| Neopterin as an Activity Index in Pulmonary Tuberculosis |
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Jae Hoon Song, Sung Koo Han, Young Soo Shim, Keun Youl Kim, Yong Chol Han |
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Department of Internal Medicine & Tuberculosis Research Institute College of Medicine, Seoul National University, Seoul, Korea |
| 뇨중 Neopterin 측정을 이용한 폐결핵의 활동성 판정 |
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송재훈, 한성구, 심영수, 김건열, 한용철 |
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| Abstract |
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Assessment of disease activity is the first step in treating pulmonary tuberculosis. But it is often difficult in clinical practice unless AFB is demonstrated in smear or culture of specimen. Until now, patient’s symptoms, CBC with ESR, Chest X-ray, tuberculin skin test and response to therapeutic trial of antituberculosis drugs are the supportive indices of disease activity. Neopterin, a kind of pteridine derived from guanosine tri-phosphate, is released in vitro and in vivo by macrophage mediated activated T-Iymphocytes. Since immunocompetent T-cells and macrophages play a central role in the host respons to mycobacteria! infection, urinary neopterin levels may be a valuable indicator of activity of tuberculosis. To elucidate the usefulness of urinary neopterin as an activity index of pulmonary tuberculosis, urinary neopterin and creatinine ratio were measured in 20 normal healthy controls, 10 inactive pulmonary tuherc비 osis and 36 active pulmonary tuberculosis by high-performance Iiquid chromatography Urinary neopterin/ creatinine ratio in normal healthy control and inactive pulmonary tuberculosis were 1.084 ± 0.375 (nmoI/mg of creatinine) and 1.236 ±0.494 (nmol/ mg of creatinine) respectively. (P > 0.3) In 14 minimal active pulmonary tuberculosis, the ratio was 2.376 ± 0.996 (nmol/mg of creatinine).
(P < 0.001 compared with control group) In 13 moderately advanced active pulmonary tuberculosis, the ratio was 5.049± 2.292 (nmoI/mg of creatinine). (P<0.001 compared with control group) In 9 far advanced active pulmonary tuberculosis, the ratio was 18.452 ± 12.382 (nmoI/mg or creatinine). (P< 0.001 compared with control group) The difference of mean urinary neopterin levels between minimal, moderately advanced and far advanced active pulmonary tuberculosis was statistically significant. (F-value 19.2999, P <0.001)
After initiation of antituberculosis chemotherapy, follow-up urinary neopterin levels in 8 partients showed decreasing tendency.
It is suggested that urinary neopterin level could be an useful index of disease activity in pulmonary tuberculosis |
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