血清腺苷脱氨酶测定在涂阴肺结核诊疗中的应用价值

目的：探讨血清腺苷脱氨酶(adenosine deaminase,ADA)在涂阴肺结核诊断及治疗中的应用价值。方法对152例涂阴肺结核、80例涂阳肺结核、63例非结核性肺部疾病及227例健康志愿者进行血清 ADA 测定,并对测定结果进行比较,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算敏感性和特异性。所有活动性肺结核患者给予标准方案的抗结核治疗,于治疗的1月末、2月末、6月末测定血清 ADA,与治疗前结果进行比较。结果治疗前涂阴肺结核组 ADA(10.795±4.164)U/L 高于非结核肺部疾病组(9.354±2.401)U/L 和健康对照组(5.971±1.734)U/L,涂阳肺结核组(14.441±6.267)U/L 高于涂阴肺结核组(10.795±4.164)U/L,差异有统计学意义。共有57例涂阴肺结核患者和45例涂阳肺结核患者于抗结核治疗1月末、2月末、6月末 进 行 了 血 清ADA 测定,两组患者治疗2月末、6月末的血清 ADA 值与疗前相比均有下降,差异有统计学意义(P <0.05)。ROC曲线分析显示以血清 ADA=6.95 U/L 为临界值鉴别涂阴肺结核和健康对照的曲线下面积(Area Under Curve, AUC)为0.921(95% CI =0.894~0.947),敏感性为94.0%,特异性为70.7%。以 ADA=18 U/L 为临界值鉴别涂阴肺结核与非结核性肺部疾病的特异性为100%,敏感性为5.9%。结论涂阴肺结核患者的血清 ADA 水平高于健康人群和非结核性肺部疾病患者,血清 ADA 可以在一定程度上协助诊断涂阴肺结核,适时检测可以反映肺结核的治疗疗效。

Value of serum adenosine deaminase in diagnosis and treatment of smear negative pulmonary tuberculosis

Objective The aim was to determine adenosine deaminase（ADA）activity in serum for the diagnosis and treatment of smear negative pulmonary tuberculosis.Methods The study involved 1 52 patients with smear negative pulmonary tuberculosis,80 patients with smear positive pulmonary tuberculosis,63 patients of non-tuberculosis pulmonary disease,227 healthy subjects.The ADA activity was measured in serum for all subjects.ROC curve was used to analyze the clinical sensitivity and specificity.All patients with active pulmonary tuberculosis were given anti-tuberculosis treatment with standard regimen and serum ADA was detected at the end of 1st,2nd,and 6th month during treatment.The ADA value was analyzed before and after treatment.Results Before treatment,ADA value in the group of smear negative pulmonary tuberculosis （10.795±4.1 64）U/L was higher than that in the groups of non-tuberculosis pulmonary disease （9.354±2.401）U/L and healthy subjects （5.971±1.734）U/L.ADA value in the group of smear positive pulmonary tuberculosis （14.441±6.267）U/L was higher than that in the group of smear negative pulmonary tuberculosis （10.795 ±4.1 64）U/L.There were statistical difference among four groups.There were 57 patients with smear negative pulmonary tuberculosis and 45 patients with smear positive pulmonary tuberculosis whose serum ADA were detected at the end of 1st,2nd,and 6th month during treatment.A statistical significant decrease was observed in ADA activities in two groups after 2 months’and 6 months’treatment（P 〈0.05）.ROC curve showed that the optimal limit value of ADA for differentiation of smear negative pulmonary tuberculosis and healthy subjects was 6.95 U/L,and the AUC was 0.921 （95% CI =0.894-0.947）.The sensitivity was 94%,the specificity was 70.7%.When ADA was 18 U/L as the critical value to identify the smear negative pulmonary tuberculosis and non-tuberculosis pulmonary disease,the specificity was 100%,the sensitivity was 5.9%. Conclusion Serum ADA activity was increased in