利用胸腔积液中10倍腺苷脱氨酶与乳酸脱氢酶的比值鉴别结核性和非结核性胸腔积液。
Differentiating between tuberculous and non-tuberculous pleural effusions using the pleural fluid ratio of 10× adenosine deaminase/lactate dehydrogenase.
作者信息
Li Yan, Chen Zhujun, Yang Pan, Duan Hailing, He Jian, Gong Liang, Zhao Lintao
机构信息
Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Respiratory Medicine, The First Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, China.
出版信息
J Thorac Dis. 2023 May 30;15(5):2627-2635. doi: 10.21037/jtd-23-383. Epub 2023 May 29.
BACKGROUND
Adenosine deaminase (ADA) is a sensitive marker of tuberculous pleural effusion (TBPE). However, in pleural effusion (PE), the detection of ADA alone cannot be used to determine whether the increase in the ADA level is caused by the rising proportion of macrophages and lymphocytes in the cell components or by the increase in the total cell number. The diagnostic precision of ADA is probably restricted due to the false positive and negative results. Thus, we explored the clinical value of the ratio of PE ADA to lactate dehydrogenase (LDH) in differentiating between TBPE and non-TBPE.
METHODS
Patients hospitalized with PEs between January 2018 and December 2021 were retrospectively recruited for this study. We analyzed the values of ADA, LDH, and 10× ADA/LDH in the patients with TBPE and non-TBPE. We also determined the sensitivity, specificity, Youden index, and area under the curve for 10× ADA/LDH at different ADA levels and evaluated its diagnostic accuracy.
RESULTS
In total, 382 patients with PEs were included in the study. Among whom, 144 were diagnosed with TBPE, this supposes a "pre-test probability" >40%. It is quite high, 134 with malignant PEs, 19 with parapneumonic PEs, 43 with empyema, 24 with transudate PEs, and 18 with other types of PE of a known etiology. The ADA levels were positively correlated with the LDH levels in TBPE. LDH levels usually increase in response to cell damage or cell death. The 10× ADA/LDH level was significantly increased in the TBPE patients. In addition, the 10× ADA/LDH level increased as the ADA level increased in TBPE. To differentiate between TBPE and non-TBPE, the optimal cut-off value of 10× ADA/LDH at different ADA levels was assessed using receiver operating curves. At an ADA level >20 U/L, 10× ADA/LDH showed the best diagnostic performance, and had a specificity and sensitivity of 0.94 (95% CI: 0.84-0.98) and 0.95 (95% CI: 0.88-0.98), respectively.
CONCLUSIONS
The 10× ADA/LDH dependent diagnostic index can be used to distinguish TBPE from non-TBPE and could be used to guide future clinical decisions.
背景
腺苷脱氨酶（ADA）是结核性胸腔积液（TBPE）的一个敏感标志物。然而，在胸腔积液（PE）中，仅检测ADA不能用于确定ADA水平升高是由细胞成分中巨噬细胞和淋巴细胞比例增加还是细胞总数增加所致。由于假阳性和假阴性结果，ADA的诊断准确性可能受到限制。因此，我们探讨了胸腔积液ADA与乳酸脱氢酶（LDH）比值在鉴别TBPE和非TBPE中的临床价值。
方法
回顾性纳入2018年1月至2021年12月因胸腔积液住院的患者进行本研究。我们分析了TBPE和非TBPE患者的ADA、LDH及10×ADA/LDH值。我们还确定了不同ADA水平下10×ADA/LDH的敏感性、特异性、约登指数和曲线下面积，并评估其诊断准确性。
结果
本研究共纳入382例胸腔积液患者。其中，144例被诊断为TBPE，这意味着“预测试概率”>40%。该概率相当高，134例为恶性胸腔积液，19例为类肺炎性胸腔积液，43例为脓胸，24例为漏出性胸腔积液，18例为其他已知病因的胸腔积液类型。TBPE患者的ADA水平与LDH水平呈正相关。LDH水平通常随细胞损伤或细胞死亡而升高。TBPE患者的10×ADA/LDH水平显著升高。此外，在TBPE中，10×ADA/LDH水平随ADA水平升高而升高。为鉴别TBPE和非TBPE，使用受试者工作曲线评估不同ADA水平下10×ADA/LDH的最佳截断值。在ADA水平>20 U/L时，10×ADA/LDH表现出最佳诊断性能，特异性和敏感性分别为0.94（95%CI：0.84-0.98）和0.95（95%CI：0.88-0.98）。
结论
10×ADA/LDH依赖的诊断指标可用于区分TBPE和非TBPE，并可用于指导未来的临床决策。
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