Relationship between serum adenosine deaminase levels and liver histology in autoimmune hepatitis

AIM To evaluate the relationship between serum adenosine deaminase(ADA) levels and histological features in patients with autoimmune hepatitis(AIH).METHODS A total of 80 subjects(52 AIH cases and 28 healthy controls) were included in the study. Patients were diagnosed according to the simplified criteria suggested by the International Autoimmune Hepatitis Group. All of the cases had been diagnosed with AIH between 2010-2015 at Hacettepe University, Department of Gastroenterology. Serum blood samples were collected and stored at-80 ℃ until the biochemical estimation of ADA activity. The diagnosis of patients was confirmed by liver biopsy. Serum ADA > 20 U/L was considered to be high level.RESULTS Mean serum ADA levels were significantly higher in AIH patients than those in healthy controls(25.4 ± 9.6 U/L vs 12.8 ± 2.2 U/L, P < 0.001). Serum ADA levels > 20 U/L were found in 63.5% AIH patients and in 0% healthy controls(P < 0.001). Mean serum ADA levels were significantly increased in each stage of histological activity: 15.2 ± 3.5 U/L for patients with mild interface hepatitis, 23.1 ± 10.0 U/L for patients with moderate interface hepatitis and 30.9 ± 7.0 U/L for patients with severe interface hepatitis(P < 0.001). Correlation analysis showed that there was a positive association between serum ADA levels and histological activity(r = 0.71, P < 0.001). Receiver operating characteristic analysis suggested that 24.5 U/L was the optimum cut-off point of ADA level for severe interface hepatitis(sensitivity 88%, specificity 85.2%, area under thecurve: 0.88).CONCLUSION Because of the positive correlation with inflammatory activity, serum ADA level may be a potential biomarker for predicting or monitoring histological activity in patients with AIH.

Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis

AIM： To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis （TBP） and peritoneal carcinoma- tosis （PC）. METHODS： A retrospective analysis of data was per- formed on consecutive patients who underwent perito- neoscopic and abdominal computed tomography （CT） evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients （36.0%） and 25 patients （33.3%） were diagnosed with TBP and PC, re- spectively. Diagnosis was confirmed by peritoneoscopic biopsy. RESULTS： Serum c-reactive protein （7.88：1：6.62 mg/ dL vs 3.12 ＋ 2.69 mg/dL, P = 0.01）, ascites adenos- ine deaminase （66.76：1：32.09 IU/L vs 13.89 ：l： 8.95 IU/L, P 〈 0.01）, ascites lymphocyte proportion （67.77 ：1： 23.41% vs 48.36 ＋ 18.78%, P 〈 0.01）, and serum- ascites albumin gradient （0.72 ＋ 0.49 g/dL vs 1.05 ＋ 0.50 g/dL, P = 0.03） were significantly different be- tween the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohy- drate antigen 19-9 showed significant difference be- tween two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group （77.8% vs 40.7%） whereas nodular involvement was more common in the PC group （14.8% vs 40.7%, P = 0.04）. From receiver operating characteristic （ROC） curves ascites adeno- sines deaminase （ADA） showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differ- ential diagnosis; sensitivity, specificity, positive predic- tive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively. CONCLUSION： Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differen- tial diagnosis of TBP and PC.

Adenosine deaminase isoenzymes estimation - as a diagnostic tool for tuberculous pleural effusions

Objective:To assess the efficacy of ADA isoenzyme estimation over that of total ADA level in pleural fluid and serum as a more efficient diagnostic indicator in tuberculous pleural effusions in high prevalence country like India.Methods:The efficacy was analysed in total thirty four patients of pleural effusions.Total ADA was estimated by Guitsi and Galanti Calorimetric method and ADA isoenzymes with and without EHNA[Erythro-9-（2- hydroxy-3-nonyl） adenine]a potent ADA1 inhibitor using the same method.Results:The results demonstrated a statistically significant values of ADA2 in serum（P【0.001）,pleural fluid（P = 0.000） and significant value for the ratio of pleural fluid ADA2/serum ADA2（P【0.001） and pleural fluid ADA/ADA(2（P【0. 005）.The sensitivity and specificity values of pleural fluid ADA|2 is 81.8%and 91.6%（cut off value 60 IU/L for Tuberculous effusions）,serum ADA2 95.4%and 66%（cut off value 70 IU/L for tuberculous effusions）. ADA2 is an isoenzyme,which is significantly raised in tuberculous pleural effusions both in the serum and pleural fluid.Conclusion:Estimation of ADA isoenzymes is redundant as a diagnostic aid over total ADA estimation in view of the limited improvements both in specificity and sensitivity patterns and also in term of cost-benefit ratio.

