ADA检测在淋巴细胞性胸腔积液中的应用价值

目的 研究不同病因产生的淋巴细胞性胸腔积液腺苷脱氨酶(ADA)值的差异，及其与传统的血液生化学参数之间的相互关系。方法 分析l05例淋巴细胞性胸水中的ADA值，其中包括结核性50例、恶性肿瘤性40例、漏出性l5例。结果 以40U/L作为诊断结核的阳性分割值，其特异性为98．2％、敏感性为89．0％；ADA值与白细胞总数、淋巴细胞百分比、中性粒细胞百分比、LDH、蛋白的含量无关。恶性胸水的ADA值与漏出性胸水比较无差异。结论 ADA检测对结核性胸腔积液具有相当高的特异性(98．2％)，但敏感度较低为(89．0％)。血液生化学参数与ADA值的大小无明显相关性。     

ADA检测在淋巴细胞性胸腔积液中的应用价值-105例临床病例分析

目的 ADA检测可作为诊断结核性胸膜炎的一种辅助方法,但在其他原因引起的淋巴细胞性胸腔积液中常出现假阳性.本文研究不同病因产生的淋巴细胞性胸腔积液ADA值的差异,分析ADA与传统的血液生化学参数之间的相互关系.方法共分析105例淋巴细胞性胸水中的ADA值,其中包括核性50例、恶性肿瘤性40例、漏出性15例.结果以40U/L作为诊断结核的阳性分割值,其特异性为98.2%,敏感性为89.0%,ADA值与白细胞总数、淋巴细胞百分比、中性细胞百分比、LDH、蛋白的含量无关.恶性胸水的ADA值与漏出性胸水比较无差异.结论 ADA检测对结核性胸腔积液具有相当高的特异性(98.2%),但敏感度较低为89.0%.血液生化学参数与ADA值的大小无明显相关性.     

Cerebrospinal Fluid Adenosine Deaminase Levels and Adverse Neurological Outcome in Pediatric Tuberculous Meningitis

AbstractBackground: There is a lack of data on the prognostic significance of changes in cerebrospinal fluid (CSF) parameters in tuberculous meningitis. Our objective was to determine whether changes in CSF parameters are associated with poor neurological outcome in tuberculous meningitis.Patients and Methods: We conducted a prospective cohort study on children admitted with a diagnosis of tuberculous meningitis to Government General Hospital in Kakinada, India. On admission, CSF parameters including cell count with fraction of lymphocytes and neutrophil leukocytes, glucose, protein, lactic dehydrogenase (LDH), and adenosine deaminase (ADA) levels were measured. We compared levels in children with and without adverse neurological outcome.Results: A total of 26 children was enrolled over a 2–year period. Ten had an adverse neurological outcome. Six had permanent neurological deficits (four hemiplegia and two cranial nerve palsies), two a hydrocephalus and two died. There was no significant (p > 0.05) difference in age, gender and in CSF parameters, including cell count, lymphocyte and neutrophil leukocyte fraction, glucose, protein, and LDH levels between patients with and without adverse neurological outcome. Patients with adverse outcome had with a mean (SD) of 17.1 (3.2) IU/l a significantly higher ADA level than patients without, who had a mean (SD) level of 11.3 (2.7) IU/l (p < 0.001, t–test).Conclusion: Adverse neurological outcome in childhood tuberculous meningitis is associated with increased cerebrospinal fluid adenosine deaminase levels.     

Adenosine Deaminase Isoenzymes in Liver Disease

To clarify the clinical significance of increased serum adenosine deaminase (ADA) activity, and its mechanisms in various liver diseases, ADA isoenzyme activities (ADAI and ADA2) in serum and in peripheral blood mononuclear cells were studied. High serum ADA activities were found in patients with acute hepatitis, alcoholic hepatic fibrosis, chronic active hepatitis, liver cirrhosis, and hepatoma. The ADA2:ADA ratio was decreased in acute hepatitis, but was increased in chronic active hepatitis and liver cirrhosis. Clinically, ADA2 activity was correlated with serum γ-globulin levels. In chronic active hepatitis, total ADA activities in the peripheral blood mononuclear cells were similar to those in controls. Furthermore, ADA2 activities after phytohemagglutinin (PHA) stimulation were significantly lower than those without PHA stimulation, although total ADA activities were increased after PHA stimulation. These findings suggest that serum ADA isoenzyme activities may be a new marker for liver disease, and that the increased serum ADA2 in chronic active hepatitis is unlikely to be the result of an increase in ADA2 production by activated peripheral blood mononuclear cells.     

