Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.
J Crohns Colitis. 2011 Oct;5(5):423-9. doi: 10.1016/j.crohns.2011.05.003. Epub 2011 Jun 2.
There has not been an extensive comparison of CRP and ESR in ulcerative colitis (UC), and thus, we aimed to explore their utility in UC.
Four previously enrolled cohorts of 451 children with UC were utilized, all including laboratory, clinical and endoscopic data. A longitudinal analysis was performed on prospectively collected data of 75 children. Disease activity was captured by both global assessment and pediatric UC activity index (PUCAI).
The best thresholds to differentiate quiescent, mild, moderate and severe disease activity, were <23, 23-29, 30-37, >37 mm/h for ESR, and <2.5, 2.5-5, 5.01-9, >9 mg/L for CRP (area under the ROC curves 0.70-0.81). Correlation of endoscopic appearance with CRP and ESR were 0.55 and 0.41, respectively (P<0.001). Both CRP and ESR may be completely normal in 34% and 5-10% of those with mild and moderate-severe disease activity, respectively. Elevated CRP in the presence of normal ESR or vice versa was noted in 32%, 38%, 30% and 17% of those with quiescent, mild, moderate and severe disease activity. Over time, the utility of CRP and ESR in reflecting disease activity remained stable in 70-80% of cases.
In ~2/3 of children, both CRP and ESR values reflect disease activity to a similar degree and in the remaining, either CRP or ESR may be sufficient, with slight superiority of CRP. CRP is more closely correlated with endoscopic appearance. When either CRP or ESR performs well for a given patient, this is likely to remain so over time. Therefore, it may not be justified to routinely test both ESR and CRP in monitoring disease activity.
尚未对 CRP 和 ESR 在溃疡性结肠炎（UC）中的广泛比较，因此，我们旨在探讨它们在 UC 中的应用。
利用之前纳入的 451 名儿童 UC 队列的 4 项研究，均包含实验室、临床和内镜数据。对 75 名儿童前瞻性收集的数据进行纵向分析。疾病活动度通过总体评估和小儿 UC 活动指数（PUCAI）进行捕捉。
区分静止期、轻度、中度和重度疾病活动度的最佳阈值分别为 ESR<23、23-29、30-37 和>37mm/h，CRP<2.5、2.5-5、5.01-9 和>9mg/L（ROC 曲线下面积 0.70-0.81）。CRP 和 ESR 与内镜表现的相关性分别为 0.55 和 0.41（P<0.001）。分别有 34%和 5-10%的轻度和中重度疾病活动患者的 CRP 和 ESR 可能完全正常。在 32%、38%、30%和 17%静止期、轻度、中度和重度疾病活动患者中，CRP 升高而 ESR 正常或 ESR 升高而 CRP 正常。随着时间的推移，CRP 和 ESR 在反映疾病活动中的作用在 70-80%的病例中保持稳定。
在大约 2/3 的儿童中，CRP 和 ESR 值反映疾病活动度的程度相似，在其余儿童中，CRP 或 ESR 可能就足够了，CRP 略占优势。CRP 与内镜表现更密切相关。当 CRP 或 ESR 对特定患者表现良好时，随着时间的推移，这种情况很可能仍然如此。因此，在监测疾病活动度时，常规检测 ESR 和 CRP 可能没有必要。
