Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Diagnostic Usefulness of Pleural Fluid Adenosine deaminase with Lymphocyte/Neutrophil Ratio in Tuberculous Pleural Effusion

결핵성 흉막삼출액에서 흉수 Adenosine Deaminase치와 림프구/호중구 비의 진단적 유용성

  • Shin, Min Khi (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Ham, Hyun Seok (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Dong Won (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Cho, Yoo Ji (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Jeong, Yi Yeong (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Kim, Ho Cheol (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Lee, Jong Deok (Department of Internal Medicine, College of Medicine, Gyeongsang National University) ;
  • Hwang, Young Sil (Department of Internal Medicine, College of Medicine, Gyeongsang National University)
  • 신민기 (경상대학교 의과대학 내과학교실) ;
  • 함현석 (경상대학교 의과대학 내과학교실) ;
  • 이동원 (경상대학교 의과대학 내과학교실) ;
  • 조유지 (경상대학교 의과대학 내과학교실) ;
  • 정이영 (경상대학교 의과대학 내과학교실) ;
  • 김호철 (경상대학교 의과대학 내과학교실) ;
  • 이종덕 (경상대학교 의과대학 내과학교실) ;
  • 황영실 (경상대학교 의과대학 내과학교실)
  • Received : 2004.03.26
  • Accepted : 2004.07.06
  • Published : 2004.08.30
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Abstract

Background : The measurement of adenosine deaminase(ADA) level in pleural fluid is useful in the diagnosis of tuberculous(TB) pleural effusion. However, ADA is also elevated in other diseases such as malignancy, bacterial infections, empyema, and collagen vascular disease, ADA alone has limited value. The object of this study is to determine diagnostic usefulness of the combined use of ADA value with lymphocyte/neutrophil ratio(L/N ratio) rather than the use of ADA alone. Method : We evaluated 198 patients(age=$55.9{\pm}12.9$, M/F=2.7:1) with pleural effusion who had admitted in Gyeong-sang National University Hospital from Jan. 1999 to Dec. 2001. retrospectively. Patients were divided into four diagnostic groups: TB pleural effusion(n=91), parapneumonic effusion(n=65), malignant effusion(n=21), and transudative effusion(n=13). The ADA level, differential cell count, biochemistry, cytology, and microbiology of each diagnostic groups were evaluated. The sensitivity, specificity, negative predictive value(npv), positive predictive value(ppv) and efficiency were calculated at each ADA values and combined ADA value with various L/N ratios. Results : The ADA level in TB pleural effusion was significantly higher than that of parapneumonic effusion, malignant pleural effusion, and transudative effusion(p<0.05). Sensitivity, specificity, ppv, npv and efficiency at $ADA{\geqq}50$ IU/L in the diagnosis of TB pleural effusion were 89.0%, 82.2%, 81.0%, 89.8% and 85.5% respectively. When $ADA{\geqq}50$ IU/L was combined with lymphocyte/neutrophil $ratio{\geqq}0.75$, sensitivity, specificity, ppv, npv, and efficiency were 83.5%, 96.3%, 95.0%, 87.9% and 90.5% respectively. Specificity, ppv and efficiency were increased with combination of ADA value and L/N ratio. Conclusion : Combination of ADA value and L/N ratio in pleural effusion is more useful than ADA value alone in the diagnosis of TB pleural effusion.

배 경 : 흉수 ADA치는 결핵성 흉막삼출액의 진단에 유용하지만 악성 흉막삼출액이나 부폐렴성 흉수, 농흉, 교원성 질환에 의한 흉수 등에서도 증가되는 경우가 있어 진단적 제한이 있다. 본 연구에서는 결핵성 흉막삼출액에서 흉수 ADA치와 림프구/호중구 비를 함께 적용할 때의 진단적 유용성에 대해 알아보았다. 대상 및 방법 : 1999년 1월부터 2001년 12월까지 경상대학교 병원에 흉수를 주소로 내원한 198명의 환자를 대상으로 하였다. 환자를 결핵성 흉막삼출액, 부폐렴성 흉막삼출액, 악성 흉막삼출액, 흉수여출액의 네 군으로 분류하였고 각 군의 ADA치, 생화학적 성상, 염증세포비율, 세포진검사, 미생물학적 검사결과를 조사하였다. 민감도, 특이도, 양성예측률, 음성예측률, 효능도를 여러 ADA 차단값과 림프구/호중구 비에서 각각 구했다. 결 과 : 1) 결핵성 흉막삼출액에서 ADA치는 다른 군에 비해 유의하게 높았다 (p<0.05). 2) ADA 50 IU/L 이상에서 민감도, 특이도, 양성예측률, 음성예측률, 효능도가 각각 89%, 82.2%, 81%, 89.8%, 85.5%였다. 3) ADA 50 IU/L 이상과 함께 림프구/호중구 비 0.75 이상을 함께 적용할 경우 민감도, 특이도, 양성예측률, 음성예측률, 효능도가 각각 83.5%, 96.3%, 95%, 87.9%, 90.5%로 특이도, 양성예측률, 효능도가 향상되었다. 결 론 : ADA치와 함께 림프구/호중구 비를 함께 적용할 경우 ADA치 만을 적용할 때보다 결핵성 흉막 삼출액에 대한 진단적 유용성이 더 증가하였다.

Keywords

References

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