2018BC指南：C反应蛋白和红细胞沉降率检测(草稿)

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1、2018BC 指南： C 反应蛋白和红细胞沉降率检测（草稿）DRAFT: C-Reactive Protein and Erythrocyte Sedimentation RateTestingDRAFT FOR EXTERNAL REVIEW: The online questionnaireis available at mendations 1. In BC the ESR will only be performed if a written indication is provided on the requisition. If both CRP and ESR areordere

2、d, only CRP is payable. 1 2. The only indication for CRP assessment in asymptomatic individuals is in the stratification ofcardiovascular risk. 3. CRP may be used to evaluate patients with unexplained symptoms or a deterioration of health status when: a) an inflammatory or infectious disease is susp

3、ected; and b) a specific diagnosis is not made effectively by other means 4. CRP may be used to monitor the activity of temporal (giant cell) arteritis 24 , polymyalgia rheumatica 5,6 , inflammatory arthritis (e.g. rheumatoid arthritis 7,8 and systemic lupus erythematosus (SLE) 9,10 ) and inflammato

4、ry bowel disease. 11 5. High sensitivity (hs) CRP may be used in patients at intermediate cardiovascular risk to help decide whether a statin should be started. 6. In the appropriate clinical context, if CRP is normal, ESR may provide useful information when: a) Used in combination with other biomar

5、kers in monitoring SLE or other rheumatic conditions where patients do not mount a CRP response. 9,10,12 b) Used in combination with other clinical tests when considering the possibility of low-grade bone and joint infections (e.g. osteomyelitis 13 and early prostheticjoint infections 12 ). Tests CR

6、P and ESR in British Columbia MSP Costof Tests 1 ESR (fee item 90515) $10.61 CRP/hsCRP (fee item 91300) $10.31 Current to January 1 st ,2018In BC the ESR will only be performed if a written indication isprovided on the requisition. If both CRP and ESR are ordered, only CRP -Reactive Protein (CRP) CR

7、P is produced in the liveras part of the acute-phase response. It is directly measurable and responsive to changes in the inflammatory process, increasing rapidly during inflammation and decreasing quickly when the inflammationsubsides. 14BCGuidelines.ca: C-Reactive Protein and ErythrocyteSedimentat

8、ion Rate DRAFT for GPAC external review Sept. 21, 2018 2 CRP is ordered: a) During the diagnosis and monitoring of disease. b) To review a therapeutic approach in primary prevention of cardiovasculardisease in patients assessed at intermediate risk. This is the only indication for CRP assessmentin a

9、symptomatic individuals. Elevated CRP values are found in a variety of pathological states and need to beconsidered along with other clinical findings. 15 If the clinical history and physical findings are suggestive of specific disease processes, other investigations are usually more appropriate. Al

10、l CRP assays measure the same protein. High sensitivity (hs) CRP is a designation given to laboratory assays able to measure CRP levels below 5 mg/L. Laboratories reporting CRP values less than 5 mg/L are using an hsCRP assay. CRPand hsCRP perform equally well for the diagnosis and monitoring of inf

11、ectious and other inflammatory conditions. CRP assays measuring below 5 mg/L (hsCRP) can be used to stratify patients for cardiovascular disease risk. Inflammation and Infection Within the appropriate clinical context, CRP levels above 5 mg/L can help support the diagnosis of an inflammatory or infe

12、ctious process. However, CRP levels less than 5 mg/L do not rule out an inflammatory or infectious process. CRP may be used to evaluate patients with unexplained symptoms or a deterioration of health status when: a) an inflammatory or infectious disease is suspected; and b) a specific diagnosis is n

13、ot made effectively by other means CRP may be used to monitor the activity of temporal (giant cell) arteritis 24 ,polymyalgiarheumatica 5,6 , inflammatory arthritis (e.g. rheumatoidarthritis 7,8and SLE 9,10 ) and inflammatory bowel disease. 11Forthe vast majority of infections, repeatCRP is not indi

14、cated andassessmentshould be made on clinicalgrounds (e.g. cellulitis16 ).MonitoringCRP levels may be useful ininfections which require longterm antibiotics (e.g. osteomyelitis 17 ). hsCRP and Cardiovascular Disease (CVD) When a patient without clinical cardiovascular disease is found to be at inter

15、mediate risk for CVD based on their Framingham Risk Score, hsCRP can be used as one of the secondary assessments to raise or lower their estimated cardiovascular risk (see the associated BC guideline resource Cardiovascular Disease Primary Prevention: Resource Guidefor Physicians). Patients at moder

16、ate cardiovascular risk who have an hsCRP 2mg/L (and typically 5 mg/L) may benefit from statin therapy.should be ordered to support the diagnosis of infectious or inflammatory conditions. There is no indication for ordering ESR when CRP is elevated. In the appropriate clinical context, if CRP is nor

17、mal, ESR may provide useful information when: a) Used in combination with other biomarkers in monitoring SLE or other rheumatic conditions where patients do not mount a CRP response. 9,10,12 b) Used in combination with other clinical tests when considering the possibility of low-grade bone and joint

18、 infections (e.g. osteomyelitis 13 and early prosthetic joint infections 12 ). 3 C-Reactive Protein and Erythrocyte Sedimentation Rate DRAFTCaregiver ResourcesHealthLinkBC.ca: C-reactive protein and highsensitivityC-Laboratory Services Outpatient Payment Schedule - Province of BritishColumbia Intern

19、et. cited 2018 Jun 13. Available from: parison of erythrocyte sedimentation rate and C-reactive protein measurements fromrandomized clinical trials of golimumab in rheumatoid arthritis. J Rheumatol. 2009 Aug;36(8):160610. 8. NRAS - National RheumatoidArthritis Society Internet. cited 2018 Jul 31. Av

20、ailable from: mon medical situations recommend actions that are sufficient and efficient,neither excessive nor deficientpermit exceptions when justified byclinical circumstancesContact Information: Guidelines and ProtocolsAdvisoryCommittee PO Box 9642 STN PROV GOVTVictoria, BCV8W9P1Email:hlth.guidel

21、inesgov.bc.caWebsite:www.BCGuidelines.caDisclaimer The Clinical Practice Guidelines (theguidelines) have been developed by the guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The guidelines are intended to give an understanding of a clinical problem, and out

22、line one or more preferred approaches to the investigation and management of the problem. The guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.