尿路性器悪性腫瘍患者における尿中ネオプテリン値の検討  [in Japanese] URINARY NEOPTERIN LEVELS IN PATIENTS WITH GENITOURINARY TRACT MALIGNANCIES  [in Japanese]

(背景と目的) ネオプテリンは,活性化されたT細胞から分泌されるγ-インターフェロンの刺激によりマクロファージから放出が増加することが知られており,T細胞-マクロファージ系の活性化の指標とされている。そのため,ネオプテリンは,拒絶反応,ウイルス感染症,自己免疫疾患,癌患者で上昇することが報告されている。今回,尿路性器悪性腫瘍忠者の尿中ネオプテリンを測定し,腫瘍マーカーとしての有用性について検討を加えた。 (方法) 尿路性器悪性腫瘍患者90名,泌尿器科良性腫瘍患者28名,正常健康人34名における尿中ネオプテリン濃度を高速液体クロマトグラフィーを用いて測定した。 (結果) 尿路性器悪性腫瘍患者の52%,泌尿器科良性腫瘍患者の7%において尿中ネオプテリン値は増加していた。陽性率は,腎細胞癌患者68%,腎孟尿管癌忠者80%,膀胱癌患者44%,前立腺患者47%,精巣腫瘍患者30%であった。low stage群とhigh stage群を比較すると,腎細胞癌患者(stage I,IIvs. stage III,IV)及び膀胱癌患者(Tis-1 vs. T2-4)で両群問の尿中ネオプテリン値に有意(p<0.0005)に差を認めた。腎細胞癌患者及び前立腺癌患者では,尿中ネオプリチン値と異型度との間に相関を認めた。(結論)今回の検討の結果,尿中ネオプテリン値は,尿路性器悪性腫瘍患者における腫瘍の進展度の把握や経過観察に有用であると思われた。

(Background) Neopterin is released from macrophages upon stimulation with γ-interferon, secreted by activated T cell. Therefore it has been recognized as a useful indicator of the activation of the T cell-macrophage system. Increased neopterin levels are observed in patients with acute graft rejections, viral infections, auto-immune diseases and several malignancies. Urinary neopterin concentrations were determined in patients with genitourinary tract malignancies to evaluate the usefulness of neopterin as a tumor marker. (Methods) Urinary neopterin concentrations were determined by high-performance liquid chromatography in 90 patients with genitourinary tract malignancies and 28 patients with benign urological tumors and 34 healthy subjects. (Results) Increased urinary neopterin levels were observed in 52% of the patients with genitourinary tract malignancies and 7% with benign urological tumors. The positivity rate in patients with renal cell carcinoma (RCO), renal pelvic and ureteral tumor, bladder tumor (BT), prostatic carcinoma (PC) and testicular tumor was 68%, 80%, 47% and 30%, respectively. The difference in the urinary neopterin levels between low and high stages was highly significant (p<0.0005) in patients with RCC (stage I-II vs. stage III-IV) and BT (T_ls1 vs. T_2 4) The urinary neopterin levels were also correlated with the tumor grade in patients with RCC and PC. (Conclusion) Our study Suggests that urinary neopterin levels may supplement laboratory examinations for patients with genitourinary tract malignancies, providing useful information in evaluating the tumor stage and follow-up of the disease.