胸水和血清ADA、TB-Ab-IgG联合检测对结核性胸膜炎的诊断探讨

目的 探讨胸水/血清腺苷脱氨酶(ADA)、结核抗体(TB-Ab-IgG)联合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234例胸腔积液进行胸水/血清ADA和TB-Ab-IgG检测结果进行分析.结果 结核性胸膜炎患者174例其胸水、血清中TB-Ab-IgG的阳性率分别为62.0%和70.1%,特异性分别为93.1%(56/60)和86.6%(52/60).ADA活性在结核性和癌性胸腔积液中分别为(59.58±29.85)U/L和(15.31±7.36)U/L(P<0.01).以P-ADA>40 U/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 胸水和血清ADA、TB-Ab-IgG联合检测在结核性胸膜炎与非结核性胸膜炎上具有诊断与鉴别诊断价值.     

结核性胸膜炎与ADA活性

腺苷脱氨酶(ADA)可使腺苷加水分解生成肌苷和氨,有报告证明先天性免疫不全综合征的小儿存在ADA 缺陷,因此两者的关系受到人们的重视。胸水中以淋巴细胞为主的代表性疾病有结核性胸膜炎和癌性胸膜炎。近年由于肺癌和老年结核性胸膜炎的增加,两者的鉴别在临床上极为重要.胸水中ADA 活性测定对两者具有鉴别诊断价值。测定191例胸水中ADA 活性值,结果恶性肿瘤平均为29.8±68.8U/L,结核性胸膜炎者为106.0±44.7U/L.此外,胸水中ADA 值大于50U/L时,结核性胸水阳性率达97.7%,恶性肿瘤为6.1%,良性非结核     

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。     

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。     

胸水ADA、TB-DNA联合检测在结核性胸膜炎中的诊断运用

目的分析胸水ADA、TB-DNA联合检测对结核性胸膜炎诊断运用价值。方法对我院收治的结核性胸膜炎患者183例、癌性胸水患者65例以及炎性胸水患者49例作为研究对象,分别进行ADA、TB-DNA的检测,并对ADA、TB-DNA在三种疾病中的阳性率以及对结核性胸膜炎的敏感度、特异性以及准确性进行分析。结果结核性胸膜炎患者的ADA含量(72.3±23.2 IU/L)明显高于炎性胸水患者(38.4±12.9 IU/L)以及癌性胸水患者(24.3±6.5 IU/L);ADA、TB-DNA联合检测对结核性胸膜炎的特异性84.2%,敏感性98.91%以及准确性为93.26%。结论对结核性胸膜炎患者采用胸水ADA、TB-DNA联合检测可明显提高其检出率,并有助于对结核性胸膜炎胸水、癌性胸水以及炎性胸水的鉴别。     

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。     

腺苷脱氨酶在胸水诊断中的临床应用价值

136例胸水患者,结核性组112例,癌性组24例。胸水腺苷脱氨酶(ADA)≥40U/L者结核性组98例,癌性组1例。ADA增高在结核性胸水中敏感性87.5％,特异性95.8％,准确性89.0％。结核性组和癌性组治疗前胸水ADA分别为(54.63±16.83)和(17.50±9.78)U/L(P<0.05),治疗后为(19.05±6.35)和(15.58±6.09)U/L。结核组治疗后ADA显著下降     

蛋白芯片技术快速诊断结核性胸膜炎的价值探讨

目的探讨结核蛋白芯片对结核性胸膜炎及其它类型胸腔积液的鉴别诊断价值。方法选取结核性胸膜炎患者49例,肺炎旁胸腔积液、恶性胸腔积液及其它胸腔积液患者48例,分为结核组和非结核组,均行结核分枝杆菌LAM、38KD、16KD抗原蛋白芯片检测。结果结核组敏感性为46．9％（23／49）,非结核组特异性为87．5％（42／48）。阳性预测值及阴性预测值分别为79．3％（23／29）及61．8％（42／68）。两组阳性率比较有显著性差异（P〈0．01）。结论结核蛋白芯片检测可将结核性胸膜炎和其它原因的胸腔积液有效区分,虽然其敏感性较胸膜活检、胸膜结核杆菌培养、胸液腺苷酸脱氨酶检测等没有优势,但特异性尚可,简便快速,可做为鉴别胸腔积液的辅助手段。     

