metode dan parameter pemeriksaan crp

8/17/2019 Metode Dan Parameter Pemeriksaan CRP

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METODE DANPARAMETER

PEMERIKSAAN CRP


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OBESITAS DAN PATOGENESISSINDROM METABOLIK

Jaringan adiposa yang membesar akanmengalami proses angiogenesis untukmemperbaiki diri. Jaringan adiposa

melepaskan TNF-α untuk memulai prosestersebut.

Namun karena jumlahnya tidak mencukupi,maka TNF-α akan mengaktivasi jaringan

preadiposa agar melepaskan MonocyteChemotractant Protein-1 (!"-#$ untukmenarik makro%ag sbg sumber TNF-α kedalam jaringan adiposa membantu

proses angiogenesis.


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akro%ag akan melepaskan sitokin proin&amasispt' TNF-α , )-*, )-#+

menstimulasi produksi !"-# kembalishg inltrasi makro%ag semakin banyakmerusak jaringan adiposa. leh sebab itu, kondisiobesitas disebut sebagai kondisi in&amasi kroniktingkat rendah.

al tersebut disebabkan jaringan adiposa yangbanyak menumpuk menjadi sumber adipositokin

diantaranya TNF-α, )-*, resistin, leptin,angiotensinogen, adiponektin, FF/ dan "/-#./danya adipositokin mengakibatkan tumpang-tindihnya peran makro%ag dan peran jaringanadiposa.

akro%ag mengekspresikan gen yang diekspresikanoleh sel adiposa, yaitu Fatty Acid Binding Protein(F/0"$, Peroxisome Proliferator Activated Receptor-γ (""/1-2$3 sedangkan jaringan adiposamengekspresikan protein yang diproduksi olehmakro%ag, spt. sitokin proin&amasi (TNF-α , )-*, )-#+$ .


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Sistem imun innate

aktivasi jalur komplemen setelah agregasiatau terikat dengan ligand opsonisasi

Mengaktivasi sel endotel untuk ekspresi molekul-molekul adesi,selectin, kemokin, MCP-1

Induksi sekresi IL-6 dan endotelin-1, menurunkan ekspresi &ioavailitas e!"S pada endotel

#ktivasi makro$ag untuk mengekspresikan sitokin & $aktorjaringan & meningkatkan up take L%L

Memperkuat e$ek proin$lamatori eerapa mediator endotoksin'

Meningkatkan nuclear factor kappa () men*eakan aktivasiapoptosis

Memicu pelepasan P#I-1

Peran CRP Pada Proses Inflamasi


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C-REACTIVE PROTEIN AND THEDEVELOPMENT O THEMETABOLIC S!NDROME

Lo+-grade in$lammation ma* e part o$ the

common soil underl*ing the metaolics*ndrome, .*pe / diaetes and

cardiovascular disease0

Lo+-grade chronic in$lammation is associated

+ith cardiovascular disease, diaetes, insulinresistance, $eatures o$ the metaolic

s*ndrome and the metaolic s*ndrome itsel$


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IL-6 is a pro-in$lammator* c*tokine produced *

adipose tissue, endothelial cells, macrophages and

l*mphoc*tes0 C-reactive protein CP', an acute-phase reactant,

is s*nthesised in the liver largel* in response to IL-

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ecent studies indicate that in$lammation, as

measured * IL-6 and CP, predicts not onl*

cardiovascular events, ut also the development o$

diaetes


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Lo+-grade in$lammation ma* promote atherosclerosis and

insulin resistance and predispose to the development o$ the

metaolic s*ndrome and diaetes * several mechanisms

IL-6 ma* inter$ere +ith insulin signalling through the

induction o$ proteins that ind to the insulin receptor, and

it appears to do+n-regulate corticosteroid-inding gloulin,+hich ma* lead to increased $ree cortisol concentrations,

insulin resistance and other mani$estation so$ the

metaolic s*ndrome

IL-6 also inhiits lipoprotein lipase activit* and increases

concentrations o$ !23#, contriuting to d*slipidaemia and

insulin resistance 0


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In addition, IL-6 stimulates the secretion o$ major pro-

in$lammator* c*tokines such as IL-1

In turn, IL-1 and .!3-4, +hich are also secreted $rom

adipose tissue, induce IL-6 secretion

.!3-4 decreases insulin-mediated glucose uptake andimpair send othelial $unction

Pro-in$lammator* c*tokines, and possil* CP itsel$, ma*

also directl* promote atherosclerosis and thromosis *the induction o$ nuclear $actor-5( and the release o$

adhesion molecules and plasminogen activator inhiitor-1


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PEMERIKSAAN CRP DAPATDILAK"KAN DENGAN BEBERAPA

METODE#

Metode kuantitati$ immunometrik assay '

menggunakan nyocard single test positi$6'

Metode L.I# Latex TurbidimetryImmunoassay, range pengukuran ) 708 - 877

mg9L'

Metode Nephelometry angka terendah CP

*ang dapat diperiksa 7,7: mg9L


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CRP !ormal kadar ;1 mg9L'

