Study on the diagnostic value of IL-27 and ADA alone and in combination in the tuberculous pleurisy

doi:10.3969/j.issn.1000-6621.2019.12.003

Abstract

Abstract:

Objective To explore the value of diagnosis and differential diagnosis for tuberculous pleural effusion and malignant pleural effusion with human interleukin-27(IL-27) and adenosine deaminase (ADA) alone and in combination.Methods A total of 101 patients with pleural effusions admitted in Fuzhou Pulmonary Hospital of Fujian Province were enrolled during December 1, 2017 to July 29, 2018.All patients were diagnosed definitely by pathological evidenceobtained by closed pleural biopsy or medical thoracoscopy and bacteriological evidence obtained by culure from sputa or pleural effusion. According to the gold standard,they were divided into group of tuberculous pleural effusion in 61 cases (tuberculosis group) and group of malignant pleural effusion in 40 cases (as malignant pleural effusion group) including pulmonary mucosa-associated lymphoid tissue lymphoma,malignant pleural mesothelioma,pulmonary mueoepidermoid carcinoma,non-Hodgkin lymphomaand small cell lung carcinoma in each one case,and pulmonary adenocarcinoma in 33 cases. The levels of IL-27 and ADA from pleural effusion were detected by enzyme-linked immunosorbent assay (ELISA) and statistically analyzed. The cut-off values of IL-27 and ADA were determined for differential diagnosis between tuberculous and malignant pleural effusion using receiver operating characteristics (ROC) curve. IL-27 combined with ADA detection(series test,parallel test) was evaluated for diagnostic efficiency in diagnosis of tuberculous pleurisy.Results The concentrations of IL-27 and ADA in the tuberculous (409.48 (229.04, 954.97) ng/L and 45.88±14.33U/L) in the tuberculosis group were higher than those (115.74 (77.72, 161.97) ng/L and 10.50 (7.00, 15.00) U/L) in the malignant pleural effusion group with significant differences statistically (Z=3.139, P<0.01,t=4.006, P<0.01). By drawing ROC curve, The cut-off value of IL-27 and ADA from pleural effusion for distinguishing tuberculous pleural effusion from malignant pleural effusion were 176.31 ng/L and 28 U/L by drawing ROC curve.The sensitivity were 85.25% (52/61) and 93.44% (57/61) respectively, and the specificity were 82.50% (33/40) and 87.50% (35/40), respectively. The specificity (95.00%, 38/40) by series test was higher than that of IL-27 (82.50%, 33/40) and ADA (87.50%, 35/40) by alone test with a good sensitivity (81.97%,50/61). The sensitivity (96.72%, 59/61) by parallel test was higher than that of IL-27 (85.25%, 52/61) and ADA (93.44%, 57/61) by alone test. However, the specificity was low (75.00%,30/40).Conclusion IL-27 and ADA in pleural effusion have higher value in the diagnosis of tuberculous pleurisy, and the series test can improve the diagnostic efficiency for the differentiation between tuberculous pleurisy and malignant pleural effusions.

Key words: Tuberculosis, pleural, Neoplasms, Pleural effusion, Diagnosis, differential, Diagnostic techniques and procedures, Adenosine deaminase, Interleukin-27

Di WU,You-fei LIN,Xiao-hong CHEN,Jian-shan SHEN,Xiao-you CHEN. Study on the diagnostic value of IL-27 and ADA alone and in combination in the tuberculous pleurisy[J]. Chinese Journal of Antituberculosis, 2019, 41(12): 1246-1251. doi: 10.3969/j.issn.1000-6621.2019.12.003

Figures/Tables 3

References 28

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组别	年龄 [岁, M(Q₁,Q₃)]	男		女
组别	年龄 [岁, M(Q₁,Q₃)]	例数	构成比(%)	例数	构成比(%)
结核组(61例)	45(25.00,66.00)	43	70.5	18	29.5
恶性组(40例)	64(55.25,73.75)	21	52.5	19	47.5
检验值	Z=-4.230	χ²=3.369
P值	<0.01	0.066

单独或联合检测胸腔积液	结核组 (61例)	恶性组 (40例)	敏感度 (%)	特异度 (%)	准确度 (%)	阳性预测值 (%)	阴性预测值 (%)	Kappa值
IL-27			85.25	82.50	84.16	88.14	78.57	0.672
阳性	52	7
阴性	9	33
ADA			93.44	87.50	91.09	91.94	89.74	0.813
阳性	57	5
阴性	4	35
IL-27+ADA(并联试验)			96.72	75.00	88.12	85.51	93.75	0.743
阳性	59	10
阴性	2	30
IL-27+ADA(串联试验)			81.97	95.00	87.13	96.15	77.55	0.753
阳性	50	2
阴性	11	38