중등도 결핵 유병률 지역에서 결핵성흉막염 진단에 있어 흉수 아데노신 탈아미 노효소와 림프구/호중구 비의 유용성
Usefulness of the Pleural Fluid Adenosine Deaminase with Lymphocyte/ Neutrophil Ratio in the Diagnosis of Tuberculous Pleurisy for a Region of Intermediate Prevalence of Tuberculosis
박성훈 (한림대학교)
황용일 (한림대학교)
장승훈 (한림대학교)
박용범 (한림대학교)
김철홍 (한림대학교)
김동규 (한림대학교)
이명구 (한림대학교)
현인규 (한림대학교)
정기석 (한림대학교)
모은경 (한림대학교)
- 다운로드 수
- 조회수
Abstract
Background: The aim of this study was to consider the significance of pleural fluid adenosine deaminase (ADA) activity combined with lymphocyte/neutrophil (L/N) ratio in the diagnosis of tuberculous pleurisy (TBpl) in a region of intermediate prevalence of tuberculosis (TB). Methods: We collected data from 388 patients with exudative pleural effusions. The final diagnoses were compared to the results from our diagnostic method using pleural fluid ADA and L/N ratio. Results: 108 patients had a final diagnosis of TBpl; 102 cases had high levels of ADA (≥40 IU/L). When we considered ADA ≥40 IU/L as a diagnostic criterion, the sensitivity was 94.4%, specificity 87.5%, and posttest posttest probability 74.5%. However, when we considered ADA ≥40 IU/L combined with the L/N ratio ≥0.75 as a diagnostic criterion, the specificity and post-test probability were rose to 97.5% and 93%, respectively. The other causes of high ADA and L/N ratios were lymphoma and metastatic carcinoma, but mass-like lesions were found on the chest radiographs or CT scans. Conclusion: To evaluate the causes of exudative pleural effusions in a region of intermediate prevalence of tuberculosis, we recommend measuring the pleural fluid ADA and L/N ratio first. If the result is high and malignancies are not suspected, it may be diagnostic of TBpl.
- keywords
- Adenosine deaminase, Diagnosis, Tuberculous pleurisy
참고문헌
Valdés L, Pose A, San José E, Martínez Vázquez JM. Tuberculous pleural effusions. Eur J Intern Med 2003;14:77-88.
Ferrer J. Pleural tuberculosis. Eur Respir J 1997;10:942-7.
Berger HW, Mejia E. Tuberculous pleurisy. Chest 1973;63:88-92.
Pérez-Rodriguez E, Jiménez Castro D. The use of adenosine deaminase and adenosine deaminase isoenzymes in the diagnosis of tuberculous pleuritis. Curr Opin Pulm Med 2000;6:259-66.
Piras MA, Gakis C, Budroni M, Andreoni G. Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. Br Med J 1978;2:1751-2.
Mo EK, Oh YM, Jung MP, Lee KY, Yoo CG, Kim YW. A prospective study on the diagnostic value of adenosine deaminase activity in tuberculous pleural effusion. Korean J Med 1995;48:625-32.
Valdés L, Alvarez D, San José E, Penela P, Valle JM, García-Pazos JM, et al. Tuberculous pleurisy: a study of 254 patients. Arch Intern Med 1998;158:2017-21.
Goto M, Noguchi Y, Koyama H, Hira K, Shimbo T, Fukui T. Diagnostic value of adenosine deaminase in tuberculous pleural effusion: a meta-analysis. Ann Clin Biochem 2003;40:374-81.
Valdés L, Alvarez D, San José E, Juanatey JR, Pose A, Valle JM, et al. Value of adenosine deaminase in the diagnosis of tuberculous pleural effusions in young patients in a region of high prevalence of tuberculosis. Thorax 1995;50:600-3.
Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Combined use of pleural adenosine deaminase with lymphocyte/ neutrophil ratio. Increased specificity for the diag nosis of tuberculous pleuritis. Chest 1996;109:414-9.
Diacon AH, Van de Wal BW, Wyser C, Smedema JP, Bezuidenhout J, Bolliger CT, et al. Diagnostic tools in tuberculous pleurisy: a direct comparative study. Eur Respir J 2003;22:589-91.
Ghanei M, Aslani J, Bahrami H, Adhami H. Simple method for rapid diagnosis of tuberculosis pleuritis: a statistical approach. Asian Cardiovasc Thorac Ann 2004;12:23-9.
Porcel JM, Vives M. Differentiating tuberculous from malignant pleural effusions: a scoring model. Med Sci Monit 2003;9:CR175-80.
Jeon EJ, Kwak HW, Song JH, Lee YW, Jeong JW, Choi JC, et al. Diagnostic value of ADA multiplied by lymphocyte to neutrophil ratio in tuberculous pleurisy. Tuberc Respir Dis 2007;63:17-23.
Roth BJ. Searching for tuberculosis in the pleural space. Chest 1999;116:3-5.
Ferrer Sancho J. Pleural tuberculosis: incidence, pathogenesis, diagnosis, and treatment. Curr Opin Pulm Med 1996;2:327-34.
Pace E, Gjomarkaj M, Melis M, Profita M, Spatafora M, Vignola AM, et al. Interleukin-8 induces lymphocyte chemotaxis into the pleural space: role of pleural macrophages. Am J Respir Crit Care Med 1999;159:1592-9.
Kim CJ, Yeon KM, Kim ST, Wang JH, Yoo KH. Relationship between age and pleural fluid adenosine deaminase activity in patients with tuberculous pleural effusion. Tuberc Respir Dis 2002;52:608-15.
Riantawan P, Chaowalit P, Wongsangiem M, Rojanaraweewong P. Diagnostic value of pleural fluid adenosine deaminase in tuberculous pleuritis with reference to HIV coinfection and a Bayesian analysis. Chest 1999;116:97-103.
Laniado-Laborin R. Adenosine deaminase in the diagnosis of tuberculous pleural effusion: is it really an ideal test? A word of caution. Chest 2005;127:417-8.
Kataria YP, Khurshid I. Adenosine deaminase in the diagnosis of tuberculous pleural effusion. Chest 2001;120:334-6.
Jaeschke R, Guyatt G, Lijmer J. Diagnostic tests. In: Guyatt G, Rennie D, editors. Users' guides to the medical literature: a manual for evidence-based clinical practice. 1st ed. Chicago: AMA Press; 2002. p. 121-40.
Lee YC, Rogers JT, Rodriguez RM, Miller KD, Light RW. Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions. Chest 2001;120:356-61.
Light RW. Diagnostic principles in pleural disease. Eur Respir J 1997;10:476-81.
Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003;58 Suppl 2:ii8-17.
- 다운로드 수
- 조회수
- 0KCI 피인용수
- 0WOS 피인용수