肺結核患者のC-reactive Protein

Abstract

For the purpose of finding out a suitable method of determining conditions and progress of lung tuberculosis, C-reactive protein tests were conducted 359 times on 157 cases of unoperated lung tuberculosis patients and 202 times on 33 cases of operated patients, and the following results were obtained. C-reactive protein is the substance first discovered by Tillet and Francis (1930) and it is not found in the serum of normal persons, but it appears often in the sera of such patients as in the cases of bacterial infection diseases and in those diseases which bring about an extensive tissue damage.Incidence of the cases positive to C-reactive protein (CRP) test is 49.1 per cent in those showing accelerated erythrocyte sedimentation rate, which is higher than that of 15.1 per ceut in those with normal erythrocyte sedimentation rate (ESR). It has been found that the higher is the ESR the greater is the positive rate of CRP. In those whose CRP is over one plus the ESR is 90-100 per cent, being extremely high.CRP in the casos of leukocytosis is 62.1 per cent, while in others it is 35.5 per cent. Classified according to leukocytes, the positive rate of CRP is 80 per cent in those with nucleus left shift, 63.1 per cent in those with neutrophilia, 100 per cent in those with eosinopenia, and 63.2 per cent in lymphocytopenia, all being higher than the other cases.The positive rate of CRP in febrile patients is 70.3 percent, higher than 32 per cent in afebrile patients. It is 51.4 per cent in Gaffky positive cases and 24.8 per cent in Gaffky negative cases, proving that the positive rate of CRP is high in open tuberculosis. In addition, the percentage of Gaffky positive cases in those with CRP of over 2 plus is about 80 per cent.The positiye rate of CRP in the tubsrculosis patients with cavity is 44.8 per cent, and it is 19.6 per cent in those without cavity, proving a higher rate generally in the patients with cavity. However, it is lower in those with isolated cavities, and the positive rate of CRP is dependent upon the nature and number of cavities as well as upon the pathological cha ges surrounding the cavity rather than presence or absence of the tu berculous cavity. Althongh the positive rate in these without the avity or with isolated cavities is 0-19.8 per cent, it ranges from 58.3 to 33.3 per cent in those with multiple chambered cavity or with the cavity located in an extensive pathologic focus, and it is 63.7 per cent in the cases with cavity belo ging to far advanced and combined type of lung tuberculosis.The positive rate CRP is high in severe lung tuberculosis and in extonsive exudative tuberculosis having strong activity; i.e. according to the lung tuberculosis classification by the Laboratorv of Department of Education, Japan, the positive rate is 63.7 per cent in F type (severe comdined type), 52.6 per cent in A type (exudative type), 31.0 per cent in C type (fibrous caseous type), 7.7 per cent in B type (infiltrative caseous type), and 0 per cent in D type (sclerotic type). Furthermore, according to N. T. A. classification, it is 6.4 per cent in minimal case of tuberculosis, 24.1 per cent in moderately advanced case, and 63 per cent in far advanced case.In the observations of CRP according to the progress of symptoms, about one half of the patients whose negative CRP turned positive shows aggravation of tuberculosis, and about one half of those whose positive CRP turned negative shows alleviation of the disease. In addition, almost all those with improved conditions tend to be negative, while thile those whose conditions worsened almost all tend to be CRP positive. All those who died proved to be CRP positive.As the CRP tends to turn positive in the case with other complication, in pursuing CRP along with the progress of tubercnlosis, it is necessary fo pay a close attention to preseuce or absence of complication that turns CRP positive.