Aoe Keisuke, Hiraki Akio, Murakami Tomoyuki, Eda Ryosuke, Maeda Tadashi, Sugi Kazuro, Takeyama Hiroyasu
Department of Respiratory Medicine, National Sanyo Hospital, Respiratory Disease Center, Yamaguchi, Japan.
Chest. 2003 Mar;123(3):740-4. doi: 10.1378/chest.123.3.740.
Tuberculosis (TB), the single most frequent infectious cause of death worldwide, also is a major cause of pleural effusion, which in TB usually has lymphocytic and exudative characteristics. Differential diagnosis between TB and nontuberculous pleural effusion can be sometimes difficult, representing a critically important clinical problem.
We studied 46 patients presenting with pleural effusion to the National Sanyo Hospital between April 2000 and January 2001 (34 men and 12 women; mean age, 64 years). Ten patients (22%) had tuberculous pleurisy, 19 patients (41%) had malignant pleuritis, and 17 patients (37%) had pleural effusion due to an etiology other than tuberculosis or cancer. Pleural fluid concentrations of four suggested markers were measured using commercially available kits.
The pleural fluid levels (mean +/- SE) of adenosine deaminase (83.3 +/- 18.2 U/L vs 25.8 +/- 20.4 U/L, p < 0.0001), interferon-gamma (137 +/- 230 IU/mL vs 0.41 +/- 0.05 IU/mL, p < 0.0001), immunosuppressive acidic protein (741 +/- 213 micro g/mL vs 445 +/- 180 micro g/mL, p < 0.001) and soluble interleukin 2 receptor (7,618 +/- 3,662 U/mL vs 2,222 +/- 1,027 U/mL, p < 0.0001) were significantly higher for tuberculous pleuritis than for other causes of effusion. Receiver operating characteristic analysis demonstrated that pleural fluid content INF-gamma was the best indicator of tuberculous pleurisy among four relevant biological markers.
INF-gamma in pleural fluid is the most sensitive and specific among four biological markers for tuberculous pleuritis. Thus, our results suggest that determination of INF-gamma at the onset of pleural effusion is informative for the diagnosis of tuberculous pleuritis. Further studies including larger numbers of patients are needed to verify this result.
结核病是全球单一最常见的感染性死亡原因，也是胸腔积液的主要病因，在结核病中胸腔积液通常具有淋巴细胞性和渗出性特征。结核病与非结核性胸腔积液的鉴别诊断有时可能很困难，这是一个极其重要的临床问题。
我们研究了2000年4月至2001年1月期间到三洋国立医院就诊的46例胸腔积液患者（34例男性和12例女性；平均年龄64岁）。10例患者（22%）患有结核性胸膜炎，19例患者（41%）患有恶性胸膜炎，17例患者（37%）的胸腔积液病因是结核病或癌症以外的其他因素。使用市售试剂盒测量了四种推荐标志物在胸腔积液中的浓度。
结核性胸膜炎患者胸腔积液中腺苷脱氨酶水平（平均±标准误）（83.3±18.2 U/L对25.8±20.4 U/L，p<0.0001）、干扰素-γ（137±230 IU/mL对0.41±0.05 IU/mL，p<0.0001）、免疫抑制酸性蛋白（741±213μg/mL对445±180μg/mL，p<0.001）和可溶性白细胞介素2受体（7618±3662 U/mL对2222±1027 U/mL，p<0.0001）显著高于其他积液病因。受试者工作特征分析表明，在四种相关生物标志物中，胸腔积液中干扰素-γ含量是结核性胸膜炎的最佳指标。
胸腔积液中的干扰素-γ在结核性胸膜炎的四种生物标志物中最敏感和特异。因此，我们的结果表明，在胸腔积液发病时测定干扰素-γ对结核性胸膜炎的诊断有参考价值。需要进一步纳入更多患者的研究来验证这一结果。
