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.

Evaluation of the diagnostic value of adenosine deaminase activity in tuberculous pleuritis

Objective To investigate the clinical value of pleural fluid adenosine deaminase (ADA) activity in differentiating tuberculous pleural effusions (TPE) from malignant effusions.Methods The serum and pleural adenosine deaminase activity of 91 cases confirmed by pleural biopsy through medical thoracoscopy were retrospectively analyzed.TPE was confirmed in 49 cases and malignant effusion in 42 cases.The o ptimal cutoff for TPE was determined by using the ROC curve.Results The mean pleural ADA was significantly (t = 7.383,P ＜ 0.01) higher in PTE (46 ± 26) U/L as compared to malignancy (16 ± 8) U/L,so was the pleural fluid/serum ADA ratio (4.1 ±4.0 vs 1.76 ± 1.2,t =3.852,P ＜0.01),but there was no statistically significant difference between malignant and tuberculous effusion in serum ADA activity (13 ±5) U/L vs (12±6) U/L,t= 1.582,P ＞ 0.05].The cutoff value of pleural ADA for PTE was 28.7 U/L,with a sensitivity of 75.5% and a specificity of 95.2%.Conclusions Pleural fluid,but not serum,ADA activity,can be used for the differentiation between tuberculous and malignant pleural effusions.