ESR : M : 0~10 mm/hr
F : 0~20 mm/hr
CRP < 0.5 mg/dl
ESR(Erythrocyte Sedimentation Rate) : 적혈구 침강계수
ESR은 질병 초기에 신체적 혹은 Chemical signs이 정상일 때 예민하게 반응하는 특성이 있어 임신, 급, 만성 염증질환, 결핵,빈혈등에서 항진됩니다.
질병에 대한 특이도가 낮지만, 비교적 검사가 간단하고 종합적인 정보를 제공하기 때문에 면역성 질환, 감염 및 염증성 질환, 악성 및 외상성 질환등 당양한 질병의 진단 및 추적관찰에 널리 이용된다.
류마티스 관절염, 만성 감염성 질환, 교원질환이 있을 때도 중등도로 증가하는데 이러한 질환에서는 진단적 가치보다는 질환의 활동성 정도를 평가하고 경과를 관찰하는데 더 유용하다.
검사법 : Westergren
임상적 의의
항응고제가 포함된 전혈을 수직으로 세우면 적혈구가 혈장으로부터 분리되어 시험관 아래로 가라앉게 되는데 이렇게 이동한 적혈구의 침강선까지의 거리를 적혈구 침강계수(ESR)라고 한다.
* 항응고제를 넣은 혈액을 관에 넣고 수직으로 세워 적혈구 침강시킨 후 혈장의 길이를 측정
1. 임상적 의의
① ESR이 증가하는 경우 : 염증, 조직손상으로 인한 α-2, β, r 글로불린, 섬유소의 증가를 의미
㉠ 감염 : 대부분의 세균성 감염, 간염, 결핵, 2차 매독, 렙토스피라증, 전신성 진균증
㉡ 혈액질환 또는 종양 : 심한 빈혈, 백혈병, 림프종, 전이암, 만성육아종성 질환, 다발
성 골수종, Cooms test 양성, 용혈성 빈혈
㉢ 위장관 질환 : 궤양성 대장염, 국한성 회장염, 급성췌장염, 담낭염, 복막염
㉣ 교원병 : 류마치성 관절염, 전신성 홍반성 낭창, 피부진균증, 경피증, 혈관염
㉤ 신장질환 : 사구체 신염, 신증, 신우 신염, 용혈, 요독증후군
㉥ 기타 : 갑상선기능 저하증, 갑상선염, 유육종(sarcoidosis), 수술 후 화상, 약제과민반응, 만성 간질환, 한냉 글로브린증, 거대 글로브린증, 심근경색증, 임신, 월경
② ESR이 감소하는 경우 : 적혈구 증가증, 진성다혈구증, 구성적혈구혈증, 겸상적혈구
빈혈, 미만성 혈관내 응고 (DIC), 악액질(Cachexia)
③ 전염성 단핵구증이나 국소적인 감염, 양성 신생물시는 ESR이 정상이다.
CRP란 C-Reactive protein(C반응성단백)의 약어로 염증성 질환 또는 체내 조직의 괴사와 같은 질환에서 현저하게 증가하는 혈장단백의 하나로 소위 급성상반응단백(acute phase protein)의 대표적인 성분이다. ... CRP는 생체에 이상이 생긴 경우 6~24시간 이내라고 하는 짧은 시간에 증가하는 동시에 병변회복에도 24시간 이내로 빨리 감소, 소실하는 등 통상 면역 globulin 항체에서 볼 수 없는 특징을 나타내는 단백이다.
따라서 CRP 측정은 염증성 또는 조직붕괴성 질환의 존재여부와 그 중증도 판정, 경과 관찰 및 예후 판정에 대단히 유용하다.
CRP는 급성 염증 질환의 정도를 판단하고 염증이나 병변으로 조직 파괴가 있을 때 나타나는 특별한 단백질로 CRP는 염증 marker이고 CRP와 ESR은 정 (+) 의 상관관계인 경우가 많다.
체내에서 급성으로 염증이 있을때 간에서 생성되는 물질로써 CRP가 증가했다는것은 염증이 있다는것이다.
