Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan, China.
World J Gastroenterol. 2012 Oct 7;18(37):5260-5. doi: 10.3748/wjg.v18.i37.5260.
To investigate the value of adenosine deaminase (ADA) for early detection of tuberculous peritonitis (TBP) among cirrhotic patients.
We retrospectively analyzed 22 patients with TBP from July 1990 to June 2010. Twenty-five cirrhotic patients with uninfected ascites were prospectively enrolled as the cirrhosis control group from July 2010 to June 2011. An additional group of 217 patients whose ascites ADA levels were checked in various clinical conditions were reviewed from July 2008 to June 2010 as the validation group.
The mean ascites ADA value of cirrhotic patients with TBP (cirrhotic TBP group, n = 8) was not significantly different from that of non-cirrhotic patients (non-cirrhotic TBP group, n = 14; 58.1 ± 18.8 U/L vs. 70.6 ± 29.8 U/L, P = 0.29), but the mean ascites ADA value of the cirrhotic TBP group was significantly higher than that of the cirrhosis control group (58.1 ± 18.8 U/L vs. 7.0 ± 3.7 U/L, P < 0.001). ADA values were correlated with total protein values (r = 0.909, P < 0.001). Using 27 U/L as the cut-off value of ADA, the sensitivity and specificity were 100% and 93.3%, respectively, for detecting TBP in the validation group.
Even with lower ADA activity in ascites among cirrhotic patients, ADA values were significantly elevated during TBP, indicating that ADA can still be a valuable diagnostic tool.
探讨腺苷脱氨酶（ADA）在肝硬化患者中对结核性腹膜炎（TBP）早期检测的价值。
回顾性分析 1990 年 7 月至 2010 年 6 月期间 22 例 TBP 患者。前瞻性纳入 2010 年 7 月至 2011 年 6 月期间 25 例无感染性腹水的肝硬化患者作为肝硬化对照组。回顾性纳入 2008 年 7 月至 2010 年 6 月期间因各种临床情况检查腹水 ADA 水平的 217 例患者作为验证组。
肝硬化合并 TBP 患者（肝硬化 TBP 组，n = 8）腹水 ADA 值与非肝硬化 TBP 患者（非肝硬化 TBP 组，n = 14）无显著差异（58.1 ± 18.8 U/L 比 70.6 ± 29.8 U/L，P = 0.29），但肝硬化 TBP 组腹水 ADA 值明显高于肝硬化对照组（58.1 ± 18.8 U/L 比 7.0 ± 3.7 U/L，P < 0.001）。ADA 值与总蛋白值呈正相关（r = 0.909，P < 0.001）。在验证组中，以 27 U/L 作为 ADA 的临界值，ADA 对 TBP 的敏感性和特异性分别为 100%和 93.3%。
即使肝硬化患者腹水 ADA 活性较低，TBP 时 ADA 值仍显著升高，表明 ADA 仍然是一种有价值的诊断工具。
