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...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 ADA<sub>1</sub> inhibitor using the same method.Results:The results demonstrated a statistically significant values of ADA<sub>2</sub> in serum（P【0.001）,pleural fluid（P = 0.000） and significant value for the ratio of pleural fluid ADA<sub>2</sub>/serum ADA2（P【0.001） and pleural fluid ADA/ADA(<sub>2</sub>（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 ADA<sub>2</sub> 95.4%and 66%（cut off value 70 IU/L for tuberculous effusions）. ADA2<sub> </sub>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.展开更多
文摘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 ADA<sub>1</sub> inhibitor using the same method.Results:The results demonstrated a statistically significant values of ADA<sub>2</sub> in serum（P【0.001）,pleural fluid（P = 0.000） and significant value for the ratio of pleural fluid ADA<sub>2</sub>/serum ADA2（P【0.001） and pleural fluid ADA/ADA(<sub>2</sub>（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 ADA<sub>2</sub> 95.4%and 66%（cut off value 70 IU/L for tuberculous effusions）. ADA2<sub> </sub>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.
文摘目的总结胸膜结核瘤(pleural tuberculoma,PTM)的临床特征,分析发病高危因素。方法回顾性分析2017年4月至2021年4月在南京市第二医院收治的56例PTM患者(病例组)资料,首先总结该56例患者的临床特征,其次与60例结核性胸膜炎(tuberculous pleurisy,TPE)(对照组)未合并PTM的病例对比,分析罹患PTM的高危因素。结果PTM的平均年龄为(29.04±6.95)岁,男女性别无差异。从诊断TPE起,PTM的平均发病时间为(4.29±2.34)个月。42例(75%)PTM位于下肺叶。病例组和对照组临床症状、基础疾病差异无显著性,在合并影像学比较中,病例组胸膜增厚更常见(44.64%vs 23.33%,P=0.02),同时胸水ADA(adenosine deaminase)水平高于对照组[(48.32±19.19)U/L vs(44.79±24.57)U/L,P=0.03]。在细胞免疫功能检测中,CD_(4)^(+)、CD_(8)^(+)T淋巴细胞绝对计数和CD_(4)^(+)/CD_(8)^(+)T比值2组差异无显著性(P>0.05),而病例组CD_(4)^(+)和CD_(8)^(+)T细胞的活化标志物Ki-67+的表达明显高于对照组(36.64±16.50 vs 7.19±5.23,P<0.001;33.31±15.94 vs 5.02±7.13,P<0.001)。结论PTM的发病年龄较轻,多见于TPE治疗半年内出现。罹患PTM的高危因素较复杂,胸膜增厚、ADA水平升高以及T淋巴细胞的免疫活化失调可能是PTM发病的高危因素。
