腺苷脱氨酶诊断结核性胸膜炎价值的再评价

目的 探讨胸腔积液和血清中腺苷脱氨酶(ADA)对鉴别结核性胸膜炎及恶性胸腔积液的临床价值.方法 回顾性分析91例经内科胸腔镜胸膜活检病理确诊为结核性胸腔积液(结核组49例)和恶性胸腔积液(恶性组42例)患者的胸腔积液及血清中ADA活性,应用受试者工作曲线(ROC曲线)确定结核性胸膜炎患者胸腔积液ADA的最佳临界值.结果 结核组胸腔积液ADA活性和胸腔积液ADA与血清ADA比值分别为(46±26)U/L和4.1±4.0,明显高于恶性组的(16±8)U/L和1.7±1.2,差异均有统计学意义(t值分别为7.383和3.852,均P＜0.01),结核组和恶性组的血清ADA活性分别为(13±5)U/L和(12±6)U/L,差异无统计学意义(t=1.582,P＞0.05).应用ROC曲线确定胸腔积液ADA诊断结核性胸膜炎的最佳临界值为28.7 U/L,灵敏度为75.5%,特异度为95.2%.结论 胸腔积液ADA活性可以作为鉴别结核性和恶性胸腔积液的重要指标,对结核性胸膜炎有较高的临床诊断价值,而血清ADA活性对鉴别两者无临床意义.     

胸水和血清ADA、CEA联合检测对良恶性胸腔积液的诊断价值

目的探讨胸水／血清腺苷脱氨酶（ADA）、癌胚抗原（CEA）联合检测对良恶性胸腔积液的鉴别诊断价值。方法采用酶连续监测法和酶联免疫（ELISA）双抗体夹心法对119例胸腔积液进行胸水／血清ADA和CEA检测分析。结果CEA在结核性和癌性胸腔积液中的阳性率分别为8．20％和63．6％,特异性91．8％（89／97）。ADA活性在结核性和癌性胸腔积液中分别为（59．62±29．86）U／L和（15．31±7．36）U／L（P〈0．01）。以P—ADA〉40U／L做为诊断结核的临界值,其敏感性为79．3％,特异性为86．4％;以P—ADA／S—ADA〉1为临界值,其敏感性为97．7％,特异性为95．5％。结论胸腔积液ADA、CEA检测对良恶性胸腔积液具有诊断与鉴别诊断价值。     

E-SLT、ADA、TB-Ab-IgG对老年结核性、癌性胸腔积液的诊断价值

目的探讨E-SLT、ADA、TB-Ab-IgG联合检测对老年结核性、癌性胸腔积液的诊断价值。方法对33例结核性胸膜炎、30例癌性老年胸腔积液患者、18例健康对照组分别进行ADA、TB-Ab-IgG检测及人可溶性E-SLT含量检测。结果结核组血清及胸腔积液中E-SLT水平均高于癌性组,且血清E-SLT水平均高于健康对照组;结核组血清及胸腔积液中ADA水平均高于癌性组,结核组中胸液/血清ADA1,在癌性组中胸液/血清ADA1。上述指标在各组间比较均有显著性差异(P0.05)。结论联合检测E-SLT、ADA、TB-Ab-IgG对结核性、癌性胸腔积液诊断有重要价值。     

TB-Ab-IgG ADA和CEA对良恶性胸水鉴别诊断意义

目的　探讨胸水结核抗体 (TB-Ab-IgG)、腺苷脱氨酶 (ADA)、癌胚抗原 (CEA)联合检测对良恶性胸腔积液的鉴别价值。方法 采用DIGFA法、Giusti改良法和放射免疫法对 92例胸腔积液行胸水TB Ab IgG、ADA和CEA检测分析。 结果 TB Ab IgG在结核性、癌性和其它组胸腔积液中的阳性率分别是 81.8%、12 .8%和 1.1% ,特异性为 87.5 % ;ADA活性在结核性和癌性胸腔积液中分别为 (5 9.6± 2 8.8)U/L和 (2 4 .7± 11.5 )U/L(P <0 .0 1) ,CEA为 (8.5± 7.3)ng/mL和 (6 0 .2± 39.6 )ng/mL(P <0 .0 1) ,ADA在其它组胸腔积液中为 (44 .6± 2 6 .5 )U /L ,与结核性胸腔积液相比 (P >0 .0 5 )。结论 胸腔积液TB Ab IgG、ADA、CEA检测对良恶性胸腔积液有鉴别价值。     

