Pleural fluid ADA,IgA‐ELISA and PCR sensitivities for the diagnosis of pleural tuberculosis

The diagnosis of pleural tuberculosis (pTB) is difficult, and more sensitive and specific techniques are needed. In the period August 1998 to November 2002, we evaluated 132 patients with a pleural effusion submitted to a thoracentesis and pleural biopsy in a tertiary care hospital in Rio de Janeiro, Brazil. Three tests were performed and compared in the pleural fluid: ADA activity measurement, IgA‐ELISA for two combined specific Mycobacterium tuberculosis antigens, and polymerase chain reaction (PCR) for detection of M. tuberculosis DNA. Ninety‐five patients (72%) were given a final diagnosis of pTB. Overall histopathologic sensitivity was 77%. The sensitivities of pleural fluid culture and AFB smear were 42% and 1%, respectively. Twenty‐one (22%) additional patients had a clinical diagnosis of pTB. Median follow‐up time of all TB patients after the completion of antituberculous treatment was 13 months. Sensitivities of ADA, IgA‐ELISA and PCR were 91%, 78% and 82%, while specificities were 93%, 96% and 85%, respectively. Only ADA sensitivity was significantly higher than the histopathologic examination (McNemar χ² test; p = 0.002) and also significantly higher than ELISA (p = 0.049), but not higher than PCR (p = 0.143). We conclude that the routine use of ADA activity measurement in pleural fluid can obviate the need for a pleural biopsy in the initial diagnostic approach to pleural effusions, while IgA‐ELISA and PCR techniques, potentially more specific tests, need further refinement to improve their accuracy.     

结核杆菌γ-干扰素体外释放试验对结核性胸腔积液的诊断价值

目的探讨体外释放酶联免疫法检测结核杆菌γ-干扰素(TB-IGRA)对结核性胸腔积液的诊断价值。 方法收集济宁医学院附属医院呼吸科2014年1～9月诊治的55例结核性和49例恶性胸腔积液患者的病例资料,对患者进行TB-IGRA、细菌涂片镜检、结核菌素皮试(PPD)和结核杆菌抗体等检测,并对以上诊断方法进行比较分析。同时联合检测血清癌胚抗原(CEA)及胸腔积液腺苷脱氨酶(ADA),以评估TB-IGRA联合CEA和ADA对鉴别诊断结核性胸腔积液的意义。采用SPSS 17.0统计软件进行数据分析,阳性例数以率表示,并进行卡方检验。CEA和ADA的测定值用均数±标准差表示,显著性检验用t检验。 结果55例结核组患者TB-IGRA阳性53例,达96.36%;49例恶性组患者TB-IGRA阳性1例,仅2.04%,两组差异有统计学意义(χ²＝88.62,P<0.05)。结核组血清CEA水平[(2.34±1.80)μg/L]显著低于恶性组[(2 358.68±1 069.40)μg/L,t＝－15.42,P<0.05];胸腔积液ADA水平[(57.51±26.90)U/L]显著高于恶性组[(14.43±3.57)U/L,t＝11.76 ,P<0.05]。结核组中TB-IGRA、涂片镜检、PPD试验以及结核杆菌抗体的阳性率分别为96.36%、22.64%、46.67%和35.14%,TB-IGRA的阳性检测率最高(χ²＝78.60,P<0.05);TB-IGRA对诊断结核性胸腔积液的敏感度(95.65%)、特异度(96.77%)、阳性预测值(97.78%)、阴性预测值(93.75%)及准确性(92.42%)最高。 结论与传统的检测指标相比,TB-IGRA更具灵敏性和特异性;TB-IGRA联合CEA、ADA检测对诊断结核性胸腔积液具有极为重要的临床价值。     

Diagnostic value of leptin in tuberculous pleural effusions

It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE). We evaluated the diagnostic value of pleural fluid and serum leptin levels in TPE and compared them with adenosine deaminase (ADA). Forty-five patients, 17 tuberculous effusion and 28 nontuberculous effusion, with exudative pleural effusions were included. Leptin and ADA levels were measured from serum and pleural fluid in all patients. There were no statistically significant differences between tuberculous and nontuberculous groups with respect to the serum ADA activity and pleural fluid/serum leptin ratio. On the contrary, pleural fluid leptin level, pleural fluid ADA activity, serum leptin level and pleural fluid/serum ADA activity ratio were statistically different between tuberculous and nontuberculous groups. When leptin levels were corrected for body mass index, serum leptin levels did not reach statistical significance. Cut-off points to predict tuberculosis were calculated as 9.85 ng/ml and 35.55 U/l for pleural fluid leptin level and pleural fluid ADA activity, respectively. Sensitivity, specificity and area under the curve +/- standard error were 82.4%, 82.1%, 0.83 +/- 0.07 for pleural fluid leptin levels and 100%, 100%, 1.00 +/- 0.00 for pleural fluid ADA activity, respectively; the difference between these curves was significant (p = 0.01). Pleural fluid leptin levels were lower in tuberculous effusions than in other exudates. Pleural fluid leptin has a diagnostic value for TPE but not as good as that of ADA.     

