当胸腔液中的钾含量超过 5.0mEq/L 时，胸腔液中腺苷脱氨酶水平升高并不一定表明患有结核性胸膜炎。

When pleural potassium exceeds 5.0 mEq/L, high pleural adenosine deaminase levels do not necessarily indicate tuberculous pleuritis.

机构信息

Department of Respiratory Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.

出版信息

Respirology. 2012 Jan;17(1):92-8. doi: 10.1111/j.1440-1843.2011.02053.x.

DOI:10.1111/j.1440-1843.2011.02053.x

PMID:21883680

Abstract

BACKGROUND AND OBJECTIVE

The aim of this study was to determine whether high levels of pleural adenosine deaminase (pADA) are predictive for tuberculosis when pleural effusions do not satisfy the criteria for lymphocytic effusions or show neutrophil predominance.

METHODS

This was a retrospective observational study of 147 consecutive patients with exudative pleural effusions that were diagnosed by analysis of fluid samples during a 3-year period from 1 April 2007 to 31 March 2010. Multiple linear correlation tests were used to assess clinical variables as possible predictors of high pADA levels.

RESULTS

High pleural LDH (pLDH) and pleural potassium (pK) levels were associated with high pADA levels (P < 0.0001). Although there was a linear correlation between pLDH and pADA levels in patients with parapneumonic effusions (PPE) (n = 75), tubercular effusions (n = 21), malignant effusions (n = 41) and miscellaneous effusions (n = 10), a significant linear correlation between pK and pADA levels was observed only in patients with PPE (ρ = 0.525, P < 0.0001). When the cut-off value for pK was set at 5.0 mEq/L, pADA levels were >50 IU/L and pK levels were >5.0 mEq/L in only one patient (5%) in the tuberculosis group (n = 21) and 15 patients (12%, all with PPE) in the non-tuberculosis group (n = 126).

CONCLUSIONS

When pK levels exceed 5.0 mEq/L, high pADA levels do not necessarily indicate the presence of tuberculous pleuritis.

摘要

背景和目的

本研究旨在确定当胸腔积液不符合淋巴细胞性胸腔积液标准或表现为中性粒细胞优势时，胸腔腺苷脱氨酶（pADA）水平升高是否可预测结核病。

方法

这是一项回顾性观察性研究，纳入了 2007 年 4 月 1 日至 2010 年 3 月 31 日期间连续 147 例渗出性胸腔积液患者。采用多元线性相关检验评估可能导致高 pADA 水平的临床变量。

结果

胸腔积液乳酸脱氢酶（pLDH）和胸腔积液钾（pK）水平与高 pADA 水平相关（P<0.0001）。虽然在类肺炎性胸腔积液（n=75）、结核性胸腔积液（n=21）、恶性胸腔积液（n=41）和其他胸腔积液（n=10）患者中，pLDH 与 pADA 水平之间存在线性关系，但仅在类肺炎性胸腔积液患者中观察到 pK 与 pADA 水平之间存在显著线性关系（ρ=0.525，P<0.0001）。当 pK 截断值设定为 5.0 mEq/L 时，在结核组（n=21）中，pADA 水平>50 IU/L 且 pK 水平>5.0 mEq/L 的患者仅 1 例（5%），而非结核组（n=126）中 pK 水平>5.0 mEq/L 的患者 15 例（12%，均为类肺炎性胸腔积液）。