Goto Masashi, Noguchi Yoshinori, Koyama Hiroshi, Hira Kenji, Shimbo Takuro, Fukui Tsuguya
Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Ann Clin Biochem. 2003 Jul;40(Pt 4):374-81. doi: 10.1258/000456303766477011.
Many studies have investigated the usefulness of adenosine deaminase activity (ADA) in pleural fluid for the early diagnosis of tuberculous pleurisy. To summarize the diagnostic characteristics of ADA we undertook a meta-analysis using a summary receiver operating characteristic (SROC) curve method.
Data sources were MEDLINE (1966-1999), the Cochrane Library and bibliographies of review and original articles. Studies were included if the absolute numbers of true positive, false negative, true negative and false positive observations were available or could be derived from the data presented; gold standards were described explicitly; and the criteria for a positive ADA result were reported. We constructed an SROC curve based on these extracted data to estimate the test characteristics.
Forty articles were available for analysis. The gold standards used were pleural biopsy histology, microbiological examination of pleural fluid, pleural biopsy and sputum and the patient's clinical course or combinations of these. The sensitivity of ADA reported in the articles ranged from 47.1% to 100% and the specificity from 50.0% to 100%. The summary measure of test characteristics derived from the SROC curve was 92.2% for both sensitivity and specificity.
The test performance of ADA in tuberculous pleural effusion is reasonably good. Measurement of pleural ADA is thus likely to be a useful diagnostic tool for tuberculous pleurisy.
许多研究探讨了胸水腺苷脱氨酶活性（ADA）在结核性胸膜炎早期诊断中的作用。为总结ADA的诊断特征，我们采用汇总受试者工作特征（SROC）曲线法进行了一项荟萃分析。
数据来源为MEDLINE（1966 - 1999）、Cochrane图书馆以及综述和原始文章的参考文献。纳入的研究需提供或可从所呈现的数据中得出真阳性、假阴性、真阴性和假阳性观察结果的绝对数量；明确描述金标准；并报告ADA结果为阳性的标准。我们基于这些提取的数据构建SROC曲线以评估检测特征。
有40篇文章可供分析。所使用的金标准为胸膜活检组织学、胸水微生物学检查、胸膜活检和痰液检查以及患者的临床病程或这些方法的组合。文章中报道的ADA敏感性范围为47.1%至100%，特异性范围为50.0%至100%。从SROC曲线得出的检测特征汇总指标显示，敏感性和特异性均为92.2%。
ADA在结核性胸腔积液中的检测性能相当不错。因此，检测胸水ADA可能是结核性胸膜炎的一种有用诊断工具。