Concurrent measurement of adenosine deaminase and dipeptidyl peptidase IV activity in the diagnosis of tuberculous pleural effusion

Measurement of pleural fluid adenosine deaminase (ADA) levels aids diagnosing tuberculous pleural effusion (TPE). Dipeptidyl peptidase IV (DPP) enzyme is closely related to ADA. Our aim was to determine the value of concurrent measurement of these T-cell–associated enzymes, ADA and DPP levels in the diagnosis of TPE. Patients with pleural effusion were grouped as TPE, parapneumonic, malignant, congestive heart failure related, and miscellaneous pleural effusions. Pleural and serum ADA and DPP levels were measured. Pleural and serum levels of ADA and pleural DPP were higher in TPE group than the rest. In 7 patients, pleural biopsy revealed granulomatous pleuritis. All of these patients had TPE and had elevated serum and pleural ADA levels. Serum and pleural ADA or DPP levels and pleural ADA and DPP levels correlated with each other. Selecting cutoff values of 40 and 27 IU/L for pleural ADA and DPP, respectively, the sensitivity of concurrent measurement of both enzymes was 77%, specificity 94%, and diagnostic efficiency 91%. ADA and DPP play an important role in tuberculous immunopathogenesis. The utility of DPP in the diagnosis of TPE has never been determined before. Concurrent measurement of ADA–DPP can aid in diagnosing TPE with higher specificity, sensitivity, and efficiency.     

腺苷脱氨酶和癌胚抗原联合检测在良恶性胸腔积液鉴别诊断中的价值

目的 探讨腺苷脱氨酶(ADA)和癌胚抗原(CEA)联合检测在临床良恶性胸腔积液鉴别诊断中的价值.方法 采用速率法检测胸腔积液ADA活性,免疫化学发光法检测胸腔积液CEA的含量.结果 63例结核患者胸腔积液CEA阳性4例,阳性率为6.3%;24例癌性胸腔积液CEA检测阳性 19例,阳性率为 79.2%.癌性胸腔积液CEA阳性率明显高于结核性胸腔积液组,差异有统计学意义(P<0.01).ADA的活性在结核性和癌性胸腔积液中分别为(69.5±13.2)U/L和(13±6.3)U/L,以ADA>40 U/L为诊断结核的临界值,其阳性率为73%(46/63).结论 联合检测胸腔积液ADA、CEA在结核性胸腔积液与癌性胸腔积液鉴别诊断中有重要的临床意义.     

不同类型标本腺苷脱氨酶对结核病诊断界点确定

目的探讨血清、胸腹腔积液、脑脊液中腺苷脱氨酶(ADA)测定对结核性胸腹腔积液、结核性脑膜炎诊断及鉴别诊断的临床应用价值。并通过ROC曲线分别确定胸腹腔积液、脑脊液中ADA测定对结核具有最佳诊断价值的界点。方法测定实验组与对照组血清、胸腹腔积液、脑脊液中的ADA。结果胸腹腔积液、脑脊液、血清中ADA对结核病诊断的阳性率分别达到了94.1%,60%,71.2%,30%,明显高于两种传统方法(P<0.01)。通过ROC曲线确定出胸腹腔积液、脑脊液ADA测定对结核病具有最佳诊断价值的界点分别为20和14U/L。结论血清、胸腹腔积液、脑脊液中ADA测定对结核病具有较高临床应用价值,但不同标本类型具有不同诊断界点。     

Cope needle biopsy

I reviewed the results of 143 Cope needle biopsies in 121 patients. Diagnostic biopsies were obtained in 26 patients. Two patients with rheumatoid pleuritis had suggestive pleural fluid. Seventeen of the 19 patients with malignancy had diagnostic pleural fluid cytology. Seven additional patients with nondiagnostic biopsies had diagnostic pleural fluid cytology. In four of five patients with tuberculosis, Mycobacterium tuberculosis grew from cultures of pleural fluid. One additional patient with a nondiagnostic biopsy also had a pleural fluid culture that grew M tuberculosis. Pleural biopsy was the sole means of diagnosis in only two patients. Diagnostic yield was not increased in the 21 patients who had multiple biopsies. In the diagnosis of malignancy, pleural fluid cytology was superior to pleural biopsy. In the diagnosis of tuberculosis, pleural fluid culture was as good as pleural biopsy. Cope needle biopsy should be done only when a strong suspicion of pleural malignancy or tuberculosis exists.     