ADA、IFN-γ及结核分枝杆菌抗体联合检测对结核性胸膜炎的诊断价值

目的探讨ADA活性、IFN-γ含量和结核分枝杆菌抗体联合检测对结核性胸膜炎的诊断价值。方法检测56例已经经组织病理学或病原学明确诊断的结核性胸膜炎患者,20例经细胞学或组织病理学明确诊断的恶性胸腔积液患者,以及12例其他渗出性胸腔积液患者的胸液和血清中的ADA活性和IFN-γ含量以及抗结核分枝杆菌抗体阳性率,经统计学处理后,评价各项指标对结核性胸膜炎诊断的灵敏度、特异度及临床诊断符合率。结果结核性胸液中ADA活性、IFN-γ含量分别为（50.98±13.07）U/L、（139.46±70.43）pg/ml,结核分枝杆菌抗体阳性率60.7%,与恶性胸液组和其他组比较差别有统计学意义,P<0.05。以45U/L为临界值,ADA对结核性胸膜炎诊断的灵敏度为80.4%,特异度96.9%,临床诊断符合率为86.4%;IFN-γ以100pg/ml为临界值对结核性胸膜炎诊断的灵敏度为83.9%,特异度93.8%,临床诊断符合率为87.5%;胸液中结核分枝杆菌抗体检测对结核性胸膜炎诊断的灵敏度为 60.7%,特异度为87.5%,临床诊断符合率为70.5%。以3项指标联合检测任何2项阳性对结核性胸膜炎诊断的灵敏度为 92.9%,特异度100%,临床诊断符合率为95.5%。结论ADA活性、IFN-γ含量和结核分枝杆菌抗体联合检测可极大地提高结核性胸膜炎的诊断效能。     

结核性与癌性胸腔积液的实验室检测比较研究

目的比较研究实验室检测腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、蛋白(TP)、葡萄糖(GLU)等多项指标对结核性与癌性胸腔积液的鉴别诊断价值。方法对151例明确诊断为结核性或癌性胸腔积液分别测定胸水ADA、LDH、CEA、TP、GLU和血清TP,并进行统计分析。结果结核性胸腔积液中ADA、LDH、TP含量都明显高于癌性胸腔积液,其中胸水ADA以28U/L作为诊断结核性胸水的临界值则其敏感性和特异性均极高,结核性胸水中GLU含量则低于癌性胸水,癌性胸水CEA的阳性率高达76.0%,而结核性胸水CEA均阴性。结论联合检测胸水ADA、LDH、CEA、TP和GLU可以作为结核性与癌性胸腔积液的诊断和鉴别诊断依据,其中ADA28U/L可以考虑作为结核性胸腔积液的单独诊断依据。     

联合检测对结核性和恶性胸腔积液的鉴别诊断价值

目的探讨联合检测胸腔积液中腺苷脱氨酶(ADA)、C反应蛋白(CRP)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)对结核性和恶性胸腔积液的诊断价值。方法以我院2012年1月至2012年12月112例住院的胸腔积液患者为研究对象,其中62例结核性胸腔积液患者,50例恶性胸腔积液患者,以酶比色法,免疫比浊法,速率法和电化学发光法检测上述患者胸腔积液中ADA、CRP、CEA和LDH浓度。结果结核性胸腔积液患者ADA和CRP的诊断敏感性显著高于恶性胸腔积液患者(P0.01),恶性胸腔积液患者CEA的诊断敏感性较结核性胸腔积液患者明显增高(P0.01)。以胸腔积液CEA7 ng/ml及LDH245 U/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为78.0%,80.6%;而以CEA7 ng/ml,LDH245 U/L及ADA40 U/L,CRP5 mg/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为94.0%,95.2%。以胸腔积液ADA40 U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为82.3%,86.0%;而以CEA7 ng/ml,LDH245 U/L及ADA4 0U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为96.8%,92.0%。结论联合检测胸腔积液中ADA、CRP、CEA、LDH的浓度可提高结核性和恶性胸腔积液鉴别诊断的敏感性和特异性。     

