Mohamed K H, Mobasher A A, Yousef A R, Salah A, El-Naggar I Z, Ghoneim A H, Light R W
Department of Chest, Zagazig University Hospital, Zagazig, Egypt.
Chest. 2001 Mar;119(3):776-80. doi: 10.1378/chest.119.3.776.
Neopterin is derived from guanosine triphosphate and is produced by stimulated macrophages under the influence of gamma-interferon of lymphocyte origin. It has been suggested that it is an excellent marker for the activation of the monocyte/macrophage axis in some clinical situations. However, to our knowledge, the relationship of BAL neopterin levels to disease states has not been studied.
To assess the usefulness of BAL neopterin levels as an index of disease activity in patients with pulmonary tuberculosis and lung cancer.
BAL and serum neopterin levels were evaluated in 20 patients with pulmonary tuberculosis, 20 patients with bronchogenic carcinoma, and 10 healthy individuals. The concentration of neopterin was evaluated by radioimmunoassay technique. The BAL level of neopterin was standardized using the BAL urea level.
The neopterin levels (mean +/- SD) in the BAL and serum of tuberculous patients (88.6 +/- 27.4 nmol/L epithelial lining fluid [ELF], 61.3 +/- 29.4 nmol/L, respectively) were significantly higher when compared with those in lung cancer patients (40.7 +/- 16.6 nmol/L ELF, 26.8 +/- 6.58 nmol/L, respectively, p < 0.001) and when compared with those in control subjects (26.3 +/- 11.3 nmol/L ELF, 6.8 +/- 2.7 nmol/L, respectively, p < 0.001). In the tuberculous group, BAL and serum neopterin levels in patients with far-advanced disease were significantly higher when compared with those in patients with moderately and minimally advanced diseases (p < 0.001). BAL and serum neopterin levels were significantly higher in patients with small cell carcinoma than in those with adenocarcinoma (p < 0.05). BAL neopterin levels were significantly (p < 0.001) higher than serum levels in all patients and control groups. In addition, there were significant positive correlations between BAL and serum neopterin levels in tuberculous (r = 0.92, p < 0.001), lung cancer (r = 0.62, p < 0.001), and control groups (r = 0.93, p < 0.001).
The levels of neopterin in BAL fluid may reflect the degree of disease activity in pulmonary tuberculous patients. In addition, BAL neopterin levels are elevated in patients with lung cancer, especially the small-cell carcinoma type.
新蝶呤由三磷酸鸟苷衍生而来，在淋巴细胞源γ-干扰素的影响下，由受刺激的巨噬细胞产生。有人认为，在某些临床情况下，它是单核细胞/巨噬细胞轴激活的一个极佳标志物。然而，据我们所知，支气管肺泡灌洗（BAL）液中新蝶呤水平与疾病状态的关系尚未得到研究。
评估BAL液中新蝶呤水平作为肺结核和肺癌患者疾病活动指标的实用性。
对20例肺结核患者、20例支气管肺癌患者和10名健康个体的BAL液和血清新蝶呤水平进行评估。采用放射免疫分析技术评估新蝶呤浓度。用BAL液尿素水平对BAL液中新蝶呤水平进行标准化。
与肺癌患者（分别为40.7±16.6 nmol/L上皮衬液[ELF]、26.8±6.58 nmol/L，p<0.001）以及对照组（分别为26.3±11.3 nmol/L ELF、6.8±2.7 nmol/L，p<0.001）相比，结核患者BAL液和血清中的新蝶呤水平（分别为88.6±27.4 nmol/L ELF、61.3±29.4 nmol/L）显著更高。在结核组中，与中度和轻度进展期疾病患者相比，晚期疾病患者的BAL液和血清新蝶呤水平显著更高（p<0.001）。小细胞癌患者的BAL液和血清新蝶呤水平显著高于腺癌患者（p<0.05）。在所有患者组和对照组中，BAL液中新蝶呤水平均显著高于血清水平（p<0.0)。此外，在结核组（r=0.92，p<0.001）、肺癌组（r=0.62，p<0.001）和对照组（r=0.93，p<0.001）中，BAL液和血清新蝶呤水平之间均存在显著正相关。
BAL液中的新蝶呤水平可能反映肺结核患者的疾病活动程度。此外，肺癌患者，尤其是小细胞癌类型患者的BAL液中新蝶呤水平升高。
