C reactive protein elevated causes. C-reactive protein is elevated in the blood: causes

C-reactive protein (CRP) is the golden marker responsible for the presence of inflammatory processes in the body.

An analysis for this element allows you to identify an infection or virus in the body on early stage.

Its increase occurs within 6 hours from the onset of the inflammatory process, but additional studies may be required to make an accurate diagnosis.

What it is?

C-reactive protein(English C-reactive protein, CRP) is an indicator of acute inflammation. It is produced by the liver, and this is carried out during necrotic and inflammatory processes in any part of the body. AT clinical diagnostics it is used along with ESR, but has a higher sensitivity.

A reactive protein can only be detected using a biochemical blood test. It increases in the blood after 6-12 hours from the onset of the pathological process. CRP responds well to therapeutic methods, which makes it possible to follow the course of treatment with a simple analysis.

Unlike ESR, C-reactive protein takes on normal values ​​immediately after the removal of inflammatory processes and the normalization of the patient's condition. High ESR values even after successful treatment, they can persist for a month or more.

Indications for carrying out

Most often, the determination of the amount of reactive protein is prescribed for:

• Calculation of the risks of occurrence of pathologies of the heart and blood vessels.
• After medical examination of elderly patients.
• postoperative period.
• Evaluation of the effectiveness of drug therapy.
• Diagnosis of autoimmune and rheumatic diseases.
• Tumor suspected.
• infectious diseases.

A laboratory study of CRP is usually prescribed for acute inflammatory diseases of an infectious nature. It also assists in the detection of pathologies of an autoimmune and rheumatic nature. It is prescribed for suspected tumors and cancer.

How is C-reactive protein determined?

The determination of C-reactive protein occurs through a biochemical blood test. For this, a latex test based on latex agglutination is used, which allows you to get a result in less than half an hour.

You can take the analysis in almost any laboratory. One of the most popular laboratories in all cities of Russia is Invitro, where specialists will help you get the results within a few hours after blood sampling.

Reactive protein concentration plays an important role in the diagnosis of cardiovascular pathologies .

In this case, cardiologists are not satisfied with conventional methods for detecting reactive protein, and the use of high-precision hs-CRP measurement, which is combined with a lipid spectrum, is required.

A similar study is carried out with:

• Pathologies of the excretory system.
• Difficult pregnancy.
• diabetes mellitus.
• Lupus erythematosus.

Functions

Reactive protein is an immune stimulant that is produced during acute inflammatory processes.

In the process of inflammation, a kind of barrier arises that localizes microbes at the sites of their invasion.

This prevents them from entering the bloodstream and causing further infection. At this time, pathogens begin to be produced that destroy the infection, during which a reactive protein is released.

The increase in reactive protein occurs after 6 hours from the onset of inflammation and reaches its maximum on the 3rd day. During acute infectious pathologies, the level can exceed the permissible value by 10,000 times..

After the inflammatory reaction stops, the production of reactive protein stops, and its concentration in the blood decreases.

SRB perform the following functions:

• Accelerate the mobility of leukocytes.
• Activate the complement system.
• Produce interleukins.
• Accelerate phagocytosis.
• Interact with B- and T-lymphocytes.

C-reactive protein normal

The change in indicators is carried out in mg. per litre. If there are no inflammatory processes in the body of an adult, the reactive protein is not found in his blood. But this does not mean that it does not exist in the body at all - its concentration is so low that tests cannot determine it.

The norms for adults and children are presented in the table:

When the reactive protein is exceeded by more than 10, a number of other studies are carried out to determine the cause of the inflammatory process. It is necessary to be especially careful at high rates in newborns and children, which indicate the presence of a malfunction in the body.

The erythrocyte sedimentation rate (ESR) also detects inflammation, but not at an early stage. The norms of ESR indicators have some differences:

ESR is an older and simpler method for detecting inflammation., which is still used in many laboratories today. The test for creative protein is more accurate and allows you to get a reliable result already at an early stage of the inflammatory process.

The advantages of the analysis for C - reactive protein in comparison with the ESR are indicated in the table:

Differential diagnosis is presented in the table:

Reasons for the increase

Elevated reactive protein indicates the presence of inflammatory and infectious diseases.Depending on the degree of increase in indicators, one or another pathology can be suspected.

There are a lot of reasons for the increase in c-reactive protein, and the more serious the pathology, the higher the rates.

High protein levels may indicate:

After surgical interventions the value of CRP is especially increased in the first hours, after which rapid decline. Even excess body weight can cause an increase in reactive protein.

The most common reasons for a slight increase include:

The increase in CRP in tonsillitis is indicated in the table:

Most often, the reactive protein rises due to inflammatory diseases of an infectious nature.

You can determine the exact cause of the increase in indicators by additional symptoms, and if they are completely absent, the specialist will offer to pass a number of other studies:

Highly sensitive hs-CRP test

To detect pathologies cordially- vascular system a special highly sensitive hs-CRP test is performed. It allows you to detect even a slight increase in protein, which undoubtedly helps in calculating the risks of diseases of the heart and blood vessels.