Relevance of adenosine deaminase as a marker for tuberculous pleural effusion in developing countries

Objective:Relevance of estimation of pleural adenosine deaminase(PADA) and serum adenosine deaminase (SADA) levels in-pleural effusion especially in cases of lymphocytic predominant exudative tubercular effusions. Methods:Fifty patients(33 male and 17 female;age:44.12±11.51 years) with pleural effusions were selected to assay adenosine deaminase(ADA) activity in pleural fluid and serum in adjunct to pleural fluid analysis.Effusions were individually classified as transudates or exudates after careful evaluation of all the biochemical parameters of pleural fluid and serum of patients and on the basis of Lights criteria.Cutoff value for PADA was taken as 60U/L and that for pleural/serum ADA ratio(P/S ADA) was 1.8.Results:Fourty -three patients had exudative effusions among which 38 patients had tuberculous pleural effusions and 5 had nontubercular effusions.7 cases were transudates.Mean PADA levels in tubercular group(78.95±25.32 U/ L) were found to be much higher P=0.0000) than nontubercular(23.00±5.22 U/L) group.SADA levels in tubercular group(31.05±6.42 U/L) were significantly higher(P=0.0000)as compared to nontubercular group(15.58±8.35 U/L).PADA cutoff at 60 U/L yielded sensitivity and.specificity of 81.5%and 100%respectively,whereas P/S ADA ratio at 1.8 gave sensitivity and specificity of 84.2% and 75%respectively. A positive correlation(r=0.507,P= 0.001 1)between PADA and SADA was found in tubercular group but no such correlation(r=0.302,P=0.3407)was observed in nontubercular group.Conclusion: The measurement of ADA in tubercular pleural effusions has not only relevance but also a high diagnostic utility when other clinical and laboratory tests are either negative or confusing.

Interaction of Cationic and Anionic Phthalocyanines with Adenosine Deaminase, Molecular Dynamics Simulation and Docking Studies

Interactions of anionic, cationic and metal phthalocyanine with adenosine deaminase were studied by molecular dynamics and docking simulation. Structural parameters such as solvent accessible surface area (SAS), mid-point of transition temperature (Tm), radial distribution function (RDF) and hydrogen bond, helix, coil, beta percentage and other physical parameters were obtained. The denaturation of adenosine deaminase (ADA) by heat, anionic and cationic phthalocyanines was compared. A series of 20 ns simulation performed at temperatures ranging from 275 to 450 K, starting from the ADA native structure. Results of radial distribution functions (RDFs) showed that metallic derivative at low concentration behaves the same as osmolytes that increases the beta form and increases the enzyme stability. Molecular docking studies have been carried out to confirm the simulation results. Investigation of binding site and free energy confirmed that the efficiency of interaction with adenosine deaminase depends on metal core. Binding energy of non-metallic form is more negative than metallic form and it significantly decreases for phthalocyanine. Self-aggregation of anionic phthalocyanine decreases in comparison with cationic derivative, therefore enzyme denaturation in the presence of anionic form is higher than the other. Furthermore, thermal stability of the enzyme also depends on temperature in presence of phthalocyanine. Binding site of phthalocyanine on the enzyme has been identified by docking analysis.

Changes in Adenosine Metabolism in Asthma. A Study on Adenosine, 5&#39-NT, Adenosine Deaminase and Its Isoenzyme Levels in Serum, Lymphocytes and Erythrocytes

Background: Adenosine deaminase (ADA) and 5'-nucleotidase (5'-NT) play a crucial role in adenosine metabolism in healthy individuals. Adenosine is an inflammatory mediator of asthma. Changes in adenosine metabolism and role of ADA and 5'-NT in regulating adenosine level in asthmatics and correlation of these changes with severity of asthma are not clearly understood. Methods: In this study, we screened 5217 patients, of which 2416 were diagnosed with asthma. Further, of 2416 asthmatics, only 45 patients who strictly fulfilled the selection criteria were enrolled in the study. The patients were classified into mild, moderate and severe persistent groups;each group consisted of fifteen patients. Fifteen healthy subjects served as controls. Adenosine levels and activities of 5'-NT, total ADA, ADA1 and ADA2 in serum, lymphocytes and erythrocytes were determined. The data were analysed statistically and p vice versa.

