Tuberc Respir Dis.  1987 Sep;34(3):223-232. 10.4046/trd.1987.34.3.223.

Immunologic Characteristics of Tuberculous Pleural Effusion -Diagnostic Value and Mechanism of Increased Adenosine Deaminase Activity-

• KMID: 2528646
• DOI: http://doi.org/10.4046/trd.1987.34.3.223

Abstract

To investigate the immunologic characteristics and the mechanism of increased adenosine deaminase (ADA) activity in tuberculous pleural effusion, we measured total lymphocyte. T-lymphocyte, helper T -cell (T₄), suppressor T-cell (T₈), T₄/ T₈ ratio, antituberculous antibody (IgG) and ADA activity both in tuberculous pleural effusion and malignant pleural effusion. 1) Total Iymphocyte count was 1844 ± 1289 cells/ mm' in tuberculosis and 1096±1012 cells/ ㎣ in malignancy, which was increased in tuberculosis compared with malignancy (p <0.05) 2) ln tuberculous pleurisy, analysis of T-cell subpopulations showed that number of T₁ was 1945± 1072 cells/ mm3, T₄ was 1594±923. T₈ was 507±295, and T₄ / T₈ ratio was 3.72±1.91. The proportion of T cell subset revealed that T₁ was 77.90±7.37% , T₄ was 63.65±10.03%, T8 was 19.96 ± 6.45% . 3) ln malignant pleural effusion number of T₁ was 758±347, T₄ was 539±274, which showed increased number of T₁ and T₄ in tuberculosis compared with malignancy (p<0.05). 4) The titer of antituberculous antibody (lgG) was 0.58±0.26 in tuberculosis and 0.4 5±0.11 in malignancy. lnspite of increased IgG titer in tuberculosis, the sensitivity and specificity were inferior t o ADA in diagnosis of tubercul osis, suggesting that humoral immunity was less contributable to the pathogenesis of tuberculous pleurisy than cellular immunity. 5) When the ADA activity was over 40 U/ L, the diagnostic accuracy of tuberculosis over malignancy was 92.5% in sensitivity. 82.4% in negative predictive value and 100% in specificity. 6) lnspite of increased ADA level in tuberculous pleurisy. there was no definite correlation between pleural fluid ADA level and T -cell subpopulation ln conclusion, above results necessitate a functional analysis of T -Iymphocyte rather than morphologic appearance in the investigation of cellular immunity in tuberculosis pleurisy and estimation of ADA activitiy in pleural effusion is simple. not expensive and has a good diagnostic value.