In women and men, determining the risk of cardiovascular pathologies is most often carried out using a cholesterol test. Hs-CRP test shows more accurate data and helps to start treatment at an early stage. It is indispensable in monitoring the effectiveness of treatment and the course of the disease.

Analysis for c-reactive protein is important for diagnosis and detection of malfunctions in the body. It allows you to determine the presence of serious pathologies at the initial stage and monitor the effectiveness of therapeutic measures. Unlike ESR, CRP analysis gives a more accurate result and tracks the slightest change in the body.

Video: C reactive protein 10

If in the human body there are any pathological changes tissues, then a biochemical blood test always shows the presence of a special C-reactive protein (CRP). This substance appears approximately four hours after the onset of any inflammation, therefore it is considered a marker of the inflammatory process. When C-reactive protein is elevated, this confirms tissue damage, but does not allow a specific cause to be established.

This substance is produced by the liver. It is an activator of the immune system, the main functions of which are related to protection. human body from injuries of various etiologies.

Against the background of any tissue damage, inflammation always begins. At this point, leukocytes produce special substances called interleukins. It is they, being components of the immune system, that stimulate the production of C-reactive protein by the liver.

Features of the analysis of C-reactive protein

C-reactive protein is attached to the surface of pathogens, being a kind of label for the immune system. As a result, the protective system launches certain sequential reactions that are aimed at eliminating the pathogen. Directly at the site of tissue damage, CRP binds to decay products and this protects the human body from their negative effects.

A feature of the analysis for CRP is that it does not give false positive results. But to obtain more accurate clinical information, the study is recommended to be carried out simultaneously with the ESR test.

When is an analysis ordered?

Today, a blood test to detect an increased concentration of CRP is prescribed not only to fix the existing inflammation. It is used to assess the risks of developing cardiovascular pathologies in practically healthy people.

That is, a blood test can be preventive in nature. Most often, such a need arises to assess the health status of older people. An increased amount of C-reactive protein may indicate the development of the following pathologies:

• The development of coronary heart disease against the background of existing atherosclerosis.
• The occurrence of exacerbations after surgical operations, for example, after bypass surgery or angioplasty.
• The development of malignant neoplasms.

An analysis is also prescribed to identify the risks of a recurrent heart attack or stroke. This study allows us to evaluate the effectiveness of antibiotic therapy.

SRO norms

• In adult men and women - 10 mg / l.
• In children - 10 mg / l.
• In newborns - 4 mg / l.
• In pregnant women - 20 mg / l.

The reference value for adults is less than 5 mg/l. It eliminates the development of the inflammatory process in the human body.

Causes of an increase in the concentration of CRP

A high rate of reactive protein is observed with bacterial infection. When the inflammatory process begins, the amount of the substance increases tens, and sometimes hundreds of times.

In this case, C-reactive protein in the blood serum can be increased up to 1000 mg / l. This indicator is an indication that it is urgent to start treatment. antibacterial drugs. An increased CRP is most often noted in the following cases:

• With viral infection, but in this case, the indicator increases slightly.
• With autoimmune diseases, in particular with rheumatoid arthritis, Crohn's disease, systemic vasculitis. In such cases, the higher the indicator, the more severe the form of the disease.
• With the development of a heart attack. As a rule, the indicator rises 18-32 hours after the attack, then gradually decreases by the twentieth day and is completely normal by the fortieth day. A very high concentration of CRP in the blood indicates an unfavorable prognosis.
• With tissue necrosis as a result of the decay of tumors.
• In case of tissue damage due to injury, burns or frostbite.
• For chronic muscle pain.

• With oncological diseases.
• At diabetes.
• At arterial hypertension.
• With hormonal imbalance.
• In the presence of diseases digestive system especially in acute pancreatitis.

C-reactive protein in the blood is always elevated in the postoperative period, but during the normal recovery process, its concentration decreases sharply. If a increased rates persist long time, this indicates the development of complications or indicates rejection of transplanted tissues.

Also, significant upward deviations of CRP are observed in women who are carrying a child, when there is a threat of preterm birth. C-reactive protein may be elevated in the blood due to various subjective factors. The main ones are:

• Large physical activity for several days before donating blood.
• Hormonal contraceptives.
• Overweight.
• Compliance with a protein diet, which athletes often adhere to.
• Depression and insomnia.
• Tobacco smoking.

Features of increasing CRP in children

C-reactive protein can be elevated in the blood of children, and the reasons for this are the same as in adults. Therefore, for the diagnosis of the inflammatory process in a child, this analysis is of high value.

You should be aware that in a newborn, protein may not appear in the blood even in the presence of sepsis. This pathology is characterized by a strong inflammatory process in one or more organs. Sepsis is always accompanied high temperature, which becomes the main indicator for the adoption of urgent measures.

The absence of CRP in the blood serum of newborns with obvious symptoms of inflammation is due to the fact that in infants the liver cannot work at full capacity, which means it does not synthesize protein. But if the analysis showed that the level of C-reactive protein in the blood is increased, then antimicrobial therapy should be urgently carried out.

When children are sick with rubella, chickenpox or measles, a blood test will also necessarily show an increase in CRP levels. Moreover, the concentration of the substance begins to rise sharply in the first days of the disease, when there is a fever and an increase in body temperature. After recovery, the indicators quickly decrease to normal.

