Department of Cellular and Molecular Medicine, Center for Cardiovascular Diagnostics and Prevention, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2014 Jun 1;113(11):1839-43. doi: 10.1016/j.amjcard.2014.03.016. Epub 2014 Mar 18.
Neopterin is synthesized by macrophages upon stimulation with gamma-interferon, and high neopterin production is associated with cellular immune activation and increased production of reactive oxygen species (oxidant stress), but the clinical utility of urine neopterin levels in patients with heart failure (HF) has not been explored. Fifty-three ambulatory patients with chronic systolic HF (left ventricular [LV] ejection fraction ≤40%) underwent comprehensive echocardiographic evaluation and cardiopulmonary exercise testing. Urine neopterin levels were quantified by liquid chromatography with tandem mass spectrometric analyses and corrected to urine creatinine (Cr) levels. In our study cohort, median urine neopterin level was 60 μmol/mol Cr (interquartile range 40 to 86). There were modest correlations between urine neopterin levels and abnormalities in cardiac structure and function by echocardiography: LV ejection fraction (r = -0.33, p = 0.017), indexed LV end-diastolic volume (r = 0.31, p = 0.029), indexed LV end-systolic volume (r = 0.32, p = 0.024), and E/septal Ea (r = 0.28, p = 0.041). Although there was no significant correlation between urine neopterin and maximal oxygen uptake (peak VO2: r = -0.25, p = 0.07), there was a modest correlation between urine neopterin and maximal ventilation/carbon dioxide production ratio (VE/VCO2 max: r = 0.38, p = 0.005). In conclusion, increase in urine neopterin levels tracks with disease severity in patients with chronic systolic HF.
新蝶呤是巨噬细胞受到γ-干扰素刺激时合成的，高水平的新蝶呤生成与细胞免疫激活和活性氧物质（氧化应激）生成增加有关，但尿新蝶呤水平在心力衰竭（HF）患者中的临床应用尚未得到探索。53 例慢性收缩性 HF（左心室[LV]射血分数≤40%）的门诊患者接受了全面的超声心动图评估和心肺运动试验。通过液相色谱-串联质谱分析定量检测尿新蝶呤水平，并校正至尿肌酐（Cr）水平。在我们的研究队列中，尿新蝶呤水平的中位数为 60 μmol/mol Cr（四分位距 40 至 86）。尿新蝶呤水平与超声心动图检查的心脏结构和功能异常之间存在适度相关性：LV 射血分数（r = -0.33，p = 0.017）、LV 舒张末期容积指数（r = 0.31，p = 0.029）、LV 收缩末期容积指数（r = 0.32，p = 0.024）和 E/间隔 Ea（r = 0.28，p = 0.041）。尽管尿新蝶呤与最大摄氧量（峰值 VO2：r = -0.25，p = 0.07）之间无显著相关性，但尿新蝶呤与最大通气/二氧化碳产生比值（VE/VCO2 max：r = 0.38，p = 0.005）之间存在适度相关性。总之，慢性收缩性 HF 患者尿新蝶呤水平升高与疾病严重程度相关。
