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Sedimantasyon & CRP - Geçmişten Geleceğe

Yıl 2019, Cilt: 2 Sayı: 2, 85 - 96, 03.08.2019
https://doi.org/10.33713/egetbd.548235

Öz

    İnflamasyon dokulara zarar veren herhangi
bir olaya karşı hasarı olabildiğince sınırlı tutmak ve nedeni ortadan kaldırmak
üzerine kurulu bir düzendir. Bu süreçte baş tehditleri içeriden metabolik,
romatizmal ve malign hastalıklar dışarıdan ise travma ve infeksiyon etkenleri
oluşturmaktadır. Pratik hekimlik hayatında inflamasyonu kantitatif olarak
değerlendirmek adına sıklıkla sedimantasyon ve C-reaktif protein (CRP) testleri kullanılmaktadır.
Sedimantasyon için normal değerin 50 yaş altı erkeklerde 15, kadınlarda 20
mm/saat; 50 yaş üzerinde ise erkeklerde 20 ve kadınlarda 30 mm/saat altında
olması beklenir. Sonucu çok çeşitli fizyolojik ya da prosedürel durumlar
etkilemektedir. İnflamatuar prosesin başlangıcında false negatif ya da sonunda
false pozitif sonuçlarla da karşılaşılabilmektedir. Sedimantasyon değeri
spesifik ve diagnostik olmamakla birlikte prognostik olabilmektedir. Ayrıca
hastalık varlığı, ciddiyeti ve aktivitesi hakkında fikir sunarak tekrarlanan
ölçümleriyle hastalık takiplerinde de yardımcı olabilmektedir. Yarılanma
ömrünün 4-6 gün kadar sürmesi nedeniyle takibinin genellikle haftalık sürelerle
yapılmasının uygun olacağı belirtilir. Bir çeşit akut faz proteini olan
C-reaktif proteinin sağlıklı bireylerdeki değeri ise ortalama 0,8 mg/L olup
toplumun çoğunluğunda 3 mg/L’nin altında seyretmektedir. Aterosklerozda intima tabakasında birikerek tüm
aşamalarda aktif rol oynadığının anlaşılmasıyla high sensitive C reaktif
protein (Hs-CRP) şeklindeki daha
düşük değerlerinin hassas bir şekilde ölçümü de devreye girmiştir. Burada
1,0 mg/L’den daha az değer kardiyovasküler olay açısından düşük riski, 3,0
mg/L üzerindeki sonuç yüksek riski ve aradaki değerler ise ortalama riski ifade
etmektedir. İ
kiye katlanma süresinin 8 saat sürmesi nedeniyle CRP yarı ömrünün 19 saat kadar olduğu belirtilmektedir.
Konsantrasyonları ile hastalığın ciddiyeti ve iki gün aralarla yapılan tedaviye
cevap kontrolleri arasında mükemmel korelasyon söz konusudur. Gerçek
inflamatuvar durumlarda her iki testin de birbirine paralel gitmesi beklenmekle
birlikte izole yüksekliklerde izlenebilmektedir. Bu makalede tarihsel
perspektifleriyle birlikte her iki testin özellikleri belirtilerek efektif
şekilde kullanılmaları ve değerlendirilmeleri anlatılmaya çalışılmıştır. 

