The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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The Ratio Between the Percentage of Lymphocytes and Glucose Levels in Pericardial Fluid as a Method to Diagnose Tuberculous Pericarditis

결핵성 심낭염 진단에 있어 심낭액 림프구-포도당 비

  • Yang, Kyung-Ho (Department of Internal Medicine, Good Samaritan Hospital) ;
  • Song, Yoon-Suk (Department of Internal Medicine, Good Samaritan Hospital) ;
  • Jung, Sun-Ho (Department of Internal Medicine, Good Samaritan Hospital) ;
  • Kim, Tae-Jin (Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital of Inje University) ;
  • Yoon, Shin-Eui (Division of Cardiology, Department of Internal Medicine, Asan Medical Center) ;
  • Jeong, Yong-Suk (Department of Internal Medicine, Good Samaritan Hospital) ;
  • Cho, Kil-Hyun (Department of Internal Medicine, Good Samaritan Hospital) ;
  • Kim, Young-Bok (Department of Internal Medicine, Good Samaritan Hospital)
  • 양경호 (인산의료재단 선린병원 내과) ;
  • 송윤석 (인산의료재단 선린병원 내과) ;
  • 정선호 (인산의료재단 선린병원 내과) ;
  • 김태진 (인제대학교 해운대백병원 심장내과) ;
  • 윤신의 (서울아산병원 심장내과) ;
  • 정용석 (인산의료재단 선린병원 내과) ;
  • 조길현 (인산의료재단 선린병원 내과) ;
  • 김용복 (인산의료재단 선린병원 내과)
  • Published : 2012.10.01
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Abstract

Background/Aims: Adenosine deaminase (ADA) is a valuable biochemical marker for pericardial effusion (PE) and may be useful for diagnosing tuberculous pericarditis (TPE) in patients with PE. However, no definite cut-off or borderline values for ADA currently exist to distinguish TPE from other PE etiologies. In this study, we identified other useful parameters and characterized their relationship with ADA as a method for diagnosing TPE. Methods: From June 2004 to November 2011, 42 patients underwent pericardiocentesis due to moderate or severe PE, as confirmed by echocardiography or chest computed tomography (CT). Patients were subdivided into TPE and non-TPE (NTPE) groups. We analyzed ADA (p) (the pericardial ADA) and %Lymph (p)/Glucose (p) (the ratio between the percentage of lymphocytes and glucose levels in PE). Results: We defined the cut-off value of ADA (p) as 48.5 IU/L, and that of %Lymph (p)/Glucose (p) as 0.678% dL/mg. In a multivariate logistic regression analysis, an odds ratio (OR) of 44.24 and a 95% confidence interval (CI) of 2.85-686.97 were observed in patients with an ADA (p) ${\geq}$ 48.5 IU/L (p = 0.023). An OR of 20.39 and a 95% CI of 1.06-392.93 were observed in patients with a %Lymph (p)/Glucose (p) ${\geq}$ 0.678% dL/mg (p = 0.046). The combination of ADA (p) and %Lymph (p)/Glucose (p) had a higher positive predictive value (PPV, 80.0%) and specificity (Sp, 93.8%) than either ADA (p) (PPV, 47.4%; Sp, 68.8%) or %Lymph (p)/Glucose (p) (PPV, 69.2%; Sp, 87.5%) alone. Conclusions: %Lymph (p)/Glucose (p) is a useful parameter for distinguishing TPE from other pericardial diseases if combined with an ADA (p) ${\geq}$ 48.5 IU/L.

목적: 결핵성 심낭염 진단에 심낭액의 검사을 통해 간편하고 유용하게 진단에 도움을 받을 수 있는 생화학적 지표로 ADA가 이용되고 있다. 그러나 심낭액 ADA로 결핵성 심낭염과 그 외 다른 심낭염을 감별해내기가 어려운 경우도 있다. 이에 심낭액 ADA 같이 결핵성 심낭염 진단에 참고될 수 있는 심낭액 생화학 검사 유무를 확인하고자 하였다. 방법: 인산의료재단 선린병원에서 2004년 6월 19일부터 2011년 11월 23일까지 42명의 심낭천자술 시행 후 생화학 검사가 결핵 진단 유무와 관련 있는지를 분석하였다. 진단기준을 정하여 이에 해당되었을 때에 결핵군, 해당되지 않을 때에 비결핵군으로 분류하였다. 분석은 ROC 곡선, 교차분석, 단순 및 다중 로지스틱 회귀분석, 단순상관분석을 시행하였다. 결과: ROC 곡선 시행 결과 심낭액 ADA와 %Lymph (p)/Glucose (p) (심낭액림프구-포도당비: 심낭액 백혈구 중 림프구 백분율을 심낭액 포도당 수치로 나눈 값; 단위: % dL/mg)의 제한치를 각각 48.5 IU/L (민감도 90.0%, 특이도 87.5%, 유의확률 < 0.001)와 0.678% dL/mg (민감도 90.0%, 특이도 71.9%, 유의확률 = 0.006)로 정하였다. 다중 로지스틱 회귀분석 결과 심낭액 ADA ${\geq}$ 48.5 IU/L (교차비 44.24; 95% 신뢰구간 2.85-686.97; 유의확률 = 0.07)이었고, 심낭액 림프구-포도당비 ${\geq}$ 0.678% dL/mg (교차비 20.39; 95% 신뢰구간 1.06-392.93; 유의확률 = 0.046)는 통계적 유의성이 있었다. %Lymph (p)/Glucose (p) ${\geq}$ 0.678% dL/mg과 ADA (p) ${\geq}$ 48.5 IU/L를 병합 (PPV 80.0% Sp 93.8%)하였을 때 %Lymph (p)/Glucose (p) ${\geq}$ 0.678% dL/mg 단독(PPV 47.4% Sp 68.8%), ADA (p) ${\geq}$ 48.5 IU/L (PPV 69.2% Sp 87.5%) 단독일 때보다 양성예측도, 특이도가 상대적으로 높았다. 결론: 향후의 대규모 연구에서도 동일한 결과가 나온다면 심낭액 림프구-포도당 비를 심낭액 ADA와 병합하여 적용하는 것이 단일 기준(심낭액 ADA, 심낭액 림프구-포도당비)일 때보다 비결핵성 심낭염(NTPE, non-tuberculous pericarditis)을 배제하는 데 더 도움이 된다.

Keywords

References

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