The Clinical Diagnostic Value Of ADA And IFN-? In Tuberculous Pleural Effusion

Objectives: Explore pleural ADA activity and IFN-? concentration in differentiating diagnosis of TPE from non-TPE and explore clinical usefulness of pleural ADA and IFN-? in diagnosis of TPE. Explore pleural ADA activity and IFN-? concentration in the TPE of different pathology types and the correlation between them. Methods: A prospective study was carried out from December 2014 to October 2015. During this period, 40 patients were diagnosed by pleural pathological examination or finding acid-fast bacilli in the pleural effusion, 40 patients diagnosed with non-TPE. Statisticed the patients, basic situations when they hospitalized. The ADA activity and IFN-? concentration in patients' pleural effusion were determined by standard enzyme colorimetric method and ELISA. In accordance with the ROC curve, analysised the diagnostic value of ADA activity and IFN-? concentration in TPE. TPE patients were classified in accordance with pleural biopsy pathology results. Analysised the diagnostic value of ADA activity and IFN-? concentration in TPE of different pathology types. Analysised the correlation between the ADA activity and the IFN-?concentration in all TPE patients. Result: 1. The medical thoracoscopy had a high diagnosis rate in the pleural effusion of unknown cause and the diagnostic rate of this research was 84.21%. Tuberculosis(40/76)and cancer(17/76) were the major cause of pleural effusion disease. The medical thoracoscopy could provide the appropriate radiological and pathological basis for the treatment. There were no serious complications in this check of medical thoracoscopy and the operation is safe. 2. The pleural effusions ADA activity(43.88±8.87U/L) in the TPE was significantly higher than that in the non-TPE(15.11±8.47U/L)(P<0.05). According to the ROC curves, the area under the curve of pleural effusions ADA activity was 0.921, and the cutoff value of pleural effusions ADA activity for TPE was 31.505U/L, with a sensitivity of 93.5% and a specificity of 85.5%. The IFN-? concentration(244.43±64.04pg/mL) in the TPE was significantly higher than that in the non-TPE(71.39±25.18pg/mL)(P<0.05). According to the ROC curves, the area under the curve of pleural IFN-? concentration was 0.975, and the cutoff value of pleural IFN-? concentration for TPE was 140.315pg/mL, with a sensitivity of 89.6% and a specificity of 90.4%. 3. In accordance with pleural biopsy pathology results, the TP could be divided into three types: caseous necrosis type, hyperplasia type and exudative type. In the three pathology types, there was significant difference in effusions ADA activity(P<0.05). The pleural effusions ADA activity(52.48±4.62 U/L) in the caseous necrosis type was significantly higher than that in the hyperplasia type(42.69±3.65U/L) and in the exudative type(37.37±8.68U/L)(P<0.05). And the pleural effusions ADA activity in the hyperplasia type was higher than in the exudative type(P<0.05). In the three pathology types, there were no significant difference in pleural effusions IFN-? concentration(P>0.05). 4. There was no correlation between the ADA activity and the IFN-? concentration in all TPE patients(r=0.222 P=0.169). In the TPE patients with different types of pathology, the ADA activity in hyperplasia type effusion was highly correlated with IFN-? concentration(r=0.884 P<0.01). The ADA activity in the exudative type effusion was moderately correlated with IFN-? concentration(r=0.615 P=0.033). There was no correlation between the ADA activity and the IFN-? concentration in the aseous necrosis type effusion(P=0.659). Conclusions:The pleural effusions ADA activity in the TPE is(43.88±8.87) U/L. According to the ROC curves, the cutoff value of pleural effusions ADA activity for TPE is 31.505U/L. The IFN-? concentration in the TPE is(244.43±64.04) pg/mL. According to the ROC curves, the cutoff value of pleural IFN-? concentration for TPE is 140.315 pg/mL. The pleural effusions ADA activity is different in the three pathology types, and ADA activity in the caseous necrosis type is significantly higher than others. In the three pathology types, there is no significant difference in pleural effusions IFN-? concentration. In the TPE patients with different types of pathology, the ADA activity in hyperplasia and exudative type effusion is correlated with IFN-? concentration.