الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 119 |  |  |
| | | from | 119 | | |
Abstract
The purpose of this study is to evaluate the usefulness of adenosine deaminase as a biomarker in diagnosis of TB pleural effusion. A prospective cross sectional study was conducted on forty patients with pleural effusion, selected from outpatient clinic and inpatient department of Abbasia Chest Hospital. They were classified into two groups:
group (A): patient with TB pleural effusion which included (20) patients.
group (B): patient with non TB pleural effusion which included (20) among them (12) patients with malignant pleural effusion; adenocarcinoma and mesothelioma, (6) patients for each, and (8) patients with non- malignant non-tuberculous pleural effusion (para pneumonic).
All patients subjected to the following:
1- Full history taken.
2- Clinical examination
Summary and conclusion
89
3- Laboratory examination including :-
- liver function tests
- kidney function tests
- CBC
- ESR
- Sputum analysis for AFB
- TST ( Tuberculin in skin test )
- Chest X – rays
- ADA levels in serum and pleural effusion.
- ADA index (effusion ADA/ADA serum)
The collected data were coded, tabulated, and statistically analyzed using IBM SPSS statistics (Statistical Package for Social Sciences) (V. 22.0) software version 22.0, IBM Corp., Chicago, USA, 2013.
This study revealed the following results:
1- group (A): diagnosed as TB pleural effusion, mainly by thoracoscope (16/20) while the rest of cases diagnosed by sonar guided biopsy (4/20).group B diagnosed as non-tuberclous pleural effusion; (6/20) mesothelioma, (8/20) pneumonia and (6/20)
Summary and conclusion
90
adenocarcinoma, the majority of cases diagnosed by thoracoscope and open pleural biopsy (9/20) for both, while just 2 cases diagnosed by Abraham’s needles biopsy.
2- There was a significant statistical difference between group A & B as regards age (29.7±10.4 vs 45.8±10.7, P=0.0001), while there were no significant difference of sex in both groups.
3- There was no statistical difference between both groups as regard presenting symptom, the most common presentation of studied cases is dyspnea (77.5%), followed by cough and expectoration (67.5%), toxic symptoms (60%), chest pain (50%) and hemoptysis (17.5 %) respectively.
4- There was no statistical significant difference between both groups as regards radiological laterality finding. Also, 7 out of 40 effusions (17.5%) had sputum positive for acid fast bacilli.
5- There was a significant difference between both groups as regards TLC (higher in group B), ESR, TST (higher ESR and more positive Tuberculin in group A) (P = 0.013, 0.0001 and 0.0001) respectively, while there was no statistical significant
Summary and conclusion
91
difference between both groups as regards HB%, platelet count and liver enzymes.
6- There was a highly statistical significant elevated serum ADA (p < 0.001) (37.16 ± 8.98 Vs 22.39 ± 5.84), a highly statistical significant elevated pleural fluid ADA (55 ± 14.2 VS 23.36 ± 6.24) and a statistical significant elevated ADA index (1.53 ± .511 VS 1.085 ±.399) in group I than group II, respectively.
7- A cut off value of serum ADA >29.5 U/L and a cut off value of pleural fluid ADA >31.4 U/L had Sensitivity, specificity, positive and negative predictive values (100%, 90%, 90% and 100 % respectively and 95% accuracy.
8- A cut off value of ADA index >1.1 and had Sensitivity, specificity, positive and negative predictive values (80%, 65%, 69% and 76%) respectively and 73% accuracy.
Summary and conclusion
92
Conclusion
from this study, we can conclude that:
1- Serum and pleural fluid ADA level significantly increases in patients with TB pleural effusion than non TB pleural effusion.
2- Serum and pleural fluid ADA level shows higher sensitivity, specificity, PPV, NPV and accuracy in predicting tuberculous pleural effusion
3- Increased ADA level in tuberculous pleural effusion has a utility in the diagnosis of tuberculosis when other clinical and laboratory tests are negative