예를들어 심근경색증은 동맥벽에 콜레스테롤이 끼어서 염증반응이 일어나고,, 혈전이 생성되어 CRP가 증가되는 것이다. 그래서 순환계환자들의 동맥경화위험성을 평가하는 참고자료로 검사한다.
CRP는 생체내 염증 또는 조직 괴사가 있는 경우 급속히 증가되는 급성반응물질로서 이들 손상의 예민한 지표가 됩니다. CRP는 ESR보다 더 예민하게 나타나며 감염 후 14~26시간이내에 혈청에 출현해서 회복기에 차츰 소실됩니다.
세균감염, 악성종양, 류마티스열에서 증가하고 급성 심근 경색 및 화상환자의 경과 판정에 사용된다.
출처 : choaswife님의 블로그
Also known as: CRP
Formal name: C-Reactive Protein
Related tests: High-Senstivity C-reactive protein (hs-CRP)
Erythrocyte sedimentation rate(ESR)
Why get tested?
To identify the presence of inflammation and to monitor response to treatment [Note: to test for your risk of heart disease, a more sensitive test (hs-CRP) is used.]
Sample required?
A blood sample taken from a vein in your arm
How is it used?
The CRP test is sometimes used in patients with inflammatory bowel disease and some forms of arthritis and autoimmune diseases to assess how active the inflammation is and to monitor the treatment. The CRP test is also used to monitor patients after surgery or other invasive procedures to detect the presence of an infection during the recovery period. CRP tests are not specific enough to diagnose a particular disease. Rather, CRP is a general marker of infection and inflammation that alerts medical professionals that further testing and treatment may be necessary.
When is it ordered?
Because CRP increases in cases of inflammation, the test is ordered when acute inflammation is a risk (such as from an infection after surgery) or suspected based on patient symptoms. It is also ordered to help evaluate conditions, such as rheumatoid arthritis and lupus. The test may be repeated to determine whether treatment of an inflammatory disease is effective since CRP levels drop as inflammation subsides.
CRP also is used to monitor wound healing and to monitor patients who have surgical cuts (incisions), organ transplants, or burns as an early detection system for possible infections.
What does the test result mean?
NOTE: A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your test results with your doctor. For more information on reference ranges, please read Reference Ranges and What They Mean
A high or increasing amount of CRP in your blood suggests that you have an acute infection or inflammation. In a healthy person, CRP is usually less than 10 mg/L. Most infections and inflammations result in CRP levels above 100 mg/L.
If the CRP level in your blood drops, it means that you are getting better and inflammation is being reduced.
When your results fall below 10 mg/L, you no longer have clinically active inflammation.
Is there anything else I should know?
Another test to monitor inflammation is called the erythrocyte sedimentation rate (ESR). Both tests give similar information about the presence of inflammation. However, CRP appears and then disappears sooner than changes in the ESR. Thus, your CRP level may fall to normal if you have been treated successfully, such as for a flare-up of arthritis, but your ESR may still be abnormal for a while longer.
1. What are chronic inflammatory diseases?
Chronic inflammatory diseases are diseases that lead to the development of long-lasting or frequently recurring inflammation. They can be caused by a number of different pathological conditions. Examples include arthritis, lupus, and inflammatory bowel disease (Crohn’s disease).
2. What is the difference between regular CRP and hs-CRP tests?
Both tests measure the same molecule in the blood. The high sensitivity CRP (hs-CRP) test, which measures very low amounts of CRP in the blood, is ordered for seemingly healthy people to help assess their risk for heart problems. It measures CRP in the range from 0.5 to 10 mg/L. The regular CRP test is ordered for patients at risk for bacterial or viral infections (such as following surgery) or patients with chronic inflammatory diseases (such as rheumatoid arthritis). It measures CRP in the range from 10 to 1000 mg/L.
ESR
Also known as: Sed rate, Sedimentation rate
Formal name: Erythrocyte sedimentation rate
Related tests: C-reactive protein (CRP), ANA, RF
How is it used?
