C-reactive protein: a critical update
C-reactive protein: a critical update
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DOI：
10.1172/jci200318921
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发表时间：
2003-06-01
影响因子：
15.9
通讯作者：
Hirschfield, GM
中科院分区：
文献类型：
--
作者：
Pepys, MB;Hirschfield, GM
20 世纪 90 年代中期，C 反应蛋白 (CRP) 的免疫测定比以前常规使用的免疫测定具有更高的灵敏度，结果显示，CRP 值的升高，即使在以前认为正常的范围内，也能强烈预测未来的冠状动脉事件。这些发现引起了广泛的兴趣，尤其是在美国，CRP 测量的临床应用在大约 30 年来一直被忽视。 CRP 的产生是对大多数形式的炎症、感染和组织损伤的非特异性急性期反应的一部分，因此被认为不能提供临床上有用的信息。事实上，CRP 值本身永远无法进行诊断，只能在床边充分了解所有其他临床和病理结果的情况下进行解释。然而，它们可以为管理做出巨大贡献，就像普遍记录患者体温（同样是非特异性参数）具有很大的临床实用性一样。自动化 CRP 测定和 CRP 本身作为研究试剂的现成商业可用性促进了目前 CRP 在心血管疾病和相关疾病中的研究洪流。然而，与美国早期因其缺乏特异性而拒绝将 CRP 作为实证检验不同，目前对 CRP 在心血管疾病中的热情的广泛特征是未能正确认识急性期反应的非特异性本质，并且缺乏关键的生物学判断。 CRP 的来源、纯度、结构和功能完整性的质量控制，以及在归因病理生理功能之前实验设计的相关性也经常被忽视。本文提供了有关 CRP 作为蛋白质和急性期反应物的信息，以及用于解释和分析与心血管和其他疾病相关的 CRP 临床观察结果的基于知识的框架。我们还回顾了 CRP 的特性、它在疾病发病机制中的可能作用，以及我们自己的观察结果，将其确定为可能的治疗靶点。
In the mid 1990s, immunoassays for C-reactive protein (CRP), with greater sensitivity than those previously in routine use, revealed that increased CRP values, even within the range previously considered normal, strongly predict future coronary events. These findings triggered widespread interest, especially, remarkably, in the US, where the clinical use of CRP measurement had been largely ignored for about 30 years. CRP production is part of the nonspecific acute-phase response to most forms of inflammation, infection, and tissue damage and was therefore considered not to provide clinically useful information. Indeed, CRP values can never be diagnostic on their own and can only be interpreted at the bedside, in full knowledge of all other clinical and pathological results. However, they can then contribute powerfully to management, just as universal recording of the patient’s temperature, an equally nonspecific parameter, is of great clinical utility. The present torrent of studies of CRP in cardiovascular disease and associated conditions is facilitated by the ready commercial availability of automated CRP assays and of CRP itself as a research reagent. However, unlike the earlier rejection in the US of CRP as an empirical test because of its perceived lack of specificity, the current enthusiasm over CRP in cardiovascular disease is widely characterized by failure to recognize appropriately the nonspecific nature of the acutephase response, and by lack of critical biological judgment. Quality control of the source, purity, and structural and functional integrity of the CRP, and the relevance of experimental design before ascribing pathophysiological functions, are also often ignored. This article provides information about CRP as a protein and an acute-phase reactant, and a knowledge-based framework for interpretation and analysis of clinical observations of CRP in relation to cardiovascular and other diseases. We also review the properties of CRP, its possible role in pathogenesis of disease, and our own observations that identify it as a possible therapeutic target.