干扰素γ、白细胞介素12及腺苷脱氨酶同工酶对结核性胸腔积液的诊断价值

目的　研究胸腔积液中干扰素γ(IFN γ)和白细胞介素 12 (IL 12 )的浓度及腺苷脱氨酶同工酶 (ADA2 )的活性三者在结核性胸腔积液诊断中的临床价值。方法　以 2 0 0 2年 3月～ 2 0 0 3年2月期间在北京大学人民医院、北京胸科医院、北京结核病胸部肿瘤研究所等医院的未经治疗的胸腔积液患者为研究对象 ,其中结核性胸腔积液 14 1例、恶性胸腔积液 4 9例。应用酶速率法检测胸腔积液标本中腺苷脱氨酶 (ADA)、ADA2 的活性 ,酶联免疫吸附测定 (ELISA)检测IFN γ和IL 12的浓度。比较两组胸腔积液中ADA和ADA2 活性 ,以及IFN γ和IL 12浓度之间的区别。结果　 (1)结核性胸腔积液组ADA、ADA2 活性分别为 (5 1 6± 10 9)U/L和 (4 7 9± 6 9)U/L ,恶性胸腔积液组ADA、ADA2 活性分别为 (2 0 4± 4 4 )U/L、(13 2± 3 2 )U/L ,结核性胸腔积液组的ADA、ADA2 活性显著高于恶性胸腔积液组 (P <0 0 1)。结核性胸腔积液组IFN γ和IL 12浓度分别为 (112 1± 4 5 8)ng/L及 (10 4 3± 32 3)ng/L ,恶性胸腔积液组IFN γ和IL 12浓度分别为 (2 4 8± 5 9)ng/L和 (6 1 8±10 8)ng/L ,结核性胸腔积液组的IFN γ和IL 12浓度水平显著高于恶性胸腔积液组 (P <0 0 1,0 0 5 ) ;(2 )ROC曲线分析结果 ,IFN γ以 6 1 7ng/L为诊

Clinical investigation of the diagnostic value of interferon-γ,interlukin-12 and adenosine deaminase isoenzyme in tuberculous pleurisy

OBJECTIVE: To investigate the diagnostic value of interferon-gamma (IFN-gamma), interleukin-12 (IL-12) and adenosine deaminase isoenzymes (ADA(2)) in tuberculous pleural effusions. METHODS: One hundred and ninety specimens of pleural effusion were collected from 190 patients with pleural effusion in Peking University People's Hospital, Beijing Chest Hospital, and Beijing Tuberculosis and Thoracic Tumor Institute, from March 2002 to February 2003. Of them 141 pleural specimens were diagnosed as tuberculous, and 49 as malignant. IFN-gamma and IL-12 concentrations and ADA isoenzyme activity in all the specimens were determined by ELISA and enzyme kinetic analytical method respectively. RESULTS: (1) ADA(2) activity (47.9 +/- 6.9) U/L in tuberculous effusions was significantly higher than that in malignant effusion (13.2 +/- 3.2) U/L (P < 0.01). The IFN-gamma level (112.1 +/- 45.8) ng/L in tuberculous effusion was significantly higher than that in malignant diseases (24.8 +/- 5.9) ng/L (P < 0.01). The IL-12 level (104.3 +/- 32.3) ng/L in tuberculous effusions was significantly higher than that in malignant diseases (61.8 +/- 10.8) ng/L (P < 0.05). (2) By analysis of ROC curves, the cut-off values for IFN-gamma, IL-12 and ADA(2) were defined. The sensitivity and specificity of IFN-gamma for tuberculous effusion were 84.4% and 95.9% respectively. Those of IL-12 for tuberculous effusion were 85.1% and 65.3% respectively, while those of ADA(2) were 84.4% and 91.8%. CONCLUSIONS: IFN-gamma and IL-12 could be used as valuable parameters for the differentiation of tuberculous effusion from malignant, and IFN-gamma was more sensitive and specific for tuberculous effusion than IL-12 and ADA(2).