The ESR is an easy, inexpensive, nonspecific test that has been used for many years to help diagnose conditions associated with acute and chronic inflammation, including infections, cancers, and autoimmune diseases. ESR is said to be nonspecific because increases do not tell the doctor exactly where the inflammation is in your body or what is causing it, and also because it can be affected by other conditions besides inflammation. For this reason, ESR is typically used in conjunction with other tests.
ESR is helpful in diagnosing two specific inflammatory diseases, temporal arteritis and polymyalgia rheumatica. A high ESR is one of the main test results used to confirm the diagnosis. It is also used to monitor disease activity and response to therapy in both of these diseases.
When is it ordered?
A physician usually orders an ESR test (along with others) to evaluate a patient who has symptoms that suggest polymyalgia rheumatica or temporal arteritis, such as headaches, neck or shoulder pain, pelvic pain, anemia, unexplained weight loss, and joint stiffness. There are many other conditions that can result in a temporary or sustained elevation in the ESR and some that will cause a decrease.
Since ESR is a nonspecific marker of inflammation and is affected by other factors, the results must be used along with the doctor’s other clinical findings, the patient’s health history, and results from other appropriate laboratory tests. If the ESR and clinical findings match, the doctor may be able to confirm or rule out a suspected diagnosis. A single elevated ESR, without any symptoms of a specific disease, will usually not give the physician enough information to make a medical decision.
Before doing an extensive workup looking for disease, a doctor may want to repeat the ESR test after a period of several weeks or months. If a doctor already knows the patient has a disease like temporal arteritis (where changes in the ESR mirror those in the disease process), s/he may order the ESR at regular intervals to assist in monitoring the course of the disease. In the case of Hodgkin’s disease, for example, a sustained elevation in ESR may be a predictor of an early relapse following chemotherapy.
What does the test result mean?
NOTE: A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your test results with your doctor. For more information on reference ranges, please read
Doctor’s do not base their decisions solely on ESR results. You can have a normal result and still have a problem.
A very high ESR usually has an obvious cause, such as an acute infection. The doctor will use other follow-up tests, such as cultures, depending on the patient’s symptoms.
Moderately elevated ESR occurs with inflammation, but also with anemia, infection, pregnancy, and old age.
A rising ESR can mean an increase in inflammation or a poor response to a therapy; a decreasing ESR can mean a good response.
A common cause of high ESR is anemia, especially if it is associated with changes in the shape of the red cells; however, some changes in red cell shape (such as sickle cells in sickle cell anemia) lower ESR. Kidney failure will also increase ESR. Persons with multiple myeloma or Waldenstrom’s macroglobulinemia (tumors that make large amounts of immunoglobulins) typically have very high ESR even if they don't have inflammation.
Although a low ESR is not usually important, it can be seen with polycythemia (a condition where a patient makes too many red blood cells), with extreme leukocytosis (patient has too many white blood cells), and with some protein abnormalities.
Is there anything else I should know?
ESR and C-reactive protein (CRP) are both markers of inflammation. Generally, ESR does not change as rapidly as does CRP, either at the start of inflammation or as it goes away. CRP is not affected by as many other factors as is ESR, making it a better marker of inflammation. However, because ESR is an easily performed test, many doctors still use ESR as an initial test when they think a patient has inflammation.
Females tend to have higher ESR, and menstruation and pregnancy can cause temporary elevations.
Drugs such as dextran, methyldopa (Aldomet), oral contraceptives, penicillamine procainamide, theophylline, and vitamin A can increase ESR, while aspirin, cortisone, and quinine may decrease it.
1. What other tests might my doctor be ordering besides ESR?
Your doctor may order the CRP test as well as other general tests, such as a comprehensive metabolic panel or a CBC, at the same time they order the ESR. They may also order additional tests based on your symptoms, such as the ANA (antinuclear antibody) and RF (rheumatoid factor) tests for symptoms of arthritis.
2. What do changes in my ESR mean?
The ESR is an indicator in your body. Like pain, it is giving you a warning that something is wrong. In most cases, the ESR will decrease over time once the underlying inflammation is addressed. If you have a chronic inflammatory disease, the ESR may fluctuate with the degree of activity your condition.
