Carstens M E, Burgess L J, Maritz F J, Taljaard J J
Department of Chemical Pathology, University of Stellenbosch, Tygerberg Hospital, Republic of South Africa.
Int J Tuberc Lung Dis. 1998 Oct;2(10):831-5.
Tygerberg Hospital, an academic teaching hospital, Republic of South Africa.
To identify the adenosine deaminase (ADA) isoenzymes as a diagnostic tool for tuberculosis in pleural effusions with increased ADA activity.
Patients (n = 157) with exudative effusions and ADA activities >20 U/l, due to causes which satisfied predetermined diagnostic criteria, participated in the study. They consisted of 87 tuberculous effusions, 27 infective effusions (12 empyematous and 15 non-empyematous), 37 malignant effusions and six other exudative effusions (systemic lupus erythematosus, pancreatitis and lung embolus). In each case the ADA isoenzymes in the pleural fluid were identified using polyacrylamide gel electrophoresis. In addition, microbiology and cytology (including differential cell counts) were also carried out.
Although ADA1c and ADA2 were the predominant isoenzymes observed in tuberculous effusions, while ADA1c and ADA1m were predominant in infective non-empyematous effusions, no additional diagnostic value was obtained. In the case of neoplastic effusions and other exudates, determination of ADA isoenzyme patterns also did not assist in diagnosing these conditions.
Determination of patterns of ADA isoenzymes does not enhance the overall diagnostic value of ADA activity in pleural effusions.
南非共和国泰格堡医院，一家学术教学医院。
将腺苷脱氨酶（ADA）同工酶鉴定为诊断ADA活性升高的胸腔积液中结核病的诊断工具。
157例渗出性胸腔积液且ADA活性>20 U/l的患者参与了本研究，这些患者的病因符合预定诊断标准。其中包括87例结核性胸腔积液、27例感染性胸腔积液（12例脓胸和15例非脓胸）、37例恶性胸腔积液和6例其他渗出性胸腔积液（系统性红斑狼疮、胰腺炎和肺栓塞）。对每例患者，采用聚丙烯酰胺凝胶电泳鉴定胸腔积液中的ADA同工酶。此外，还进行了微生物学和细胞学检查（包括细胞分类计数）。
虽然ADA1c和ADA2是结核性胸腔积液中观察到的主要同工酶，而ADA1c和ADA1m在非脓胸感染性胸腔积液中占主导，但未获得额外的诊断价值。对于肿瘤性胸腔积液和其他渗出液，ADA同工酶模式的测定也无助于诊断这些疾病。
ADA同工酶模式的测定并不能提高胸腔积液中ADA活性的总体诊断价值。
