Is adenosine deaminase in pleural fluid a useful marker for differentiating tuberculosis from lung cancer or mesothelioma in Japan, a country with intermediate incidence of tuberculosis?
Is adenosine deaminase in pleural fluid a useful marker for differentiating tuberculosis from lung cancer or mesothelioma in Japan, a country with intermediate incidence of tuberculosis?
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DOI：
10.18926/amo/46851
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发表时间：
2011-08
影响因子：
0.5
通讯作者：
Yoshiko Ogata;K. Aoe;A. Hiraki;K. Murakami;D. Kishino;K. Chikamori;T. Maeda;H. Ueoka;K. Kiura;M. Tanimoto
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文献类型：
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作者：
Yoshiko Ogata;K. Aoe;A. Hiraki;K. Murakami;D. Kishino;K. Chikamori;T. Maeda;H. Ueoka;K. Kiura;M. Tanimoto
本研究的目的是评估在结核病（TB）发病率中等的日本，胸腔积液中腺苷脱氨酶（ADA）水平测定在结核性胸腔积液（TPE）和恶性胸腔积液（MPE）鉴别诊断中的实用性。我们回顾性分析了435例胸腔积液患者的临床记录，并通过自动分析仪测定其胸腔ADA水平。还进行了ROC分析。该研究包括MPE（n=188）、TPE（n=124）、良性非结核性胸腔积液（n=94）和病因不明的胸腔积液（n=29）患者。TPE组ADA水平中位数为70.8U/L，显著高于其他各组（p<0.05）。ROC分析的曲线下面积（AUC）为0.895。以ADA为36 U/L为界值时，其敏感性、特异性、阳性预测值和阴性预测值分别为85.5%、86.5%、69.7%和93.6%。多达9%的肺癌患者和15%的间皮瘤患者在ADA临界值设置下为假阳性。虽然胸水中的ADA活性有助于TPE的诊断，但应注意的是，与高患病率地区相比，在TB发病率中等的地理区域，某些肺癌或间皮瘤病例显示出高ADA活性。
The objective of this study was to evaluate the utility of the determination of adenosine deaminase (ADA) level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) in Japan, a country with intermediate incidence of tuberculosis (TB). We retrospectively reviewed the clinical records of 435 patients with pleural effusion and investigated their pleural ADA levels as determined by an auto analyzer. ROC analysis was also performed. The study included patients with MPE (n＝188), TPE (n＝124), benign nontuberculous pleural effusion (n＝94), and pleural effusion of unknown etiology (n＝29). The median ADA level in the TPE group was 70.8U/L, which was significantly higher than that in any other groups (p＜0.05). The area under the curve (AUC) in ROC analysis was 0.895. With a cut-off level for ADA of 36U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.5%, 86.5%, 69.7%, and 93.6%, respectively. As many as 9% of patients with lung cancer and 15% of those with mesothelioma were false-positive with this ADA cutoff setting. Although the ADA activity in pleural fluid can help in the diagnosis of TPE, it should be noted that some cases of lung cancer or mesothelioma show high ADA activity in geographical regions with intermediate incidence of TB, in contrast to high prevalence areas.