An increase in CRP in the blood after any operation is an indicator of infection of the child's body. If the level of a substance in the blood remains high despite antibiotic therapy, this indicates the development of complications.

Therapy for elevated CRP

An elevated concentration of CRP, confirmed by a biochemical blood test, is not an accurate confirmation of a specific disease. This is an indicator of development possible pathology. With what it can be connected can be determined only on the basis of additional research.

It is noteworthy that if the therapy is chosen correctly, then the level of C-reactive protein quickly decreases and returns to normal. For example, with the correct use of antibacterial drugs, positive result marked by a decrease in the level of CRP already during the day. If there are no obvious signs of bacterial or viral infection, but the analysis showed an increased concentration of CRP in the blood, then consultation with an oncologist is required.

In order for any prescribed therapy to be effective, the rules must be followed. healthy eating And do not forget about moderate physical activity. In addition, efforts should be made to eradicate existing bad habits. Such standard rules will contribute to the rapid recovery and preservation of health for many years.

The doctor often looks at C-reactive protein in blood tests along with the ESR to determine the possibility of an inflammatory process in the body in the acute phase. The analysis of the presence of C-reactive protein in the blood began to be used as early as the 30s of the twentieth century. Distinctive feature of this protein is a rapid response to the onset of the disease. The level rises already within 6 to 12 hours after the onset of the disease, when there are still no symptoms.

The “golden marker” is what clinicians call C-reactive protein for its ability to detect the acute phase of the inflammatory process. To the delight of the same clinicians, the results of the tests can now be obtained in half an hour (in some cases, in an hour) instead of a day due to the introduction of modern techniques. With such a speed of processing a blood test, in addition to diagnosing a disease, it is also possible to monitor the treatment process.

CRP (CRP is an abbreviation for C-Reactives protein) is a protein found in blood plasma and produced in the liver. It belongs to the indicators of the acute phase of inflammation.

The synthesis of C-reactive protein is activated during the development of an inflammatory process of any localization in the human body. The main mechanism of action of this marker is the precipitation reaction with C-polysaccharide of pneumococci and other bacteria, fungi already at the earliest stages of the pathological condition.

The main characteristics of SRB are:

• Higher sensitivity to inflammation in contrast to the erythrocyte sedimentation rate.
• It reacts within 4 - 6 hours after exposure to the pathogen or the development of a pathological condition (meaning the state of non-infectious genesis).
• Changes in indicators can be diagnosed already during the first day of the disease.

The modern medical literature provides evidence that there are two types of C-reactive protein:

• Native (pentameric, consists of 5 subunits) protein - this marker, which is known to everyone as CRP itself.
• The new protein (monomeric, consists of 1 subunit) is characterized by faster mobility, reduced platelet aggregation time, and the ability to activate and synthesize biological substances.

Monomeric protein antigens are located on the surface of lymphocytic and plasma cells, killer cells. With the acute development of inflammation, the usual C-reactive protein is transformed into a monomeric one, which already has all the effects inherent in CRP.

For reference. In the body of a healthy and sick person, such an inflammatory trigger and its concentration are responsible for the most important immune functions.

C-reactive protein functions

Since this marker is included in the complex of the main acute-phase indicators of inflammation, it is characterized by the following functions:

• The most important duty of the CRP is to participate in the implementation of humoral innate immunity. This effect is realized through complex sequential immune reactions, which provides a strong link between innate and acquired immunity:
  • Destruction of the membranes of healthy cells by a pathogen, other pathological factor. This leads to cell death. Leukocytes and phagocytes migrate to such foci.
  • Now begins a local reaction to the utilization of dead cells, which causes an inflammatory reaction. In places of such reactions, first neutrophils accumulate, then monocytes, in order to absorb foreign elements, to promote the synthesis of mediators, with the help of which CRP begins to be intensively produced.
  • After this, the accelerated formation of all acute phase components begins.
  • At this stage, T-lymphocytes enter into the reaction, which, in response to the delivery of antigens by macrophages to The lymph nodes recognize antigenic structures and transmit information to B-lymphocytes. It is from this moment that the active formation of antibodies begins, which is a key link in humoral immunity. At all these stages, C-reactive protein takes part in the reactions.
  • Already within 10-12 hours, CRP levels in the blood are growing rapidly, which confirms its main functions - anti-inflammatory and protective.
• It has properties, like immunoglobulin G, which is manifested by the ability to activate the complement system with platelet aggregation.
• Causes hemolysis of erythrocytes during inflammation, which are associated with pathological units.
• In the focus of the infectious process, the effect of decay products of pathogens is inhibited.

How the analysis is done

For reference. The main method for determining C-reactive protein is immunoturbodimetry, with the help of which even those values ​​\u200b\u200bthat are below 0.5 mg / l are detected.

It should be noted that a blood test to determine CRP is not mandatory for everyone. Such a test is carried out according to some indications.