血清ADA联合GLB、CREA、β2-MG、HGB在初诊多发性骨髓瘤中的临床意义

目的:研究血清腺苷脱氨酶(ADA)联合球蛋白(GLB)、肌酐(CREA)、β2-微球蛋白(β2-MG)、血红蛋白(HGB)对多发性骨髓瘤(MM)的初筛作用,减少MM的漏诊及误诊。方法:回顾性分析2018年4月至2021年12月成都医学院第一附属医院血液科收治的62例初诊多发性骨髓瘤(NDMM)患者的资料,并以33例良性血液病患者和30例健康体检者作为对照组。用TCGA和GTEx数据库分析ADA在泛癌中的表达。收集受试者的一般资料及实验室检测指标,比较各组ADA活性及其他实验室指标水平的差异。分析血清ADA活性与NDMM患者临床资料的关系。比较NDMM患者化疗前后ADA活性的变化以及不同DS、ISS分期NDMM患者中ADA活性的差异。多因素Logistic回归分析NDMM发生的危险因素。采用ROC曲线评价ADA及其联合其他实验室指标对MM的诊断效能。生物信息学分析ADA的共表达网络和富集途径。结果:TCGA数据库中有14种癌组织中ADA水平显著上调,TCGA联合GTEx数据库中ADA在11种癌症中高表达。NDMM组外周血清ADA、GLB、UA、CysC、β2-MG水平明显高于良性血液病组及健康对照组(P<0.05),ALB、A∶G明显低于良性血液病组及健康对照组(P<0.001)。不同ADA活性水平的NDMM患者的DS分期(P=0.036)、ISS分期(P=0.019)、CREA(P=0.036)、UA(P=0.034)、β2-MG(P=0.019)水平具有统计学差异。NDMM患者初次化疗后ADA活性及β2-MG浓度有所下降(P<0.01)。不同DS分期和ISS分期患者比较结果显示,DS I+II期患者ADA活性明显低于Ⅲ期患者(P<0.05),ISS I+II期患者ADA活性也明显低于Ⅲ期患者(P<0.01)。多因素Logistic回归分析结果显示,GLB增高、ADA活性增加、CREA增高、β2-MG增高、HGB降低是NDMM的独立危险因素。ADA诊断MM的曲线下面积为0.847,其联合GLB、CREA、β2-MG、HGB诊断MM的曲线下面积为0.940。共表达网络和富集途径分析结果显示,ADA与20种蛋白质结合,并与嘌呤代谢、嘧啶代谢、烟酸和烟酰胺代谢通路显著相关。结论:检测血清中的ADA活性,对MM患者的辅助诊断、疗效评估以及监测疾病的发展有着积极的意义。ADA联合GLB、CREA、β2-MG、HGB可提高MM的初筛检出率,可在一定程度上减少漏诊及误诊。

ADA2基因变异与腺苷脱氨酶2缺乏症的研究进展

腺苷脱氨酶2缺乏症是一种罕见的常染色体隐性遗传的自身炎症性疾病,是由ADA2基因纯合或复合杂合变异导致腺苷脱氨酶2活性低下或缺乏而致病。该缺乏症主要临床表现为儿童期起病的全身性炎症、血管炎、体液免疫缺陷和血液学异常等,早期诊断困难,发病机制尚不完全清楚。全身性炎症表型患者治疗首选肿瘤坏死因子α受体拮抗剂,其次为沙利度胺。造血干细胞移植主要用于严重血液学表型患者或对肿瘤坏死因子α受体拮抗剂治疗无效患者。本文对腺苷脱氨酶2缺乏症的临床特征、人口学特征、基因型以及与临床表型相关性、可能的发病机制和诊疗策略进行阐述。