Kaynakça

  • 1- Neto NSR, Carvalho JF. The use of inflammatory laboratory tests in rheumatology. Bras J Rheumatol 2009; 49(4): 413-30
  • 2- Maria Antonelli and Irving Kushner. It’s time to redefine inflammation. The FASEB J. 2017; 31, 1787–1791
  • 3- Grzybowski A, Sak JJ. Who Discovered the Erythrocyte Sedimentation Rate? J Rheumatol 2011; 38:7, Pages 1521-1522
  • 4- Kucharz EJ. Sesquicentennial of the birth of Edmund Faustinus Biernacki, a discoverer of the erythrocyte sedimentation rate. Reumatologia 2017; 55, 1: 24–28
  • 5- Ablij HC, Meinders AE. C-reactive protein: history and revival. European Journal of Internal Medicine 2002; 13, Pages 412–422
  • 6- Bochen K, Krasowska A, Milaniuk S, Kulczynska M, Prystupa A, Dzida G. Erythrocyte sedimentation rate - an old marker with new applications. Journal of Pre-Clinical and Clinical Research 2011; Vol 5, No 2, 50-55
  • 7- Miller A, Green M, Robinson, D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (ClinRes Ed) 1983; 286 (6361): 266
  • 8- Colombet et al. Agreement between Erythrocyte Sedimentation Rate and C-Reactive Protein in Hosipital Practice. The American Journal of Medicine 2010; September Vol 123, No 9
  • 9- Costenbader KH, Chibnik LB, Schur PH. Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: clinical signifi cance. Clinical and Experimental Rheumatology 2007; 25: 746-749
  • 10- Beşışık SK. Eritrosit sedimantasyon hızı. Nobel Med 2005; Cilt 1, Sayı 1, Pages 4-9
  • 11- Calderon AJ, Wener MH. Erythrocyte Sedimentation Rate and C-Reactive Protein. Hosp Med Clin 2012; 1, e313-e337
  • 12- Daniels LM, Tosh PK, Fiala JA, Schleck CD, Mandrekar JN, Beckman TJ. Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients’ Diagnoses, Demographic Characteristics, and Comorbidities. Mayo Clin Proc. 2017; 92(11):1636-1643
  • 13- Manzo C, Milchert M. Polymyalgia rheumatica with normal values of both erythrocyte sedimentation rate and C-reactive protein concentration at the time of diagnosis: a four-point guidance. Reumatologia 2018; 56, 1: 1–2
  • 14- Hacımustafaoğlu M. Akut Faz Reaktanları (Eritrosit Sedimentasyon Hızı, CRP). J Pediatr Inf 2017; 11: 53-55
  • 15- Gaitonde S, Samols D, Kushner I. C-Reactive Protein and Systemic Lupus Erythematosus. Arthritis & Rheumatism 2008; December Vol. 59, No. 12, Pages 1814-1820
  • 16- Harrison M. Erythrocyte sedimentation rate and C-reactive protein. Australian Prescriber 2015; June Vol 38: No 3, 93-94
  • 17- Aysalar U, Sandıkçı S, Akpınar E, Saatçi E. Eritrosit Sedimantasyon Hızı ve C-Reaktif Protein: Hala Değerli mi? Türk Aile Hek Derg 2007; 11(4): 154-162
  • 18- Sharma et al. The Relationship of the Erythrocyte Sedimentation Rate to Inflammatory Cytokines and Survival in Patients With Chronic Heart Failure Treated With Angiotensin-Converting Enzyme Inhibitors. Journal of the American College of Cardiology 2010; August Vol.36, No.2, Pages 523-528
  • 19- Maradit-Kremers H, Nicola PJ, Crowson CS, Ballman KV, Jacobsen SJ, Roger VL, Gabriel SE. Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis. Ann Rheum Dis 2007; 66:76–80
  • 20- Genest J. C-reactive protein: Risk factor, biomarker and/or therapeutic target? Can J Cardiol 2010; 26 (Suppl A): 41A - 44A
  • 21- Amezcua-Guerra LM, Castillo-Martinez D, Bojalil R. The Story Behind the Acute-phase Reactants. J Rheumatol 2010; 37:2
  • 22- Sisman AR, Kume T, Akan P, Tuncel p. C-Reaktif Protein: Klinik Önem, Ölçüm Yöntemlerindeki Gelişmeler, Preanalitik ve Analitik Değişkenlikler. Türk Klinik Biyokimya Derg 2007; 5(1): 33-41
  • 23- Pepys MB, Hirschfield GM. C-reactive protein: acritical update. Journal of Clinical Investigation 2003; Vol. 111, No. 12,1805-1812
  • 24- Marnell L, Mold C, Du Clos DW. C-reactive protein: Ligands, receptors and role in inflammation. Clinical Immunology 2005; 117, 104-111
  • 25- Haran JP, Suner S, Gardiner F. Correlation of C-reactive protein to severity of symptoms in acute influenza A infection. J Emerg Trauma Shock 2012; Apr-Jun; 5(2): 149-152
  • 26- Husain TM, Kim DH. C-Reactive Protein and Erythrocyte Sedimentation Rate in Orthopaedics. The University of Pennsylvania Orthopaedic Journal 2002; 15: 13-16
  • 27- Rao JRM, Syam D Gopal SD. C-Reactive Protein - A critical Review. Int.J.Curr.Microbiol.App.Sci 2015; 4(12): 55-61
  • 28- Park JE et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J. Clin. Med. 2018; 7, 333