25例不明原因胸腔积液患者内科电子胸腔镜检查结果分析

目的探讨内科电子胸腔镜在不明原因胸腔积液诊断中的临床应用价值及与血清癌胚抗原(CEA)、胸苷激酶1(TK1)及胸水腺苷脱氨酶(ADA)的相关性。方法回顾性分析2015年1月-2015年11月该科接受可弯曲内科电子胸腔镜检查的25例不明原因胸腔积液患者临床病理资料及血清CEA、TK1及胸水ADA检查结果。结果在25例不明原因的胸腔积液患者中,有22例得以明确诊断,确诊率高达88.00%。包括恶性胸腔积液9例(36.00%),结核性胸腔积液11例(44.00%),炎性胸腔积液2例(8.00%),未能明确诊断胸腔积液3例(12.00%);恶性组TK1血、CEA胸水/CEA血阳性率明显高于结核组和炎性组,结核组ADA胸水阳性率明显高于恶性组和炎性组。结论内科电子胸腔镜检查确诊率高,创伤性小,并发症少,安全性高,是诊断不明原因胸腔积液的有效手段,有着广泛的临床应用前景,与血清CEA、TK1及胸水ADA等相结合有助于提高不明原因胸腔积液的确诊率。     

探讨渗出性胸腔积液ADA、CEA对良恶性胸腔积液的诊断价值

目的 探究渗出性胸腔积液腺苷脱氨酶(ADA)、癌胚抗原(CEA)对良恶性胸腔积液的诊断价值.方法 选择2017年1月至2020年8月本院收治的106例渗出性胸腔积液患者,将患者分为恶性组(n=36)和良性组(n=70).对两组患者胸水ADA、胸水CEA、血清CEA水平进行比较,采用单因素、多因素Logistic回归分析...     

Adenosine deaminase in body fluids: a useful diagnostic tool in tuberculosis

The performance of a colorimetric ADA determination in body fluids other than serum in the diagnosis of tuberculosis was assessed in 1063 patients from whom pleural (600), peritoneal (136), pericardial (77), or cerebrospinal (250) fluids were obtained. In exudative pleuroperitoneal and pericardial effusions, an ADA decision level of 0.71 mu kat/L displayed a sensitivity of 1.00, and was higher than those of histologic (0.83) and bacteriologic (0.62) studies. At this level, ADA reached a specificity of 0.92 and efficiency of 0.94. In cerebrospinal fluid, an ADA catalytic concentration above 0.15 mu kat/L strongly suggests tuberculous meningitis in patients older than 7 years (sensitivity 1.00, specificity 0.99 and efficiency 0.99). ADA results obtained with a UV-method were closely correlated with those of the colorimetric method in pleuroperitoneal effusions (r = 0.989) and in cerebrospinal fluids (r = 0.905). Sample blanks should be processed, otherwise false positive results may be found in non-tuberculous cerebrospinal fluids (5.3%) and pleuroperitoneal effusions (3.8%).     

四联检测在结核性与恶性胸腔积液中的临床价值

目的探讨腺苷脱氨酶(ADA)、C反应蛋白(CRP)、癌胚抗原(CEA)和内皮抑素(Endostatin)对恶性及结核性胸腔积液鉴别诊断的价值。方法分别采用酶比色法测定ADA值;采用速率散射比浊法测定CRP浓度;采用酶联免疫吸附试验(ELISA)测定CEA和内皮抑素水平。并根据临床资料进行回顾性分析,对各组的ADA、CRP、CEA、内皮抑素水平进行比较。结果在结核性胸腔积液中,ADA[(54.73±20.17)U/L]和CRP[(32.48±19.17)mg/L]均明显高于癌性胸腔积液(P0.01);相反,在癌性胸腔积液中,CEA[(55.45±37.66)μg/L]与内皮抑素[(138.09±81.11)μg/L]的均值都显著高于结核性胸腔积液(P0.01)。结论ADA、CRP、CEA和内皮抑素四联检测在结核性与恶性胸腔积液中的鉴别诊断中具有显著的临床意义。     