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Indications for analysis

As with each marker, the determination of CRP is characterized by its own conditions in which research is necessary:

• Assessment of the risk of pathology of the cardiovascular system in healthy and sick people.
• If patients have coronary heart disease, arterial hypertension, the prognosis of such complications as sudden cardiac death, acute coronary syndrome, myocardial infarction, and stroke is assessed.
• Evaluation of the vastness of the zone of ischemia and necrosis in myocardial infarction.
• Analysis of the effectiveness of treatment.
• Prevention of complications.
• Diagnosis of acute infections.
• Controlling the development of graft-versus-host disease.
• Diagnosis of neoplasms.
• Determination of complications in the postoperative period.
• Monitoring dynamics diffuse diseases connective tissue and evaluation of their treatment.
• Differential diagnosis between viral and bacterial infection.
• When complaining of prolonged joint pain, elevated temperature body, pain in the back, muscles, as well as with an increase in lymph nodes.

When evaluating the data obtained, it is necessary to build on the values ​​of the norm for different categories of persons.

In a healthy adult, C-reactive protein in the blood is not detected by a biochemical blood test or it is allowed
the indicator is not more than 5 - 10 mg / l (according to various sources).

For the correct interpretation of the data obtained, the following factors must be taken into account:

• Age.
• The physiological state of a person.
• The presence of diseases.

Norm. Currently normal indicators are considered:

• Adult men and women - no more than 10 mg / l.
• Pregnant women - no more than 20 mg / l.
• Newborns - the indicator should not exceed 15 mg / l
• Children - up to 10 mg / l.
• Smokers - concentration up to 20 mg / l.
• Athletes, especially after severe physical activity– no more than 60 mg/l.

In addition to taking into account the normal test numbers, it is necessary to take into account some factors that can affect the analysis data.

Factors affecting the level of CRP

• The use of contraceptives.
• Treatment with hormonal drugs.
• Pregnancy.
• Intense physical activity.
• Age.

Since C-reactive protein is an indicator of the acute phase of inflammation and pathological disorders in the body, it is necessary to identify the source that caused the change in test levels.

C-reactive protein (CRP, C-Reactives protein - CRP) is a rather old laboratory test, which, like, shows that there is an acute inflammatory process in the body. It is not possible to detect CRP by conventional methods; in a biochemical blood test, an increase in its concentration is manifested by an increase in α-globulins, which it, along with other acute-phase proteins, represents.

The main reason for the appearance and increase in the concentration of C-reactive protein are acute inflammatory diseases which give a multiple (up to 100 times) increase in this acute phase protein already after 6 - 12 hours from the start of the process.

In addition to the high sensitivity of CRP to various events occurring in the body, changes for better or worse, it responds well to therapeutic measures, so it can be used to control the course and treatment of various pathological conditions accompanied by an increase this indicator. All this explains the high interest of clinicians, who called this acute phase protein the “gold marker” and designated it as the central component of the acute phase of the inflammatory process. However, the detection of CRP in the patient's blood at the end of the last century was associated with certain difficulties.

CRP in the blood and a single protein molecule

Problems of the last century

The detection of C-reactive protein almost until the end of the last century was problematic, due to the fact that CRP was not amenable to traditional laboratory studies, which make up. The semi-quantitative method of capillary ring precipitation using antiserum was rather qualitative, as it was expressed in "pluses" depending on the amount (in millimeters) of precipitated flakes (precipitates). The biggest drawback of the analysis was the time taken to get the results − the answer was ready only a day later and could have the following meanings:

• No sediment - the result is negative;
• 1mm sediment - + (weakly positive reaction);
• 2 mm - ++ (positive reaction);
• 3mm - +++ (very positive);
• 4 mm - ++++ (sharply positive reaction).

Of course, waiting for such an important analysis for 24 hours was extremely inconvenient, because in a day a lot could change in the patient's condition and often not for the better, so doctors most often had to rely primarily on ESR. The erythrocyte sedimentation rate, which is also a non-specific indicator of inflammation, unlike CRP, was determined in an hour.

Currently, the described laboratory criterion is valued higher than both ESR and leukocytes - indicators. C-reactive protein, appearing earlier increase in ESR, disappears as soon as the process subsides or the treatment has its effect (after 1 - 1.5 weeks), while the erythrocyte sedimentation rate will be above normal values ​​even up to a month.

How is CRP determined in the laboratory and what do cardiologists need?

C-reactive protein is one of the very important diagnostic criteria, so the development of new methods for its determination has never faded into the background, and at present, tests to detect CRP have ceased to be a problem.

C-reactive protein, which is not included in a biochemical blood test, is easy to determine with latex test kits based on latex agglutination (qualitative and semi-quantitative analysis). Thanks to this technique, even half an hour will not pass, as the answer, which is so important to the doctor, will be ready. Such a rapid study has proven itself as the very initial stage of the diagnostic search for acute conditions, the technique correlates well with turbidimetric and nephelometric methods, therefore it is suitable not only for screening, but also for the final decision regarding the diagnosis and choice of treatment tactics.

The concentration of this laboratory indicator is recognized using highly sensitive latex-enhanced turbidimetry, enzyme immunoassay(ELISA) and radioimmunological methods.