胸腔积液ADA联合外周血T-SPOT.TB、D-二聚体对结核性胸膜炎的早期诊断价值

目的:探讨胸腔积液腺苷脱氨酶(adenosine deaminase,ADA)、结核感染T细胞斑点实验(tuberculosis infection T-cell spot test,T-SPOT.TB)、D-二聚体(D-dimer,D-D)联合检测对结核性胸膜炎(tuberculosis pleurisy,TPE)的早期诊断价值。方法:选取2021年1月—2023年12月南通市第六人民医院收治住院患者118例,其中TPE患者62例为TPE组,非结核性胸膜炎患者56例为非结核性胸膜炎(non-tuberculous pleurisy,NTPE)组。分别检测和比较两组胸腔积液中ADA含量、外周血T-SPOT.TB试验中ESAT6、CFP10斑点孔数及D-D水平,比较不同指标之间的差异性及相关性。应用ROC曲线分析上述指标对TPE的早期诊断价值。结果:TPE组胸腔积液ADA含量、外周血ESAT6、CFP10斑点孔数以及D-D水平分别为[38.95(24.92,49.17)U·L^(-1)、20.00(12.75,40.00)孔、20.00(8.50,40.00)孔、3.52(1.99,5.95)mg·L^(-1)],与NTPE组[10.55(7.35,16.57)U·L^(-1)、1.00(0.00,4.00)孔、0.00(0.00,4.00)孔、1.17(0.74,2.29)mg·L^(-1)]相比均明显升高(Z=-6.405、-5.411、-6.517、-6.468,均P<0.001)。TPE组外周血ESAT6、CFP10斑点孔数与胸腔积液ADA含量均呈中度正相关(r=0.596、0.581,均P<0.001),而外周血ESAT6、CFP10斑点孔数与D-D水平则呈低度正相关(r=0.398、0.443,均P<0.001)。胸腔积液ADA、外周血ESAT6、CFP10及D-D早期诊断TPE的ROC曲线的AUC分别为0.842、0.845、0.840、0.789。上述4种指标联合检测的AUC为0.960,敏感度和特异度分别为87.1%和96.43%,均高于单个指标。结论:TPE患者胸腔积液ADA含量、外周血ESAT6、CFP10斑点孔数及D-D水平均升高,联合诊断可提高TPE的诊断效果,有助于临床早期诊断TPE。

Adenosine deaminase 2 regulates the activation of the toll-like receptor 9 in response to nucleic acids

Human cells contain two types of adenosine deaminases(ADA)each with unique properties:ADA1,which is present in all cells where it modulates intracellular functions and extracellular signaling,and ADA2,which is secreted by immune cells.The exact intracellular functions of ADA2 remain undetermined and less defined than those of ADA1.ADA2 has distinct characteristics,such as low adenosine affinity,heparin-binding ability,and putative lysosomal entry.Here,we confirm that ADA2 is a lysosomal protein that binds toll-like receptor 9(TLR9)agonists,specifically CpG oligodeoxynucleotides(CpG ODNs).We show that interferon-alpha(IFN-α)is secreted in response to TLR9 activation by CpG ODNs and natural DNA and markedly increases when ADA2 expression is downregulated in plasmacytoid dendritic cells(pDCs).Additionally,the pretreatment of pDCs with RNA further stimulates IFN-αsecretion by pDCs after activation with CpG ODNs.Our findings indicate that ADA2 regulates TLR9 responses to DNA in activated pDCs.In conclusion,decreasing ADA2 expression or blocking it with specific oligonucleotides can enhance IFN-αsecretion from pDCs,improving immune responses against intracellular infections and cancer.