  • 29- Yücel E. C-Reaktif Protein (CRP) ve Diğer Akut Faz Proteinlerinin Klinik Kullanımı. Türkiye Tıp Dergisi 2004; 11(1): 42-52
  • 30- Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. M. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. WMJ 2016; December Vol:115, No:6, Pages 317-321
  • 31- Osei-Bimpong A, Meek JH, Lewis SM. ESR or CRP? A comparison of their clinical utility. Hematology 2007; August, 12(4): 353–357
  • 32- Keenan RT, Swearingen CJ, Yazici Y. Erythrocyte sedimentation rate and C-reactive protein levels are poorly correlated with clinical measures of disease activity in rheumatoid arthritis, systemic lupus erythematosus and osteoarthritis patients. Clinical and Experimental Rheumatology 2008; 26: 814-819
  • 33- Hanada M, Takahashi M, Furuhashi H, Koyama H, Matsuyama Y. Elevated erythrocyte sedimentation rate and high-sensitivity C-reactive protein in osteoarthritis of the knee: relationship with clinical findings and radiographic severity. Annals of Clinical Biochemistry 2016; Vol. 53(5) 548–553
  • 34- Nielen et al. Increased Levels of C-Reactive Protein in Serum From Blood Donors Before the Onset of Rheumatoid Arthritis. Arthritis & Rheumatism 2004; August Vol. 50, No. 8
  • 35- Doğan ŞK. Tur BS. Akut Faz Proteinleri. Romatoloji E-Kitap. Türkiye Romatoloji Araştırma ve Savaş Derneği 2018. ISBN 978-605-81727-0-8. Available from : http://www.trasdromatolojiekitap.org/
  • 36- Costales C, Butler-Wu SM. A real pain: diagnostic quandaries and septic arthritis. J Clin Microbiol 2018; February Volume 56, Issue 224
  • 37- Enocsson H, et al. Interferon-alpha mediates suppression of C-reactive protein: explanation for muted C-reactive protein response in lupus flares? Arthritis & Rheumatism 2009; 60(12):3755-60
  • 38- Bitik et al. Differential diagnosis of elevated acute phase Reactants. Eur J Rheumatol 2015; 4: 131-4
  • 39- Kritchevsky SB. Inflamatory markers and Cardiovascular health in older adults. Cardiovascular Research 2005; 666, 265-275
  • 40- Thiele JR, Zeller J, Bannasch H, Stark GB, Peter K, Eisenhardt SU. Targeting C-Reactive Protein in Inflammatory Disease by Preventing Conformational Changes. Mediators of Inflammation 2015; 1-9
  • 41- Fay WP. Linking inflammation and thrombosis: Role of C-reactive protein. World J Cardiol 2010; November 26; 2(11): 365-369
  • 42- Medscape. Erişim tarihi: Thursday, February 28, 2019. An Expert Interview With Paul M. Ridker, MD, on hs-CRP
  • 43- Kushner I, Samols D, Magrey M. A Unifying Biologic Explanation for “High-Sensitivity” C-Reactive Protein and “Low-Grade” Inflammation. Arthritis Care & Research 2010; April Vol. 62, No. 4, Pages 442-446
  • 44- Ridker PM. A Test in Context. High-Sensitivity C-Reactive Protein Journal of the American College of Cardiology 2016; February Vol: 67, No: 6, Pages 712-723
  • 45- Cortez AF, Muxfeldt ES. The Role of C - reactive protein in the Cardiovascular Risk and its Association with Hypertension. JSM Atheroscler 2016; 1(3): 1015
  • 46- Jimenez et al. Association Between Markers of Inflammation and Total Stroke by Hypertensive Status Among Women. American Journal of Hypertension 2016; September, 29(9), Pages 1117-1124
  • 47- Pfützner A, Schöndorf T, Hanefeld M, Forst T. High-Sensitivity C-Reactive Protein Predicts Cardiovascular Risk in Diabetic and Nondiabetic Patients: Effects of Insulin-Sensitizing Treatment with Pioglitazone. J Diabetes Sci Technol 2010; May, Vol 4, Issue 3, Pages 706-716
  • 48- Ridker PM. High-Sensitivity C-Reactive Protein Potential Adjunct for Global Risk Assessment in the Primary Prevention of Cardiovascular Disease. Circulation 2001; 103:1813-1818
  • 49- Ridker PM. C-Reactive Protein A Simple Test to Help Predict Risk of Heart Attack and Stroke. Circulation 2003; 108:e81-e85
  • 50- Ridker PM. The JUPITER Trial Results, Controversies, and Implications for Prevention. Circ Cardiovasc Qual Outcomes 2009; 2:279-285
  • 51- Nidorf SM et al. Low-Dose Colchicine for Secondary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology 2013; January, Vol. 61, No. 4 : 404-10
  • 52- Ridker PM, Everett BM, Pradhan A et al. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med 2019; 380: 752-762
  • 53- Ridker PM et al. Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled tria. The Lancet 2018; January Vol 391, Pages 320-328
Yıl 2019, Cilt: 2 Sayı: 2, 85 - 96, 03.08.2019
https://doi.org/10.33713/egetbd.548235