It should be noted that very often the described criterion is used for diagnostics of pathological conditions of the cardiovascular system where CRP helps to identify possible risks of complications, monitor the course of the process and the effectiveness of the measures taken. It is known that CRP itself is involved in the formation of atherosclerosis, even at relatively low values ​​of the indicator (we will return to the question of how this happens). To solve such problems, traditional methods laboratory diagnostics cardiologists are not satisfied, therefore, in these cases, a highly accurate measurement of hsCRP in combination with a lipid spectrum is used.

In addition, this analysis is used to calculate the risk of developing cardiovascular pathology in diabetes mellitus, diseases of the excretory system, and unfavorable pregnancy.

SRP norm? One for all, but...

In the blood of a healthy person, the level of CRP is very low or this protein is completely absent.(in a laboratory study, but this does not mean that it does not exist at all - the test simply does not capture scanty amounts).

The following limits of values ​​​​are accepted as the norm, moreover, they do not depend on age and gender: in children, men and women, it is the same - up to 5 mg / l, the only exception is newborn babies - they are allowed to have up to 15 mg/l of this acute phase protein (as evidenced by the reference literature). However, the situation is changing on suspicion of: neonatologists begin urgent measures (antibiotic therapy) with an increase in CRP in a child up to 12 mg / l, while doctors note that a bacterial infection in the first days of life may not give a sharp increase in this protein.

A laboratory test is prescribed to detect C-Reactives protein in the case of many pathological conditions accompanied by inflammation, the cause of which was an infection or destruction of the normal structure (destruction) of tissues:

• Acute period of various inflammatory processes;
• Activation chronic diseases inflammatory nature;
• Infections of viral and bacterial origin;
• Allergic reactions of the body;
• Active phase of rheumatism;
• Myocardial infarction.

In order to better understand the diagnostic value of this analysis, it is necessary to understand what acute phase proteins are, to learn about the reasons for their appearance in the patient's blood, in more detail consider the mechanism of immunological reactions in acute inflammatory process. Which is what we will try to do in the next section.

How and why does C-reactive protein appear during inflammation?

CRP and its binding to the cell membrane in case of its damage (for example, during inflammation)

CRP, participating in acute immunological processes, promote phagocytosis at the first stage of the body's response ( cellular immunity) and are one of the key components of the second phase of the immune response - humoral immunity. It happens like this:

1. Destruction of cell membranes by a pathogen or other factor leads to the destruction of the cells themselves, which does not go unnoticed by the body. Signals sent from the pathogen or from leukocytes located near the site of the “accident” attract phagocytic elements to the affected area, capable of absorbing and digesting particles foreign to the body (bacteria and the remains of dead cells).
2. Local response to the removal of dead cells causes an inflammatory response. Those with the highest phagocytic ability rush to the scene from the peripheral blood. A little later they arrive there to help with education mediators that stimulate the production of acute phase proteins (CRP), if necessary, and perform the function of a kind of "wipers" when you need to "clean up" the focus of inflammation (macrophages are able to absorb particles that are larger than themselves).
3. For the implementation of the processes of absorption and digestion of foreign factors occurs at the site of inflammation stimulation of the production of own proteins(C-reactive protein and other acute phase proteins) capable of resisting an invisible enemy, enhancing the phagocytic activity of leukocyte cells and attracting new components of the immune system to fight infection. The role of inducers of this stimulation is taken by substances (mediators) synthesized by macrophages "ready for battle" located in the focus and arriving in the inflammation zone. In addition, other regulators of the synthesis of acute-phase proteins (cytokines, glucocorticoids, anaphylotoxins, mediators formed by activated lymphocytes) also participate in the formation of CRP. CRP is produced mainly by liver cells (hepatocytes).
4. Macrophages, after performing the main tasks in the area of ​​inflammation, leaving, capture a foreign antigen and are sent to the lymph nodes to present it (antigen presentation) to immunocompetent cells - (helpers), which will recognize it and instruct B cells to start antibody production (humoral immunity). In the presence of C-reactive protein, the activity of lymphocytes with cytotoxic abilities increases markedly. From the beginning of the process and at all its stages, CRP itself is actively involved in the recognition and presentation of the antigen, which is possible due to other factors of immunity with which it is in close relationship..
5. In less than half a day (up to approximately 12 hours) from the onset of cell destruction, how the concentration of whey C-reactive protein will increase many times. This gives reason to consider it one of the two main proteins of the acute phase (the second is serum amyloid protein A), which have the main anti-inflammatory and protective functions (other acute phase proteins perform mainly regulatory tasks during inflammation).

Thus, an elevated level of CRP indicates the beginning of an infectious process. at the earliest stage of its development, and the use of antibacterial and anti-inflammatory drugs, on the contrary, reduces its concentration, which makes it possible to give this laboratory indicator a special diagnostic significance, calling it the “gold marker” of clinical laboratory diagnostics.

Cause and investigation

Due to the qualities that ensure the performance of numerous functions, C-reactive protein has been nicknamed the "two-faced Janus" by the researcher-wit. The nickname turned out to be apt for a protein that performs a lot of tasks in the body. Its versatility lies in the roles it plays in the development of inflammatory, autoimmune, and necrotic processes: in the ability to bind to many ligands, recognize foreign agents, and timely engage the body's defenses in the destruction of the "enemy".