三种检测方法对结核性胸膜炎诊断价值的探讨

目的探讨腺苷脱氨酶（ADA）,结核蛋白芯片,结核分枝杆菌特异性酶联免疫斑点技术（ELISPOT）三种方法在结核性胸膜炎诊断中的应用价值。方法对102例结核性胸膜炎患者的胸腔积液、血清和48例非结核性胸膜炎患者的胸腔积液、血清分别用ADA、结核蛋白芯片和结核分枝杆菌特异性ELISPOT三种方法进行检测。结果胸液中的ADA、结核蛋白芯片和结核分枝杆菌特异性ELISPOT的灵敏性分别是84.3%、52.9%、97.1%,特异性分别是85.4%、89.6%、97.9%;血清中的ADA、结核蛋白芯片和结核分枝杆菌特异性ELISPOT的灵敏性分别是31.4%、74.5%、91.2%,特异性分别为75.0%、93.8%、95.8%。结论胸水的ADA检测,血清的结核蛋白芯片检测,胸水与血清的结核分枝杆菌特异性ELISPOT检测对结核性胸膜炎有较高的灵敏性与特异性,对结核性胸膜炎有较高的临床诊断价值。     

超敏C-反应蛋白和腺苷脱氨酶联合检测鉴别结核性胸膜炎和肿瘤胸腔积液

目的探讨超敏C-反应蛋白（hs-CRP）和腺苷脱氨酶（ADA）联合检测鉴别结核性胸膜炎和肿瘤胸腔积液的价值。方法对2007年武汉市结核病防治所住院收治的116例胸腔积液患者,患者分为结核组和肿瘤组,分别检测hs-CRP、ADA,并纳入受试者工作曲线,以最高敏感性和特异性决定截断点。结果结核组hs-CRP、ADA中位数为(56.76±16.62) mg/L和(47.89±12.97) IU/L,肿瘤组为(22.72±5.04) mg/L和(21.61±5.97) IU/L。结核组hs-CRP、ADA的敏感性和特异性分别为98.6%、97.6%和95.9%、95.2%,曲线下面积(AUC)分别为0.999(0.998-1.001,95%CI)、0.993(0.982-1.003,95%CI)。hs-CRP联合ADA的敏感性和特异性分别为90.5%、98.7%。结论hs-CRP和ADA对结核渗出性胸膜炎和肿瘤胸腔积液的鉴别都有很重要的参考价值,CRP优于ADA,联合检测意义更大。     

多种实验方法在诊断结核性胸膜炎的临床应用价值的比较

目的评估实验室检查用于诊断结核性胸膜炎的临床有效性。方法我院2014年1月至2015年9月收治的胸腔积液患者102例,进行了外周血单个核细胞(PBMC)T-SPOT.TB检测、胸水ADA、结核抗体、结核分枝杆菌培养、涂片抗酸染色等,探讨各种诊断方法的敏感性、特异性。结果 102例胸腔积液患者中71例(69.61%)为结核性胸膜炎,31例(30.39%)为非结核性胸膜炎(包括肺癌16例,细菌性胸膜炎15例)。T-SPOT.TB灵敏度和特异性分别为:PBMC(≥6个斑点)为84.51%和70.97%,结核分枝杆菌培养、涂片抗酸杆菌染色灵敏度仅为4.23%、2.82%;结核抗体、ADA灵敏度分别为52.11%、71.83%。结论外周血T-SPOT.TB检测是诊断结核性胸膜炎一项有效的辅助诊断方法。     

Adenosine deaminase 2 in the diagnosis of tuberculous pleuritis

PURPOSE: We examined the usefulness of adenosine deaminase 2 (ADA2) in the diagnosis of tuberculous pleuritis. SUBJECTS: A hundred cases, 78 male and 22 female, with pleural effusion were examined. With regard to pleural effusion, 18 cases were transudate and 82 cases (9 tuberculous pleuritis, 27 lung cancer, 8 mesothelioma, 5 malignant diseases except lung cancer and mesothelioma, 5 benign asbestos pleurisy, 10 empyema, 10 parapneumonic effusion, one SLE, one parasitic infection, and 6 undetermined etiology) were exudates. The last 6 cases with unknown origin were excluded in this study. RESULTS: Pleural adenosine deaminase (ADA) was 90.4 +/- 22.4 U/l (mean +/- SD) and pleural ADA2 was 80.4 +/- 21.9 U/l in tuberculous pleuritis, both were significantly higher than those in non-tuberculous exudates (p < 0.001). In the diagnosis of tuberculous pleuritis, pleural ADA showed 100% sensitivity and 88% specificity, whereas pleural ADA2 showed 100% sensitivity and 91% specificity. CONCLUSION: Pleural ADA2 is useful in the diagnosis of tuberculous pleuritis, which has similar sensitivity and a little better specificity compared with pleural ADA.     

