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作 者:Bernardo Henrique Ferraz Maranhão Cyro Teixeira da Silva Junior Jorge Luiz Barillo Joeber Bernardo Soares Souza Patricia Siqueira Silva Roberto Stirbulov
机构地区:[1]Department of Specialized Medicine,Federal University of the State of Rio de Janeiro,Rio de Janeiro 20270004,State of Rio de Janeiro,Brazil [2]Medical Clinics,Federal Fluminense University,Niteroi 24020080,Rio de Janeiro,Brazil [3]Department of Thoracic Surgery,General Hospital Santa Teresa,Petropolis 25680-003,Rio de Janeiro,Brazil [4]Medical Clinics,Antonio Pedro University Hospital,Niteroi 24020-080,Rio de Janeiro,Brazil [5]Professor Mazzini Bueno Tuberculosis Research and Assistance Center,Federal Fluminense University,Niteroi 24020-080,Rio de Janeiro,Brazil [6]Department of Clinics,Rua Baronesa de Itu,São Paulo 1231001,São Paulo,Brazil
出 处:《World Journal of Clinical Cases》2025年第19期14-23,共10页世界临床病例杂志(英文)
摘 要:BACKGROUND Although inflammatory diseases commonly affect the pleura and pleural space,their mechanisms of action remain unclear.The presence of several mediators emphasizes the concept of pleural inflammation.Adenosine deaminase(ADA)is an inflammatory mediator detected at increased levels in the pleural fluid.AIM To determine the role of total pleural ADA(P-ADA)levels in the diagnosis of pleural inflammatory diseases.METHODS 157 patients with inflammatory pleural effusion(exudates,n=124,79%)and noninflammatory pleural effusion(transudates,n=33,21%)were included in this observational retrospective cohort study.The P-ADA assay was tested using a kinetic technique.The performance of the model was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.RESULTS The transudates included congestive heart failure(n=26),cirrhosis of the liver with ascites(n=3),chronic renal failure(n=3),and low total protein levels(n=1).The exudate cases included tuberculosis(n=44),adenocarcinoma(n=37),simple parapneumonic effusions(n=15),complicated parapneumonic effusions/empyema(n=8),lymphoma(n=7),and other diseases(n=13).The optimal cutoff value of P-ADA was≥9.00 U/L.The diagnostic parameters as sensitivity,specificity,positive and negative predictive values,positive and negative likelihood values,odds ratio,and accuracy were 77.69(95%CI:69.22-84.75);68.75(95%CI:49.99-83.88);90.38 and 44.90(95%CI:83.03-95.29;30.67-59.77);2.48 and 0.32(95%CI:2.21-11.2;0.27-0.51);7.65(95%CI:0.78-18.34),and 75.82(95%CI:68.24-82.37),respectively(χ^(2)=29.51,P=0.00001).An AUC value of 0.8107(95%CI:0.7174-0.8754;P=0.0000)was clinically useful.The Hosmer-Lemeshow test showed excellent discrimination.CONCLUSION P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.
关 键 词:Pleural effusion BIOMARKER Adenosine deaminase INFLAMMATION transudate EXUDATE
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