Tuberc Respir Dis.  1997 Jun;44(3):611-620.

Diagnostic Significance of TNF-alpha in Tuberculous and Non-Tuberculous Pleural Effusion

• Na HJ
• Park SC
• Kang KW
• Park HK
• Kim YC
• Choi IS
• Park KO

Abstract

OBJECTIVES
The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various cytokines including Inteferon-γ, tumor necrosis factor alpha(TNF-α) are considered as useful diagnostic tools in differentiating exudative pleural effusion The author would like to demonstrate the diagnostic usefulness of TNF-α in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-α with ADA.
METHODS
Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-α
RESULTS
Tuberculous pleural fluid showed higher levee of ADA and TNF-α, 48.7α 32.7U/L and 184.1±214.2pg/mL than that of non-tuberculous effusion 26.0α41.3U/L and 44.1α114.2pg/mL, respectively (ADA, TNF-α : p<0.05, p<0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-α, and the best cut-off value for adenosine deaminase and TNF-α were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-α
CONCLUSION
For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-α as well as ADA was considered as useful diagnostic method. However adding TNF-α to ADA has no further diagnotic benefit than ADA alone.

Keyword

Adenosine deaminase; ADA; Tumor necorosis factor; TNF; Tuberculosis

MeSH Terms

Adenosine
Adenosine Deaminase
Biopsy
Cell Count
Cytokines
Diagnosis, Differential
Exudates and Transudates
Humans
Immunity, Cellular
Pleural Effusion*
ROC Curve
Tuberculosis
Tumor Necrosis Factor-alpha*
Adenosine
Adenosine Deaminase
Cytokines
Tumor Necrosis Factor-alpha