Caswell M, Pike L A, Bull B S, Stuart J
Department of Haematology, Medical School, University of Birmingham, England.
Arch Pathol Lab Med. 1993 Sep;117(9):906-10.
Tests of the acute-phase response are used to screen for occult disease in the elderly, but there is little consensus as to their diagnostic value because of uncertainty as to the effect of age on reference ranges. We have therefore measured, as a function of age, the blood concentration of acute-phase proteins (C-reactive protein, alpha 1-acid glycoprotein, fibrinogen, albumin, and globulin) in parallel with three screening tests of the acute-phase response (erythrocyte sedimentation rate, plasma viscosity, and zeta sedimentation ratio). The study included 164 healthy individuals (age range, 25 to 84 years) plus 91 elderly ill but ambulant patients (age range, 65 to 84 years) from a family practitioner screening clinic. Reference ranges for the erythrocyte sedimentation rate, plasma viscosity, and zeta sedimentation ratio rose with age, with the erythrocyte sedimentation rate showing a particularly wide reference range. Healthy individuals aged 75 to 84 years, compared with those aged 65 to 74 years, showed a trend to a lower reference range for all three screening tests that may have reflected survival of the fittest individuals to the higher decade. Precise reference ranges are therefore required in the elderly; when these were used, the three screening tests showed a significant difference between elderly well and ill individuals.
急性期反应检测用于筛查老年人的隐匿性疾病，但由于年龄对参考范围的影响存在不确定性，关于其诊断价值几乎没有共识。因此，我们测量了急性期蛋白（C反应蛋白、α1-酸性糖蛋白、纤维蛋白原、白蛋白和球蛋白）的血浓度随年龄的变化情况，并同时进行了三项急性期反应筛查试验（红细胞沉降率、血浆粘度和ζ沉降率）。该研究纳入了164名健康个体（年龄范围为25至84岁）以及来自一家家庭医生筛查诊所的91名老年患病但可走动的患者（年龄范围为65至84岁）。红细胞沉降率、血浆粘度和ζ沉降率的参考范围随年龄增加而升高，其中红细胞沉降率的参考范围尤为宽泛。与65至74岁的健康个体相比，75至84岁的健康个体在这三项筛查试验中的参考范围有降低趋势，这可能反映了最健康个体活到更高年龄段的情况。因此，老年人需要精确的参考范围；使用这些精确范围时，这三项筛查试验显示健康老年个体和患病老年个体之间存在显著差异。