腺苷脱氨酶在胸腔积液鉴别诊断中的作用

目的探讨腺苷脱氨酶(ADA)在胸腔积液鉴别诊断的价值。方法用G iusti比色法测定187例胸腔积液中胸水ADA水平。结果以ADA≥45U/L为阳性界值,阳性率结核性胸膜炎占80%(48/60例);漏出液占11.6%(5/43例);恶性肿瘤占19.7%(12/61例);肺炎、脓胸占28.6%(4/14例);经t检验结核性胸膜炎与非结核性胸腔积液ADA≥45U/L水平时有显著差异(P<0.01)。结论ADA在结核性胸腔积液中有应用价值,但需与PPD试验、结核中毒症状、血沉增快等因素综合考虑。     

联合测定分泌型白细胞蛋白酶抑制因子和腺苷脱氨酶在结核性胸腔积液中的诊断意义

目的探讨联合测定胸腔积液中分泌型白细胞蛋白酶抑制因子（SLPI）和腺苷脱氨酶（ADA）浓度对结核性胸腔积液的诊断价值。方法收集103例胸腔积液及其同源外周血,其中结核性胸腔积液组为45例,恶性胸腔积液组31例,细菌性胸腔积液组16例,漏出液组11例。应用ELISA法测定胸水上清液和血清中SLPI的浓度,用比色法测定ADA水平,并对结果及意义进行分析。结果 （1）结核组SLPI浓度（193790±15476）pg/ml,与恶性组（121700±13101）pg/ml、细菌组（92885±26962）pg/ml、漏出液组（109360±21619）pg/ml相比差异均有统计学意义（P〈0.05）;恶性组、细菌组及漏出液组间相比差异均无统计学意义（P〉0.05）。结核组及细菌组ADA水平与恶性组及漏出液组比较差异有统计学意义（P〈0.05）。（2）受试者工作特征曲线（ROC曲线）结果显示,胸腔积液SLPI浓度对于诊断结核性胸腔积液的最佳阈值为236071pg/ml,曲线下面积（AUC）为69.9%（95%可信区间为58.2%～81.6%）,灵敏度和特异度分别为43.2%和91.4%（P〈0.05）;ADA对于诊断结核性胸腔积液的曲线下面积、灵敏度、特异度、诊断阈值分别是71.9%（可信区间60.9%～82.8%）、75%、64.2%和29.5（P〈0.001）;SLPI和ADA同时高于各自的诊断阈值,得出最佳诊断特异度为95%;SLPI或ADA高于诊断阈值,得出最佳诊断灵敏度为89%。结论单独测定SLPI及ADA均有助于诊断结核性胸腔积液,但联合测定更能提高诊断效能。     

The usefulness of pleural biopsy in benign or malignant pleurisy

Retrospective studies of pleural biopsy, cytology and ADA in pleural effusion were performed in 116 patients with pleural effusion between 1980 and 1988. Pleural malignant disease was diagnosed in 25 patients (75.8%) by cytology, in 19 patients (57.6%) by pleural biopsy. Thus, cytology should be performed first in patients with pleurisy. Both of cytologic study and CEA in pleural effusion were negative in 3 cases of squamous cell carcinoma. Tuberculous pleuritis was diagnosed in 24 patients (50.0%) by pleural biopsy, in 5 patients (10.4%) by isolation of Mycobacterium tuberculosis. Both pleural biopsy and adenosine deaminase activity (ADA) were examined in 19 cases of tuberculous pleuritis and ADA was elevated in 16 patients (84.2%). These data suggested that pleural biopsy was useful for diagnosis of pleuritis and the combination of cytology, tumor markers and ADA with biopsy improved diagnostic rates of pleuritis.     

Diagnosis and treatment of tuberculous pleurisy--with special reference to the significance of measurement of pleural fluid cytokines

Tuberculous pleurisy as well as malignant pleuritis is a representative disease presenting pleural effusion. The diagnosis of tuberculous pleurisy is made from examination of pleural effusion, but the sensitivity of smear or culture of Mycobacterium tuberculosis from pleural fluid is generally low. Although the pleural fluid concentration of adenosine deaminase (ADA) is useful in terms of sensitivity or specificity, the value could be high in empyema or rheumatoid pleuritis. Thoracoscopic biopsy of pleura is more sensitive rather than conventional percutaneous needle biopsy, but is more invasive. Tuberculous pleural effusion is caused by delayed allergy which macrophage and T-helper 1 cells mainly relate and the stimuli of bacterial body consecutively induces T-helper 1 cytokines. Pleural fluid interferon-gamma (INF-gamma) is important not only in pathogenesis but also in diagnosis. We demonstrated that INF-gamma is a more sensitive and specific indicator for tuberculous pleurisy than ADA using receiver operating characteristics (ROC) analysis. Cytometric bead array (CBA) is a tool to simultaneously measure abundance of various cytokines and is expected to be a very useful method to provide informations for understanding a feedback mechanism of cytokine network. It is needed to clear the immunity in pleural fluid and to establish the less invasive and more useful method to diagnose tuberculous pleurisy.     