ADAR1 p150和p110参与肝癌细胞增殖、迁移和侵袭

目的:研究腺苷脱氨酶1(adenosine deaminase acting on RNA 1,ADAR1)对肝细胞癌(liver hepatocellular carcinoma,LIHC)增殖、迁移与侵袭的影响。方法:利用基因表达谱交互式分析网站GEPIA检测ADAR1在LIHC中的表达水平和预后价值;提取人体肝癌标本的蛋白,通过Western blot实验检测ADAR1的表达情况。将ADAR1 p150和p110过表达质粒和靶向ADAR1 p150和p110的小干扰RNA分别转染进HepG2和Huh7细胞,利用Western blot和qPCR检测转染后细胞的ADAR1表达情况。通过CCK-8实验检测ADAR1对肝癌细胞增殖能力的影响。通过细胞划痕实验和Transwell实验检测ADAR1对肝癌细胞迁移和侵袭的影响。最后,在DAVID在线数据库中分析与ADAR1相关的信号通路,利用Western blot实验检测信号通路中相关蛋白的表达。结果:肝癌组织中ADAR1蛋白质水平明显高于癌旁组织,这与生物信息学的预测一致,且高表达的ADAR1与肝癌的不良预后相关;通过CCK-8实验,本研究发现过表达ADAR1可以促进肝癌细胞的增殖能力(P<0.05),敲低ADAR1使肝癌细胞增殖能力下降(P<0.05)。通过划痕和Transwell实验,本研究发现ADAR1的过表达促进了肝癌细胞的迁移和侵袭(P<0.05),敲低ADAR1后,肝癌细胞迁移和侵袭能力受到抑制(P<0.05)。DAVID在线分析结果显示,ADAR1主要富集在Wnt信号通路中。Western blot结果提示,过表达ADAR1抑制GSK3β表达和β-catenin的磷酸化水平,敲低ADAR1后GSK3β表达和β-catenin的磷酸化水平升高。结论:本研究结果表明,ADAR1在肝癌中处于高表达水平,可激活Wnt/β-catenin信号通路,从而促进肝癌的增殖、迁移和侵袭。

2型糖尿病合并急性脑梗死患者血清ADA、 SERPINE1水平及临床意义

目的 探讨2型糖尿病(T2DM)合并急性脑梗死(ACI)患者血清腺苷脱氨酶(ADA)、纤溶酶原激活物抑制因子1(SERPINE1)水平及预后预测价值。方法 选择2019年3月至2023年3月西安工会医院收治的195例T2DM合并ACI患者为ACI组和174例单纯T2DM患者为对照组。比较ACI组、对照组及不同神经缺损程度及预后患者血清ADA、SERPINE1水平,分析T2DM合并ACI患者预后不良影响因素,以及各指标预测预后不良的价值。结果 ACI组血清ADA、SERPINE1水平高于对照组(P<0.05)。随着T2DM合并ACI患者神经缺损程度加重,血清ADA、SERPINE1水平升高(P<0.05)。预后不良组血清ADA、SERPINE1水平高于预后良好组(P<0.05)。重度神经缺损及高水平ADA、SERPINE1、HbA1c是T2DM合并ACI患者预后不良的危险因素(P<0.05)。ADA、SERPINE1联合预测T2DM合并ACI患者预后的曲线下面积为0.896,高于单独预测(P<0.05)。结论 T2DM合并ACI患者血清ADA、SERPINE1水平升高与神经缺损程度较重和预后不良有关,联合检测可预测T2DM合并ACI患者预后不良。

血清ADA、GAP43水平与2型糖尿病周围神经病变的相关性研究

目的 研究2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清腺苷脱氨酶(adenosine deaminase,ADA)及生长相关蛋白43(growth associated proteins 43,GAP43)水平与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的相关性。方法 选取2020-02/2022-12月于作者医院诊治的T2DM患者142例,根据是否合并DPN分为非DPN组(n=100)和DPN组(n=42),另以60例健康体检者为对照组。采用酶联免疫吸附试验检测血清ADA、GAP43水平。Pearson法分析血清ADA、GAP43与临床指标的相关性。多因素Logistic回归分析影响T2DM患者发生DPN的因素。受试者工作特征(receiver operating characteristic,ROC)曲线分析血清ADA、GAP43及其联合检测对DPN的预测价值。结果 与对照组比较,T2DM组血清ADA较高,GAP43较低,差异均有统计学意义(P均<0.05)。与非DPN组比较,DPN组患者糖尿病病程更长,空腹血糖(fasting blood glucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,HbA_(1)c)、稳态模型的胰岛素抵抗指数(homeostasis model assessment insulin resistance,HOMA-IR)、血清ADA水平更高,GAP43水平较低,差异均有统计学意义(P均<0.05)。糖尿病病程、 FPG、HbA_(1)c、HOMA-IR水平与血清ADA呈正相关(P均<0.05),与GAP43呈负相关(P<0.05)。血清ADA水平高是影响T2DM患者发生DPN的独立危险因素,而GAP43水平低是其保护因素。血清ADA、GAP43联合检测对预测T2DM患者发生DPN的曲线下面积为0.904[95%置信区间(confidence interval,CI):0.862~0.949],大于ADA[0.850(95%CI:0.803~0.894)]、GAP43[0.839(95%CI:0.690~0.877)]单项指标诊断,差异均有统计学意义(P均<0.05)。结论 T2DM合并DPN患者血清ADA升高,GAP43降低,ADA、GAP43是T2DM患者发生DPN的独立影响因素,两者联合检测有助于预测T2DM患者DPN的发生。

