Supplemental Readings and References
include induction of inflammatory cytokines, prevention
of adhesion of neutrophils to endothelial cells by inhibit-
ing the surface expression of L-selectin, and inhibition
of superoxide production by neutrophils. Measurement
of serum C-reactive protein is useful in differentiating
an acute inflammatory condition from a noninflammatory
one, as well as in the assessment of the severity of inflam-
mation and its prognosis. Another widely used test in the
assessment of acute phase disorders is erythrocyte sedi-
mentation rate (ESR). ESR determines the rate at which
erythrocytes fall through the plasma to the bottom (sedi-
ment) of the test tube, and it depends largely on the plasma
concentration of fibrinogen, an acute phase reactant
(Table VI-1). Thus, ESR is decreased during acute
phase disorder. Compared to ESR measurement, serum
C-reactive protein measurement has several advantages.
ESR changes occur relatively slowly and increase with
age, whereas C-reactive protein concentrations change
rapidly and levels do not change with age. Since inflamma-
tion may play a role in cardiovascular disorders, measure-
ment of a serum inflammation marker, such as C-reactive
protein, is useful as a predictor of subsequent coronary
events (Chapter 20). In one prospective study, healthy sub-
jects with higher baseline serum C-reactive protein lev-
els had increased risk of myocardial infarction and is-
chemic stroke. The use of aspirin, an antiinflammatory
agent (Chapter 18), also was associated with reduction in
the risk of myocardial infarction. Another inflammatory
marker, lipoprotein-associated phospholipase A
, is an in-
dependent predictor of risk for abnormal cardiovascular
Acute phase phenomena also include a variety of
metabolic and neuroendocrine changes. For example,
fever is a neuroendocrine change that occurs as an acute
phase response.
Supplemental Readings and References
G. C. Blobe, W. P. Schiemann, and H. F. Lodish: Role of transforming growth
in human disease.
N ew E n g la n d J o u rn a l o f M ed icin e
342, 1350
C. Gabay and I. Kushner: Acute-phase proteins and other systemic re-
sponses to inflammation.
N ew E n g la n d J o u rn a l o f M ed ic in e
340, 448
J-M. Halimi, J Ribstein, G. Du Cailar, et ah: Nephrotic-range proteinuria in
patients with renovascular disease.
A m e rica n J o u rn a l o f M ed ic in e
E. Kallee: Bennhold’s analbuminemia: a follow up study of the first two
cases (1953-1992).
J o u rn a l o f L a b o ra to ry a n d C lin ica l M ed icin e
R. A. Kyle and M. A. Gertz: Monoclonal gammopathies and related dis-
H em a to lo g y/O n co lo g y C lin ics o f N o rth A m e rica
13 (1999). This
complete volume is dedicated to topics on monoclonal gammopathies.
D. A. Morrow and P. M. Ridker: High sensitivity c-reactive protein (hs-CRP):
a novel risk marker in cardiovascular disease.
P reven tive C a rd io lo g y
C. J. Packard, D. S. J. O’Reilly, M. Caslake, et al.: Lipoprotein-associated
phospholipase A
as an independent predictor of coronary heart disease.
N ew E n g la n d J o u rn a l o f M ed ic in e
343, 1148 (2000).
D. J. Rader: Inflammatory markers of coronary risk.
N ew E n g la n d J o u rn a l
o f M ed icin e
343, 1179 (2000).
P. M. Ridker and P. Haughie: Prospective studies of c-reactive protein as a
risk factor for cardiovascular disease.
J o u rn a l o f In vestig a tive M ed icin e
46,391 (1998).
P. M. Ridker, C. H. Hennekens, J. E. Buring, et ah: C-reactive protein and
other markers of inflammation in the prediction of cardiovascular disease
in women.
N ew E n g la n d J o u rn a l o f M ed ic in e
342, 836 (2000).
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