Tumour necrosis factor-alpha in comparison to adenosine deaminase in tuberculous pleuritis

BACKGROUND: Adenosine deaminase (ADA) is already used for the differential diagnosis of tuberculosis pleurisy. Tumour necrosis factor-alpha (TNF) is another marker which has been investigated for this purpose. OBJECTIVE: We evaluated the diagnostic value of pleural fluid and serum TNF concentrations in tuberculous pleuritis and compared them to ADA. METHODS: Sixty-two patients (24 tuberculous pleuritis, 38 non-tuberculous pleuritis) with exudative pleurisy were included. Serum and pleural fluid TNF concentrations were determined in all patients and ADA activity in 54 patients. Pleural fluid TNF concentrations and pleural fluid/serum TNF were compared to pleural fluid ADA activity and pleural fluid/serum ADA. RESULTS: When the tuberculous and non-tuberculous groups were compared, pleural fluid TNF concentrations (65.4 +/- 136.9 pg/ml vs. 54.5 +/- 144.2 pg/ml, respectively; p < 0.001), pleural fluid ADA activity (74.2 +/- 33.3 U/l vs. 23 +/- 16.3 U/l; p < 0.0001), pleural fluid/serum TNF (2.55 +/- 5.23 vs. 0.26 +/- 0.2; p < 0.001) and pleural fluid/serum ADA (4.58 +/- 8.14 vs. 1.15 +/- 0.7; p < 0.0001) were significantly higher in the tuberculous group. When cut-off points were assessed, 8 pg/ml and 40 U/l were found for pleural fluid TNF concentrations and pleural fluid ADA activity, respectively. Sensitivity, specificity, area under the curve were 87.5%, 76.3%, 0.772 for pleural fluid TNF concentrations and 90.9%, 89.5%, 0.952 for pleural fluid ADA activity, respectively; the difference between these areas under the curves was significant (p < 0.05). CONCLUSIONS: Pleural fluid TNF levels and pleural fluid/serum TNF were higher in tuberculous effusions than in other exudates, but their diagnostic value appears to be poorer than that of ADA.     

Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid

OBJECTIVES: Tuberculosis, a reemergent killer, is threatening to assume serious proportions all over the world, particularly in view of the AIDS pandemic. The detection of mycobacterial DNA by polymerase chain reaction (PCR) in clinical samples is a promising approach for the rapid diagnosis of tuberculous infections. The aims of this study were to evaluate PCR for detection of Mycobacterium tuberculosis in pleural fluids and to correlate the results with adenosine deaminase activity (ADA) estimation and acid-fast bacilli (AFB) screening. METHODS: The sensitivity and specificity of PCR in detection of mycobacterial DNA in 20 samples of tuberculous pleural effusion were evaluated using 40 samples of nontubercular pleural effusion as controls. The results were correlated with the ADA in all 60 pleural fluids. In addition, AFB detection by Ziehl-Neelsen staining on cytospin smears of all pleural fluids was also compared. RESULTS: Of the 20 samples of tuberculous pleural effusion, mycobacterium could be detected by AFB staining in 4 samples. Fourteen samples were PCR positive. None of the samples from the control group were AFB or PCR positive. The sensitivity of PCR, therefore, was 70.0% with specificity of 100% (positive predictive value, 100%; negative predictive value, 86.95%). The sensitivity of AFB screening was at best 20%. The mean of ADA values in tubercular pleural effusions was 63.21 U/L (SD, 33.01), and the mean in the control samples was 51.1 U/L (SD, 29.71). Taking a cut-off value of 50 U/L, both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were only 55%. CONCLUSION: PCR represents a rapid and sensitive method for the detection of mycobacterial DNA in tuberculous pleural effusions. AFB screening has low sensitivity, and ADA estimation has both low sensitivity and specificity. Therefore, when the clinical suspicion is high and smear result is negative, but the signs and symptoms of M tuberculosis are apparent, PCR is the method of choice for identifying the infection.