胸膜活检术联合胸腔积液GeneXpert MTB/RIF、ADA检测对结核性胸腔积液的诊断效能

目的:研究胸膜活检术联合胸腔积液GeneXpert结核分枝杆菌(mycobacterium tuberculosis,MTB)/利福平(Rifampin,RIF)、腺苷脱氨酶(adenosine deaminase,ADA)检测对结核性胸腔积液(tuberculous pleural effusion,TPE)的诊断效能。方法:以60例疑似TPE患者为研究对象,所有患者均行胸腔闭式引流术,抽取胸腔积液送检,行常规、ADA及GeneXpert MTB/RIF检测,部分患者经皮胸膜活检术或内科胸腔镜检查,取得病理结果。以综合参考标准(common reporting standard,CRS)为金标准,计算各检测方法单独及联合检测的诊断效能。结果:60例疑似TPE患者,经CRS检查确定结核性28例、非结核性32例。结核性患者胸腔积液ADA高于非结核性患者,差异有统计学意义(P<0.001)。与胸膜活检术、胸腔积液GeneXpert MTB/RIF、ADA单一检测比较,联合检测敏感度、准确度及阴性预测值更高,差异有统计学意义(P<0.05);而四者特异度、阳性预测值比较,差异无统计学意义(P>0.05)。结论:胸膜活检术、胸腔积液GeneXpert MTB/RIF、ADA联合检测对TPE具有较高的诊断效能。

WBC、MLR、ADA、FDP联合应用在社区获得性肺炎与肺结核鉴别诊断中的价值研究

目的研究白细胞计数(WBC)、单核细胞与淋巴细胞比值(MLR)、腺苷脱氨酶(ADA)及纤维蛋白原降解产物(FDP)联合应用在社区获得性肺炎(CAP)与肺结核鉴别诊断中的价值。方法回顾性收集2020年1月至2023年12月贵州医科大学附属医院感染科收治住院的203例成人CAP和191例肺结核患者,分别作为CAP组和肺结核组。比较两组患者基本资料及WBC、MLR、ADA、FDP的差异,使用单因素Logistic回归分析WBC、MLR、ADA、FDP与肺结核相关性,绘制受试者操作特征(ROC)曲线分析WBC、MLR、ADA、FDP单独及联合应用在鉴别CAP和肺结核中的价值。结果CAP组患者体重指数大于肺结核组患者,差异有统计学意义(P<0.05)。CAP组的WBC为7.76(5.70,10.67)×10^(9)/L,高于肺结核组[6.47(5.14,8.10)×10^(9)/L],MLR、ADA、FDP水平分别为0.34(0.24,0.58)、9.1(7.1,12.4)U/L、1.63(0.70,4.10)μg/mL,均低于肺结核组[0.50(0.33,0.80)、13.0(10.4,16.5)U/L、3.80(1.18,8.00)μg/mL],差异均有统计学意义(P<0.05)。单因素Logistic回归分析结果显示WBC、MLR、ADA、FDP均与肺结核有相关性(P<0.05)。WBC、MLR、ADA、FDP在CAP与肺结核的鉴别中曲线下面积(AUC)分别为0.635(95%CI:0.581~0.689)、0.651(95%CI:0.597~0.705)、0.745(95%CI:0.697~0.793)、0.632(95%CI:0.578~0.687),四者联合应用时ROC曲线结果显示AUC为0.77(95%CI:0.724~0.816),敏感度及特异度分别为73.8%和70.9%。结论CAP患者与肺结核患者的WBC、MLR、ADA及FDP有明显差异,四者联合应用可更有效对CAP与肺结核进行鉴别,为CAP与肺结核的早期鉴别提供了一定的诊疗思路。

