ADA、TB-Ab-IgG检测对结核性胸膜炎诊断及鉴别诊断的临床价值

Diagnostic value of ADA and TB-Ab-IgG determination in pleural tuberculosis

目的探讨胸水和血清腺苷脱氨酶(ADA)、结核抗体(TB-Ab-IgG)检测对结核性胸膜炎的诊断价值。方法采用斑点金免疫渗滤试验(DIGFA)和酶连续监测法对117例患者进行胸水和血清TB-Ab-IgG和ADA检测分析。结果87例结核性胸膜炎患者胸水、血清中TB-Ab-IgG的敏感性分别为62.0%和70.1%,特异性分别为93.1%和86.6%。ADA活性在结核性和癌性胸水中分别为52.51和10.26 U/L(P<0.01)。以胸水ADA≥40 U/L做为诊断结核的临界值,其敏感性为79.3%,特异性为86.6%;以胸水ADA/血清ADA>1.00为临界值,其敏感性为97.7%,特异性为96.6%。结论胸水和血清ADA、TB-Ab-IgG检测对结核性胸膜炎和非结核性胸膜炎具有诊断和鉴别诊断价值。

Objective To study the diagnostic value of pleura1 effusion and serum adenosine deaminase （ADA） and antibody to mycobacterium tuberculosis （TB-Ab-IgG） in pleural tuberculosis. Methods The TB-Ab-IgG levels were detected by dot immunogold filtration assay （DIGFA）, and the ADA levels were detected by continuous monitored enzymatic method in 117 samples of pleural exudates and serum. Results The sensitivity of TB-Ab-IgG in pleural effu- sion and serum of 87 patients with pleural tuberculosis was 62.0% and 70.1% respectively, the specificity was 93.1% and 86.6% respectively. The ADA activity of tuberculous and malignant effusion was 52.51 and 10.26 U/L（ P 〈 0.01 ）. If the cut-off value of ADA was I〉40 U/L in tuberculosis diagnosis, its sensitivity was 79.3% and specificity was 86.6%. If the cut-off value of pleural effusion ADA/serum ADA was 〉 1.00 in tuberculosis diagnosis, its sensitivi- ty was 97.7% and specificity was 96.6%. Conclusions The detection of ADA and TB-Ab-IgG of pleural effusion and serum is of great value in differentiating tuberculous pleuritis from nontuberculous pleuritis.