Significance of Pleural Fluid PCR and ADA Activity in the Diagnosis of Tuberculous Pleurisy

결핵성 늑막염의 진단시 늑막액의 Tb PCR 및 ADA활성도에 관한 연구

  • 황재준 (고려대학교 부속 구로병원 흉부외과) ;
  • 최영호 (고려대학교 부속 구로병원 흉부외과) ;
  • 김욱진 (청주 한국병원 흉부외과) ;
  • 신재승 (고려대학교 부속 구로병원 흉부외과) ;
  • 손영상 (고려대학교 부속 구로병원 흉부외과) ;
  • 김학제 (고려대학교 부속 구로병원 흉부외과)
  • Published : 2000.08.01

Abstract

Background: Tuberculous pleurisy is the leading cause of pleural effusion in Korea. And differential diagnosis of tuberculous pleurisy with other cause is clinically very important. Traditional diagnostic methods such as routine analysis of pleural fluid, staining for acid-fast bacilli or pleural biopsy have major inherent limitaion. This study was designed to evaluate the significance of pleural fluid polymerase chain reaction(PCR) and adenosine deaminase (ADA) activity in early diagnosis of tuberculous pleurisy. Material and Method: Between March 1996 and July 1997, 198 patients with pleural effusion reviewed retrospectively. The study group included 112 cases with tuberculous effusion and 86 cases with non-tuberculous effusions, whose diagnoses were confirmed by pleural biopsy, microbiological methods, or cytology. We compared the results of PCR and pleural fluid levels of ADA between tuberculous and non-tuberculous effusions. Result: Mean age was 47.54$\pm$19.52 years(range 2 to 85 years). The positive rate of PCR was significantly higher in tuberculous group than non-tuberculous group(p<0.05). The sensitivty, specificity, positive predictive value(PPV), and negative predictive value(NPV) for PCR were 31.7, 90.9, 83.0, and 48.8%, respectively. Mean ADA activity was significantly higher in tuberculous group than non-tuberculous group(83.2 U/L vs 49.8 U/L)(p<0.05). With diagnostic thresholds of 40 U/L, the sensitivity, specificity, PPV, and NPV of ADA for tuberculosis were 75.9, 70.9, 77.3, and 69.3% respectively. At a level of 70 U/L, the sensitivity, specificity, PPV, and NPV of ADA for tuberculosis were 70.1, 75.9, 82.9, and 60.3% respectively. Conclusion: PCR is very highly specific, but less sensitive methods in diagnosis of tuberculous pleurisy. But ADA level of pleural fluid has acceptable sensitivity and specificity in diagnosis of tuberculous pleurisy. ADA activity is more useful test in the evaluation of pleural effusions.

Keywords

References

  1. Lancet v.4 Rapid diagnosis of tuberculosis by amplification of mycobacterial DNA in clinical samples Brisson-Noel A;Gicquel B;Lecossier D;Levy-Frebault V;Nassif X;Hance AJ
  2. J Clin Microbiol v.28 Detection and identification of Mycobacterium tuberculosis by DNA amplification Pao CC;Benedict Yen Ts;You JB;Maa JS;Fiss EH;Chang CH
  3. J Clin Microbiol v.28 Direct detection of Mycobacterium tuberculosis in clinical specimens by DNA amlpification de Wit D;Steyn L;Shoemaker S;Sogin M
  4. J Clin Microbiol v.28 Sequence analysis and amplification by polymerase chain reaction of a cloned DNA fragment for identification fof Mycobacterium tuberculosis Patel RJ;Frcis JW;Piessens WF;Wirth DF
  5. Science v.29 Primer-directed enzymatic amlification of DNA with a Thermostable DNA polymerase Saiki RK;Genfand DH;Stoffel SJ;Higuchi R;Horn GT;Mullis KB;Enrlich HA
  6. 결핵 및 호흡기 질환 v.39 Polymerase chain reaction (PCR)을 이용한 결핵의 진단에 관한 연구 김호중;김영환;한성구;심영수;김건열;한용철
  7. J Clin Microbiol v.33 Diagnosis of tuberculosis by Amplicor Mycobacterium tuberculosis test: a multicenter study Carpentier E;Drouillard B;Dailloux M(et al)
  8. J Med Microbiol v.46 Comparative usefulness of PCR in the detection of Mycobacterium tuberculosis in defferent clinical specimens Tan MF;Ng WC;Chan SH;Tan WC
  9. J Clin Pathol v.49 Single-tube nested PCR in the diagnosis of tuberculosis Chan CM;Yuen KY;Chan KS
  10. J Immunol v.122 The destribution of adenosine deaminase among lymphocyte populations in the rat Barton R;Martiniuk F;Hirschhorn R;Goldschneider I
  11. Clin Exp Immunol v.44 Role of adenosme deaminase in the early stages of precursor T cell maturation Shore A;Dosch HM;Gelfand EW
  12. J Clin Invest v.58 A role for adenosine deaminase in human monocyte maturation Fischer D;Van der Weyden MB;Synderman R;Kelly WN
  13. Lancet v.18 Adenosine deaminase deficiency in two patients with severely impaired cellular immunity Giblett ER;Anderson JE;Cohcn F;Pollara B;Mcuwissen HJ
  14. Proc Soc Expt Biol Med v.101 Serum adenosine deaminase activity in cancer Schwarts MK;Bodansky O
  15. Clin Chim Acta v.13 Diagnostic value of adenosine deaminase in some liver disease Raczynska J;Jonas S;Krawczynski J
  16. Br Med J v.23 Adenosine deaminase activity in pleural effusiong: An aid to differ ential diagnosis Piras MA;Gakis C;Budroni M;Andreokni G
  17. Nippon Kyobu Shikkan Gakkai Zasshi v.19 Measurement of ADA activity in pleural effusion with special reference to carcinomatous and tuberculous pleuritis Hayashi R;Ishihara Y;Kitamura S;Kosaka K
  18. 대한내과학회잡지 v.31 흉막액 adenoshine deaminase 활성도의 진단적 가치에 관한 연구 장상호;장준;손희영;김성규;김기호
  19. Chost v.84 Adenosine deaminase in pleural flinds: Test for diagnosis of tuberculous pleural effusion Ocana I;Martinex-Vazques JM;Sequra RM;Fernandez-De-Sevijja T;Capdevila JA
  20. 대한내과학회잡지 v.33 각종 늑막저류에서 adenosine deaminase 활성도에 관한 연구 성낙억;신계철;이홍새;이경원