THE CHANGES OF C-REACTIVE PROTEIN IN THE PATIENTS ASSOCIATED WITH MANDIBULAR FRACTURE

하악골 골절 환자에서의 C-Reactive Protein의 변화

  • Gwak, Jong-Min (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University) ;
  • Kim, Chul-Hwan (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University) ;
  • Kim, Kyung-Wook (Dept. of Oral & Maxillofacial Surgery, School of Dentistry, Dankook University)
  • 곽종민 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 김철환 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 김경욱 (단국대학교 치과대학 구강악안면외과학교실)
  • Published : 2006.01.31

Abstract

It is well known that concentration of C-reactive protein(CRP) in the serum increase as nonspecific reaction of the various tissue injury. The CRP, synthesized in the hepatocyte, is one of 'acute phase proteins' in the serum. The main signal patterns of this protein are regulated by synthesis of interleukin-I secreted from macrophage in the area of tissue injury. Many studies were performed for quantitative analysis for CRP according to various surgical operation, but the study for fracture patients associated with trauma, especially in mandible, are rare. The mandible fracture have intrinsic danger for infection in oral bacteria associated with open wound in oral cavity, and, are difficult for detection of tissue reaction between surgical swelling and infection by facial swelling. In this study, quantitative analysis for CRP associated tissue injury in mandibular fracture and surgical intervention was done, the results were as follows: 1. After initial mandibular trauma, the value of serum CRP diminished sequentially, most high value was presented in post-traumatic 2 days. 2. The CRP was diminished significantly 2 days after surgical intervention, and maintained normal value in 5 days after surgery. 3. The change of CRP are higher value in surgical intervention than initial trauma, it suggested that tissue injury from surgery was severe than trauma. 4. The high value of CRP was obtained in mandibular fracture combined soft tissue injury than no associated soft tissue injury. 5. In measurement of CRP according to surgical approach, highest serum value in patients of combined intra-oral and extra-oral approach was showed, and intra-oral approach, extra-oral approach, in sequential orders. 6. The CRP value are more higher in patient of 2 fracture site than only one fracture site. From the results obtained in this study, CRP has showed different values in mandibular fracture associated with severity of tissue injury and surgical intervention, and quantitative analysis of CRP value in serum can be applied to the clinical management of mandibular fracture.

