腺苷脱氨酶同工酶在结核性胸腔积液中的诊断效用。

The diagnostic utility of adenosine deaminase isoenzymes in tuberculous pleural effusions.

作者信息

Zemlin A E, Burgess L J, Carstens M E

机构信息

Division of Chemical Pathology, National Health Laboratory Service, Tygerberg Hospital, Stellenbosch University, Parow, Tygerberg, South Africa.

出版信息

Int J Tuberc Lung Dis. 2009 Feb;13(2):214-20.

PMID:19146750

Abstract

SETTING

Pleural adenosine deaminase (ADA) levels have been found to be useful in diagnosing tuberculous pleuritis. Elevated ADA levels have been attributed to ADA2 isoenzyme, although no comprehensive studies have evaluated ADA2 as a diagnostic test.

OBJECTIVE

To estimate the diagnostic accuracy of ADA and ADA2 in diagnosing tuberculous pleurisy.

METHOD

A 3-year retrospective study was carried out. ADA and ADA2 were determined on patients diagnosed according to predetermined criteria.

RESULTS

A total of 951 samples were received, including 387 patients with tuberculosis (TB). ADA values>or=52.4 U/l yielded a sensitivity, specificity and positive (PPV) and negative predictive value (NPV) respectively of 93.7% (95%CI 90.0-96.0), 88.7% (95%CI 85.7-91.3), 85.5% (95%CI 81.7-88.8) and 95.2% (95%CI 92.9-96.9). ADA2 values>or=40.6 U/l yielded a sensitivity, specificity and PPV and NPV of respectively 97.2% (95%CI 95.0-98.7), 94.2% (95%CI 91.8-96.0), 92.2% (95%CI 89.1-94.7) and 98.0% (95%CI 96.3-99.0). The chi2 and McNemar tests proved the superiority of ADA2 statistically.

CONCLUSION

ADA2 is superior to ADA in the diagnosis of tuberculous pleuritis and should be used as a routine test in the diagnostic work-up of patients with pleural effusions in areas with high TB prevalence.

摘要

背景

已发现胸腔腺苷脱氨酶（ADA）水平有助于诊断结核性胸膜炎。ADA水平升高归因于ADA2同工酶，尽管尚无全面研究将ADA2作为诊断检测方法进行评估。

目的

评估ADA和ADA2诊断结核性胸膜炎的准确性。

方法

进行了一项为期3年的回顾性研究。根据预定标准对患者测定ADA和ADA2水平。

结果

共收到951份样本，其中包括387例结核病（TB）患者。ADA值≥52.4 U/L时，敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为93.7%（95%CI 90.0 - 96.0）、88.7%（95%CI 85.7 - 91.3）、85.5%（95%CI 81.7 - 88.8）和95.2%（95%CI 92.9 - 96.9）。ADA2值≥40.6 U/L时，敏感性、特异性、PPV和NPV分别为97.2%（95%CI 95.0 - 98.7）、94.2%（95%CI 91.8 - 96.0）、92.2%（95%CI 89.1 - 94.7）和98.0%（95%CI 96.3 - 99.0）。卡方检验和McNemar检验在统计学上证明了ADA2的优越性。