Institute of Respiratory Diseases, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China.
Chin Med J (Engl). 2013;126(17):3215-21.
Previous studies reported interleukin-27 (IL-27), interferon-γ (IFN-γ), or adenosine deaminase (ADA) alone plays a helpful role in diagnosing tuberculous pleural effusion (TPE). The present study aims at comparing the diagnostic accuracy of pleural IL-27, IFN-γ, and ADA, and investigate the diagnostic accuracy of the combination of IL-27, IFN-γ, or/and ADA for differentiating TPE from pleural effusions with the other etiologies.
The concentrations of IL-27, IFN-γ and ADA were simultaneously determined in pleural fluids and sera from 40 patients with TPE; 26 with malignant pleural effusion, seven with infectious pleural effusion, and eight with transudative pleural effusion by enzyme linked immunosorbent assay and colorimetric method. The corresponding biochemical indexs were also simultaneously determined.
The concentrations of pleural IL-27 and IFN-γ in the tuberculous group were significantly higher than those in the malignant, infectious, and transudative groups. The concentrations of ADA in TPE were significantly higher than those in MPE or transudative effusions, while much lower than those in infectious effusions. Among these three biomarkers, IL-27 was the most effective for TPE diagnosis, with the cut off value of 900.8 ng/L. IL-27 had a high sensitivity of 95% and specificity of 97.6% for differential diagnosis of TPE from non-TPEs. Combinations of IL-27, IFN-γ and ADA measurements further increased the sensitivity or specificity up to 100%.
Compared to non-TPEs, IL-27, IFN-γ and ADA all simultaneously increased in TPE; and among these three rapid detection methods, IL-27 appeared to be the best for distinguishing tuberculous from non-TPEs, especially from MPE. Combinations of the three markers (IL-27, IFN-γ and ADA) yielded the highest sensitivity and specificity. These findings suggest that the applications of a new biomarker, IL-27, alone or with IFN-γ and ADA, may contribute to more efficient diagnosis strategies in the management of tuberculous pleurisy.
先前的研究表明白细胞介素-27（IL-27）、干扰素-γ（IFN-γ）或腺苷脱氨酶（ADA）单独在诊断结核性胸腔积液（TPE）中具有一定的辅助作用。本研究旨在比较胸腔液中 IL-27、IFN-γ 和 ADA 的诊断准确性，并探讨 IL-27、IFN-γ 或/和 ADA 联合检测对 TPE 与其他病因所致胸腔积液的诊断准确性。
采用酶联免疫吸附试验和比色法同时检测 40 例 TPE 患者、26 例恶性胸腔积液患者、7 例感染性胸腔积液患者和 8 例渗出性胸腔积液患者胸腔液和血清中 IL-27、IFN-γ 和 ADA 的浓度，并同时检测相应的生化指标。
结核组胸腔液中 IL-27 和 IFN-γ 浓度明显高于恶性、感染和渗出组。TPE 患者胸腔液中 ADA 浓度明显高于恶性胸腔积液或渗出性胸腔积液，而明显低于感染性胸腔积液。在这三个生物标志物中，IL-27 对 TPE 的诊断最有效，截断值为 900.8ng/L。IL-27 对 TPE 与非 TPE 的鉴别诊断具有 95%的高灵敏度和 97.6%的特异性。IL-27、IFN-γ 和 ADA 联合检测可进一步提高诊断的敏感性或特异性，达到 100%。
与非 TPE 相比，TPE 中同时出现 IL-27、IFN-γ 和 ADA 增加；在这三种快速检测方法中，IL-27 似乎是鉴别结核性和非结核性胸腔积液的最佳方法，尤其是与恶性胸腔积液的鉴别。三种标志物（IL-27、IFN-γ 和 ADA）联合应用具有最高的敏感性和特异性。这些发现表明，新生物标志物 IL-27 的单独或与 IFN-γ 和 ADA 联合应用，可能有助于提高结核性胸膜炎管理中的诊断策略效率。
