{"id":9417,"date":"2020-04-23T03:37:25","date_gmt":"2020-04-23T00:37:25","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/proteina-c-reactiva-hscrp-inalt-sensibila\/"},"modified":"2026-02-18T23:45:03","modified_gmt":"2026-02-18T21:45:03","slug":"proteina-c-reactiva-hscrp-inalt-sensibila","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/proteina-c-reactiva-hscrp-inalt-sensibila\/","title":{"rendered":"\u0412\u044b\u0441\u043e\u043a\u043e\u0447\u0443\u0432\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0439 \u0421-\u0440\u0435\u0430\u043a\u0442\u0438\u0432\u043d\u044b\u0439 \u0431\u0435\u043b\u043e\u043a (\u0432\u0447\u0421\u0420\u0411)"},"content":{"rendered":"

\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/span><\/p>\n

CRP reprezinta \u00a0unul din cei mai sensibili reactanti de faza acuta. Nivelurile sale plasmatice cresc dramatic (de 100 ori sau mai mult) dupa traumatisme severe, infectii bacteriene, inflamatii, interventii chirurgicale sau in cursul unor proliferari tumorale.<\/span><\/p>\n

In mod traditional, determinarea CRP a fost utilizata pentru a evalua si a monitoriza activitatea afectiunilor inflamatorii, pentru a depista infectiile post-operatorii si respingerea grefelor2<\/sup>.<\/span><\/p>\n

In ultimii ani numeroase studii epidemiologice au confirmat faptul ca pacientii cu niveluri plasmatice bazale crescute de CRP prezinta un risc crescut de boala coronariana si infarct miocardic. Studiile prospective desfasurate in tarile europene si SUA au furnizat rezultate concordante in ceea ce priveste valoarea predictiva a determinarilor CRP asupra riscului cardiovascular atat la barbati cat si la femei. Astfel, CRP este un factor de risc indirect pentru boala coronariana, iar nivelurile crescute pot reflecta unele din urmatoarele situatii:<\/span><\/p>\n

-o inflamatie a arterelor coronare ca raspuns la agenti infectiosi;<\/span><\/p>\n

-severitatea raspunsului inflamator in vasele aterosclerotice;<\/span><\/p>\n

-extinderea inflamatiei asociate cu ischemia miocardica;<\/span><\/p>\n

-extinderea inflamatiei asociate cu necroza miocardica;<\/span><\/p>\n

-cantitatea si activitatea citokinelor proinflamatorii circulante1<\/sup>.<\/span><\/p>\n

Desi exista dovezi certe privind rolul inflamatiei in boala coronariana nu a fost stabilit pana acum mecanismul precis al relatiei dintre nivelurile plasmatice CRP si riscul cardiovascular. O problema ramasa inca nerezolvata este aceea daca cresterea nivelului CRP reprezinta cauza sau consecinta bolii (probabil amandoua). Este posibil ca raspunsul inflamator asociat cu leziunile ateromatoase sa declanseze productia de citokine intr-o cantitate suficienta pentru a induce o crestere masurabila a CRP in plasma. La randul sau CRP, datorita efectelor proinflamatorii, poate determina cresterea vulnerabilitatii placii ateromatoase sau poate avea alte actiuni care agraveaza boala.<\/span><\/p>\n

Centralizarea datelor obtinute din studiile prospective in care testarea CRP a fost folosita pentru estima riscul pe termen scurt sau lung de evenimente coronariene recurente sau deces de cauza cardiaca la pacientii care au fost monitorizati pe o perioada de timp variabila (90 zile \u2013 9 ani) a relevat urmatoarele aspecte majore:<\/span><\/p>\n

-nivelurile serice medii ale CRP sunt in general crescute la persoanele cu boala coronariana in comparatie cu martorii sanatosi (inainte si dupa ajustarea pentru alti factori de risc cardiovascular);<\/span><\/p>\n

-nivelurile serice CRP se coreleaza atat cu factorii de risc cardiovascular \u201cclasici\u201d: fumat, varsta, indice de masa corporala, diabet cat si cu unele variabile clinice cum ar fi: infarct miocardic in antecedente si severitatea stenozei arterelor coronare;<\/span><\/p>\n

-nivelurile serice CRP sunt crescute la pacientele care urmeaza terapie hormonala de substitutie;<\/span><\/p>\n

-nivelurile bazale CRP constituie un factor predictiv independent pentru riscurile pe termen scurt si lung de infarct miocardic recurent sau deces la pacientii cu angina instabila sau infarct miocardic in antecedente;<\/span><\/p>\n

