003）。类风湿关节炎（RA）患者ESR升高/CRP降低的可能性略低（p=0.008，经Bonferroni校正后无统计学意义）。低血清白蛋白与两种不一致情况均相关。
感染、肾功能不全和低白蛋白与ESR升高/CRP降低相关；低白蛋白预示着CRP升高/ESR降低以及ESR升高/CRP降低不一致。RA患者ESR升高/CRP降低的可能性较小。在感染、肾功能不全和低白蛋白的情况下，ESR作为系统性风湿性疾病炎症的指标可能受到限制。
