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KMID : 0383820090660060437
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Tuberculosis and Respiratory Diseases
2009 Volume.66 No. 6 p.437 ~ p.443
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Usefulness of the Pleural Fluid Adenosine Deaminase with Lymphocyte/Neutrophil Ratio in the Diagnosis of Tuberculous Pleurisy for a Region of Intermediate Prevalence of Tuberculosis
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Kim Chang-Hwan
Kim Cheol-Hong
Hyun In-Gyu
Park Yong-Bum
Chung Ki-Suck
Lee Myung-Goo
Kim Dong-Gyu
Hwang Yong-Il
Jang Seung-Hun
Mo Eun-Kyung
Park Sung-Hoon
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Abstract
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Background: The aim of this study was to consider the significance of pleural fluid adenosine deaminase (ADA) activity combined with lymphocyte/neutrophil (L/N) ratio in the diagnosis of tuberculous pleurisy (TBpl) in a region of intermediate prevalence of tuberculosis (TB).
Methods: We collected data from 388 patients with exudative pleural effusions. The final diagnoses were compared to the results from our diagnostic method using pleural fluid ADA and L/N ratio.
Results: 108 patients had a final diagnosis of TBpl; 102 cases had high levels of ADA (≥40 IU/L). When we considered ADA ≥40 IU/L as a diagnostic criterion, the sensitivity was 94.4%, specificity 87.5%, and post-test probability 74.5%. However, when we considered ADA ≥40 IU/L combined with the L/N ratio ≥0.75 as a diagnostic criterion, the specificity and post-test probability were rose to 97.5% and 93%, respectively. The other causes of high ADA and L/N ratios were lymphoma and metastatic carcinoma, but mass-like lesions were found on the chest radiographs or CT scans.
Conclusion: To evaluate the causes of exudative pleural effusions in a region of intermediate prevalence of tuberculosis, we recommend measuring the pleural fluid ADA and L/N ratio first. If the result is high and malignancies are not suspected, it may be diagnostic of TBpl.
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KEYWORD
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Adenosine deaminase, Diagnosis, Tuberculous pleurisy
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