腺苷脱氨酶用于结核性与肿瘤性胸腹水鉴别诊断的meta分析

目的　评价腺苷脱氨酶(ADA)用于结核性与肿瘤性胸腹水诊断的价值。方法　对入选的8篇文献(3篇腹水文献和5篇胸水文献)进行齐性检验、两个均数之差的合并及meta统计分析。结果　腹水标本结核组ADA含量比肿瘤组高1. 559 4~6. 206 6倍标准差;胸水标本结核组ADA含量比肿瘤组高0. 627 3~3. 264 7倍标准差,差异均有显著性(P<0. 001)。结论　ADA检测是鉴别诊断结核性与肿瘤性胸腹水的快速、简便、特异、敏感的方法。     

渗出性胸腔积液135例诊断分析

目的 探讨腺苷脱氨酶(ADA)、癌胚抗原(CEA)、糖类抗原153(CA153)、神经元烯醇化酶(NSE)、糖类抗原199(CA199)对渗出性胸腔积液鉴别诊断的价值.方法 应用电化学发光法测定胸腔积液患者的血清及胸水CEA、CA153、NSE、CA199水平,采用酶偶联速率法测定胸水ADA水平,并评价联合检查对胸腔积液的诊断价值.结果 结核性胸腔积液组胸水ADA含量为(65.89±19.81)U/L,恶性组为(27.44±22.64)U/L,炎性组为(17.33±16.58)U/L,结核组显著高于其余2组(q=12.19、10.72,P均＜0.01).结性胸腔积液组ADA阳性29例(82.88%),恶性组11例(13.41%),炎性纽2例(11.11%),组间比较差异有统计学意义(X~2=59.07,P＜0.01).恶性胸腔积液组CEA、CA153、NSE、CA199含量和阳性率均高于结核组,差异均有统计学意义(P均＜0.05),炎性组和恶性组相比差异无统计学意义.82例恶性胸腔积液患者血清4项肿瘤标记物联检阳性率为74.3%(61/82),胸腔积液中阳性率为82.9%(68/82).结论 ADA、CEA、CA153、NSE、CA199联合检测对胸腔积液的鉴别诊断具有一定意义.     

胸腔积液ADA、CRP和LAM-IgG联合检测的鉴别诊断价值

目的探讨胸腔积液腺苷脱氨酶(ADA)、C反应蛋白(CRP)、阿拉伯糖甘露糖脂抗体(LAM-IgG)联合检测对良恶性胸腔积液鉴别诊断的意义。方法以氨试剂法、散射比浊法和金标渗滤法同时检测了48例结核性胸水、27例癌性胸水和31例非结核炎性胸水的ADA、CRP和LAM-IgG。结果结核性胸水ADA、CRP活性明显高于癌性胸水(P<0.01),其它炎性胸腔积液CRP含量明显高于结核性和恶性胸腔积液(P<0.01);以ADA>30u/L,CRP>8mg/L,及LAM-IgG阳性等单个指标来诊断结核性胸腔积液,其敏感性达到95.7%,特异性为98.1%;以ADA<30u/L,CRP<8mg/L,及LAM-IgG阴性等单个指标来诊断恶性胸腔积液,其敏感性达到98.7%,特异性为97.1%。结论ADA、CRP、LAM-IgG联合检测可为良恶性胸腔积液的鉴别诊断提供可靠的实验室依据。     

胸水中CYFRA21－1测定的临床意义

利用ＢｏｅｈｒｉｎｇｅｒＭａｎｎｈｅｉｍ公司的ＣＹＦＲＡ２１－１酶免疫分析试剂盒，测定了已有明确诊断的１３０例胸腔渗漏液标本。结果表明，ＣＹＦＲＡ２１－１对于癌性胸水的诊断敏感性为６１．３％，特异性为８７．３％，准确度为７２．３％。若同时利用ＡＤＡ活性测定排除结核性胸膜炎，则其特异性可达９２．８％。揭示ＣＹＦＲＡ２１－１测定对胸水良恶性的诊断与鉴别诊断具有重要的临床价值。     

ADA、TB-Ab-IgG检测对结核性胸膜炎诊断及鉴别诊断的临床价值

目的探讨胸水和血清腺苷脱氨酶（ADA）、结核抗体（TB—Ab—IgG）检测对结核性胸膜炎的诊断价值。方法采用斑点金免疫渗滤试验（DIGFA）和酶连续监测法对117例患者进行胸水和血清TB_Ab．IgG和ADA检测分析。结果87例结核性胸膜炎患者胸水、血清中TB-Ab-IgG的敏感性分别为62．0％和70．1％,特异性分别为93．1％和86．6％。ADA活性在结核性和癌性胸水中分别为52．51和10．26U／L（P〈0．01）。以胸水ADA≥40U／L做为诊断结核的临界值,其敏感性为79．3％,特异性为86．6％;以胸水ADA／血清ADA〉1．00为临界值,其敏感性为97．7％,特异性为96．6％。结论胸水和血清ADA、TB—Ab—IgG检测对结核性胸膜炎和非结核性胸膜炎具有诊断和鉴别诊断价值。     

