Emadi Koochak Hamid, Davoudi Setareh, Salehi Omran Abbas, Mohsenipour Reyhaneh, Hajifathalian Keveh, Saeidi Behtash, Amirzargar Ali Akbar, Sotoudeh Maryam, Seifirad Soroush
Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2013 Aug 7;51(7):449-53.
Tuberculosis pericarditis as a potentially fatal complication of tuberculosis requires effective diagnosis and treatment. We evaluated the efficacy of interferon-gamma (IFN-gamma) and adenosine deaminase (ADA) for diagnosing tuberculosis pericarditis in a cohort of Iranian patients presenting with pericarditis. We enrolled 38 patients with presentation of pericarditis. All patients underwent diagnostic and therapeutic pericardiostomy with drainage and biopsy. Adenosine deaminase and interferon-gamma levels were determined in pericardial fluid samples of all patients. Pericardial tissue samples were submitted for histopathologic and microbiologic studies. Polymerase chain reaction (PCR) was performed on all pericardial fluid samples to detect Mycobacterium tuberculosis. From 38 patients with pericarditis, 7 cases were diagnosed as having tuberculosis pericarditis (18.4%). Mean concentration of interferon-gamma in tuberculosis group was significantly higher compared to non-tuberculosis group (69257 pg/l [range: 26600-148000] vs. 329 pg/l [range: 0-2200], P<0.000). Receiver operating characteristic (ROC) curve showed a value of 14400 pg/l as the cutoff point with a sensitivity of 100% and specificity of 100% for diagnosing tuberculosis pericardial effusion. Adenosine deaminase was not found to be significantly higher in tuberculosis group in comparison with non-tuberculosis causes of pericardial effusion (35.7 [range: 9-69] vs. 36.03 [range: 8-420], P=0.28). In this study interferon-gamma showed to be a valuable diagnostic test for detection of tuberculosis pericarditis among a cohort of Iranian patients. We suggest using interferon-gamma to diagnose tuberculosis pericarditis to make diagnose in case of suspicion. While in this study, adenosine deaminase measurement did not prove to have the characteristics of an accurate diagnostic test for tuberculosis pericarditis.
结核性心包炎作为结核病的一种潜在致命并发症，需要有效的诊断和治疗。我们评估了干扰素-γ（IFN-γ）和腺苷脱氨酶（ADA）在一组患有心包炎的伊朗患者中诊断结核性心包炎的疗效。我们纳入了38例有心包炎表现的患者。所有患者均接受了诊断性和治疗性心包造口引流及活检。测定了所有患者心包液样本中的腺苷脱氨酶和干扰素-γ水平。心包组织样本被送去进行组织病理学和微生物学研究。对所有心包液样本进行聚合酶链反应（PCR）以检测结核分枝杆菌。在38例心包炎患者中，7例被诊断为结核性心包炎（18.4%）。结核组干扰素-γ的平均浓度显著高于非结核组（69257 pg/l[范围：26600 - 148000]vs.329 pg/l[范围：0 - 2200]，P<0.000）。受试者工作特征（ROC）曲线显示，以14400 pg/l作为诊断结核性心包积液的截断点，敏感性为100%，特异性为100%。与非结核性心包积液病因相比，结核组的腺苷脱氨酶未发现显著升高（35.7[范围：9 - 69]vs.36.03[范围：8 - 420]，P = 0.28）。在本研究中，干扰素-γ被证明是在一组伊朗患者中检测结核性心包炎的有价值的诊断试验。我们建议使用干扰素-γ来诊断结核性心包炎，以便在怀疑时进行诊断。而在本研究中，腺苷脱氨酶测量并未证明具有作为结核性心包炎准确诊断试验的特征。