Keywords

References

  1. Pepys MB : C reactive protein fifty years on. Lancet 1 : 653, 1981
  2. Gewurz H : C reactive protein and the acute phase response. Adv Intern Med 27 : 345, 1982
  3. Morley JJ, Kushner I : Serum C reactive protein levels in disease. Ann NY Acad Sci 389 : 406, 1982 https://doi.org/10.1111/j.1749-6632.1982.tb22153.x
  4. Ghoneim AT, Howarths, Ionescu MI : Serial C reactive protein measurements in infective complications following cardiac operation evaluation and use in monitoring response to therapy. Ann Thorac Surg 34 : 166, 1982 https://doi.org/10.1016/S0003-4975(10)60878-8
  5. Aalto K, Osterman K, Peltola H : Changes in erythrocyte sedimentation rate and C-reactive protein after total hip arthroplasty. Clin Orthoped 184 : 118, 1984
  6. Maury CPJ, Teppo A-M, Raunio P : Control of acute phase serum amyloid A and C-reactive protein response: Comparison of total replacement of the hip and knee. Eur J Clinical Invest 14 : 323, 1984 https://doi.org/10.1111/j.1365-2362.1984.tb01190.x
  7. Mustard RA, Bohnen JMA, Haseeb S et al : C-reactive protein values predict postoperative septic complications. Arch Surg 122 : 69, 1987 https://doi.org/10.1001/archsurg.1987.01400130075011
  8. Kock-Jensen C, Brandslund I, Sogaard I : Lumbar disc surgery and variations in C-reactive protein, erythrocyte sedimentation rate and complement split product C 3d. Acta Neurochir 90 : 42, 1988 https://doi.org/10.1007/BF01541265
  9. Stahl WM : Acute phase response to tissue injury. Critical Care Medicine. 15 : 545, 1987 https://doi.org/10.1097/00003246-198706000-00001
  10. Shine B, deBeer FC, Pepys MB : Solid phase radioimmunoassays for human C-reactive protein. Clin Chim Acta 117 : 13, 1981 https://doi.org/10.1016/0009-8981(81)90005-X
  11. Shih LY, Wu JJ, Yang DJ : Erythrocyte sedimentation rate and c-reactive protein values in patients with total hip arthroplasty. Clin Orthop 255 : 238, 1988
  12. Moore FD, Ball MR, Codding MB : The metabolic response to surgery. Springfield. IL. Charles C Thomas, 1952
  13. Oppenheim JJ, Stadler BM, Siraganian RP et al : Lymphokines: Their role in lymphocyte responses. Fed Proc 41 : 257, 1982
  14. Giles S : Interleukin biochemistry and biology: summary and introduction. Fed Proc 42 : 2635, 1983
  15. Powanda MC, Beisel WR. Hypothesis : Leukocyte endogenous mediator/endogenous pyogen/lymphocyte-activating factor modulates the development of nonspecific immunity and affects nutritional status. Am J Clin Nutr 35 : 762, 1982
  16. Dinarello CA : Interleukin-I and the pathogenesis of the acute phase response. N Engl J Med 311 : 1413, 1984 https://doi.org/10.1056/NEJM198411293112205
  17. Clowes GHA Jr, Hirsch E et al : The significance of altered protein metabolism regulated by proteolysis inducing factor, the circulating cleavage product of interleukim-I. Ann Surg 202 : 446, 1985 https://doi.org/10.1097/00000658-198510000-00006
  18. Baracos V, Rodemann HP, Dinarello CA et al : Stimulation of muscle protein degradation and prostaglandin E2 release by leukocytic pyrogen(interleukin-I). N Engl J Med 308 : 553, 1983 https://doi.org/10.1056/NEJM198303103081002
  19. Morrison G, Rundles SC, Clowes GHA et al : Augmentation of NK cell activity by a circulating peptide isolated from the plasma of trauma patients. Ann Surg 203 : 21, 1985
  20. Woloski BM, Smith EM, Meyer WJ et al : Corticotropinreleasing activity of monokines. Science 230 : 1035, 1985 https://doi.org/10.1126/science.2997929
  21. MacIntyre SS, Schultz D, Kushner I : Biosynthesis of Creactive protein. Ann NY Acad Sci 389 : 76, 1982 https://doi.org/10.1111/j.1749-6632.1982.tb22126.x
  22. Tillett WS, Francis T : Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med 52 : 561-571, 1930 https://doi.org/10.1084/jem.52.4.561
  23. Young B, Gleeson M, Cripps AW : C-reactive protein: A critical review. Pathology 23 : 118-124, 1991. Pepys MB. C-reactive protein fifty years on. Lancet 1 : 653, 1981
  24. Mayer AD, McMahon KJ, Bowen M, et al : C-reactive protein: An aid to assessment and monitoring of acute pancreatitis. J Clin Pathol 37 : 207, 1984 https://doi.org/10.1136/jcp.37.2.207
  25. Reny JL. Vuagnat A, Ract C : Diagnosis and follow-up of infections in intensive care patients: value of C-reactive protein compared with other clinical and biological variables. Crit Care Med 30 : 529, 2002 https://doi.org/10.1097/00003246-200203000-00006
  26. Clyne B, Olsaker JS : The C-reactive protein. J Emerg Med 17 : 1019, 1999 https://doi.org/10.1016/S0736-4679(99)00135-3
  27. Terregino CA, Lopez BL, Karrars DJ : Endogenous mediators in emergency department patients with presumed sepsis; Are levels associated with progression to severe sepsis and death- Ann Emerg Med 35 : 26, 2000 https://doi.org/10.1016/S0196-0644(00)70101-6
  28. Evans MI, Hajj SN, Devoe LD : C-reactive protein as a predictor of infectious morbidity with premature rupture of membranes. Am J Obstet Gynecol 13 : 648, 1980
  29. Dawes PT, Fowler PT, Clarke S : Rheumatoid arthritis: treatment which controls the C-reactive protein and erythrocyte sedimentation rate reduces radiological progression. Br J Rheumatol 25 : 44, 1986 https://doi.org/10.1093/rheumatology/25.1.44
  30. Kim ID, Lee SY, Kim PT : A diagnostic value of C-reactive protein in acute bacterial infection of bone and joint. J of Korean Orthop Assoc 21 : 39, 1986
  31. Fassbender K, Pargger H, Muller W : Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients: Diagnostic signs in nosocomial infection. Crit care Med 21 : 1175, 1993 https://doi.org/10.1097/00003246-199308000-00017
  32. Saarinen UM, Strandijord SE, Warkentin PI : Differentiation of presumed sepsis from acute graft-versushost disease by C-reactive protein and serum total IgE in bone marrow transplant recipients. Transplantation 44 : 540, 1987 https://doi.org/10.1097/00007890-198710000-00017
  33. Lee JH, Kim CS, Lee SH et al : The changes of serum Creactive protein in the head and neck infection. J Kor Oral Maxillofac Surg 29 : 5, 2003
  34. Yoon SI, Lim SS, Rha JD et al : The C-reactive protein(CRP) in patients with long bone fracture and after arthroplasty. Int Orthop(SICOT) 17 : 198, 1993
  35. Waydhas C, Nast-Kolb D, Trupka A et al : Posttraumatic inflammatory response, secondary operations, late multiple organ failure. J Trauma 40 : 624, 1996 https://doi.org/10.1097/00005373-199604000-00018