Öz

Kaynakça

  • 1- Neto NSR, Carvalho JF. The use of inflammatory laboratory tests in rheumatology. Bras J Rheumatol 2009; 49(4): 413-30
  • 2- Maria Antonelli and Irving Kushner. It’s time to redefine inflammation. The FASEB J. 2017; 31, 1787–1791
  • 3- Grzybowski A, Sak JJ. Who Discovered the Erythrocyte Sedimentation Rate? J Rheumatol 2011; 38:7, Pages 1521-1522
  • 4- Kucharz EJ. Sesquicentennial of the birth of Edmund Faustinus Biernacki, a discoverer of the erythrocyte sedimentation rate. Reumatologia 2017; 55, 1: 24–28
  • 5- Ablij HC, Meinders AE. C-reactive protein: history and revival. European Journal of Internal Medicine 2002; 13, Pages 412–422
  • 6- Bochen K, Krasowska A, Milaniuk S, Kulczynska M, Prystupa A, Dzida G. Erythrocyte sedimentation rate - an old marker with new applications. Journal of Pre-Clinical and Clinical Research 2011; Vol 5, No 2, 50-55
  • 7- Miller A, Green M, Robinson, D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (ClinRes Ed) 1983; 286 (6361): 266
  • 8- Colombet et al. Agreement between Erythrocyte Sedimentation Rate and C-Reactive Protein in Hosipital Practice. The American Journal of Medicine 2010; September Vol 123, No 9
  • 9- Costenbader KH, Chibnik LB, Schur PH. Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: clinical signifi cance. Clinical and Experimental Rheumatology 2007; 25: 746-749
  • 10- Beşışık SK. Eritrosit sedimantasyon hızı. Nobel Med 2005; Cilt 1, Sayı 1, Pages 4-9
  • 11- Calderon AJ, Wener MH. Erythrocyte Sedimentation Rate and C-Reactive Protein. Hosp Med Clin 2012; 1, e313-e337
  • 12- Daniels LM, Tosh PK, Fiala JA, Schleck CD, Mandrekar JN, Beckman TJ. Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients’ Diagnoses, Demographic Characteristics, and Comorbidities. Mayo Clin Proc. 2017; 92(11):1636-1643
  • 13- Manzo C, Milchert M. Polymyalgia rheumatica with normal values of both erythrocyte sedimentation rate and C-reactive protein concentration at the time of diagnosis: a four-point guidance. Reumatologia 2018; 56, 1: 1–2
  • 14- Hacımustafaoğlu M. Akut Faz Reaktanları (Eritrosit Sedimentasyon Hızı, CRP). J Pediatr Inf 2017; 11: 53-55
  • 15- Gaitonde S, Samols D, Kushner I. C-Reactive Protein and Systemic Lupus Erythematosus. Arthritis & Rheumatism 2008; December Vol. 59, No. 12, Pages 1814-1820
  • 16- Harrison M. Erythrocyte sedimentation rate and C-reactive protein. Australian Prescriber 2015; June Vol 38: No 3, 93-94
  • 17- Aysalar U, Sandıkçı S, Akpınar E, Saatçi E. Eritrosit Sedimantasyon Hızı ve C-Reaktif Protein: Hala Değerli mi? Türk Aile Hek Derg 2007; 11(4): 154-162
  • 18- Sharma et al. The Relationship of the Erythrocyte Sedimentation Rate to Inflammatory Cytokines and Survival in Patients With Chronic Heart Failure Treated With Angiotensin-Converting Enzyme Inhibitors. Journal of the American College of Cardiology 2010; August Vol.36, No.2, Pages 523-528
  • 19- Maradit-Kremers H, Nicola PJ, Crowson CS, Ballman KV, Jacobsen SJ, Roger VL, Gabriel SE. Raised erythrocyte sedimentation rate signals heart failure in patients with rheumatoid arthritis. Ann Rheum Dis 2007; 66:76–80