Probably, each of us has ever experienced an acute phase of an inflammatory disease, where the central place is given to C-reactive protein. Even without knowing all the mechanisms of CRP formation, one can independently suspect that the whole organism is involved in the process: the heart, blood vessels, head, endocrine system(the temperature rises, the body “aches”, the head hurts, the heartbeat quickens). Indeed, the fever itself already indicates that the process has begun, and changes in metabolic processes in various organs and entire systems have begun in the body, due to an increase in the concentration of acute-phase markers, activation of the immune system, and a decrease in the permeability of the vascular walls. These events are not visible to the eye, but are determined using laboratory parameters (CRP, ESR).

C-reactive protein will be increased already in the first 6-8 hours from the onset of the disease, and its values ​​will correspond to the severity of the process (the more severe the course, the higher the CRP). Such properties of CRP allow it to be used as an indicator at the onset or progress of various inflammatory and necrotic processes, which will reasons for the increase in the indicator:

1. Bacterial and viral infections;
2. Acute cardiac pathology ();
3. Oncological diseases (including metastasis of tumors);
4. Chronic inflammatory processes localized in various organs;
5. Surgical interventions (violation of tissue integrity);
6. Injuries and burns;
7. Complications of the postoperative period;
8. Gynecological pathology;
9. Generalized infection, sepsis.

Elevated CRP often occurs with:

• tuberculosis;
• (SLE);
• Acute lymphoblastic (ALL);
• jade;
• Cushing's disease;
• Visceral leishmaniasis.

It should be noted that indicator values ​​for different groups of diseases can differ significantly, for example:

1. Viral infection, tumor metastases, rheumatic diseases that proceed sluggishly, without severe symptoms, give a moderate increase in the concentration of CRP - up to 30 mg/l;
2. Exacerbation of chronic inflammatory processes, infections caused by bacterial flora, surgical interventions, acute myocardial infarction can increase the level of the acute-phase marker by 20 or even 40 times, but in most cases, such conditions can be expected to increase the concentration to 40 – 100 mg/l;
3. Severe generalized infections, extensive burns, septic conditions can very unpleasantly surprise clinicians with numbers indicating the content of C-reactive protein, they can reach exorbitant values ​​( 300mg/l and much higher).

And further: not having the desire to scare anyone, I would like to touch on a very important issue regarding the increased amount of CRP in healthy people. A high concentration of C-reactive protein with external complete well-being and the absence of signs of at least some kind of pathology suggests the development of an oncological process. Such patients should undergo a thorough examination!

but on the other hand

In general, in terms of its properties and abilities, CRP is very similar to immunoglobulins: it “can distinguish between “self-foe”, bind to the components of a bacterial cell, to ligands of the complement system, and nuclear antigens. But to date, two types of C-reactive protein are known and how they differ from each other, thereby adding new functions of C-Reactives protein, can show a good example:

• Native (pentameric) acute phase protein, discovered in 1930 and consisting of 5 interconnected circular subunits located on the same surface (which is why it was called pentameric and assigned to the pentraxin family) is the CRP that we know and talk about. Pentraxins consist of two sections responsible for certain tasks: one recognizes a “stranger”, for example, an antigen of a bacterial cell, the other “calls for help” those substances that have the ability to destroy the “enemy”, since CRP itself does not have such abilities;
• "New" (neoSRP), represented by free monomers (monomeric CRP, which is called mCRP), which has other properties that are not characteristic of the native variant (fast mobility, low solubility, acceleration of platelet aggregation, stimulation of production and synthesis of biologically active substances). A new form of C-reactive protein was discovered in 1983.

A detailed study of the new acute phase protein revealed that its antigens are present on the surface of lymphocytes circulating in the blood, killer cells and plasma cells, and it turns out (mCRP) from the transition of a pentameric protein to a monomeric protein with the rapid development of the inflammatory process. However, the most important thing that scientists have learned about the monomeric variant is that "new" C-reactive protein contributes to the formation of cardiovascular pathology. How does this happen?

Elevated CRP is involved in the formation of atherosclerosis

The body's response to the inflammatory process sharply increases the concentration of CRP, which is accompanied by an enhanced transition of the pentameric form of C-reactive protein to the monomeric one - this is necessary to induce the reverse (anti-inflammatory) process. An increased level of mCRP leads to the production of inflammatory mediators (cytokines), the adhesion of neutrophils to vascular wall, activation of the endothelium with the release of factors that cause spasm, the formation of microthrombi and circulatory disorders in microvasculature, that is, the formation of .

This should be taken into account in the latent course of chronic diseases with a slight increase in the level of CRP (up to 10-15 mg/l). A person continues to consider himself healthy, and the process slowly develops, which can lead first to atherosclerosis, and then to myocardial infarction (first) or others. Can you imagine how much a patient is at risk, having high concentrations of C-reactive protein in the blood test, the predominance of the low-density lipoprotein fraction in the lipid spectrum and high values ​​of the atherogenic coefficient (CA)?

In order to prevent sad consequences, patients at risk should not forget to take the necessary tests for themselves, moreover, their CRP is measured by highly sensitive methods, and is studied in the lipid spectrum with the calculation of the atherogenic coefficient.

