Texas Health Presbyterian Hospital Dallas, Texas.
Transl Res. 2013 Jan;161(1):37-43. doi: 10.1016/j.trsl.2012.07.006. Epub 2012 Aug 23.
C-reactive protein (CRP) levels and the erythrocyte sedimentation rate (ESR) are widely used tests of inflammation that sometimes show opposite results. We performed a retrospective cohort study to clarify the frequency and causes of CRP/ESR discordance in adults. Between January and December of 2011, the laboratories of Texas Health Presbyterian Hospital performed 2150 paired CRP/ESR measurements in 1753 patients, 1731 of whom were nonpregnant adults aged ≥ 18 years. Initial CRP and ESR results for each patient were divided into quartiles. CRP/ESR discordance, predefined as results differing by 2 or 3 quartiles, occurred in 212 patients (12%), 105 of whom had high CRP/low ESR discordance (6%) and 107 of whom had high ESR/low CRP discordance (6%). The 212 patients in the CRP/ESR-discordant group (128 women and 84 men) were subdivided into 1 of 6 diagnostic categories, and the causes of discordances were compared. The high CRP/low ESR-discordant group had more patients with infections than the high ESR/low CRP-discordant group (P = 0.001), particularly infections in the urinary tract (P = 0.03), gastrointestinal tract (P = 0.001), lungs (P = 0.005), and bloodstream (P = 0.03). However, they had fewer bone and joint infections than the high ESR/low CRP-discordant group (P = 0.001). Connective tissue diseases, such as systemic lupus erythematosus, were less common in the high CRP/low ESR-discordant group than in the high ESR/low CRP-discordant group (P = 0.001). Ischemic strokes or transient ischemic attacks almost invariably occurred in the high ESR/low CRP-discordant group (P = 0.001), whereas myocardial infarction or venous thromboembolism was limited to the high CRP/low ESR-discordant group (P = 0.001). Our findings provide information to physicians who order these 2 tests together and receive discordant results, which occurs in approximately 1 in 8 patients.
C 反应蛋白（CRP）水平和红细胞沉降率（ESR）是广泛用于炎症检测的指标，有时它们的结果会出现相反的情况。我们进行了一项回顾性队列研究，以明确成人 CRP/ESR 不相符的频率和原因。2011 年 1 月至 12 月，德克萨斯健康长老会医院的实验室对 1753 名患者进行了 2150 次 CRP/ESR 配对检测，其中 1731 名为年龄≥18 岁的非妊娠成年人。每位患者的初始 CRP 和 ESR 结果分为四分位组。CRP/ESR 不相符定义为结果相差 2 或 3 个四分位组，共 212 例患者（12%）出现这种情况，其中 105 例为高 CRP/低 ESR 不相符（6%），107 例为高 ESR/低 CRP 不相符（6%）。在 CRP/ESR 不相符的 212 例患者（128 名女性和 84 名男性）中，根据 6 种诊断类别进行了细分，并对不相符的原因进行了比较。高 CRP/低 ESR 不相符组患者的感染发生率高于高 ESR/低 CRP 不相符组（P = 0.001），尤其是尿路感染（P = 0.03）、胃肠道感染（P = 0.001）、肺部感染（P = 0.005）和血流感染（P = 0.03）。然而，该组患者的骨和关节感染发生率低于高 ESR/低 CRP 不相符组（P = 0.001）。与高 ESR/低 CRP 不相符组相比，高 CRP/低 ESR 不相符组结缔组织疾病（如系统性红斑狼疮）的发病率较低（P = 0.001）。高 ESR/低 CRP 不相符组几乎总是发生缺血性中风或短暂性脑缺血发作（P = 0.001），而心肌梗死或静脉血栓栓塞仅发生在高 CRP/低 ESR 不相符组（P = 0.001）。我们的研究结果为同时开这两种检查并出现不相符结果的医生提供了信息，大约每 8 例患者中就会出现 1 例不相符的情况。
