Millner M M, Franthal W, Thalhammer G H, Berghold A, Aigner R M, Füger G F, Reibnegger G
Department of Pediatrics, Karl-Franzens-University of Graz, Austria.
Clin Chem. 1998 Jan;44(1):161-7.
Neopterin is a sensitive indicator for cellular immune activation. Its concentrations were determined in cerebrospinal fluid (CSF) and serum specimens from 91 children with no evidence of central nervous system (CNS) or peripheral inflammations, 43 with definite neuroborreliosis, 51 with other CNS infections, and 33 with peripheral infections. The aim of our study was (a) to establish a range of normal CSF neopterin concentrations in control children, and (b) to inquire into the diagnostic potential of neopterin measurements in both body compartments for aiding in differential diagnosis of inflammatory vs noninflammatory diseases, and CNS vs peripheral inflammations. CSF neopterin concentrations in controls were invariably low (up to 9.3 nmol/L), but in children with neuroborreliosis and, even more so, with other CNS infections neopterin concentrations were significantly (P <0.0001) increased. Children with peripheral infections, however, rarely showed raised CSF neopterin concentrations. Serum concentrations of neopterin, on the other hand, were not significantly different between controls and children with neuroborreliosis. Although serum concentrations were significantly different between controls and children with other CNS infections, diagnostic efficiency was poor for this comparison. Peripheral infections, in contrast, were associated with significantly higher (P <0.0001) serum neopterin concentrations when compared with controls. A classification tree was constructed on the basis of CSF and serum neopterin concentrations, allowing with high accuracy the discrimination between controls, children with CNS infections, and children with peripheral infections. Thus, on the basis of a comparatively large control group, our data underline the diagnostic validity of neopterin as an aid in differential diagnosis of inflammatory vs noninflammatory diseases, and confirm that CSF neopterin concentrations are not correlated with serum neopterin concentrations, and, therefore, CSF neopterin appears to be produced intrathecally.
新蝶呤是细胞免疫激活的敏感指标。我们测定了91名无中枢神经系统（CNS）或外周炎症迹象儿童、43名确诊神经莱姆病儿童、51名患有其他CNS感染的儿童以及33名患有外周感染儿童的脑脊液（CSF）和血清样本中的新蝶呤浓度。我们研究的目的是：（a）确定对照儿童CSF中新蝶呤浓度的正常范围；（b）探究在两个身体部位测量新蝶呤对于辅助鉴别炎症性疾病与非炎症性疾病以及CNS炎症与外周炎症的诊断潜力。对照儿童的CSF新蝶呤浓度始终较低（最高9.3 nmol/L），但神经莱姆病儿童以及其他CNS感染儿童的新蝶呤浓度显著升高（P<0.0001）。然而，外周感染儿童很少出现CSF新蝶呤浓度升高。另一方面，对照儿童与神经莱姆病儿童的血清新蝶呤浓度无显著差异。虽然对照儿童与其他CNS感染儿童的血清浓度存在显著差异，但该比较的诊断效率较低。相比之下，外周感染儿童的血清新蝶呤浓度与对照儿童相比显著更高（P<0.0001）。基于CSF和血清新蝶呤浓度构建了分类树，能够高精度地区分对照儿童、CNS感染儿童和外周感染儿童。因此，基于相对较大的对照组，我们的数据强调了新蝶呤在辅助鉴别炎症性疾病与非炎症性疾病方面的诊断有效性，并证实CSF新蝶呤浓度与血清新蝶呤浓度不相关，因此CSF新蝶呤似乎是鞘内产生的。