-un studiu efectuat pe un lot de barbati cu hipercolesterolemie si boala coronariana severa a constat ca asocierea dintre CRP si prognosticul bolii coronariene a fost atenuata de alti factori de risc.<\/span><\/p>\n

Ca o concluzie, persoanele cu niveluri serice CRP care depasesc in mod sustinut 1 mg\/L prezinta un risc crescut de infarct miocardic.<\/span><\/p>\n

In ceea ce priveste studiile prospective efectuate pe perioade cuprinse intre 3 si 8 ani care au inclus persoane asimptomatice, initial sanatoase, s-au comunicat observatii similare:<\/span><\/p>\n

-nivelurile bazale CRP crescute constituie un factor predictiv independent pentru riscul pe termen lung de boala coronariana al persoanelor aparent sanatoase si, in unele cazuri reprezinta factorul predictiv cel mai puternic;<\/span><\/p>\n

-riscul de afectiuni cardiovasculare este de 2-7 ori mai mare\u00a0 la persoanele cu niveluri CRP crescute fata de cei cu niveluri joase; cresterea CRP este inregistrata cu cativa ani inainte de debutul clinic al bolii coronariene;<\/span><\/p>\n

-nivelurile CRP sunt crescute la persoanele de sex feminin sanatoase care urmeaza terapie hormonala de substitutie postmenopauza;<\/span><\/p>\n

-rezultatele testului CRP se adauga la cele obtinute pentru markerii cardiovasculari standard (colesterol total si LDL colesterol) contribuind la cresterea valorii predictive a acestora, la persoane sanatoase apartinand ambelor sexe;<\/span><\/p>\n

-riscul crescut al persoanelor cu nivel CRP ridicat este evident pe termen lung si este independent de alti factori de risc cardiovascular cum ar fi hiperlipemia si fumatul;<\/span><\/p>\n

-se pare ca valoarea predictiva a CRP este mai mare la persoanele care nu prezinta factori de risc\u00a0 \u201eclasici\u201d (spre exemplu, indivizi normolipemici sau nefumatori).<\/span><\/p>\n

Cercetarile indica faptul ca persoanele care prezinta niveluri CRP crescute trebuie sa intrerupa fumatul, sa scada in greutate, sa reduca valorile tensiunii arteriale, sa practice exercitii fizice si sa urmeze o dieta echilibrata, indiferent de nivelul colesterolului seric. In plus, se crede ca terapia cu statine poate fi utila in scaderea nivelurilor CRP1<\/sup>.<\/span><\/p>\n

Exista doua tipuri de teste CRP: unul dintre acestea prezinta un domeniu masurabil \u00a0care include valorile obtinute la pacientii cu procese infectioase sau inflamatorii (in general, 3-200 mg\/L) iar celalalt poate detecta niveluri CRP mai mici (sensibilitate analitica in jur de 0.1 mg\/L) pentru estimarea riscului de evenimente cardiace. Din acest motiv, cel de-al doilea test este denumit CRP cu sensibilitate inalta (CRP ultrasensibil; \u201chigh-sensitive\u201d CRP)2<\/sup>.<\/span><\/p>\n

Determinarile CRP ultrasensibile sunt folosite si pentru depistarea precoce a infectiilor in pediatrie3<\/sup>.<\/span><\/p>\n

Recomandari pentru determinarea CRP<\/em><\/strong><\/span><\/p>\n

Pentru estimarea riscului cardiac, AHA (American Heart Association) si CDC (Centers for Disease Control and Prevention) au formulat urmatoarele recomandari de testare hsCRP:<\/span><\/p>\n

-testarea nu trebuie efectuata la pacientii cu semne de infectie, inflamatie sistemica sau traumatisme;<\/span><\/p>\n

-in mod optim, pentru estimarea riscului cardiovascular se va folosi o valoare hsCRP<\/strong> medie<\/strong>, rezultata din 2 valori masurate la un interval de 2 saptamani; daca la una dintre determinari se depisteaza o valoare > 10 mg\/L trebuie cercetata o cauza inflamatorie iar testarea va fi repetata peste alte 2 saptamani;<\/span><\/p>\n

-vor beneficia cel mai mult de testare persoanele la care determinarea markerilor standard a furnizat un risc moderat (de exemplu, un risc de 10-20% de a dezvolta afectiuni cardiovasculare in urmatorii 10 ani) iar medicul clinician solicita informatii suplimentare pentru a conduce tratamentul preventiv;<\/span><\/p>\n

