血清新喋呤在肾综合征出血热病程中的变化及临床意义  

Change of Serum Neopterin and Its Pathogenic Significance in Hemorrhagic Fever with Renal Syndrome

作　　者：张元度 孙志坚[2] 张东军[1] 马志俊[1] 王锁荣[1] 

机构地区：[1]丹阳市人民医院,212300 [2]南京医科大学第一附属医院

出　　处：《天津医药》2008年第6期423-426,共4页Tianjin Medical Journal

摘　　要：目的:探讨血清新喋呤的变化在肾综合征出血热(HFRS)发病中的意义。方法:对22例HFRS患者(轻症组14例,重症组8例)按病期采血,分别用酶联免疫吸附试验(ELISA)检测新喋呤含量,用自动生化仪检测血尿素氮(BUN)、丙氨酸氨基转移酶(ALT)和血小板(Pt)计数;另取20例健康者作对照。结果:病程各期(发热期、低血压少尿期、多尿期和恢复期)血清新喋呤含量分别为(102.84±98.53)μmol/L,(186.12±115.27)μmol/L,(45.10±30.44)μmol/L,(19.42±17.38)μmol/L,均显著高于对照组的(7.14±4.68)μmol/L,新喋呤的变化曲线与BUN、ALT的变化趋势相一致,而与血小板的变化趋势相反。在发热期,轻、重2组间血清新喋呤含量差异有统计学意义(P<0.05),重症组([186.47±118.39)μmol/L]显著高于轻症组([55.04±37.00)μmol/L]。结论:HFRS急性期血清新喋呤显著增高,且与病情轻重相关,是T细胞-巨噬细胞轴激活的标志,提示T细胞、单核-巨噬细胞介导的细胞免疫参与了HFRS的发病机制。其早期出现对特异性抗体尚未出现的HFRS患者有辅助诊断价值。Objective： To investigate the change of serum neopterin and its significance in the pathogenesis of hemorrhagic fever with renal syndrome（HFRS ）. Methods： Twenty-two cases with HFRS（ 14 with moderate type, and 8 with severe type） and 20 healthy individuals were enrolled in this study. The serum neopterin was detected by enzyme-linked immunosorbent assay （ELISA）,and BUN,ALT and platelets counting by automatic biochemical analyzer. Results： The serum levels of neopterin in febrile stage with（ 102.84 ± 98.53 ）μmol/L, hypotension-olignric stage with （ 186.12 ± 115.27 ） μmol/L, polyuric stage with （45.10 ± 30.44 ）μmol/L, and recovery stage with （19.42 ± 17.38 ）μmol/L during HFRS course were significantly higher than that in control group [（7.14 ± 4.68 ）μmol/L） ,P 〈 0.01]. The curve of neopterin was similar to the curves of BUN and ALT,but was contrary to that of blood platelet count. There was a significant difference between severe group （186.47 ± 118.39）μmol/L and moderate group （55.04 ± 37.00）μmol/L during febrile stage （P 〈 0.05）. Conclusion： In acute phases of HFRS,the serum concentration of neopterin increased remarkably,which reflected the status of activation in T cell-macrophage axis and paralleled to patients＇ condition, suggesting that the activated T cells and monocyte/macrophages might involve in the pathogenesis of HFRS. The early detection of serum neopterin may help to diagnose this disease.

关 键 词：蝶呤类 肾综合征出血热 T淋巴细胞 单核细胞 巨噬细胞 

分 类 号：R512.8[医药卫生—内科学] R285.5[医药卫生—临床医学]