  • 20- Genest J. C-reactive protein: Risk factor, biomarker and/or therapeutic target? Can J Cardiol 2010; 26 (Suppl A): 41A - 44A
  • 21- Amezcua-Guerra LM, Castillo-Martinez D, Bojalil R. The Story Behind the Acute-phase Reactants. J Rheumatol 2010; 37:2
  • 22- Sisman AR, Kume T, Akan P, Tuncel p. C-Reaktif Protein: Klinik Önem, Ölçüm Yöntemlerindeki Gelişmeler, Preanalitik ve Analitik Değişkenlikler. Türk Klinik Biyokimya Derg 2007; 5(1): 33-41
  • 23- Pepys MB, Hirschfield GM. C-reactive protein: acritical update. Journal of Clinical Investigation 2003; Vol. 111, No. 12,1805-1812
  • 24- Marnell L, Mold C, Du Clos DW. C-reactive protein: Ligands, receptors and role in inflammation. Clinical Immunology 2005; 117, 104-111
  • 25- Haran JP, Suner S, Gardiner F. Correlation of C-reactive protein to severity of symptoms in acute influenza A infection. J Emerg Trauma Shock 2012; Apr-Jun; 5(2): 149-152
  • 26- Husain TM, Kim DH. C-Reactive Protein and Erythrocyte Sedimentation Rate in Orthopaedics. The University of Pennsylvania Orthopaedic Journal 2002; 15: 13-16
  • 27- Rao JRM, Syam D Gopal SD. C-Reactive Protein - A critical Review. Int.J.Curr.Microbiol.App.Sci 2015; 4(12): 55-61
  • 28- Park JE et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J. Clin. Med. 2018; 7, 333
  • 29- Yücel E. C-Reaktif Protein (CRP) ve Diğer Akut Faz Proteinlerinin Klinik Kullanımı. Türkiye Tıp Dergisi 2004; 11(1): 42-52
  • 30- Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. M. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. WMJ 2016; December Vol:115, No:6, Pages 317-321
  • 31- Osei-Bimpong A, Meek JH, Lewis SM. ESR or CRP? A comparison of their clinical utility. Hematology 2007; August, 12(4): 353–357
  • 32- Keenan RT, Swearingen CJ, Yazici Y. Erythrocyte sedimentation rate and C-reactive protein levels are poorly correlated with clinical measures of disease activity in rheumatoid arthritis, systemic lupus erythematosus and osteoarthritis patients. Clinical and Experimental Rheumatology 2008; 26: 814-819
  • 33- Hanada M, Takahashi M, Furuhashi H, Koyama H, Matsuyama Y. Elevated erythrocyte sedimentation rate and high-sensitivity C-reactive protein in osteoarthritis of the knee: relationship with clinical findings and radiographic severity. Annals of Clinical Biochemistry 2016; Vol. 53(5) 548–553
  • 34- Nielen et al. Increased Levels of C-Reactive Protein in Serum From Blood Donors Before the Onset of Rheumatoid Arthritis. Arthritis & Rheumatism 2004; August Vol. 50, No. 8
  • 35- Doğan ŞK. Tur BS. Akut Faz Proteinleri. Romatoloji E-Kitap. Türkiye Romatoloji Araştırma ve Savaş Derneği 2018. ISBN 978-605-81727-0-8. Available from : http://www.trasdromatolojiekitap.org/
  • 36- Costales C, Butler-Wu SM. A real pain: diagnostic quandaries and septic arthritis. J Clin Microbiol 2018; February Volume 56, Issue 224
  • 37- Enocsson H, et al. Interferon-alpha mediates suppression of C-reactive protein: explanation for muted C-reactive protein response in lupus flares? Arthritis & Rheumatism 2009; 60(12):3755-60
