Povzetek Izhodisca: Etiolosko diagnosticiranje plevralnih izlivov je veckrat tezko in zahteva invazivne diagnosticne postopke. Odkrivanje oznacevalcev, ki omogocajo diferencialno diagnozo vsaj med ...malignimi in nemalignimi plevralnimi izlivi, je predmet vec raziskav. Metode: Dolocali smo raven adenozin deaminaze (ADA) in lizozima v plevralni tekocini 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 kineticna metoda. Rezultati: V skupini s tuberkuloznim plevralnim izlivom v primerjavi s skupino z malignim plevralnim izlivom so bile izmerjene znatno visje koncentracije ADA in lizozima v plevralni tekocini (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, so1,8 za ADA in 1,5 za lizozim. Razlika med dvema skupinama z dvema testoma je signifikantna (p < 0,001). V skupini s tuberkuloznim plevralnim izlivom ima 76,9% bolnikov vrednosti enake ali visje 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 tice lizozima v skupini s tuberkuloznim plevralnim izlivom, ima 84,6% bolnikov razmerje Lp/Ls enako ali vecje 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 obcutljivost 76,90% in 84,16%, specificnost 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%, diagnosticna zanesljivost pa 82,14% in 89,28%. Zakljucki: 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.
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 3.1%. 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.
