腺苷脱氨酶、干扰素-γ和白细胞介素-6对结核性胸膜炎的诊断价值

Diagnostic Significance of Adenosine Deaminase Activity, Interferon-γ and Interleukin-6 in Tuberculous Pleural Effusions

目的 :研究胸水中腺苷脱氨酶 (ADA)活性、干扰素γ(IFN γ)和白介素 6 (IL 6 )水平对结核性胸膜炎的诊断价值。方法 :分别用酶联免疫吸附试验 (ELISA)和Giusti改良法检测 34例结核性、2 0例恶性胸液、7例肺炎旁积液和 10例漏出液患者胸水中ADA活性、IFN γ和IL 6水平。并绘制受试者工作特征曲线 (ROC曲线 )评价 3项指标检测结核性胸膜炎的敏感性和特异性。结果 :结核性胸液组胸水中ADA、IFN γ和IL 6水平均显著高于非结核性胸液组 (P <0 .0 1)。ROC曲线显示 3项指标中IFN γ具有最高的敏感性和特异性。结论 :胸水中ADA、IFN γ和IL 6水平测定有助于结核性胸膜炎的诊断。

Objective: To evaluate the determination of adenosine deaminase (ADA) activity, measurement of interferon(IFN)-γ and interleukin(IL)-6 in pleural fluid in the diagnosis of pleural tuberculosis. Methods: 71 patients with pleural effusion (43 men and 28 women; 60 years of mean age) were involved. 34 patients had tuberculous pleurisy, 20 patients had malignant pleuritis, and 17 patients had pleural effusion due to an etiology other than tuberculousis or cancer. Pleural fluid concentrations of the three suggested markers were measured by enzyme-linked immunosorbent assay and Giusti's. Then receiver operating characteristic (ROC) curves were constructed. Results: The pleural fluid levels of adenosine deaminase (51.3±13.3 U·L -1 vs 13.4±12.4 U·L -1 , P<0.01), interferon-γ (2463.5±2019.5 ng·L -1 vs 149.3±136.9ng·L -1 , P<0.01) and interleukin-6 (564.5±337.0 ng·L -1 vs 113.7±125.9 ng·L -1 , P<0.01) were significantly higher for tuberculous pleuritis than for other causes of effusion. Receiver operating characteristic analysis demonstrated that pleural fluid content IFN-γ should be the best indicator of tuberculous pleurisy among the three relevant biological markers. Conclusion: Detection of ADA, IFN-γ and IL-6 in pleural fluid may be helpful for diagnosing tuberculous pleurisy.