Inflammation is the body's response to injury or infection it can be classified as either acute or chronic. Acute inflammation is the initial inflammatory response it occurs almost immediately after minor injuries like burns and cuts as well as major trauma such as myocardial infarction (MI). Acute inflammation results in the healing of the tissue when the injury or infection is removed. Symptoms include redness, swelling, heat, pain and stiffness in the affected area. Chronic inflammation or prolonged inflammation may follow acute inflammation or exist independently. Chronic inflammation is a continuous process for example tissue breakdown and repair attempts that often results in scarring and tissue destruction. Chronic inflammation can arise after bacterial infection or as a result of an autoimmune disease. In autoimmune diseases, the inflammatory response is triggered when there are no stimuli and the immune system attacks itself.
Extra protein is often released from the site of inflammation these proteins can be readily detected in the bloodstream and are therefore referred to as inflammatory markers. Perhaps the most commonly used marker of inflammation is C-reactive protein (CRP).
C-reactive protein (CRP) is synthesised in the liver and despite being a minor plasma protein levels are dramatically increased within 6 hours after the onset of inflammation. The final increase can sometimes be as much as 60-fold furthermore CRP is much more specific than some of the other commonly used markers of inflammation such as the erythrocyte sedimentation rate (ESR).
In significant bacterial infections CRP levels are unusual below 10mg/L except in neonates where 10-40mg/L typically represents mild inflammation; levels between 40-200mg/L represent significant acute inflammation or bacterial infection. In burns or serious bacterial infection levels may rise to 300mg/L or higher.
Many chronic inflammatory diseases are difficult to monitor clinically, serial CRP measurements can be valuable in assessing an individual’s response to therapy and changes in disease activity. This is particularly true of:
When assessing the extent or activity of inflammation, the serum CRP level provides a rough guide to the amount of tissue involved in inflammation and to the integrity of the inflammatory response. Persistent elevation may indicate a poor prognosis in both inflammatory and malignant disease
Bacterial infection is the most potent activator of the acute phase response. A sudden rise in CRP may be a useful pointer of intercurrent sepsis after major surgery or in individuals with little intrinsic response such as leukaemia and SLE. Viral infections cause little acute phase response therefore CRP measurement may be useful in indicating bacterial aetiology in diseases such as pneumonia and meningitis. Falling CRP levels are a useful indication of response to antibacterial therapy.
Generally inflammatory markers include both mediators and inhibitors of inflammation as well as scavengers of potentially dangerous substances such as toxins. The following protein changes are noticed during the inflammatory response; a rapid fall in serum albumin, prealbumin and transferrin levels as well as an increase in a1- and a2-globulin levels. In chronic inflammatory conditions and some malignancies the level of a1-globulin remains the same but a2-globulin levels are increased leading to a diffuse increase in gamma-globulins.
As well as being markers of inflammation, many of the proteins mentioned have specific roles and thus play an important part in the diagnosis, monitoring and treatment of pathological conditions.
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