胸腔积液中腺苷脱氨酶在漏出液和渗出液鉴别中的作用

Atalay Figen, Ernam Dilek, Hasanoglu H Canan, Karalezli Aysegul, Kaplan Ozgül

Atatürk Chest Diseases Chest Surgery Center, Department of Pulmonary Diseases, Eserkoy sitesi 6B no.2 06530 Umitkoy, Ankara, Turkey.

Clin Biochem. 2005 Dec;38(12):1066-70. doi: 10.1016/j.clinbiochem.2005.07.009. Epub 2005 Oct 13.

OBJECTIVE

The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient).

METHODS

From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity.

RESULTS

There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests.

CONCLUSIONS

The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.

目的

本研究旨在评估一个新参数——胸膜腺苷脱氨酶（PADA）在区分漏出性胸腔积液和渗出性胸腔积液方面的效用，并将结果与其他检测方法（白蛋白梯度和蛋白梯度）进行比较。

方法

2001年11月至2003年1月，359例连续接受诊断性胸腔穿刺术的胸腔积液患者纳入本研究。根据Light标准，在仔细评估患者胸腔积液和血清的所有临床数据及生化参数后，将积液分别分类为漏出液或渗出液。评估漏出性和渗出性积液的PADA、胸膜/血清ADA（P/S ADA）比值、白蛋白梯度和蛋白梯度的均值及标准差。通过使用受试者工作特征（ROC）曲线确定每项检测的最佳截断值。通过选择提供最大灵敏度和特异性之和的检测值点来确定最佳截断水平。

结果

有113例漏出液和246例渗出液。对于每项检测，漏出液组和渗出液组之间的均值差异具有统计学意义（t检验，P<0.001）。PADA和P/S ADA的最佳截断水平分别为15.3 U/L和0.66 U/L。ROC分析证实了先前关于白蛋白梯度（12 g/L）和蛋白梯度（31 g/L）的建议。对于检测渗出液，PADA检测的灵敏度和特异性分别为85.8%和82.3%。白蛋白梯度的灵敏度和特异性分别为88.5%和79.3%，蛋白梯度的灵敏度和特异性分别为85%和83.2%。曲线下面积（AUC）数据和准确性表明，在所检测的检测方法中具有相似的鉴别特性。