Soliman A A, el-Aggan H A, el-Hefnawy A M, Mahmoud S A, Abo Deya S H
Department of Medicine (Hepatobiliary Unit), Faculty of Medicine, Alexandria University, Egypt.
J Egypt Soc Parasitol. 1994 Apr;24(1):93-105.
The diagnosis of tuberculous ascites is often difficult because of the subtle clinical clues, poorly discriminative biochemical assays, delayed results of bacteriological studies and hazards of laparoscopy. Therefore, the role of ascites adenosine deaminase (ADA) activity and interferon-gamma (IFN-delta) level in distinguishing tuberculous from other causes of ascites was examined in 50 patients with ascites. Following bacteriologic culture, seventeen (34%) patients were found to have tuberculous ascites; nine (59.9%) of them had also schistosomal hepatic fibrosis (SHF). Therefore, 36% (9 out of 25) of all patients with SHF included in the study, had coexistent peritoneal tuberculosis despite the presence of transudative ascites and unrecognized clinical features. Ascites ADA activity was significantly higher in tuberculous than in other causes of ascites (P < 0.001) regardless of the presence of an underlying liver disease. A cut-off of 28 U/L reached a sensitivity of 94.4% and a specificity of 100%. A direct correlation was found between ascites ADA activity and total proteins in the tuberculous group (r = 0.613) and the only false-negative result occurred in a patient with SHF and low-ascites protein. Ascites IFN-delta level was also significantly higher in tuberculous ascites with or without SHF than in other causes of ascites (P < 0.05). A cut-off of 26 pg/ml reached a sensitivity of 81% and a specificity of 100%. There was no correlation between ascites ADA activity and IFN-delta level in the tuberculous group (r = 0.329). Based on the results of the present study, it can be concluded that tuberculous ascites should be considered as an important cause of ascites particularly in patients with underlying liver disease. Ascites ADA activity was more sensitive than ascites IFN-delta in diagnosing tuberculosis (TB). It has proved to be an easy, rapid, safe and reliable method for routine use in the early diagnosis of tuberculous ascites.
结核性腹水的诊断往往很困难，这是因为临床线索不明显、生化检测缺乏鉴别力、细菌学研究结果滞后以及腹腔镜检查存在风险。因此，对50例腹水患者进行了研究，以探讨腹水腺苷脱氨酶（ADA）活性和干扰素-γ（IFN-δ）水平在鉴别结核性腹水与其他病因所致腹水方面的作用。经细菌学培养，17例（34%）患者被诊断为结核性腹水；其中9例（59.9%）还患有血吸虫性肝纤维化（SHF）。因此，本研究纳入的所有SHF患者中，36%（25例中的9例）尽管存在漏出性腹水且临床特征未被识别，但仍合并有腹膜结核。无论是否存在基础肝病，结核性腹水患者的腹水ADA活性均显著高于其他病因所致腹水患者（P < 0.001）。ADA活性阈值为28 U/L时，灵敏度达94.4%，特异度达100%。在结核性腹水中，腹水ADA活性与总蛋白之间存在直接相关性（r = 0.613），唯一的假阴性结果出现在1例合并SHF且腹水蛋白含量低的患者中。无论是否合并SHF，结核性腹水患者的腹水IFN-δ水平也显著高于其他病因所致腹水患者（P < 0.05）。IFN-δ阈值为26 pg/ml时，灵敏度达81%，特异度达100%。结核性腹水中，腹水ADA活性与IFN-δ水平之间无相关性（r = 0.329）。基于本研究结果，可以得出结论，结核性腹水应被视为腹水的一个重要病因，尤其是在有基础肝病的患者中。在诊断结核病（TB）时，腹水ADA活性比腹水IFN-δ更敏感。它已被证明是一种简便、快速、安全且可靠的方法，可用于结核性腹水的早期诊断常规应用。
