Author/Editor		Ilievska-Poposka, Biljana; Minovska, Nada; Talevski, Stefan; Atanasova, Sonja; Metodieva, Marija; Pilovska, Karolina
Title		Diagnostična vrednost adenozin deaminaze in lizozima pri plevralnih izlivih
Translated title		Diagnostic utility of adenosine deaminase and lysozyme in pleural fluids
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 74, št. 3
Publication year		2005
Volume		str. 143-6
Language		slo
Abstract		Background. The diagnosis of pleural effusions is sometimes difficult and needs invasive diagnostic procedures; the search for markers that will at least allow to obtain a differential diagnosis between malignant and benign effusions is the objective of many studies. Methods. The level of adenosine deaminase (ADA) and lysozyme in pleural fluid and serum was determined in 84 patients (52 with tuberculous pleural effusions - TB and 32 with malignant pleural effusions - CA), by Giusti/Galcanti and turbidimetric kinetic method. Results. In the group with TB there were significant higher serum and pleural fluid concentrations of ADA (ADAp; ADAs) and lysozyme (Lp; Ls) compared to CA. In the differential diagnosis between tuberculous and malignant pleural effusion ratios ADAp/ADAs = or > 1.8 and Lp/Ls = or > 1.5 were accepted as a cutoff level. We found significant differences between two groups in both tests (p < 0.001): in the group with TB 76.9% of patients had ADAp/ADAs ratio = or > 1.8 contrary to the group with CA where the percentage is only 9.4%. In the group with TB there were 84.6% of patients with Lp/Ls ratio = or > 1.5, contrary to the group with malignancy where the percentage is only 31%. ADAp/ADAs ratio of 1.8 and Lp/Ls ratio of 1.5 showed sensitivity of 76.92% and 84.65%, specificity of 80.70% and 87.71%, positive predictive value of 78.43% and 86.27%, negative predictive value of 78.83% and 86.20% and diagnostic accuracy of 78.83% and 86.23% in the diagnosis of tuberculous pleurisy, separately. Conclusions. These results suggest that the determination of the Lp/Ls and ADAp/ADAs ratios provides a simple and rapid method which can be used as a screening test in the differential diagnosis between tuberculous and malignant pleural effusions.
Summary		Izhodišča. Etiološko diagnosticiranje plevralnih izlivov je večkrat težko in zahteva invazivne diagnostične postopke. Odkrivanje označevalcev, ki omogočajo diferencialno diagnozo vsaj med malignimi in nemalignimi plevralnimi izlivi, je predmet več raziskav. Metode. Določali smo raven adenozin deaminaze (ADA) in lizozima v plevralni tekočini in v serumu 84 bolnikov, od teh 52 s plevralnim izlivom s tuberkulozno in 32 z maligno etiologijo. Uporabljeni sta metoda Gusti/Galcanti in turbidimetrijska kinetična metoda. Rezultati. V skupini s tuberkuloznim plevralnim izlivom v primerjavi s skupino z malignim plevralnim izlivom so bile izmerjene znatno višje koncentracije ADA in lizozima v plevralni tekočini (ADAp; Lp) ter v serumu (ADAs; Ls). Mejne vrednosti razmerja ADAp/ADAs in Lp/Ls, ki naj bi bile pomembne v diferenciaciji diagnosticiranja med malignimi in tuberkuloznimi plevralnimi izlivi, so 1,8 za ADA in 1,5 za lizozim. Razlika med dvema skupinama z dvema testoma je signifikantna (p < 0,001). vskupini s tuberkuloznim plevralnim izlivom ima 76,9% bolnikov vrednosti enake ali višje od 1,8 (= ali > 1,8) za razmerje ADAp/ADAs, medtem ko v skupini z malignim plevralnim izlivom to velja za 9,4% bolnikov. Kar se tiče lizozima v skupini s tuberkuloznim plevralnim izlivom, ima 84,6% bolnikov razmerje Lp/Ls enako ali večje od 1,5 (= ali > 1,5), v skupini z malignim plevralnim izlivom pa je samo 3,1%. Pri diagnosticiranju tuberkuloznega plevralnega izliva s testi ADAp/ADAs in Lp/Ls je občutljivost 76,90% in 84,16%, specifičnost pa 90,62% in 96,87%, napovedna vrednost za pozitivne izvide 93,02% in 97,77%, napovedna vrednost za negativne izvide 70,73% in 79,48%, diagnostična zanesljivost pa 82,14% i n 89,28%. Zaključki. Testa ADAp/ADAs in Lp/Ls sta enostavni in hitri metodi, ki se lahko uporabita za presejanje v diferenciranju diagnoze malignih in tuberkuloznih plevralnih izlivov.
Descriptors		PLEURAL EFFUSION ADENOSINE DEAMINASE MURAMIDASE TUBERCULOSIS, PLEURAL PLEURAL EFFUSION, MALIGNANT