Eksudatif Lenfositik Plevral Sıvılarda Tüberküloz ve Malignite Ayırımında Adenozin Deaminaz Düzeyinin Tanısal Değeri
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Öz: Amaç: Plevra sıvısı eksudatif-lenfositik özellik gösteren olguların Tüberkuloz plörezi (TBP) ve Malign plörezi (MP) ayırımında adenozin-deaminaz (ADA) düzeyinin tanısal performansını değerlendirmek. Yöntemler: Eksudatif-lenfositik plörezili olguları içeren doktora tez çalışmasının verileri retrospektif olarak değerlendirildi. Çalışma populasyonu 37'si TBP, 17'si MP olmak üzere toplam 54 olguyu içeriyordu. Bulgular: TBP ve MP grubu arasında yaş, ADA, total protein, albumin ve LDH düzeyi açısından anlamlı farklılık gözlendi. ADA cut off düzeyi 35,1 olarak belirlendi. Bu cut off düzeyi için sensitivite ve spesifite sırasıyla %92 ve %100 olarak bulundu. TBP ile ilişkili bağımsız değişkenleri değerlendirmek için lojistik regresyon analizi yapıldı. Modelde bağımsız tahmin ettirici faktörler olarak ADA (OR 1,21, 95% GA: 1,06-1,39, p=0,006)] ve yaş (OR 0,92, 95% GA: 0,84-1,00, p=0,052)] kaldı. Regresyon denkleminin AUC değeri 0,979 olarak bulundu (p<0,001). Olgular yaşa göre kategorize edildiğinde (<50 ve >=50), iki farklı cut off değeri ile (>13,51, >35,1) ile bir hasta haricinde tüm TBP'li olgulara tanı konulabilmekteydi. Sonuç: Plevral ADA düzey ölçümü biopsi işleminin yapılamadığı veya sonuçsuz kaldığı durumlarda TBP tanısı için oldukça faydalı bir testtir. Bahsedilen grupta ADA için konvansiyonel cut off düzeyini düşürmek ve/veya yaş bazlı yaklaşım bu testin tanısal performansını artırıyor gözükmektedir.
Abstract: Objective: To evaluate the diagnostic performance of adenosine deaminase (ADA) levels in patients with exudative lymphocytic pleurisy for the differential diagnosis of tuberculous pleurisy (TBP) and malignant pleural effusion (MPE). Methods: Data on patients with exudative lymphocytic pleurisy were retrospectively analyzed. The study population comprised 54 patients. Thirtyseven were diagnosed with TBP and 17 were diagnosed with MPE. Results: Significant differences were determined in terms of age and ADA, total protein, albumin, and LDH levels between the TBP and MPE groups. The optimal cut-off value of ADA levels was 35.1 U/L for diagnosing TBP. Sensitivity and specificity were 92% and 100%, respectively. Logistic regression analysis was performed to assess independent variables associated with TBP. Independent predictive factors in the model were ADA (OR: 1.21, 95% CI: 1.06-1.39, p=0.006)], and (OR: 0.92, 95% CI: 0.84-1.00, p = 0.052)]. The AUC value by the regression equation was 0.979 (p<0.001). When patients were categorized according to age (<50 ve >=50), two different cut-off values (>13.51 and >35.1) for each age range were found in all, but one, TBP patients. Conclusion: ADA levels are useful for the diagnosis of TBP in cases where pleural biopsy cannot be performed or that are inconclusive in making a diagnosis of TBP. In this group, reducing the conventional cut-off value and/or performing an age-based approach seems to improve the diagnostic performance of ADA levels.
Abstract: Objective: To evaluate the diagnostic performance of adenosine deaminase (ADA) levels in patients with exudative lymphocytic pleurisy for the differential diagnosis of tuberculous pleurisy (TBP) and malignant pleural effusion (MPE). Methods: Data on patients with exudative lymphocytic pleurisy were retrospectively analyzed. The study population comprised 54 patients. Thirtyseven were diagnosed with TBP and 17 were diagnosed with MPE. Results: Significant differences were determined in terms of age and ADA, total protein, albumin, and LDH levels between the TBP and MPE groups. The optimal cut-off value of ADA levels was 35.1 U/L for diagnosing TBP. Sensitivity and specificity were 92% and 100%, respectively. Logistic regression analysis was performed to assess independent variables associated with TBP. Independent predictive factors in the model were ADA (OR: 1.21, 95% CI: 1.06-1.39, p=0.006)], and (OR: 0.92, 95% CI: 0.84-1.00, p = 0.052)]. The AUC value by the regression equation was 0.979 (p<0.001). When patients were categorized according to age (<50 ve >=50), two different cut-off values (>13.51 and >35.1) for each age range were found in all, but one, TBP patients. Conclusion: ADA levels are useful for the diagnosis of TBP in cases where pleural biopsy cannot be performed or that are inconclusive in making a diagnosis of TBP. In this group, reducing the conventional cut-off value and/or performing an age-based approach seems to improve the diagnostic performance of ADA levels.
Açıklama
Anahtar Kelimeler
Kaynak
İstanbul Medical Journal
WoS Q Değeri
Scopus Q Değeri
Cilt
17
Sayı
2
Künye
ALTINSOY B,YALÇINSOY M,ÜNVER E,GÜNGÖR S,MİHMANLI A,AKKAYA E (2016). Eksudatif Lenfositik Plevral Sıvılarda Tüberküloz ve Malignite Ayırımında Adenozin Deaminaz Düzeyinin Tanısal Değeri. İstanbul Medical Journal, 17(2), 59 - 63.
