title: Clinical diagnostic utility of adenosine deaminase, interferon-γ, interferon-γ-induced protein of 10 kDa, and dipeptidyl peptidase 4 levels in tuberculous pleural effusions.
abstract: OBJECTIVE
  Current tools for the diagnosis of tuberculous pleural effusions are suboptimal. The study was undertaken to evaluate the accuracy of pleural fluid adenosine deaminase (ADA), interferon (IFN)-γ, interferon-γ-induced protein of 10 kDa (IP-10), and dipeptidyl peptidase (DPP) 4 levels in differentiating tuberculous pleural effusion (TPE) and non-TPE.
  
  
  METHODS
  A total of 122 samples of pleural effusion were studied. Pleural fluid ADA activity was measured with the colorimetric method, and IP-10, IFN-γ, and DPP4 levels were measured with enzyme-linked immunosorbent assay.
  
  
  RESULTS
  ADA activity and IP-10, IFN-γ, and DPP4 levels were significantly higher in TPE than in non-TPE (88.9 ± 62.7 U/L vs 18.1 ± 16.2 U/L, P < .05; 147.5 ± 117.3 ng/L vs 24.9 ± 19.7 ng/L, P < .05; 627.2 ± 345.3 ng/L vs 152.6 ± 71.4 ng/L, P < .05; and 560.6 ± 451.2 vs 56.8 ± 57.7, P < .05, respectively). The diagnostic sensitivity and specificity of ADA activity (cutoff value of 40 U/L) were 93.6% and 90.9%, respectively, and higher than those of IFN-γ (91.0% and 88.6% at the cutoff value of 225 ng/L, respectively), DPP4 (88.5% and 81.8% at the cutoff value of 75 ng/L, respectively), and IP-10 (83.3% and 86.4% at the cutoff value of 44 ng/L, respectively).
  
  
  CONCLUSIONS
  The roles of ADA and IFN-γ in the differential diagnosis of tuberculous pleurisy are pivotal. ADA or IFN-γ in combination with DPP4 or IP-10 can aid in differentiation between TPE and non-TPE with improved specificity and diagnostic efficiency.
authors.affiliation: Key Laboratory of Mycobacteria Tuberculosis, Shanghai Pulmonary Hospital, affiliated with Tongji University of Medical School, Shanghai, People's Republic of China.
authors.forename: Hongxiu
authors.initials: H
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Yue
authors.forename: Jinghui
authors.initials: J
authors.lastname: Yang
authors.forename: Rongliang
authors.initials: R
authors.lastname: Gao
authors.forename: Jinming
authors.initials: J
authors.lastname: Liu
mesh_terms: D000243:Adenosine Deaminase / Q000032:analysis*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D018819:Dipeptidyl Peptidase 4 / Q000032:analysis*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis*; D020382:Interleukin-18 / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000201:enzymology / Q000378:metabolism*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020382:Interleukin-18; D007371:Interferon-gamma; D018819:Dipeptidyl Peptidase 4; D000243:Adenosine Deaminase