Combined detections of interleukin 27, interferon-γ, and adenosine deaminase in pleural effusion for diagnosis of tuberculous pleurisy

• Published in: Chinese medical journal Vol. 126; no. 17; pp. 3215 - 3221
• Main Authors: Wu, Yan-Bin, Ye, Zhi-Jian, Qin, Sou-Ming, Wu, Cong, Chen, Yi-Qiang, Shi, Huan-Zhong
• Format: Journal Article
• Language: English
• Published: China Institute of Respiratory Diseases, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi 530021, China%Department of Respiratory Medicine,First People's Hospital of Foshan, Sun Yat-sen University, Foshan,Guangdong 528000, China%Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 2013; Department of Respiratory and Critical Care Medicine, Beijing ChaoYang Hospital, Capital Medical University, Beijing 100020, China
• Subjects: Adenosine Deaminase - blood; Adenosine Deaminase - metabolism; Aged; Female; Humans; Interferon-gamma - blood; Interferon-gamma - metabolism; Interleukin-27 - blood; Interleukin-27 - metabolism; Male; Middle Aged; Pleural Effusion - blood; Pleural Effusion - metabolism; Tuberculosis, Pleural - blood; Tuberculosis, Pleural - diagnosis; Tuberculosis, Pleural - metabolism; 干扰素-γ; 白细胞介素; 结核; 联合检测; 胸腔积液; 胸膜炎; 腺苷脱氨酶; 调查诊断; tuberculous pleurisy; interferon-γ; interleukin 27; adenosine deaminase
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.20130020

Background Previous studies reported interleukin-27 （IL-27）, interferon-y （IFN-γ）, or adenosine deaminase （ADA） alone plays a helpful role in diagnosing tuberculous pleural effusion （TPE）. The present study aims at comparing the diagnostic accuracy of pleural IL-27, IFN-γ, and ADA, and investigate the diagnostic accuracy of the combination of IL-27, IFN-γ, or/ and ADA for differentiating TPE from pleural effusions with the other etiologies. Methods The concentrations of IL-27, IFN-γ and ADA were simultaneously determined in pleural fluids and sera from 40 patients with TPE; 26 with malignant pleural effusion, seven with infectious pleural effusion, and eight with transudative pleural effusion by enzyme linked immunosorbent assay and colorimetric method. The corresponding biochemical indexs were also simultaneously determined. Results The concentrations of pleural IL-27 and IFN-γ in the tuberculous group were significantly higher than those in the malignant, infectious, and transudative groups. The concentrations of ADA in TPE were significantly higher than those in MPE or transudative effusions, while much lower than those in infectious effusions. Among these three biomarkers, IL- 27 was the most effective for TPE diagnosis, with the cut off value of 900.8 ng/L. IL-27 had a high sensitivity of 95% and specificity of 97.6% for differential diagnosis of TPE from non-TPEs. Combinations of IL-27, IFN-γ and ADA measurements further increased the sensitivity or specificity up to 100%. Conclusions Compared to non-TPEs, IL-27, IFN-γ and ADA all simultaneously increased in TPE; and among these three rapid detection methods, IL-27 appeared to be the best for distinguishing tuberculous from non-TPEs, especially from MPE. Combinations of the three markers （IL-27, IFN-γ and ADA） yielded the highest sensitivity and specificity. These findings suggest that the applications of a new biomarker, IL-27, alone or with IFN-γ and ADA, may contribute to more efficient diagnosis strategies in the management of tuberculous pleurisy.