Gupta Bharat Kumar, Bharat Vinay, Bandyopadhyay Debapriya
Department of Biochemistry, Subharti Medical College, S. V. S. University, Meerut, India.
J Clin Med Res. 2010 Mar 20;2(2):79-84. doi: 10.4021/jocmr2010.03.280w. Epub 2010 Mar 31.
Tuberculosis kills five lakh patients every year in India, commonest being pulmonary tuberculosis and is often associated with effusion. Delay in diagnosis and treatment results in poor prognosis. Several studies have suggested the role of adenosine deaminase (ADA) in the diagnosis of tuberculous pleural effusions, but false-positive results from lymphocytic effusions have also been reported. The purpose of this study is to find out the role of ADA levels in differentiation of tuberculous and non-tuberculous exudative pleural effusions of different etiologies.
Ninety-six lymphocytic pleural fluid samples were consecutively selected and divided into two groups: tuberculous (n = 56) and non-tuberculous (n = 40), depending upon the etiology [Malignancy (n = 16), Infectious diseases (n = 18), Pulmonary embolism (n = 1), Collagen vascular diseases (n = 3) and Sarcoidosis (n = 2)]. ADA was estimated in pleural fluid in all the cases.
In all 56 samples, ADA level of tuberculous group was above diagnostic cut-off (40 U/L), while only one sample was above cut-off in non-tuberculous group (2.5%). The negative predictive value of ADA for the diagnosis of non-tuberculous etiology was 97.5% (39 of 40) lymphocytic pleural effusion patients.
In this study, ADA levels in nontuberculous exudative pleural effusions rarely exceeded the cut-off; set for tuberculous disease. The pleural fluid ADA levels were significantly higher in tuberculous exudative pleural effusions when compared with non-tuberculous exudative pleural effusions.
Adenosine deaminase; Tuberculous effusion; Pleural fluid; Exudative pleural effusions.
在印度，结核病每年导致50万患者死亡，其中最常见的是肺结核，且常伴有胸腔积液。诊断和治疗的延迟会导致预后不良。多项研究表明腺苷脱氨酶（ADA）在结核性胸腔积液的诊断中发挥作用，但也有淋巴细胞性胸腔积液出现假阳性结果的报道。本研究的目的是探讨ADA水平在鉴别不同病因的结核性和非结核性渗出性胸腔积液中的作用。
连续选取96份淋巴细胞性胸腔积液样本，根据病因分为两组：结核性（n = 56）和非结核性（n = 40），后者包括恶性肿瘤（n = 16）、传染病（n = 18）、肺栓塞（n = 1）、胶原血管疾病（n = 3）和结节病（n = 2）。对所有病例的胸腔积液进行ADA检测。
在所有56份结核性样本中，ADA水平高于诊断临界值（40 U/L），而非结核性组中只有1份样本高于临界值（2.5%）。ADA对非结核性病因诊断的阴性预测值为97.5%（40例淋巴细胞性胸腔积液患者中的39例）。
在本研究中，非结核性渗出性胸腔积液的ADA水平很少超过为结核病设定的临界值。与非结核性渗出性胸腔积液相比，结核性渗出性胸腔积液的胸腔积液ADA水平显著更高。
腺苷脱氨酶；结核性积液；胸腔积液；渗出性胸腔积液
