腺苷脱氨酶检测对结核性腹膜炎的诊断价值

Diagnostic value of adenosine deaminase detection in tuberculous peritonitis

目的评价腹腔积液腺苷脱氨酶(ADA)检测对结核性腹膜炎(TBP)的诊断价值.方法回顾性分析2016年1月至2018年12月陕西省结核病防治院和北京胸科医院收治的203例疑似TBP患者腹腔积液标本的实验室检测资料,纳入同时采用抗酸杆菌(AFB)涂片镜检(简称“AFB涂片”)、BACTEC MGIT 960液体培养(简称“MGIT 960培养”)、GeneXpert MTB/RIF(简称“GeneXpert”)和ADA检测的119例疑似TBP患者,其中确诊TBP患者73例、非TBP患者46例.以临床确诊TBP患者为参考标准,评价AFB涂片、MGIT 960培养、GeneXpert和ADA检测对TBP的诊断效能,并以ROC曲线分析ADA检测的最佳临界值和曲线下面积(AUC).结果在119例疑似TBP患者中,AFB涂片、MGIT 960培养、GeneXpert和ADA检测的敏感度分别为4.1%(3/73)、11.0%(8/73)、12.3%(9/73)和86.3%(63/73),特异度分别为100.0%(46/46)、100.0%(46/46)、100.0%(46/46)和84.8%(39/46),符合率分别为41.2%(49/119)、45.4%(54/119)、46.2%(55/119)和85.7%(102/119).ROC曲线分析显示,当区分TBP与非TBP的ADA检测最佳临界值为31.45U/L时,AUC为0.836.结论AFB涂片、MGIT 960培养、GeneXpert检测腹腔积液结核分枝杆菌敏感度均很低,而ADA检测在早期诊断TBP时有较高的敏感度和特异度,检测效能良好,可作为临床诊断TBP的参考.

Objective To evaluate the diagnostic value of adenosine deaminase(ADA)detection in tuberculous peritonitis(TBP).Methods The laboratory testing data of peritoneal effusion specimens of 203 suspected TBP patients from Shaanxi Tuberculosis Hospital and Beijing Chest Hospital were retrospectively analyzed between January 2016 and December 2018,and then 119 suspected TBP patients who underwent acid-fast bacilli(AFB)smear microscopy(AFB smear),BACTEC MGIT 960 liquid culture(MGIT 960),GeneXpert MTB/RIF(GeneXpert)and ADA detection at the same time were included in this study.Among these cases,73 were diagnosed as TBP patients,while the other 46 were non-TBP patients.The diagnostic efficacy of AFB smear,MGIT 960 culture,GeneXpert and ADA detection for TBP was evaluated with clinically diagnosed TBP patients as the reference standard,and the optimal critical value and area under curve(AUC)of ADA detection were analyzed by ROC curve.Results In 119 suspected TBP patients,the sensitivities of AFB smear,MGIT 960 culture,GeneXpert and ADA detection were 4.1%(3/73),11.0%(8/73),12.3%(9/73)and 86.3%(63/73),respectively;the specificities were 100.0%(46/46),100.0%(46/46),100.0%(46/46)and 84.8%(39/46),respectively;and the coincidence rates were 41.2%(49/119),45.4%(54/119),46.2%(55/119)and 85.7%(102/119),respectively.ROC curve analysis showed that the critical value of ADA detection for distinguishing TBP patients from non-TBP patients was 31.45 U/L,and AUC was 0.836.Conclusion The sensitivities of AFB smear,MGIT 960 culture and GeneXpert for detection of Mycobacterium tuberculosis in peritoneal effusion are all very low,while ADA exhibits promising detection efficiency with high sensitivity and specificity in early diagnosis of TBP,which can be used as an alternative for clinical diagnosis of TBP.