Devkota K C, Shyam B K, Sherpa K, Ghimire P, Sherpa M T, Shrestha R, Gautam S
Department of Internal Medicine, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal.
Nepal Med Coll J. 2012 Jun;14(2):149-52.
Tuberculosis (TB) is a major public health problem in developing countries including Nepal. One of the common presentations of TB is pleural effusion. The diagnosis of tubercular pleural effusion can be difficult because of the low rate of detecting tubercule bacilli by direct stain and culture of pleural fluid for acid-fast bacilli (AFB). Pleural biopsy can be useful but is invasive and requires experts. In this context, pleural fluid Adenosine Deaminase (ADA) level has been proposed as easy, cheap and highly sensitive test for diagnosis of TB pleural effusion. The present study was undertaken to define the role ofpleural fluid ADA value in accurate diagnosis of TB pleural effusion. A Prospective analysis of 100 patients admitted in Nepal Medical College and teaching Hospital with pleural effusion was done. Pleural fluid ADA level was evaluated in all patients, and significance of pleural fluid ADA level in TB pleural effusion was studied. It was found that mean ADA level in pleural fluid was 105.8 +/- 67.23 U/L in cases of TB, as compared to 16.83 +/- 8.91 U/L in malignancy, 44.53 +/- 32.84 U/L in parapneumonic effusion and 15.94 +/- 4.88 U/L in patients with miscellaneous diagnosis. For a cut-off value of 42.19 U/L for diagnosis of TB pleural effusion, sensitivity was found to be 90.8% and specificity 82.8%. Almost all patients diagnosed to have TB pleural effusion responded completely to anti-tubercular treatment. So, we concluded that pleural fluid ADA analysis could be easy, cheap and highly sensitive and specific test for diagnosis of TB pleural effusion.
结核病（TB）是包括尼泊尔在内的发展中国家的一个主要公共卫生问题。结核性胸膜炎是结核病常见的临床表现之一。由于通过直接染色和胸水培养抗酸杆菌（AFB）来检测结核杆菌的阳性率较低，结核性胸膜炎的诊断可能会很困难。胸膜活检可能有用，但具有侵入性且需要专业人员操作。在此背景下，胸水腺苷脱氨酶（ADA）水平被认为是一种简便、廉价且高度敏感的诊断结核性胸膜炎的检测方法。本研究旨在确定胸水ADA值在准确诊断结核性胸膜炎中的作用。对尼泊尔医学院和教学医院收治的100例胸腔积液患者进行了前瞻性分析。对所有患者的胸水ADA水平进行了评估，并研究了胸水ADA水平在结核性胸膜炎中的意义。结果发现，结核患者胸水ADA平均水平为105.8±67.23 U/L，而恶性肿瘤患者为16.83±8.91 U/L，类肺炎性胸腔积液患者为44.53±32.84 U/L，其他诊断患者为15.94±4.88 U/L。以42.19 U/L作为诊断结核性胸膜炎的临界值，敏感性为90.8%，特异性为82.8%。几乎所有诊断为结核性胸膜炎的患者对抗结核治疗均有完全反应。因此，我们得出结论，胸水ADA分析对于诊断结核性胸膜炎可能是一种简便、廉价且高度敏感和特异的检测方法。
