Immunologic Characteristics of Tuberculous Pleural Effusion -Diagnostic Value and Mechanism of Increased Adenosine Deaminase Activity- |
K. S. Jung, H. S. Chung, S. K. Han, Y. S. Shim, K. Y. Kim, Y. C. Han |
Department of Internal Medicine and Tuberculosis Research Institute, College of Medicine, Seoul National University, Seoul, Korea |
결핵성 흉막염의 세포면역학적 특성에 관한 연구 -Adenosine Deaminase의 진단적 가치 및 증가기전에 관하여- |
정기석, 정희순, 한성구, 심영수, 김건열, 한용철 |
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Abstract |
To investigate the immunologic characteristics and the mechanism of increased adenosine deaminase (ADA) activity in tuberculous pleural effusion, we measured total lymphocyte.
T-lymphocyte, helper T -cell (T4), suppressor T-cell (T8), T4/ T8 ratio, antituberculous antibody (IgG) and ADA activity both in tuberculous pleural effusion and malignant pleural effusion.
1) Total Iymphocyte count was 1844 ± 1289 cells/ mm' in tuberculosis and 1096±1012 cells/ ㎣ in malignancy, which was increased in tuberculosis compared with malignancy (p <0.05)
2) ln tuberculous pleurisy, analysis of T-cell subpopulations showed that number of T1 was 1945±
1072 cells/ mm3, T4 was 1594±923. T8 was 507±295, and T4 / T8 ratio was 3.72±1.91. The proportion of T cell subset revealed that T1 was 77.90±7.37% , T4 was 63.65±10.03%, T8 was 19.96 ± 6.45% .
3) ln malignant pleural effusion number of T1 was 758±347, T4 was 539±274, which showed increased number of T1 and T4 in tuberculosis compared with malignancy (p<0.05).
4) The titer of antituberculous antibody (lgG) was 0.58±0.26 in tuberculosis and 0.4 5±0.11 in malignancy. lnspite of increased IgG titer in tuberculosis, the sensitivity and specificity were inferior t o ADA in diagnosis of tubercul osis, suggesting that humoral immunity was less contributable to the pathogenesis of tuberculous pleurisy than cellular immunity.
5) When the ADA activity was over 40 U/ L, the diagnostic accuracy of tuberculosis over malignancy was 92.5% in sensitivity. 82.4% in negative predictive value and 100% in specificity.
6) lnspite of increased ADA level in tuberculous pleurisy. there was no definite correlation between pleural fluid ADA level and T -cell subpopulation ln conclusion, above results necessitate a functional analysis of T -Iymphocyte rather than morphologic appearance in the investigation of cellular immunity in tuberculosis pleurisy and estimation of ADA activitiy in pleural effusion is simple. not expensive and has a good diagnostic
value. |
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