The main tasks of the SRB are determined by its “diversity”

It is possible that the reader has not received answers to all his questions regarding the central component of the acute phase - the C reactive protein.
Considering that complex immunological reactions of stimulation, regulation of CRP synthesis and its interaction with other immunity factors can hardly be of interest to a person who is far from these scientific and incomprehensible terms, the article focused on the properties and important role of this acute phase protein in practical medicine.

And the importance of SRP is really difficult to overestimate: it is indispensable in monitoring the course of the disease and the effectiveness of therapeutic measures, as well as in the diagnosis of acute inflammatory conditions and necrotic processes, where it exhibits high specificity. At the same time, it, like other acute-phase proteins, is also characterized by non-specificity (a variety of reasons for the increase in CRP, the multifunctionality of C-reactive protein due to the ability to bind to many ligands), which does not allow us to differentiate using this indicator various states and establish an accurate diagnosis (it’s not for nothing that he was called “two-faced Janus”?). And then it turns out that he takes part in the formation of atherosclerosis ...

On the other hand, many laboratory research and instrumental diagnostic methods that will help CRP, and the disease will be established.

Video: C-reactive protein in the program “Live healthy!”

According to WHO, pathologies of the cardiovascular system (CVS) occupy a leading position among the causes of death in people around the world. This fact determines the importance of detecting deviations from the norm at an early stage. Laboratory analysis to detect the level of c-reactive protein (CRP) in the blood is necessary to assess the risk of cardiovascular diseases and predict their outcome, as well as to identify the inflammatory process. Of particular importance is the study when it is necessary to select adequate antibiotic therapy or when correcting already selected methods.

C-reactive protein is a two-component molecule consisting of proteins (peptides) covalently linked to several oligosaccharides. The name is due to its ability to interact with C-polysaccharides of bacteria of the Streptococcaceae family, thus forming a stable antigen-antibody complex (precipitation reaction). This mechanism refers to the protective reactions of the human body to infectious infection.

When a pathogen enters, it activates the immune system, which stimulates the synthesis of small peptide molecules - cytokines. They provide signal transmission about the manifestation of the inflammatory process and the need to increase the production of acute phase proteins, which are CRP. After 1-2 days, there is an increase in CRP by tens and hundreds of times compared with normal values.

It is noted that the maximum level of CRP (more than 150 mg/ml) is recorded in infectious diseases of bacterial etiology. While with viral infection, the protein concentration does not exceed 30 mg / l. Tissue death (necrosis) is another cause of elevated c-reactive protein, including heart attack, cancer, and atherosclerosis (deposition of excess cholesterol in the blood vessels).

Physiological function of CRP

CRP belongs to the proteins of the acute phase of the inflammatory process, it takes an active part in:

• launching a cascade of enzymatic reactions of the compliment system;
• increased production of monocytes - white blood cells capable of implementing the process of phagocytosis of relatively large foreign particles;
• stimulating the synthesis of adhesion molecules, which are necessary for the attachment of immunity cells to the surface of an infectious agent;
• the process of binding and converting low-density lipoproteins (“bad” cholesterol), the accumulation of which indirectly increases the risk of developing CCC pathologies.

Thus, the importance of c-reactive protein for the human body is difficult to overestimate, since without it it is impossible to implement full protection against foreign pathogenic microorganisms.

Blood test with reactive protein

Determination of the CRP value quantitatively is a technique implemented in private and some state laboratories. The term of execution, not counting the day of taking the biomaterial, does not exceed 1 day. However, results may be delayed due to high laboratory workload.

The analysis is performed using the method of immunoturbidimetry, the essence of which is to determine the degree of turbidity of the solution in the presence or absence of the formation of a stable antigen-antibody complex. The advantages of the method include low cost, a high degree of reliability and the possibility of obtaining quantitative results.

The technique is divided into analysis with normal and increased sensitivity. A highly sensitive blood test is necessary to diagnose the presence of not only an acute, but also a chronic inflammatory process in the blood vessels, as well as an early form of atherosclerosis. The minimum level of CRP detected by the devices is 0.1 mg/l.

Signs of elevated c-reactive protein

Symptoms advanced level CRP correspond to the clinical picture of the disease that caused this pathological condition. Often, patients have a sharp increase in body temperature (fever), joint pain, nausea and vomiting, as well as general state weakness and increased drowsiness.

Oncology for a long time can proceed without the manifestation of typical signs. classical clinical picture can develop at stages 3-4 of cancer when malignant neoplasm led to tissue necrosis and spread of metastases.

The danger of atherosclerosis lies in the long-term asymptomatic course. With this disease, the risk of myocardial infarction, which can be fatal, is significantly increased.

Therefore, it is extremely important to undergo an annual scheduled preventive examination, which includes a set of mandatory general clinical and biochemical analyzes, and often specific laboratory markers (if indicated).