胸腔积液ADA、VEGF及血清CEA、CA125鉴别良恶性胸腔积液的价值

目的研究胸腔积液腺苷脱氨酶(ADA)、血管内皮生长因子(VEGF)联合血清癌胚抗原(CEA)、糖类抗原125(CA125)鉴别良恶性胸腔积液的价值。方法对2022年1月至2023年9月住院治疗的188例胸腔积液患者进行回顾性研究,根据细胞学、经皮穿刺胸膜活检结果,按胸腔积液性质分为良性组(n=105)与恶性组(n=83)。检测比较2组胸腔积液ADA、VEGF及血清CEA、CA125水平,通过受试者工作特征(ROC)曲线分析胸腔积液ADA、VEGF及血清CEA、CA125单独诊断恶性胸腔积液的价值,Kappa一致性分析胸腔积液ADA、VEGF及血清CEA、CA125联合诊断恶性胸腔积液的准确率。结果良性组胸腔积液ADA水平[(54.47±8.96)U/L]高于恶性组[(21.49±5.37)U/L],胸腔积液VEGF及血清CEA、CA125水平[(213.46±35.27)ng/mL、(1.95±0.52)μg/mL、(324.59±9.26)U/mL]低于恶性组[(409.81±46.63)ng/mL、(21.39±3.54)μg/mL、(408.73±98.14)U/mL](P<0.05)。ROC曲线分析证实,胸腔积液ADA、VEGF及血清CEA、CA125对诊断恶性胸腔积液有一定价值,曲线下面积分别为0.880、0.871、0.892、0.796,均P<0.05。经Kappa一致性分析,胸腔积液ADA、VEGF及血清CEA、CA125联合诊断恶性胸腔积液的敏感度为0.943,特异度为0.867,准确率为0.910,Kappa=0.815。结论胸腔积液ADA、VEGF及血清CEA、CA125均可用于恶性胸腔积液的鉴别,四项联合检测对恶性胸腔积液具有较高的诊断价值。

VEGF、IL-33、ADA2以及ACE联合检测对胸腔积液性质的诊断价值

目的探讨血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)、白细胞介素-33(Interleukin 33,IL-33)、腺苷脱氨酶2(Adenosine Deaminase 2,ADA2)以及血管紧张素转化酶(Angiotensin Converting Enzyme,ACE)联合检测对胸腔积液性质的诊断价值。方法选取2018年1月—2021年1月在大荔县医院行胸腔穿刺抽液的100例胸腔积液患者进行回顾性分析,其中病理诊断为恶性患者58例(恶性组),病理诊断为良性患者42例(良性组),另外选取同期在大荔县医院根据Light诊断标准诊断的20例非胸腔积液患者为对照组,对所有患者的胸腔积液进检测,检测指标为血管内皮生长因子(VEGF)、白细胞介素-33(IL-33)、腺苷脱氨酶2(ADA2)和血管紧张素转换酶(ACE),分析其表达情况;并分析单独检测这4项指标以及联合检测这4项指标对诊断恶性胸腔积液的效果。结果三组患者胸腔积液中VEGF、IL-33、ADA2和ACE的表达水平比较,其中,检测出VEGF、ADA2、IL-33、ACE在恶性组中具有更高的表达,差异均有统计学意义(P<0.05)。诊断胸腔积液性质使用4项指标联合诊断的效果比各指标单独诊断的效果更高,其中灵敏度、特异度和准确度均升高(P<0.05)。受试者操作特征(ROC)曲线分析显示胸腔积液VEGF、IL-33、ADA2、ACE与4项指标联合检测对恶性胸腔积液的诊断曲线下面积为0.810、0.780、0.760、0.750、0.855。结论良、恶性胸腔积液患者中的VEGF、IL-33、ADA2和ACE水平具有较大的差异,VEGF、IL-33、ADA2和ACE联合检测对胸腔积液性质的诊断价值明显高于单项指标。

自身免疫性肝病早期外周血RDW、ADA及补体水平的检测意义

目的观察自身免疫性肝病患者早期外周血红细胞分布宽度(red blood cell distribution width,RDW)、腺苷脱氨酶(adenosine deaminase,ADA)及补体水平的检测意义。方法回顾性分析濮阳市安阳地区医院2019年10月至2022年10月收治的150例自身免疫性肝病患者的临床资料,将其归为观察组,再收集150例同期健康体检人群,将其归为对照组。比较两组早期外周血RDW、ADA及补体水平差异,分析患者早期外周血RDW、ADA及补体水平与自身免疫性肝病发生的相关性,采用ROC曲线分析早期外周血RDW、ADA及补体水平对自身免疫性肝病的诊断效能。结果观察组外周血RDW、ADA及补体水平均高于对照组(P<0.05)。患者早期外周血RDW、ADA及补体水平与自身免疫性肝病发生均呈正相关(P<0.05)。早期外周血RDW、ADA、ADA补体水平曲线均明显高于参考线(P<0.05),其cut-off值分别为16.61%、25.10 U/L、59.91%。结论自身免疫性肝病患者外周血RDW、ADA及补体水平明显高于正常人群,临床早期检测外周血RDW、ADA及补体水平,有利于预防自身免疫性肝病的发生,具有较高临床检测价值。