-rolul hsCRP in preventia secundara (la pacientii deja diagnosticati cu afectiuni cardiovasculare) este limitat, deoarece nu influenteaza deciziile terapeutice (acestea trebuie sa fie agresive, indiferent de valorile CRP);<\/span><\/p>\n

-nu se recomanda screening-ul intregii populatii adulte, iar hsCRP nu trebuie sa se substituie markerilor standard ai riscului cardiovascular (reprezinta un element adjuvant)3;4<\/sup>.<\/span><\/p>\n

Pregatire pacient<\/em><\/strong> \u2013 nu este necesara3<\/sup>.<\/span><\/p>\n

Specimen recoltat <\/em><\/strong>\u2013 sange venos3<\/sup>.<\/span><\/p>\n

Recipient de recoltare <\/em><\/strong>\u2013 vacutainer fara anticoagulant cu\/fara gel separator3<\/sup>.<\/span><\/p>\n

Prelucrare necesara dupa recoltare <\/em><\/strong>\u2013 se separa serul prin centrifugare3<\/sup>.<\/span><\/p>\n

Volum proba<\/em><\/strong> \u2013 minim 0.5 mL ser3<\/sup>.<\/span><\/p>\n

Cauze\u00a0 de respingere a probei <\/em><\/strong>\u2013 specimen intens lipemic sau intens hemolizat3<\/sup>.<\/span><\/p>\n

Stabilitate proba <\/em><\/strong>\u2013 serul este stabil 3 zile<\/em> la temperatura camerei; 8 zile<\/em> la 2-8\u00baC; timp idelungat <\/em>\u00a0la \u201320\u00baC3<\/sup>.\u00a0<\/em><\/strong><\/span><\/p>\n

Metoda <\/em><\/strong>- latex-<\/em><\/span>imunoturbidimetrie<\/span>3<\/sup>.<\/span><\/p>\n

Limita de detectie<\/em><\/strong> \u2013 0.15 mg\/L3<\/sup>.<\/span><\/p>\n

Valori de referinta si interpretarea rezultatelor<\/em><\/strong><\/span><\/p>\n

Intervalele de decizie pentru evaluarea riscului cardiovascular sunt stabilite conform recomandarilor CDC\/AHA:<\/span><\/p>\n

< 1mg\/L : risc scazut<\/span><\/p>\n

1- 3 mg\/L : risc moderat<\/span><\/p>\n

> 3 mg\/L : risc crescut<\/span><\/p>\n

In cazul valorilor > 10 mg\/L trebuie luata in considerare o cauza non-cardiovasculara3<\/sup>.<\/span><\/p>\n

Valori de referinta pentru nou-nascuti si copii:<\/span><\/p>\n

Nou-nascuti (0-3 saptamani): 0.1-4.1 mg\/L<\/span><\/p>\n

Copii (1 luna \u2013 15 ani): 0.1 -2.8 mg\/L<\/span><\/p>\n

Factori de conversie:<\/em><\/span><\/p>\n

mg\/L x 9.52 = nmol\/L<\/span><\/p>\n

mg\/L x 0.1 = mg\/dL3<\/sup>.<\/span><\/p>\n

Limite si interferente<\/em><\/strong><\/span><\/p>\n

Cresterile nivelului CRP sunt nespecifice si nu trebuie interpretate decat in contextul clinic al pacientilor.<\/span><\/p>\n

Determinarile seriate de CRP nu trebuie folosite pentru monitorizarea tratamentului.<\/span><\/p>\n

\u2022 Interferente analitice<\/span><\/p>\n

In cazuri foarte rare prezenta gamapatiei, in special IgM (macroglobulinemia Waldenstr\u00f6m) poate determina rezultate eronate3<\/sup>.<\/span><\/p>\n

\u00a0<\/span>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n

1. Francesco Dati & Erwin Metzmann. Acute Phase Proteins. In Proteins Laboratory Testing and Clinical Use, Media Print Taunusdruck GmbH, Frankfurt am Main; 2005, 301-305.<\/span><\/p>\n

2. Frances Fischbach. Overview of Immunodiagnostics Studies. In A Manual of Laboratory and Diagnostics Tests. Lippincott Williams & Wilkins, USA, 8 Ed., 2009, 642-643.<\/span><\/p>\n

3. Laborator Synevo. Referintele specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog<\/span><\/p>\n

4. Richard A. McPherson, Matthew R. Pincus. Evaluation of Cardiac Injury and Function. In Henry\u2019s clinical diagnosis and management by laboratory methods, Ed., 2007, 224-225.<\/span><\/p>","protected":false},"excerpt":{"rendered":"

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