CAJ | 학술논문

目的：探讨血清腺苷脱氨酶(adenosine deaminase,ADA)在涂阴肺结核诊断及治疗中的应用价值。方法对152例涂阴肺结核、80例涂阳肺结核、63例非结核性肺部疾病及227例健康志愿者进行血清 ADA 测定,并对测定结果进行比较,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算敏感性和特异性。所有活动性肺结核患者给予标准方案的抗结核治疗,于治疗的1月末、2月末、6月末测定血清 ADA,与治疗前结果进行比较。结果治疗前涂阴肺结核组 ADA(10.795±4.164)U/L 高于非结核肺部疾病组(9.354±2.401)U/L 和健康对照组(5.971±1.734)U/L,涂阳肺结核组(14.441±6.267)U/L 高于涂阴肺结核组(10.795±4.164)U/L,差异有统计学意义。共有57例涂阴肺结核患者和45例涂阳肺结核患者于抗结核治疗1月末、2月末、6月末进行了血清ADA 测定,两组患者治疗2月末、6月末的血清 ADA 值与疗前相比均有下降,差异有统计学意义(P <0.05)。ROC曲线分析显示以血清 ADA=6.95 U/L 为临界值鉴别涂阴肺结核和健康对照的曲线下面积(Area Under Curve, AUC)为0.921(95% CI =0.894~0.947),敏感性为94.0%,特异性为70.7%。以 ADA=18 U/L 为临界值鉴别涂阴肺结核与非结核性肺部疾病的特异性为100%,敏感性为5.9%。结论涂阴肺结核患者的血清 ADA 水平高于健康人群和非结核性肺部疾病患者,血清 ADA 可以在一定程度上协助诊断涂阴肺结核,适时检测可以反映肺结核的治疗疗效。
목적：탐토혈청선감탈안매(adenosine deaminase,ADA)재도음폐결핵진단급치료중적응용개치。방법대152례도음폐결핵、80례도양폐결핵、63례비결핵성폐부질병급227례건강지원자진행혈청 ADA 측정,병대측정결과진행비교,채용수시자공작특정곡선(receiver operating characteristic curve,ROC)계산민감성화특이성。소유활동성폐결핵환자급여표준방안적항결핵치료,우치료적1월말、2월말、6월말측정혈청 ADA,여치료전결과진행비교。결과치료전도음폐결핵조 ADA(10.795±4.164)U/L 고우비결핵폐부질병조(9.354±2.401)U/L 화건강대조조(5.971±1.734)U/L,도양폐결핵조(14.441±6.267)U/L 고우도음폐결핵조(10.795±4.164)U/L,차이유통계학의의。공유57례도음폐결핵환자화45례도양폐결핵환자우항결핵치료1월말、2월말、6월말 진 행 료 혈 청ADA 측정,량조환자치료2월말、6월말적혈청 ADA 치여료전상비균유하강,차이유통계학의의(P <0.05)。ROC곡선분석현시이혈청 ADA=6.95 U/L 위림계치감별도음폐결핵화건강대조적곡선하면적(Area Under Curve, AUC)위0.921(95% CI =0.894~0.947),민감성위94.0%,특이성위70.7%。이 ADA=18 U/L 위림계치감별도음폐결핵여비결핵성폐부질병적특이성위100%,민감성위5.9%。결론도음폐결핵환자적혈청 ADA 수평고우건강인군화비결핵성폐부질병환자,혈청 ADA 가이재일정정도상협조진단도음폐결핵,괄시검측가이반영폐결핵적치료료효。
Objective The aim was to determine adenosine deaminase(ADA)activity in serum for the diagnosis and treatment of smear negative pulmonary tuberculosis.Methods The study involved 1 52 patients with smear negative pulmonary tuberculosis,80 patients with smear positive pulmonary tuberculosis,63 patients of non-tuberculosis pulmonary disease,227 healthy subjects.The ADA activity was measured in serum for all subjects.ROC curve was used to analyze the clinical sensitivity and specificity.All patients with active pulmonary tuberculosis were given anti-tuberculosis treatment with standard regimen and serum ADA was detected at the end of 1st,2nd,and 6th month during treatment.The ADA value was analyzed before and after treatment.Results Before treatment,ADA value in the group of smear negative pulmonary tuberculosis (10.795±4.1 64)U/L was higher than that in the groups of non-tuberculosis pulmonary disease (9.354±2.401)U/L and healthy subjects (5.971±1.734)U/L.ADA value in the group of smear positive pulmonary tuberculosis (14.441±6.267)U/L was higher than that in the group of smear negative pulmonary tuberculosis (10.795 ±4.1 64)U/L.There were statistical difference among four groups.There were 57 patients with smear negative pulmonary tuberculosis and 45 patients with smear positive pulmonary tuberculosis whose serum ADA were detected at the end of 1st,2nd,and 6th month during treatment.A statistical significant decrease was observed in ADA activities in two groups after 2 months’and 6 months’treatment(P <0.05).ROC curve showed that the optimal limit value of ADA for differentiation of smear negative pulmonary tuberculosis and healthy subjects was 6.95 U/L,and the AUC was 0.921 (95% CI =0.894-0.947).The sensitivity was 94%,the specificity was 70.7%.When ADA was 18 U/L as the critical value to identify the smear negative pulmonary tuberculosis and non-tuberculosis pulmonary disease,the specificity was 100%,the sensitivity was 5.9%. Conclusion Serum ADA activity was increased in smear negative pulmonary tuberculosis patients and decreased after treatment,therefore,it may be a helpful parameter for diagnosis and monitoring therapy.