Levy H, Wayne L G, Anderson B E, Barnes P F, Light R W
Tuberculosis Research Laboratory, Veterans Administration Medical Center, Long Beach, Calif.
Chest. 1990 May;97(5):1144-7. doi: 10.1378/chest.97.5.1144.
The objective of this study was the prospective evaluation of the relationship between serum and pleural fluid antibody levels to mycobacterial antigens and their role in the diagnosis of tuberculous pleuritis. The setting was a tertiary care medical center. Thirteen patients with tuberculous pleuritis and 53 control subjects with pleural effusion (22 with carcinoma, 17 with cardiac failure, and 14 with empyema or parapneumonic effusion) were studied. The level of IgG was measured by ELISA. The median titers of antibody to both Mycobacterium tuberculosis and M avium were significantly higher in the serum and pleural fluid of the patients with tuberculosis than in the control patients. There was a very close relationship between the levels of M tuberculosis (r = 0.95) and M avium (r = 0.94) antibodies in the serum and pleural fluid. We concluded that the levels of antimycobacterial IgG in pleural fluid, adjusted to constant protein concentration, are very closely related to the serum levels. Therefore, these antibodies in the pleural fluid probably result from passive diffusion from serum and not local production. Measurement of pleural fluid antibody levels will not add diagnostic sensitivity or specificity to that achieved with serodiagnosis.
本研究的目的是前瞻性评估血清和胸腔积液中抗分枝杆菌抗原抗体水平之间的关系及其在结核性胸膜炎诊断中的作用。研究地点为一家三级医疗中心。对13例结核性胸膜炎患者和53例胸腔积液对照受试者（22例为癌症，17例为心力衰竭，14例为脓胸或肺炎旁积液）进行了研究。采用酶联免疫吸附测定法（ELISA）检测IgG水平。结核患者血清和胸腔积液中抗结核分枝杆菌和抗鸟分枝杆菌抗体的中位滴度显著高于对照患者。血清和胸腔积液中结核分枝杆菌抗体水平（r = 0.95）与鸟分枝杆菌抗体水平（r = 0.94）之间存在非常密切的关系。我们得出结论，调整至恒定蛋白质浓度的胸腔积液中抗分枝杆菌IgG水平与血清水平密切相关。因此，胸腔积液中的这些抗体可能是由血清被动扩散而来，而非局部产生。检测胸腔积液抗体水平并不会增加血清诊断的诊断敏感性或特异性。