温脾活血汤治疗结核性胸膜炎作用及对胸膜肥厚、纤溶活性和胸腔积液ADA、MCP-1表达影响

目的观察温脾活血汤治疗结核性胸膜炎的作用及对胸膜肥厚、纤溶活性和腺苷脱氨酶(ADA)、单核细胞趋化蛋白-1(MCP-1)表达的影响。方法选择2020年3月—2021年3月于河北省胸科医院治疗的120例结核性胸膜炎患者,以随机数字表法分组,60例患者为对照组,60例患者为研究组,对照组给予2HRZE/4HR抗结核方案及胸腔穿刺抽液治疗,研究组给予2HRZE/4HR抗结核方案、温脾活血汤及胸腔穿刺抽液治疗,治疗前、后检测两组患者γ-干扰素诱导蛋白10(IP-10)、干扰素-γ(IFN-γ)、白细胞介素-17(IL-17)、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)、ADA、MCP-1、Ⅲ型前胶原(PCⅢ)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制因子-1(PAI-1)、免疫球蛋白IgM、IgG、IgA水平,测量两组患者胸膜厚度,记录两组胸腔积液消失时间,给予两组患者中医证候积分,比较两组患者临床疗效,记录两组不良反应发生情况。结果研究组IL-17、IP-10、IFN-γ、TNF-α水平低于对照组(P<0.05),研究组TGF-β1、ADA、MCP-1水平低于对照组(P<0.05),研究组免疫球蛋白IgM、IgG、IgA水平高于对照组(P<0.05),研究组PCⅢ水平低于对照组(P<0.05),研究组t-PA/PAI-1水平高于对照组(P<0.05),研究组证候评分低于对照组(P<0.05),研究组胸膜薄于对照组(P<0.05),研究组胸腔积液消失时间短于对照组(P<0.05),研究组患者总有效率(96.67%)较对照组(85.00%)高(P<0.05),研究组不良反应发生率(8.33%)较对照组(33.33%)低(P<0.05)。结论温脾活血汤治疗结核性胸膜炎患者,可抑制患者炎症,减低TGF-β1、ADA、MCP-1水平,提升患者免疫力,增加胸腔积液纤溶活性,抑制胸膜肥厚,提升临床疗效,减少不良反应发生。

传染性单核细胞增多症肝损害患儿血清ADA、LDH及EBV-DNA水平对评估病情及预后的临床价值

目的:探究血清ADA、LDH及EBV-DNA水平对传染性单核细胞增多症肝损害患儿病情及预后评估的临床价值。方法:选取109例传染性单核细胞增多症(IM)患儿为研究对象,按是否出现肝损害将患儿分为肝损害组(n=62)与非肝损害组(n=47)。检测两组患儿血清腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)水平及EB病毒脱氧核糖核酸(EBV-DNA)载量,分析不同肝损害程度上述指标表达水平及其与传染性单核细胞增多症并发肝损害的相关性,绘制ROC曲线分析上述指标的诊断效能。结果:肝损害组患儿发生肝肿大率、ALT、AST、TBil水平均高于非肝损害组(P<0.05);肝损害组患儿血清ADA、LDH及EBV-DNA水平高于非肝损害组(P<0.05),且均随肝损害程度升高而升高(P<0.05);传染性单核细胞增多症患儿血清ADA、LDH及EBV-DNA水平与ALT、AST均呈正相关(P<0.05);ROC曲线显示,血清ADA、LDH及EBV-DNA的曲线下面积(AUC)分别为0.831、0.861和0.934,截断值分别为30.60 U/L、544.63 U/L和2.35 lg copies/mL,联合诊断的AUC为0.957。结论:血清ADA、LDH及EBV-DNA水平与IM患儿肝损害相关,对于评估IM合并肝损害诊断以及预后评估方面具有一定参考价值,值得临床广泛应用。