Naito T, Ohtsuka M, Ishikawa H, Satoh H, Hasegawa S
Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan.
Kekkaku. 1997 Oct;72(10):565-72.
We measured the activity of adenosine deaminase (ADA) and the concentration of interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) in the pleural effusions from 28 patients with tuberculosis, 30 with neoplastic diseases, 25 with bacterial infections and 18 with congestive heart failure or liver cirrhosis. The levels of ADA (83.0 +/- 32.1 IU/L) and IFN-gamma (795.0 +/- 666.4 pg/ml) in tuberculous effusions were significantly higher than those in other groups (p < 0.0001). IL-1 beta level in the effusions of bacterial infections (265.2 +/- 379.2 pg/ml) was higher than that in other groups (p < 0.0001). TNF-alpha level in the effusions of tuberculosis (31.7 +/- 36.7 pg/ml) and bacterial infections (69.5 +/- 232.9 pg/ml) was higher than that in other groups. IL-8 level of exudative effusions was higher than that of transudates. IL-2 was only present in 4 effusions from tuberculosis and 1 effusion from bacterial infections. Diagnostic utilities of cytokines and ADA for tuberculous effusion were evaluated using receiver operating characteristics (ROC) curve analysis. The cut-off points of ADA, IL-1 beta, IL-8, TNF-alpha and IFN-gamma determined in this analysis were 54 IU/L, 5.5 pg/ml, 405 pg/ml, 4.5 pg/ml and 28 pg/ml, respectively and the sensitivity and the specificity of them were 88.0% and 95.9%, 19.1% and 74.1%, 57.1% and 63.2%, 81.0% and 77.2%, and 96.2% and 98.5%, respectively. In ADA, TNF-alpha and IFN-gamma, the areas under the curve (AUC) that represent the diagnostic accuracy were 0.968, 0.719 and 0.993, respectively. AUC of IFN-gamma was significantly higher than that of ADA or TNF-alpha. In tuberculous pleural effusion, IFN-gamma was significantly correlated with TNF-alpha, IL-1 beta and ADA. The correlation was also present between TNF-alpha and ADA.
我们检测了28例结核病患者、30例肿瘤性疾病患者、25例细菌感染患者以及18例充血性心力衰竭或肝硬化患者胸腔积液中的腺苷脱氨酶（ADA）活性，以及白细胞介素-1β（IL-1β）、白细胞介素-2（IL-2）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）和干扰素-γ（IFN-γ）浓度。结核性胸腔积液中ADA水平（83.0±32.1 IU/L）和IFN-γ水平（795.0±666.4 pg/ml）显著高于其他组（p<0.0001）。细菌感染性胸腔积液中IL-1β水平（265.2±379.2 pg/ml）高于其他组（p<0.0001）。结核病（31.7±36.7 pg/ml）和细菌感染（69.5±232.9 pg/ml）胸腔积液中的TNF-α水平高于其他组。渗出液中IL-8水平高于漏出液。IL-2仅在4例结核性胸腔积液和1例细菌感染性胸腔积液中存在。采用受试者工作特征（ROC）曲线分析评估细胞因子和ADA对结核性胸腔积液的诊断效用。该分析确定的ADA、IL-1β、IL-8、TNF-α和IFN-γ的截断点分别为54 IU/L、5.5 pg/ml、405 pg/ml、4.5 pg/ml和28 pg/ml，其敏感性和特异性分别为88.0%和95.9%、19.1%和74.1%、57.1%和63.2%、81.0%和77.2%、96.2%和98.5%。在ADA、TNF-α和IFN-γ中，代表诊断准确性的曲线下面积（AUC）分别为0.968、0.719和0.993。IFN-γ的AUC显著高于ADA或TNF-α。在结核性胸腔积液中，IFN-γ与TNF-α、IL-1β和ADA显著相关。TNF-α与ADA之间也存在相关性。