In$lamasi, in$eksi virus dan akteri ringan 17<

:7 mg9L'

In$eksi akteri sedang :7?)

isiko endah) kadar hs-CP ;1 mg9L

isiko Sedang9 intermediate) kadar hs-CP 1-8 mg9L

isiko .inggi) kadar hs-CP 8 mg9L


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?euntungan pemeriksaan @s-CP

@asil leih akurat dan cepat, range pengukuran*ang luas

mendeteksi In$lamasi9in$eksi akut secara cepat

6-A jam setelah in$lamasi'

@s-CP meningkat tajam saat terjadi in$lamasi dan

menurun jika terjadi peraikan

L2% naik kadarn*a setelah 1: hari dan menurun

secara lamat sesuai dengan +aktu paruhn*a


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C-eakti$ Protein

CP'

Protein $ase akutmeningkatselama :-6 jam puncakn*a /:-A/

jam'.idak spesi$ik untuk in$eksi ↑pada) proses in$lamasi akut, nekrosis,

in$ark, luka akar trauma dan tumor

ganas

3B!SIoIndikator a+al in$eksi akutoMonitor perjalanan pen*akit


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Metode pemeriksaan

CP'kuantitai$

N$o%ard CRP Sin&le Tes' ()osi'if *+,

Merupakan suatu solid fase $ase padat',

sandwich format, immunometric assay Pada sumur tes terdapat memran *ang

dilapisi dengan # monoklonal spesi$ik CP

*ang immoile0C-eactive Protein akan diikat oleh #0

CP terperangkap pada memran


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Metode pemeriksaan

CP'

metoda L.I# LateD .uridimetr*

Immunoassa*'

range pengukuran ) 708 - 877 mg9L


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CP (ackman coulter'

C-P reagent is used to measure C-

reactive protein concentration * a

turidimetric method0 In the reaction, ananti-CP antiod*-coated particle inds

to C-reactive protein in the patient

sample resulting in the $ormation o$

insoluleaggregates causing turidit*'


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measures low levels of CRP using lasernephelometryThe test gives results in 25 minutes with asensitivity down to 0.04 mg/

!ormal "on"entration in healthy human serum isusually lower than #0 mg/$ slightly in"reasing withageing%igher levels are found in late pregnant women$mild inflammation and viral infe"tions '40 mg/($a"tive inflammation$ )a"terial infe"tion &40' 200 mg/($ severe )a"terial infe"tions and )urns

&*200 mg/(.

# i&-sensi'i.i'$ CRP s-CRP' test

http://en.wikipedia.org/wiki/Nephelometryhttp://en.wikipedia.org/wiki/Ageinghttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Viral_infectionhttp://en.wikipedia.org/wiki/Bacterial_infectionshttp://en.wikipedia.org/wiki/Burnhttp://en.wikipedia.org/wiki/Burnhttp://en.wikipedia.org/wiki/Bacterial_infectionshttp://en.wikipedia.org/wiki/Viral_infectionhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Ageinghttp://en.wikipedia.org/wiki/Nephelometry


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nephelometry

It is ased on the principle that a dilute suspension o$ small particles +ill

scatter light usuall* a laser' passed through it rather than simpl*

asoring it0 .he amount o$ scatter is determined * collecting the light

at an angle usuall* aout A7 or AE degrees'0


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Plasma proteins

S*nthesiFed * liver or produced * plasma ('

cells

#0 #lumin

(0 .rans$errin

C0 Ceruloplasmin

%0 2nF*mes < coagulation enF*mes,complement $actors

20 C-reactive protein < acute phase reactant

30 Immunogloulins < humoral immunit*

.ransport proteins


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.he acute phase response is regulated * c*tokain0

Interleukin-6 IL-6' is the ma*or stimulator o$ mostacute phase proteinsG other c*tokines produced

during in$lammation, like interleukin-1H IL-6',

tumor necrosis $actor-4 .!3-4', inter$eron- I3!-ϒ

' and trans$orming gro+th $actor- H .3- H',ϒupregulated sugroup o$ #Ps

.he ma*or sources o$ these c*tokaines are

macrophages and monoc*tes at sites o$

im$lammation


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C-2#C.I2 P".2I! CP'

•

Major component o$ the acute phase responseand a marker o$ acterial in$ection• Mediates the inding o$ $oreign

pol*saccharides, phospholipids and compleD

pol*anions, as +ell as the activation o$complement• ;1 mg9mL in normal plasma• Slightl* elevated levels o$ CP are indicative

o$ chronic, lo+-grade in$lammation and haveeen correlated +ith an increased risk o$

cardiovascular disease


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?ecepatan 2ndap %arah ?2%'

.ujuan mengukur sedimentasieritrosit dalam plasma pada darah utuh

ditamah antikoagulan mm9jam'

3aktor *ang mempengaruhi)10 ukuran9massa eritrosit

/0 ?omposisi plasma

80 3aktor mekanikG suhu, taung dankemiringan !ilai !ormal ) + , 0-20 mm/am , 0-#5 mm/am


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metode dan parameter pemeriksaan crp

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