Takemura Y, Matsuta H, Kugai N, Sekiguchi S
Department of Laboratory Medicine, National Defense Medical College, Tokorozawa.
Rinsho Byori. 1994 Oct;42(10):1055-61.
We have re-evaluated the usefulness of the inflammation markers in the "essential laboratory tests" advocated by Japan Society of Clinical Pathology and analyzed for efficacious selection of these items by applying these tests to 349 new outpatients visited Comprehensive Medicine, National Defense Medical College. Among the patients with "tentative initial diagnoses" of infectious or inflammation-related diseases (133 cases), the diagnoses were confirmed in 102 patients by positive inflammation marker(s), whereas additional 22 cases with the diagnoses other than inflammation-related diseases were found to be in the inflammatory status by these tests. Elevated C-reactive protein (CRP) levels were not correlated with the leukocyte number, however, neutrophilia (neutro. > 70%) and/or left shift of the neutrophils (stab > 15%) were demonstrated in approximately 50% of the patients with elevated serum CRP levels. Increases of serum sialic acid highly accompanied with increases of CRP, alpha 1 or alpha 2 fraction of serum protein and elevation of erythrocyte sedimentation rate (ESR), indicating that serum sialic acid levels reflected more strictly inflammatory status than ESR. There is a relatively good correlation (r = 0.813) between serum sialic acid values and the total amounts of alpha 1 and alpha 2 protein fraction, while poor correlations were shown between CRP and sialic acid values (r = 0.606), or ESR and sialic acid values (r = 0.671). These results indicate that (1) simultaneous measurements of CRP, leukocyte number and leukocyte differential fraction are useful for the confirmation of early stage of inflammation and evaluation of the nature of infectious diseases; (2) measurement of serum sialic acid levels is more desirable for the evaluation of inflammatory status than ESR; and (3) serum protein profile can be substituted by sialic acid for the evaluation of acute inflammatory status alone.
我们重新评估了日本临床病理学会倡导的“基本实验室检查”中炎症标志物的效用，并通过将这些检查应用于349名就诊于国防医科大学综合内科的新门诊患者，分析了这些项目的有效选择。在初步诊断为感染性或炎症相关疾病的患者（133例）中，102例患者通过阳性炎症标志物确诊，而另外22例非炎症相关疾病的患者通过这些检查发现处于炎症状态。C反应蛋白（CRP）水平升高与白细胞数量无关，然而，在血清CRP水平升高的患者中，约50%表现为中性粒细胞增多（中性粒细胞>70%）和/或中性粒细胞核左移（杆状核>15%）。血清唾液酸升高与CRP、血清蛋白α1或α2组分增加以及红细胞沉降率（ESR）升高高度相关，表明血清唾液酸水平比ESR更严格地反映炎症状态。血清唾液酸值与α1和α2蛋白组分总量之间存在较好的相关性（r = 0.813），而CRP与唾液酸值之间（r = 0.606）或ESR与唾液酸值之间（r = 0.671）相关性较差。这些结果表明：（1）同时测量CRP、白细胞数量和白细胞分类对确认炎症早期和评估传染病性质有用；（2）测量血清唾液酸水平比ESR更适合评估炎症状态；（3）仅评估急性炎症状态时，血清蛋白谱可用唾液酸替代。