Serum Selenium Levels in Malignant Lymphoproliferative Diseases

Serum selenium levels were measured in 38 patients with malignant lymphoproliferative diseases (MLD) and in 34 non-hospitalized healthy individuals. Selenium was determined by proton induced x-ray emission. In Hodgkin's disease and non-Hodgkin malignant lymphoma the mean serum levels of selenium were not different from those of the control group. On the contrary lowered mean serum selenium concentrations were observed in the group with chronic lymphocytic leukaemia (5.2 + 0.7 μg/100 ml) as compared to normal individuals (7.9 + 0.3 μg/100 ml). The difference is highly significant (P < 0.005). A second selenium test was made in 11 out of the 38 patients within 8 weeks from the beginning of radiotherapy or chemotherapy; unchanged levels were found.     

Serum Pancreatic Enzyme Concentrations in Chronic Viral Liver Diseases

Serum amylase and lipase concentrations weredetermined in 78 patients with chronic liver diseases[26 chronic active hepatitis (CAH) and 52 livercirrhosis] and in 15 healthy subjects. Pancreaticisoamylase concentrations and macroamylase complexes wereassayed in hyperamylasemic sera. Serum amylase levelswere abnormally elevated in 27 patients (35%; 22 livercirrhosis, 5 CAH), whereas serum lipase levels were elevated in 16 patients (21%; 15 livercirrhosis, 1 CAH). In 9 of the 27 hyperamylasemicpatients, the hyperamylasemia was of pancreatic type.Macroamylasemic complexes were not detected inhyperamylasemic sera. Patients with liver cirrhosis had serumlevels of amylase and lipase significantly higher thanboth the healthy subjects and the patients with CAH,while no significant differences were found in serum levels of these enzymes in patients with CAH ascompared to the healthy subjects. A decreased livermetabolism of serum amylase and lipase in patients withchronic infective liver disease, especially in those having liver cirrhosis, may lead to anaccumulation of these enzymes in the blood.     

Adenosine Deaminase in the Diagnosis of Pleural Effusions

ABSTRACT The activity of adenosine deaminase (ADA) was determined in serum and pleural fluid of 90 patients with pleural effusions of various aetiology. Tuberculous pleural effusions, empyemas and rheumatoid pleural effusions demonstrated significantly higher activities of ADA than parapneumonic, nonspecific and malignant pleural effusions and effusions in systemic lupus erythematosus and congestive heart failure. In tuberculosis, empyema and rheumatoid arthritis ADA activity was significantly higher in pleural fluid than in serum, indicating a local synthesis of ADA by cells within the pleural cavity in these diseases.     

Serum Vascular Endothelial Growth Factor Levels in Various Liver Diseases

The clinical significance of circulatingvascular endothelial growth factor (VEGF) in patientswith various liver diseases was investigated. Twenty-onepatients with acute hepatitis (AH), 40 with chronic hepatitis (CH), 34 with cirrhosis (LC), 16 withfulminant hepatitis (FH), 10 with primary biliarycirrhosis (PBC), 12 with autoimmune hepatitis (AIH), and120 healthy individuals were included. Serum VEGF levels were measured by a chemiluminescenceenzyme-linked immunosorbent assay. The mean values ofserum VEGF levels in the patients with AH, CH, LC, FH,AIH, PBC, and control were 172.7, 58.0, 44.1, 37.3, 49.7, 74.9, and 65.0 pg/ml, respectively. Thepatients with AH had a level of serum VEGF significantlyhigher than that of the control group (P < 0.001).The serum VEGF levels in survivors of FH weresignificantly increased, but not in the nonsurvivors in therecovery phase compared with the levels on admission (P< 0.05). In the LC patients, serum VEGF levels weresignificantly lower than those of the control group (P < 0.05). These findings suggest thatserum VEGF level may be associated with hepatocyteregeneration grade.     

Increased Pleural Fluid Adenosine Deaminase Levels in Patients with Malignant Pleural Effusions: A Potential Predictor of Talc Pleurodesis Outcome

Chemical pleurodesis using various sclerosing agents is accepted palliative therapy for patients with recurrent, symptomatic, malignant pleural effusions (MPE). However, the utility of various clinical and biochemical parameters in predicting pleurodesis outcome is still controversial. The objective of this study was to investigate the relationship between pleural fluid adenosine deaminase (Pf-ADA) levels and talc pleurodesis outcomes, and to compare Pf-ADA levels to various other biochemical variables with respect to predicting talc pleurodesis outcome in patients with MPE. In this prospective trial, 60 consecutive patients with MPE were enrolled; 35 had malignant mesothelioma (MM) and 25 had metastatic pleural carcinoma (MPC). A complete response was achieved in 49 of 60 MPE patients (81.7%). The Pf-ADA, pH, and albumin levels in patients with successful pleurodesis were significantly higher than in those with unsuccessful pleurodesis (p values < 0.001, 0.036, 0.027, respectively). ROC curve analysis revealed that optimal differentiation between successful and unsuccessful pleurodesis could be achieved with cutoff points of 17.5 U/L for Pf-ADA (area under the curve = 0.873; sensitivity = 77.6%; specificity = 90.9%); >2.5 g/dl for albumin (area under the curve = 0.715; sensitivity = 85.4%; specificity = 54.5%); and >7.26 for pleural fluid pH (area under the curve = 0.703; sensitivity = 83.7%; specificity = 54.5%). In analysis of the subgroup, Pf-ADA were found to be a good marker for discrimination between successful and unsuccessful pleurodesis in patients with MM (p < 0.001) but not in the MPC group (p = 0.068). These results indicate that Pf-ADA levels could be considered predictors of the outcome of pleurodesis, especially in patient with MM. Furthermore, the present study also demonstrated that Pf-ADA level is a superior test to predict the outcome of pleurodesis compared to pleural fluid pH and albumin level.     

