2. Istoricul
William S. Tillett,
Thomas Francis,
1930
• O proteina, care intra in reactie cu
polizaharida capsulara (C) a
pneumococului
• Titrul proteinei scade dupa scaderea
7. Nivelul in plasma
• secretie la 4-6 ore dupa stimul
• se dubleaza conc. din 8 in 8 ore
• max. la 36–50 de ore
• timp de injumatatire 19 ore
• revine la nivelul normal in 3-7 zile
8. Nivelul in plasma
PCR (mg/L)
10 – 40 Inflamatie usoara, infectie virala sau bacteriana
40 – 100 Inflamatie moderata, infectie virala sau
bacteriana
100 – 200 Inflamatie importanta, infectie bacteriana
> 200 Infectie bacteriana severa sau leziuni extinse
(ex. arsuri)
9. PCR sau VSH
• PCR: „participant” in procesul inflamator,
iar VSH: estimarea indirecta a severitatii
inflamatiei PCR neinfluentat
de:
anemie
policitemie
insuf. cardiaca
hipergamaglo
b.
PCR urmareste
mai rapid dinamica inflamatiei
10. Importanta clinica
• Nivel crescut:
– inflamatii: RAA, artrite, vasculite, boli
inflamatorii intestinale, etc. (in infectiile cronice
NU este caracteristica)
– necroze tisulare: ischemie, infarct, tumori
maligne, interventii chirurgicale (5-7
zile), arsuri, traumatisme, etc.
– infectii: virale (de obicei sub 40mg/l) si
bacteriene (foarte util in infecti neonatale, resp.
diagnosticul diferential al meningitelor, nivelul PCR in
LCR)
11. Importanta clinica
• Valori normale:
– astm bronsic
– convulsii
– boli autoimune: LES, dermatomiozita,
etc.
– intercurentele respiratorii obisnuite
– sarcina
– efort fizic epuizant
12. Importanta clinica
British Journal of General Practice, 1999, 49, 119-121.
• Improving diagnostic accuracy of bacterial pharyngitis
by near patient measurement of C-reactive protein
13. Importanta clinica
Arch Dis Child
1999;81:417–421
Diagnostic markers
of infection:
comparison of
procalcitonin with C
reactive protein and
leucocyte count
14. Importanta clinica
Arch Dis Child
1999;81:417–421
Diagnostic markers
of infection:
comparison of
procalcitonin with C
reactive protein and
leucocyte count
15. Importanta clinica
• Sensitivitatea si specificitatea nivelului de
PCR, numarul leucocitelor si neutrofilelor in
pneumonii
[Cserháti E, Gyurkovics K, Nagy B: Gyermekkori légzőszervi betegségek, Medicina, Bp,
2003]
Proba Sensitivitate Specificitate
PCR 26 % 83 %
Neutrofile nr.
28 % 63 %
(> 10.000/ul)
Leucocite nr.
33 % 60 %
(> 15.000/ul)
Valoarea analizei PCR este nesemnificativa in
diagnostizarea si dg. diferential al pneumoniilor.