Tuon Felipe Francisco, Litvoc Marcelo Nóbrega, Lopes Max Igor Banks Ferreira
Infectious and Parasitic Diseases Clinic, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Enéas de Carvalho Aguiar 255, 4 Andar. Sala 4028-ICHC, Cerqueira Cesar, CEP Number 05403-010 São Paulo, Brazil.
Acta Trop. 2006 Aug;99(1):67-74. doi: 10.1016/j.actatropica.2006.07.004. Epub 2006 Sep 6.
Adenosine deaminase (ADA) activity in pericardial fluid is a valuable aid in the diagnosis of tuberculous pericarditis (TP), but there is no systematic review performed to evaluate the benefits of ADA activity as an adjunctive test for TP diagnosis. The objective of this systematic review was to evaluate the utility of ADA activity as a diagnostic marker of TP on patients presenting with pericardial effusion.
MEDLINE, LILACS and Cochrane Library databases (1980-2005) searches to identify articles related to adenosine deaminase activity on TP diagnosis. Articles with patients with at least one TP diagnostic criteria were included. The controls were patients with other pericardial diseases with moderate or large pericardial effusion. To calculate the sensitivity, specificity, as well as positive and negative likelihood ratios we extracted the total number of confirmed TP cases over all patients with pericardial effusion as well as the number of cases with ADA activity values of 40 U/L and over.
Thirty one studies met our initial inclusion criteria and five articles were selected. The heterogeneity limited the specificity analysis (p=0.004). The method yielded a sensitivity and specificity of 88% and 83%, respectively. The SROC curve presented an area with a tendency towards 1 (value of 0.9539) and corroborates the diagnostic value of ADA activity.
The present study confirms the clinical value of ADA activity as adjunctive diagnostic marker of TP among other causes of pericardial effusion.
心包积液中的腺苷脱氨酶（ADA）活性对结核性心包炎（TP）的诊断有重要辅助作用，但尚无系统评价来评估ADA活性作为TP诊断辅助检查的益处。本系统评价的目的是评估ADA活性作为心包积液患者TP诊断标志物的效用。
检索MEDLINE、LILACS和Cochrane图书馆数据库（1980 - 2005年），以识别与ADA活性对TP诊断相关的文章。纳入至少符合一项TP诊断标准的患者的文章。对照组为患有其他心包疾病且有心包中、大量积液的患者。为计算敏感性、特异性以及阳性和阴性似然比，我们提取了所有心包积液患者中确诊的TP病例总数以及ADA活性值在40 U/L及以上的病例数。
31项研究符合我们的初始纳入标准，最终选取了5篇文章。异质性限制了特异性分析（p = 0.004）。该方法得出的敏感性和特异性分别为88%和83%。SROC曲线显示曲线下面积趋向于1（值为0.9539），证实了ADA活性的诊断价值。
本研究证实了ADA活性作为心包积液其他病因中TP辅助诊断标志物的临床价值。
