Diagnostic value of adenosine deaminase detection in tuberculous peritonitis

doi:10.3969/j.issn.1000-6621.2019.12.004

Abstract

Abstract:

Objective To evaluate the diagnostic value of adenosine deaminase (ADA) detection in tuberculous peritonitis (TBP).Methods The laboratory testing data of peritoneal effusion specimens of 203 suspected TBP patients from Shaanxi Tuberculosis Hospital and Beijing Chest Hospital were retrospectively analyzed between January 2016 and December 2018, and then 119 suspected TBP patients who underwent acid-fast bacilli (AFB) smear microscopy (AFB smear), BACTEC MGIT 960 liquid culture (MGIT 960), GeneXpert MTB/RIF (GeneXpert) and ADA detection at the same time were included in this study. Among these cases, 73 were diagnosed as TBP patients, while the other 46 were non-TBP patients. The diagnostic efficacy of AFB smear, MGIT 960 culture, GeneXpert and ADA detection for TBP was evaluated with clinically diagnosed TBP patients as the reference standard, and the optimal critical value and area under curve (AUC) of ADA detection were analyzed by ROC curve.Results In 119 suspected TBP patients,the sensitivities of AFB smear, MGIT 960 culture, GeneXpert and ADA detection were 4.1% (3/73), 11.0% (8/73), 12.3% (9/73) and 86.3% (63/73), respectively; the specificities were 100.0% (46/46), 100.0% (46/46), 100.0% (46/46) and 84.8% (39/46), respectively; and the coincidence rates were 41.2% (49/119), 45.4% (54/119), 46.2% (55/119) and 85.7% (102/119), respectively. ROC curve analysis showed that the critical value of ADA detection for distinguishing TBP patients from non-TBP patients was 31.45 U/L, and AUC was 0.836.Conclusion The sensitivities of AFB smear, MGIT 960 culture and GeneXpert for detection of Mycobacterium tuberculosis in peritoneal effusion are all very low, while ADA exhibits promising detection efficiency with high sensitivity and specificity in early diagnosis of TBP, which can be used as an alternative for clinical diagnosis of TBP.

Key words: Peritonitis,tuberculous, Ascites, Adenosine deaminase, Diagnostic techniques and procedures, Diagnosis,differential, Comparative study, Data interpretation,statistical

Jing LI,Yi-feng MA,Yu PANG,Zhuo WANG,Xiao-lin WANG,Jing FENG,Qian-hong WU. Diagnostic value of adenosine deaminase detection in tuberculous peritonitis[J]. Chinese Journal of Antituberculosis, 2019, 41(12): 1252-1257. doi: 10.3969/j.issn.1000-6621.2019.12.004

Figures/Tables 3

ADA测定	TBP患者(73例)	非TBP患者(46例)	统计值	P值
>31.45U/L[例(构成比,%)]	63(86.3)	7(15.2)	χ²=58.87	0.000
≤31.45U/L[例(构成比,%)]	10(13.7)	39(84.8)
平均值(U/L, $x ˉ$ ±s)	67.66±8.59	17.34±2.76	t=38.45	0.000

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检测方法结果	临床诊断		敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)
检测方法结果	TBP(73例)	非TBP(46例)	敏感度 (%)	特异度 (%)	阳性预测值 (%)	阴性预测值 (%)	符合率 (%)
AFB涂片			4.1	100.0	100.0	39.7	41.2
阳性(例)	3	0
阴性(例)	70	46
MGIT 960培养			11.0	100.0	100.0	41.4	45.4
阳性(例)	8	0
阴性(例)	65	46
GeneXpert检测			12.3	100.0	100.0	41.8	46.2
阳性(例)	9	0
阴性(例)	64	46
ADA测定			86.3	84.8	90.0	79.6	85.7
阳性(例)	63	7
阴性(例)	10	39