Informative value of adenosine deaminase and 2-deoxyadenosine deaminase in the diagnosis of tuberculous pleurisy

Adenosine deaminase (ADA) and 2-deoxyadenosine deaminase (2-deoxyADA) activities were measured in pleural exudation of different origin in 373 patients (124 of these with serous tuberculous pleurisy and 75 with specific empyema). High diagnostic value of ADA activity in the presence of threshold value higher than 35 Units/liter was established: the sensitivity of the test in the diagnosis of tuberculous pleurisy and empyema was 94.4 and 93.3% respectively, specificity 93.0 and 89.5%, respectively. Judging by the coefficient of 2-deoxyADA/ADA, total ADA activity is determined by the activity of ADA-2 isoenzyme, while in tuberculous empyema by ADA-1. Additional use of this coefficient, requiring measurement of 2-deoxyADA activity, does not improve the efficiency of the diagnostic process, including measurement of total ADA activity in pleural exudate.     

腺苷脱氨酶及C-反应蛋白检测对胸腔积液鉴别诊断的临床意义

目的探讨腺苷脱氨酶(ADA)及C-反应蛋白(CRP)检测对诊断结核性与癌性胸腔积液的价值。方法对临床确诊的93例结核性和56例癌性患者胸腔积液分别进行ADA及CRP的检测,并对结果进行比较分析。结果结核性患者胸腔积液ADA和CRP的水平含量分别为(51±7)U/L、(27.0±8.4)mg/L;癌性患者胸腔积液ADA和CRP的水平含量分别为(19±4)U/L、(14.0±5.7)mg/L,两者比较差异均有统计学意义(P<0.05)。结论 ADA及CRP检测在鉴别结核性和癌性胸腔积液方面具有较好的实用价值和临床意义。     

胸膜厚度、腺苷脱氨酶、胸腔积液癌胚抗原/血清癌胚抗原比值对恶性与结核性胸腔积液的鉴别诊断价值

目的评价胸膜厚度、腺苷脱氨酶（ADA）、胸腔积液癌胚抗原/血清癌胚抗原（胸腔积液CEA/血清CEA）比值在恶性与结核性胸腔积液的鉴别诊断中的价值。方法选择经胸腔镜病理组织检查确诊胸腔积液患者91例,按病理结果分为2组,结核性胸膜炎组（结核性组）43例和恶性胸腔积液组（恶性组）48例。对2组患者胸腔积液CEA/血清CEA比值、ADA和CT影像学上表现的胸膜厚度、胸腔积液密度变化进行比较。结果恶性组胸腔积液CEA/血清CEA比值高于结核性组[6.72±6.9 vs 0.82±0.43（t=-3.832,P=0.001）,ADA水平低于结核性组（21.9±6.5）vs（50.3±31.9）U/L（t=4.474,P=0.000）];恶性组胸膜厚度〉10.0 mm且以弥漫型为主,结核性组胸膜厚度6.0 mm左右且以局限性为主;胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测的灵敏度、特异度、灵敏度/1-特异性（AUC）分别为90.0%、96.0%、0.869,均高于单检和2项联检,且3项联检的特异度与胸腔积液CEA/血清CEA＋ADA、胸膜厚度＋胸腔积液CEA/血清CEA联检的特异度比较差异均有统计学意义（均P〈0.05）。结论胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测对鉴别恶性与结核性胸腔积液有较高的临床价值。     

胸水生化检查对结核性和恶性胸水的诊断价值

[目的]检测胸水中腺苷脱氨酶（adenosine deaminase,ADA）、乳酸脱氢酶（lactate dehydrogenase,LDH）、葡萄糖（Glucose,Glu）和总蛋白（total protein,TP）的水平,探讨其对结核性和恶性胸水的诊断价值。[方法]对所收集的标本进行胸水生化项目检测,并对结果统计分析。[结果]结核性胸水中ADA、TP含量明显高于恶性胸水,LDH和Glu明显低于恶性胸水,由ROC曲线得到ADA诊断结核性胸水最佳临界值为31．56U／L,此时灵敏度为77．2％,特异性为92．6％,当其值〉125U／L时,可以排除恶性胸水。[结论]联合检测有助于结核性和恶性胸水的诊断及鉴别诊断。