| Objective:This study aimed to investigate the etiology,clinical features and pathological mechanism of elevated ADA in non-tuberculous pleural effusion(NTPE)with adenosine deaminase(ADA),To evaluate the diagnosis and differential diagnosis of ADA in non-tuberculous pleural effusion,and to further improve the diagnosis and differential diagnosis of the cause of pleural effusion with ADA.Methodes:Thirteen patients with non-tuberculous pleural effusion with ADA who were hospitalized in Department of Respiratory Medicine,Sino-Japanese Friendship Hospital,Jilin University from January 2017 to January 2018 were collected,Retrospective analysis of its clinical data、imaging data、laboratory test results and other related information;Using the Chinese Journal Full-text Database,Wanfang Database and VIP database for “pleural effusion,pleural effusion with elevated ADA,elevated adenosine deaminase,misdiagnosis of pleural effusion”as the key words,using Pub Med database for “ADA elevated pleural effusion、pleural effusion、elevated ADA levels”as the key words,Retrievingcases of ADA raised non-tuberculous pleural effusion reported at home and abroad from January 2008 to January 2018,comprehensive analysis of 87 cases with incomplete information and non-repetitive reports was conducted.Results:1.13 cases of our hospital basic situation:(1)Patient baseline clinical data : thirteen patients with NTPE included 8 males and 5females,the ratio of males to females was 1.6:1,with an average age of61.8 years.Of these,10 were acute(course duration is less than or equal to 2 weeks),and 3 were chronic(duration of 2 months and above).(2)Clinical manifestations:clinical symptoms were followed by cough(12/13)、shortness of breath(11/13)、sputum(9/13)、chest pain(6/13)、fever(6/13)、chest tightness(3/13)、night sweats(1/13);Including bloody sputum(2/13)occurred in the more intense cough,the blood volume is small,can stop on their own.(3)Chest imaging findings:thoracic CT was found in 12 cases(92.3%)of pleural effusion,1 case was found through the chest radiograph(7.7%).Unilateral pleural effusion in10 cases,bilateral pleural effusion in 3 cases,of which 3 cases were encapsulated fluid.(4)Pleural fluid examination:all 13 cases were exudative fluid.The appearance of hydrothorax was yellow in 7 cases(53.8%),purulent in 5 cases(38.5%),bloody in 1 case(7.7%).The cell count of the pleural effusion increased>500×106/L,Mainly inlymphocytes and multinucleated cells,6 cases in each.5 cases of significantly lower sugar content(< 1.4mmol/L),elevated protein content(11/13),elevated LDH(12/13),the levels of ADA in 13 patients were elevated in varying degrees.Two cases of pleural effusion cytology found malignant cells,of which 1 was adenocarcinoma,the other 1confirmed by immunohistoch-emistry diffuse large B-cell non-Hodgkin’s lymphoma.The culture of hydrothorax was positive(3/13),they were Streptococcus intermedius,Escherichia coli,and Staphylococcus aureus.(5)Etiology:5 cases of empyema(38.5%),4 cases of complicated parapneumonic pleural effusion(30.8%),3 cases of malignant pleural effusion(23.0%)and 1 case of rheumatic pleural effusion(7.7%).In malignant pleural effusion,2 cases were caused by lung cancer and 1 case was caused by malignant lymphoma.2.Literature review results:(1)Patient baseline clinical data:from January 2008 to January 2018,a total of 87 cases with complete data of non-tuberculous pleural effusion with ADA reported at home and abroad were reported.There were 57 males and 30 females in 87 patients,and the proportion of men and women was 1.9:1.The average age was 44 years,of which the youngest was 5 months old and the maximum was 76 years old.(2)The main clinical manifestations:breathlessness(51/87)、cough(46/87)、fever(38/87)、chest pain(36/87)、expectoration(26/87)、Chest tightness(20/87)、night sweats(14/87)、weight loss(10/87)、blood in thesputum(2/87)、hoarse voice(1/13).(3)Chest and abdominal imaging:there were 66 cases of unilateral pleural effusion(30 cases of right pleural effusion,36 cases of left pleural effusion),21 cases with bilateral pleural effusion,and the ratio of single and bilateral to 3.1:1.10 cases were combined with pericardial effusion,5 cases with celiac effusion,4 cases with pneumothorax,and 1 case with multiple serous cavity effusion.(4)Pleural fluid examination:among the 87 cases pleural effusion,85 cases of exudate.The appearance of hydrothorax was yellow in 55 cases,purulent in 13 cases,bloody in 12 cases,6 cases of orange,1 case of milky white.80 cases reported LDH levels in pleural effusion,72 cases(90%)were higher than the upper limit of normal,of which 65% of patients had LDH≥500U/L.(5)Etiology:among the 87 patients,50 cases were malignant lymphoma(57.5%),including 49 cases of non Hodgkin lymphoma(98%,11 cases of B cell lymphoma,38 cases of T cell lymphoma),1 case of Hodgkin lymphoma(2%);Empyema in 13 cases(14.9%);the complicated parapneumonic pleural effusion in 6 cases(6.9%);5 cases of paragonimiasis(5.7%);5 cases of multiple myeloma(5.7%);3 cases of acute lymphoblastic leukemia(3.4%);2 cases of lung cancer(2.2%);1 case of pleural mesothelioma(1.1%);1 case of systemic lupus erythematosus(1.1%);1 case of Behcet’s disease(1.1%).Conclusions:1.Common causes of non-tuberculous pleural effusion with elevatedADA:malignant lymphomas、empyema、the complicated parapneumonic pleural effusion、paragonimiasis、multiple myeloma、acute lymphoblastic leukemia;the less common causes:Pleural mesothelioma、Connective tissue disease.2.Malignant lymphoma is caused by non-tuberculous pleural effusion increased ADA the most important cause,followed by empyema.ADA levels in pleural effusion caused by malignant lymphoma and acute lymphoblastic leukemia were significantly increased,even exceeding the ADA content in tuberculous pleural effusion.3.Empyema not only significantly increased ADA,LDH was also significantly higher(>5000U/L).4.A single application of ADA differential diagnosis of pleural effusion have some limitations,too high should consider the possibility of non-tuberculous pleural effusion. |
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