Cedars Sinai Medical Center, Los Angeles, California, USA.
Lupus. 2011 May;20(6):588-97. doi: 10.1177/0961203310393378. Epub 2011 Mar 24.
Levels of C-reactive protein (CRP) have been shown to rise in acute illnesses such as infections and some autoimmune diseases, but not in flares of systemic lupus erythematosus (SLE). Our goal was to investigate the high-sensitivity CRP (hsCRP) response to infection versus disease flare in patients with SLE, and to compare this with the erythrocyte sedimentation rate (ESR) response in these patients. We aimed to determine the hsCRP level that distinguishes between infection and flare in SLE, and investigated the correlation between hsCRP and organ involvement in SLE. We reviewed electronic medical records of all patients with SLE admitted to Cedars Sinai Medical Center between 28 August 2001 and 27 April 2008. Patients were divided into three groups based on the reason for hospitalization: (1) lupus flare; (2) active infection; and (3) both lupus flare and active infection. Data were collected on patient demographics, medication use, microbial culture results, organ involvement in lupus flare, ESR and CRP levels. Data were collected on 85 eligible patients, of whom 54 had a lupus flare, 22 had active infection and eight had both. While the ESR levels did not differ significantly between patients with disease flare and active infection, the hsCRP level was significantly lower in the lupus flare group than in the infection group. Most patients in the lupus flare group who had a significantly high hsCRP level had serositis. We found that at a cut-off of above 5 mg/dl, hsCRP level was correlated with infection with a specificity of 80%. At a cut-off of above 6 mg/dl, hsCRP correlated with infection with a specificity of 84%. hsCRP level was found to be significantly higher in patients with pulmonary involvement than without. hsCRP levels are significantly lower in SLE patients with disease flare than in those with active infection. Elevated hsCRP levels can be used as a predictor of active infection in SLE patients with a high specificity. We review the relationship between IL-6 and hsCRP production in lupus patients.
C 反应蛋白（CRP）水平已被证明在急性疾病如感染和一些自身免疫性疾病中升高，但在系统性红斑狼疮（SLE）的发作中不会升高。我们的目标是研究 CRP 对 SLE 患者感染与疾病发作的高敏反应，并将其与这些患者红细胞沉降率（ESR）的反应进行比较。我们旨在确定区分 SLE 患者感染与发作的 hsCRP 水平，并研究 hsCRP 与 SLE 器官受累之间的相关性。我们回顾了 2001 年 8 月 28 日至 2008 年 4 月 27 日期间 Cedars Sinai 医疗中心收治的所有 SLE 患者的电子病历。根据住院原因将患者分为三组：（1）狼疮发作；（2）活动性感染；（3）狼疮发作和活动性感染。收集患者的人口统计学数据、用药情况、微生物培养结果、狼疮发作时的器官受累情况、ESR 和 CRP 水平。共纳入 85 例符合条件的患者，其中 54 例为狼疮发作，22 例为活动性感染，8 例为两者兼有。虽然疾病发作和活动性感染患者的 ESR 水平无显著差异，但狼疮发作组的 hsCRP 水平显著低于感染组。狼疮发作组中大多数 hsCRP 水平显著升高的患者均有浆膜炎。我们发现，hsCRP 水平在截断值高于 5mg/dl 时与感染具有 80%的特异性相关，在截断值高于 6mg/dl 时与感染具有 84%的特异性相关。hsCRP 水平在有肺部受累的患者中明显高于无肺部受累的患者。hsCRP 水平在有疾病发作的 SLE 患者中明显低于有活动性感染的患者。hsCRP 水平升高可作为 SLE 患者活动性感染的预测指标，具有较高的特异性。我们回顾了白细胞介素-6（IL-6）与狼疮患者 hsCRP 产生之间的关系。
