Brant C Q, Silva M R, Macedo E P, Vasconcelos C, Tamaki N, Ferraz M L
Discipline of Gastroenterology, EPM-UNIFESP, São Paulo, SP, Brazil.
Rev Inst Med Trop Sao Paulo. 1995 Sep-Oct;37(5):449-53. doi: 10.1590/s0036-46651995000500011.
In order to evaluate the role of the determination of adenosine deaminase activity (ADA) in ascitic fluid for the diagnosis of tuberculosis, 44 patients were studied. Based on biochemical, cytological, histopathological and microbiological tests, the patients were divided into 5 groups: G1-tuberculous ascites (n = 8); G2-malignant ascites (n = 13); G3-spontaneous bacterial peritonitis (n = 6); G4-pancreatic ascites (n = 2); G5-miscelaneous ascites (n = 15). ADA concentration were significantly higher in G1 (133.50 +/- 24.74 U/l) compared to the other groups (G2 = 41.85 +/- 52.07 U/l; G3 = 10.63 +/- 5.87 U/l; G4 = 18.00 +/- 7.07 U/l; G5 = 11.23 +/- 7.66 U/l). At a cut-off value of > 31 U/l, the sensitivity, specificity and positive and negative predictive values were 100%, 92%, 72% and 100%, respectively. ADA concentrations as high as in tuberculous ascites were only found in two malignant ascites caused by lymphoma. We conclude that ADA determination in ascitic fluid is a useful and reliable screening test for diagnosing tuberculous ascites. Values of ADA higher than 31 U/l indicate more invasive methods to confirm the diagnosis of tuberculosis.
为了评估腹水腺苷脱氨酶活性（ADA）测定在结核病诊断中的作用，对44例患者进行了研究。根据生化、细胞学、组织病理学和微生物学检查，将患者分为5组：G1-结核性腹水（n = 8）；G2-恶性腹水（n = 13）；G3-自发性细菌性腹膜炎（n = 6）；G4-胰源性腹水（n = 2）；G5-其他腹水（n = 15）。与其他组相比，G1组的ADA浓度显著更高（133.50 +/- 24.74 U/l）（G2 = 41.85 +/- 52.07 U/l；G3 = 10.63 +/- 5.87 U/l；G4 = 18.00 +/- 7.07 U/l；G5 = 11.23 +/- 7.66 U/l）。在临界值> 31 U/l时，敏感性、特异性、阳性预测值和阴性预测值分别为100%、92%、72%和100%。仅在两例淋巴瘤引起的恶性腹水中发现了与结核性腹水一样高的ADA浓度。我们得出结论，腹水ADA测定是诊断结核性腹水的一种有用且可靠的筛查试验。ADA值高于31 U/l表明需要采用更具侵入性的方法来确诊结核病。
