【摘要】 目的: 探讨胸水的腺苷脱氨酶(ADA)测定值对结核性胸膜炎的诊断意义和应用价值。方法: 对436例住院的胸腔积液患者分别行结核菌素纯蛋白衍生物(PPD)试验，同时应用酶速率法检测胸水标本中ADA 的活性，比较二者的灵敏度及特异度。所有患者试验前均未行抗结核治疗。结果: ADA试验灵敏度(96.1%)高于PPD(90.2%)，二者差异有显著性(P<0.05)。结论: 胸腔积液ADA含量的检测对于早期诊断及治疗结核性胸膜炎具有积极意义。
【关键词】 腺苷脱氨酶(ADA);胸腔积液;结核性胸膜炎;诊断
Test for Adenosine Deaminase in Pleural Effusion for Diagnosing Tuberculous Pleuritis
QIAN Haihong，ZHAO Jianqing
Department of Respiratory,The First Affiliated Hospital,
Hebei North University,Zhangjiakou,075000,Hebei,China
【ABSTRACT】 Objective: To study the relationship between the ADA rising in pleural effusion and tuberculous pleuritis,so as to prefer early chemotherapy. Methods: 436 cases with pleural effusion were tested with PPD and ADA activity was determined by enzyme kinetic analytical method respectively at the same time.All the patients had never been treated with chemotherapy for tuberculosis. Results: Statistical analysis suggest significant differences of sensitivity and specificity between ADA and PPD (P<0.05),the former sensitivity was higher (96.1%) than that of the later (90.2%). Conclusion: ADA test has active value in early diagnosis for tuberculous pleural effusion and its chemotherapy.
【KEY WORDS】 Adenosine deaminase(ADA); Pleural effusion; Tuberculous pleuritis; Diagnosis
胸腔积液常因结核性胸膜炎、全身恶性肿瘤等疾病所致，胸水常规及酶学检查为结核性胸膜炎的诊断和鉴别诊断以及早期治疗提供着有力和必不可少的帮助。近年来，胸液及血清腺苷脱氨酶(Adenosine deaminase，ADA )的检测已被不少学者和临床工作者用于发现和确诊结核性胸膜炎。经过几年的探索和临床经验积累，本文分析了对疑似结核性胸膜炎患者胸水ADA的测定结果，旨在探讨其对结核性胸膜炎的早期诊断和治疗意义，现报告如下。
1 资料与方法
1.1 一般资料
我科1999.9～2005.12月间收治胸腔积液患者的胸腔积液标本436份，所选患者的标本均为渗出液，符合胸腔积液诊断金标准[1]，即胸液/血清蛋白>0.5，胸液/血清乳酸脱氢酶>0.6和胸液乳酸脱氢酶>200IU/L。结核性胸膜炎(结核组)256例，男147例，女 109例;年龄 15～78(43.4±13.1)岁;经临床表现、胸腔积液分析、胸水PCR、影像学检查和抗痨治疗反应确诊。非结核组180例，恶性胸腔积液137例，所有患者均经组织学和细胞学检查证实，非特异性感染32例，其他11例;男102例，女78例;年龄17～86(56±10.3)岁。
1.2 方法
采用上海森雄公司生产的试剂盒，参照试剂盒中提供的方法，用速率法检测ADA，同时采用传统的 PPD 试验对照检测， 7 年间检测试剂均为同一厂家来源，
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