Value of Adenosine Deaminase Estimation in the Diagnosis of Tuberculous Ascites

Adenosine deaminase was estimated in ascitic fluids of 49 patients with ascites (19 tuberculous, 20 cirrhotic, and 10 malignant). The adenosine deaminase concentration in tuberculous ascitic fluid was 98.8 +/- 20.1 U/L (mean +/- SD), which was significantly more than that noted in cirrhotic (14 +/- 10.6 U/L) or malignant (14.6 +/- 6.7 U/L) ascitic fluids (p less than 0.001 for each). At a cut-off value of greater than 33 U/L, the sensitivity, specificity, positive and negative predictive value, and the overall diagnostic accuracy for diagnosing tuberculous ascites were 100%, 96.6%, 95%, 100%, and 98%, respectively. We conclude that estimation of adenosine deaminase in ascitic fluid is an easy and reliable method for diagnosing tuberculous ascites.     

日本血吸虫腺苷脱氨酶基因的克隆和融合表达

目的 克隆和表达日本血吸虫（Sj）腺苷脱氨酶（ADA）编码基因，分析该基因的系统发育及预测其编码蛋白的空间结构。 方法 根据表达序列标签（EST）测序的结果设计引物，PCR法从含有SjADA基因的cDNA克隆中扩增得到该编码基因片段，亚克隆入原核表达载体pET32中表达，表达的融合蛋白用螯合琼脂糖凝胶FF亲和层析纯化。采用 MrBayes算法构建系统发育进化树，用自动蛋白注释工具(DS GeneAtlas)软件模拟SjADA的蛋白空间结构。结果 获得SjADA基因全长为1 059 bp的编码序列，并克隆、表达和纯化了重组蛋白（SjADA）。生物信息学分析显示，该基因与曼氏血吸虫的同源基因之间的序列一致性仅25%，属于不同的亚家族。其空间结构与PDB模板1A4M的一致性为41%，具有相似的二级结构和相应的活性位点残基。 结论 获得了SjADA重组蛋白。提示日本血吸虫嘌呤补救合成代谢途径与曼氏血吸虫有差异。     

On the Appearance, Levels and Regulation of Pancreatic Enzyme Serum Concentrations

The evaluation of serum pancreatic enzyme activity on whole and diluted serum permits the estimation of serum enzyme inhibitor activity via a ADS/AWS ratio. This has diagnostic value in chronic pancreatic disease. The serum pancreatic ferment activity appears to be regulated in part by serum steroid levels. It is responsive to high protein diet. A physiologic rationale is presented for the use of steroids and high protein diet in the treatment of acute and chronic pancreatic inflammation.     

Evaluation of Serum Pancreatic Enzymes, Carbohydrate Antigen 19-9, and Carcinoembryonic Antigen in Various Pancreatic Diseases

Comparative studies of pancreatic enzymes carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) were performed in various pancreatic disease. In acute pancreatitis as well as during acute exacerbation of chronic pancreatitis, all pancreatic enzymes were abnormally high. In chronic pancreatitis, they did not have any diagnostic sensitivity for pancreatic insufficiency. In pancreatic carcinoma, serum elastase levels may have a diagnostic value compared with other pancreatic enzymes. In studies of CEA and CA 19-9, both tumor markers were within normal range in benign pancreatitis but 27.7% of CEA and 30.7% of CA 19-9 in acute pancreatitis were above normal. In pancreatic carcinoma, although most of these patients had advanced disease, both tumor markers were extremely high and 61% for CEA and 71% for CA 19-9 were above normal. In patients with resected pancreatic carcinoma, serum CEA was slightly higher than normal CA 19-9 was much higher than normal. The sensitivity of CEA and CA 19-9 in this group were 33 and 77.7%, respectively. The results indicate that the CA 19-9 assay is a useful adjunct in the diagnosis of pancreatic carcinoma, possibly in the resectable stage especially combined measurement of serum elastase and CEA.     

多学科合作,提高胰腺疾病的临床诊治水平

近年来，我国临床医学界同道对胰腺疾病的临床和实验研究给予了高度关注。目前内外科均已成立了相应的胰腺疾病学组，并创办了《胰腺病学》杂志，为我国胰腺病学的学科建设奠定了坚实的基础。2003年12月中华医学会消化病学分会在上海成功召开了全国胰腺疾病学术大会．在较大程度上