腺苷脱氨酶在胸水性质鉴别的临床应用

目的 研究腺苷脱氨酶（ADA）在鉴别胸水性质的临床应用价值.方法 以确诊为结核性胸水59例设为结核组,其他98例非结核性胸水设为非结核组,比较两组胸水ADA及与相应的血清ADA比值（P/S ADA）,并以TB-Ab检测结果为对照,研究ADA对结核性胸水性质鉴别的方法学指标.结果 结核组胸水ADA（64.3±16.7）、P/S ADA（4.1±2.8）与非结核组有差异统计学（P〈0.05）,血清ADA无统计学差异（P〉0.05）;结核组胸水ADA阳性率（96.6%）与TB-Ab阳性性（93.2%）比较无统计学差异（P〉0.05）,非结核组ADA阳性率（5.1%）与TB-Ab阳性性（12.2%）有统计学差异（P〈0.05）;胸水ADA灵敏度、特异度、约登指数、符合率及阴（阳）性预测值均优于胸水TB-Ab.结论 ADA相对于结核性胸水的鉴别诊断有重要的临床价值.     

蛋白芯片检测诊断结核病分析

目的探讨结核蛋白芯片检测对诊断结核病的价值。方法使用蛋白芯片系统检测患者血清结核抗体,蛋白芯片技术检测结核分枝杆菌(MTB)中5种成分,即ESAT-6、CFP10、LAM、38KD和16KD。结果共检测4439例,其中结核病458例,非结核病3931例,HIV/AIDS组(其中结核病12例,非结核病38例)。458例结核病患者中315例结核抗体阳性,阳性率为68.78%;3931例非结核病例734例阳性,阳性率为18.67%;HIV/AIDS组(结核病患者阳性率66.67%,非结核病例阳性率为28.95%)。结论结核蛋白芯片是诊断结核病的较有效方法,具有特异性好、快速方便等优点,对结核病快速辅助诊断起积极作用。     

Measurement of adenosine deaminase activity (ADA) in the pleural fluid

ADA was examined in pleural fluid in cases of tuberculous and cancerous pleurisy. The level of ADA in pleural fluid in tuberculosis group (59.6 +/- 33.6 U/L) was significantly higher than that of cancerous group (13.3 +/- 4.0 U/L) (P less than 0.01). The positive rates were 90.0% and 3.3% respectively.     

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。     

Adenosine deaminase in pleural fluids. Test for diagnosis of tuberculous pleural effusion

Adenosine deaminase (ADA) activity was studied in 221 patients with pleuroperitoneal effusions. Patients were subdivided into the following six groups: (1) 48 cases of tuberculosis; (2) 46 with malignancies; (3) 30 postpneumonic effusions; (4) 19 cases of several diseases; (5) 18 patients with pleural effusions of unknown origin; and (6) 60 with acellular transudates. Mean ADA activity was 92.43 +/- 29.43 U/L 37 degrees C in group 1; 13.43 +/- 10.69 in group 2; 19.91 +/- 19.64 in group 3; 14.27 +/- 17.47 in group 4; 14.48 +/- 13.92 in group 5; and 2.29 +/- 3.4 in group 6. Comparing the level achieved in group 1 with all others, the difference is significant at the p less than 0.001 level. Specificity (0.97) and sensitivity (1) of the test in tuberculosis is very high, when a value of more than 45 U/L is considered. In patients with pleural tuberculosis, T-lymphocytes predominate in the fluid but their number did not correlate with ADA-activity (p greater than 0.10). Assessment of ADA in pathologic fluids is of great value in the diagnosis of tuberculosis of the pleura.     

The usefulness of serum adenosine deaminase 2 (ADA2) activity in adults for the diagnosis of pulmonary tuberculosis

Rapid diagnosis of Mycobacterium tuberculosis remains an obstacle for therapy of tuberculosis (TB). Adenosine deaminase isoform 2 (ADA2) is produced by activated macrophages and has been used for diagnosis of TB from extra-pulmonary sites. However, few studies adequately address whether serum ADA2 activity is useful for diagnosis of active pulmonary tuberculosis (PTB). We prospectively measured serum ADA2 activity in 110 patients with pulmonary disease (65 cases with active PTB and 45 cases with other respiratory diseases) and 78 healthy volunteers (eight with tuberculin skin test positive). The serum ADA2 for the diagnosis of PTB had the sensitivity of 36.9%, the specificity of 84.5%, the positive predictive value of 10.9% and the negative predictive value of 96.2%. We concluded that serum ADA2 activity is neither useful to diagnosis of active PTB nor to differentiate from other respiratory diseases.     

Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions

OBJECTIVES: Adenosine deaminase (ADA) can aid in the diagnosis of tuberculous pleural effusions, but false-positive findings from lymphocytic effusions have been reported. We studied the ADA levels in a variety of nontuberculous lymphocytic effusions and analyzed the relationships between ADA and conventional hematologic and biochemical parameters. METHODS: One hundred six lymphocytic pleural fluid samples (lymphocyte count > 50%) were analyzed. These included post-coronary artery bypass grafting (CABG) effusions (n = 45), malignant effusions (n = 27), miscellaneous exudative effusions (n = 10), and transudative effusions (n = 24). ADA levels were determined using the Giusti method. In 22 randomly selected cases, ADA was measured again on the same sample 6 weeks later. RESULTS: The ADA level reached the diagnostic cutoff for tuberculosis (40 U/L) in only three cases (2.8%): two lymphomas and one complicated parapneumonic effusion. There was no significant correlation between effusion ADA levels and the total leukocyte (r = 0.08), differential lymphocyte (r = 0.18) or monocyte (r = - 0.18) counts. ADA levels were significantly lower in the transudative effusions (7.2 +/- 3.5 U/L) than in post-CABG (16.6 +/- 7.2 U/L), malignant (15.3 +/- 11.2 U/L), and other exudative (15.4 +/- 13.1 U/L) effusions (p < 0.001). ADA measurements were consistent when assayed 6 weeks apart (r = 0.95; p < 0.00001; coefficient of variation, 14%). CONCLUSIONS: ADA levels in nontuberculous lymphocytic effusions seldom exceeded the diagnostic cutoff for TB. Effusion ADA levels cannot be predicted from total or differential leukocyte counts. Post-CABG pleural fluids had ADA levels similar to other nontuberculous lymphocytic effusions. ADA is stable in effusion fluids, and its measurement is reproducible.     

腺苷脱氨酶及结核抗体在糖尿病合并肺结核诊断中的价值

目的评价腺苷脱氨酶和结核抗体检测用于辅助诊断糖尿病合并肺结核的价值。方法对116例糖尿病合并肺结核患者、133例糖尿病合并非结核肺部感染患者以及120例健康人群的血清腺苷脱氨酶（ADA）、结核抗体（TB-Ab）进行检测并分析。结果糖尿病合并肺结核患者血清ADA水平（22.7±7.3 u/L）和阳性率（70.3%）明显高于其它两组,均有显著性差异（P〈0.01）。糖尿病合并肺结核患者TB-Ab阳性率（71.5%）较糖尿病合并非结核肺部感染患者（8.5%）和健康人群对照组（7.5%）有显著性差异（P〈0.01）。结论 ADA和TB-Ab联合检测对于辅助诊断糖尿病合并肺结核特别是结核症状不典型的病例有一定价值。     

The diagnostic value of adenosine deaminase activity in sputum in pulmonary tuberculosis

This study was carried out in Atatürk Chest Diseases and Surgery Center. It's aim to determine and compare sputum adenosine deaminase (ADA) activity in pulmonary tuberculosis (tb), lung cancer and chronic obstructive pulmonary disease (COPD) patients in order to assess its diagnostic value. PATIENTS AND METHOD: Eighty-four patients (25 tb, 30 lung cancer and 29 COPD) were included in the study. ADA activity in sputum and serum was measured. Sputum ADA activities of tb patients were significantly higher than the other two groups (P < 0.05). Sputum/serum ADA ratios were similar in all groups. Sputum ADA activities between 150 and 200 U/L were the measurements with the best test performance according to the ROC curve. Sensitivity, specificity, positive predictive value, and negative predictive value were 44.0, 86.4, 57.8, 78.4% for 150 U/L and 32.0, 96.6, 80.0, 77.0% for 200 U/L, respectively. Area under the curve was 0.663. Because of low sensitivity, routine determination of ADA activity in sputum for the diagnosis of pulmonary tb is not recommended. However, it can be helpful in the diagnosis of smear-negative cases who are strongly suspected of tb.     

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。     

Ascites Adenosine Deaminase Activity is Decreased in Tuberculous Ascites with Low Protein Content

The value of adenosine deaminase activity (ADA) in ascitic fluid was examined in 12 patients with confirmed peritoneal tuberculosis and compared with that of 96 patients with ascites of other different etiologies as an age-matched control group, to determine the diagnostic value of the ADA activity in tuberculous ascites. The mean adenosine deaminase activity (ADA) value in ascitic fluid of the tuberculous peritonitis group was 47.9 +/- 21.9 IU/L and in the control group 9.6 +/- 5 U/L (mean +/- SD); p less than 0.01. A different method than that usually reported in tuberculous peritonitis was used for ascites ADA estimation. The best sensitivity and specificity was obtained when greater than 32 U/L was used as a cutoff point. The ascites ADA activity correlated with the ascites total protein concentration in the tuberculosis group (r = 0.842). Our findings confirm other results and support the ADA activity determination in ascitic fluid as a useful noninvasive screening test in the diagnosis of peritoneal tuberculosis in endemic areas or in high risk patients. However, false-negative results may occur in those patients in which ascites total protein concentration is low.