  • 38- Bitik et al. Differential diagnosis of elevated acute phase Reactants. Eur J Rheumatol 2015; 4: 131-4
  • 39- Kritchevsky SB. Inflamatory markers and Cardiovascular health in older adults. Cardiovascular Research 2005; 666, 265-275
  • 40- Thiele JR, Zeller J, Bannasch H, Stark GB, Peter K, Eisenhardt SU. Targeting C-Reactive Protein in Inflammatory Disease by Preventing Conformational Changes. Mediators of Inflammation 2015; 1-9
  • 41- Fay WP. Linking inflammation and thrombosis: Role of C-reactive protein. World J Cardiol 2010; November 26; 2(11): 365-369
  • 42- Medscape. Erişim tarihi: Thursday, February 28, 2019. An Expert Interview With Paul M. Ridker, MD, on hs-CRP
  • 43- Kushner I, Samols D, Magrey M. A Unifying Biologic Explanation for “High-Sensitivity” C-Reactive Protein and “Low-Grade” Inflammation. Arthritis Care & Research 2010; April Vol. 62, No. 4, Pages 442-446
  • 44- Ridker PM. A Test in Context. High-Sensitivity C-Reactive Protein Journal of the American College of Cardiology 2016; February Vol: 67, No: 6, Pages 712-723
  • 45- Cortez AF, Muxfeldt ES. The Role of C - reactive protein in the Cardiovascular Risk and its Association with Hypertension. JSM Atheroscler 2016; 1(3): 1015
  • 46- Jimenez et al. Association Between Markers of Inflammation and Total Stroke by Hypertensive Status Among Women. American Journal of Hypertension 2016; September, 29(9), Pages 1117-1124
  • 47- Pfützner A, Schöndorf T, Hanefeld M, Forst T. High-Sensitivity C-Reactive Protein Predicts Cardiovascular Risk in Diabetic and Nondiabetic Patients: Effects of Insulin-Sensitizing Treatment with Pioglitazone. J Diabetes Sci Technol 2010; May, Vol 4, Issue 3, Pages 706-716
  • 48- Ridker PM. High-Sensitivity C-Reactive Protein Potential Adjunct for Global Risk Assessment in the Primary Prevention of Cardiovascular Disease. Circulation 2001; 103:1813-1818
  • 49- Ridker PM. C-Reactive Protein A Simple Test to Help Predict Risk of Heart Attack and Stroke. Circulation 2003; 108:e81-e85
  • 50- Ridker PM. The JUPITER Trial Results, Controversies, and Implications for Prevention. Circ Cardiovasc Qual Outcomes 2009; 2:279-285
  • 51- Nidorf SM et al. Low-Dose Colchicine for Secondary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology 2013; January, Vol. 61, No. 4 : 404-10
  • 52- Ridker PM, Everett BM, Pradhan A et al. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. N Engl J Med 2019; 380: 752-762
  • 53- Ridker PM et al. Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled tria. The Lancet 2018; January Vol 391, Pages 320-328
Toplam 53 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm Derleme
Yazarlar

Ahmet Çayakar 0000-0002-9524-2920

Yayımlanma Tarihi 3 Ağustos 2019
Kabul Tarihi 21 Haziran 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 2 Sayı: 2

Kaynak Göster

EndNote Çayakar A (01 Ağustos 2019) Sedimantasyon & CRP - Geçmişten Geleceğe. Ege Tıp Bilimleri Dergisi 2 2 85–96.

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