Indications for the test

An analysis for c-reactive protein in the blood is prescribed for:

• the need to identify inflammatory processes resulting from autoimmune pathologies or infectious invasion;
• evaluation of the effectiveness of the chosen tactics for the treatment of infectious diseases;
• differentiation of a bacterial infection from a viral one;
• determining the severity of an inflammatory or autoimmune disease;
• postoperative control and prevention of infectious complications;
• deciding on the need to prescribe antibiotic therapy, as well as the duration of the course;
• making a prognosis, including a lethal one, against the background of pancreatic necrosis;
• analysis of the degree of spread and extent of damaged tissues by malignant neoplasms;
• differentiation of some pathological conditions that are similar in symptoms and manifestations. For example: with granulomatous enteritis, c-reactive protein is increased, and with nonspecific ulcerative colitis- lowered;
• continuous monitoring of the activity of chronic pathologies.

A blood test for c-reactive protein in newborns is performed if sepsis is suspected. It is characterized by infection by pathogenic microorganisms not of individual organs and tissues, but of the entire human body as a whole. The condition is life threatening.

Norm indicators for adults and children

Important: only the attending physician can decipher the results of a blood test, determine the diagnosis and select treatment methods.

It should be noted that the isolated use of the CRP test when examining a patient is unacceptable. Data from other laboratory tests and instrumental methods diagnosis and patient history.

The rate of c-reactive protein in women and men varies depending on the degree of sensitivity of the method used and is presented in the table.

It should be noted that the norm of c-reactive protein in children is similar to adults and should not exceed the specified reference (normal) values.

The rate of reactive protein in women over 50 also corresponds to the standard values, while even a slight increase in reference values ​​is a sufficient reason for a comprehensive examination.

CRP risk assessment

Important: for the purpose of assessing the risk of a heart attack, it is permissible to use an exclusively highly sensitive technique. A test with normal sensitivity does not allow you to determine the likelihood of developing a heart attack or other cardiovascular diseases.

A direct relationship has been established between the level of CRP and the degree of risk of CVS pathologies, as well as their complications. Thus, normal values, not exceeding 1 mg/l, are characteristic of a low probability of developing cardiovascular disease. The concentration of the considered laboratory criterion from 1 to 3 mg/l correlates with the average risk of developing atherosclerosis and, as a consequence, myocardial infarction. An increase in the value to 3 mg / l or more indicates a high probability of vascular and cardiac pathologies.

An increase in CRP to 10 mg / l or more is a sufficient reason for conducting an additional examination in order to identify infectious diseases, viral or bacterial etiology.

It should be noted that, comparatively, patients with elevated CRP levels and normal levels of "bad" cholesterol are characterized by a higher risk of developing CV pathologies than people with normal CRP and elevated cholesterol.

In the event that a person with ischemic disease heart, high values ​​of the criterion under consideration are recorded, then we can talk about a dangerous risk of recurrence of a heart attack or stroke, as well as a high probability of developing complications after coronary bypass surgery.

What does it mean if an adult has elevated c-reactive protein?

The reasons for the increase in c-reactive protein in a child and adult patients may be different, which makes it possible to classify the study as low-specific. List of possible reasons:

• acute form infectious infection with viruses (increase within 10 - 30 g / l) or bacteria (from 40 to 100 mg / ml, and with severe infection - up to 200 mg / l);
• autoimmune pathologies (arthritis, vasculitis, polyarthritis);
• some lymphadenopathy;
• extensive damage to the integrity of tissues and organs: surgery, trauma, acute form of pancreatitis, pancreatic tissue necrosis, heart attack, stroke (up to 100 mg / l);
• penetration of pathogenic microorganisms into the tissues of the heart valve;
• cancer, accompanied by the spread of metastases;
• extensive burns and sepsis (more than 300 mg/l);
• excessive production of female sex hormones (estrogen and progesterone). What explains the increased CRP in the blood of women during pregnancy, as well as when taking oral contraceptives. However, it should be borne in mind that a significant deviation from the norm (2 or more times) indicates the development of the disease and requires immediate additional examination.

It was noted that a slight excess of the norm is recorded in diabetes mellitus, increased blood pressure and if the person is overweight.

Preparation for the delivery of biomaterial

The biomaterial for the test is venous blood serum taken by a specialist from the cubital vein at the elbow bend. More than 70% of errors are made at the preanalytical stage: at the stage of patient preparation and in case of incorrect implementation of the blood sampling procedure. Therefore, the reliability of the results obtained depends not only on the exact implementation of the test in the laboratory, but also on the correct preparation of the patient himself.

It is necessary to donate blood in the morning strictly on an empty stomach, the minimum time interval after the last meal should be 12 hours. In addition, half an hour before the delivery of the biomaterial, the patient is forbidden to smoke, as well as experience physical and emotional overstrain. Sports training in the evening before the morning visit to the laboratory should also be canceled.

For 2 days, you should exclude the reception of any medicines after consulting with your doctor. This rule is of particular importance for people who use the following medicines:

• aspirin ® ;
• ibuprofen ® ;
• steroids;
• lipid-lowering agents;
• beta blockers.

This fact is due to the ability of the above drugs to temporarily reduce the concentration of the considered laboratory criterion. Neglect of the rule can lead to false negative results, and, as a result, a delay in the appointment of the necessary treatment.

It is extremely important to take a responsible approach to your health and be aware of the fact that the earlier the disease is detected, the easier it will be to cure it and the more favorable the prognosis of the outcome for the patient himself.