Diagnostic utility of adenosine deaminase in bronchoalveolar lavage (BAL) in pulmonary tuberculosis from a tertiary care hospital in North India

Unairah Naqash, Rukhsana Taj, Nahid Nahvi
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Abstract

Adenosine Deaminase (ADA) has been acclaimed as a biochemical marker in numerous studies in the diagnosis of tuberculosis of pleura, peritoneum, meninges etc because of its high sensitivity and specificity. As a diagnostic test, ADA offers several advantages; it is rapid, simple, low cost, non-invasive and can be performed easily in most clinical laboratories. The current retrospective study was carried out on a total of 91 specimens of bronchoalveolar lavage collected on bronchoscopy. The samples were collected and sediments were confirmed for presence of tubercular bacilli through Lowenstein Jensen(LJ) media (Gold standard), GeneXpert(CBNAAT).Simultaneously the ADA estimation was done from supernatant fluid obtained after centrifugation of sample.The Mean ADA level for Culture Positive samples in BAL was 5.899± 1.723 and from Culture Negative Samples the Mean ADA was1.217 ± 1.439. The ADA cut off levels of >4.0 IU/L in BAL when compared with LJ culture media (gold standard) showed a sensitivity of 90.0% and a specificity of 97.2%. Upon ROC analysis a high rate of accuracy was recorded in diagnosis of TB through ADA estimation with sensitivity and specificity reaching 100% and 97.2% at a ADA cut off 3.76 IU/L when compared with LJ culture media (gold standard). However, the sensitivity and specificity achieved was slightly lower when ADA results were compared with GeneXpert results.The determination of ADA levels may help in early diagnosis, improve the prognosis and reduce the spread of disease and thereby the test should be included in routine investigations in patients suspected of tuberculosis.
印度北部三级医院支气管肺泡灌洗(BAL)中腺苷脱氨酶的诊断价值
腺苷脱氨酶(Adenosine Deaminase, ADA)具有较高的敏感性和特异性,在胸膜、腹膜、脑膜等结核的诊断研究中被广泛认为是一种生化标志物。作为诊断测试,ADA有几个优点;它具有快速、简单、低成本、无创、可在大多数临床实验室轻松进行的特点。本研究对支气管镜下收集的91例支气管肺泡灌洗液标本进行回顾性研究。采集样品,并通过Lowenstein Jensen(LJ)培养基(金标准)、GeneXpert(CBNAAT)确认沉积物中是否存在结核杆菌。同时对样品离心后得到的上清液进行ADA估计。培养阳性样本ADA平均值为5.899±1.723,培养阴性样本ADA平均值为1.217±1.439。与LJ培养基(金标准)相比,ADA切断BAL中>4.0 IU/L的水平,灵敏度为90.0%,特异性为97.2%。经ROC分析,与LJ培养基(金标准)相比,ADA对TB的诊断准确率较高,在ADA截断值为3.76 IU/L时,其敏感性和特异性分别达到100%和97.2%。然而,与GeneXpert结果相比,ADA结果的敏感性和特异性略低。测定ADA水平有助于早期诊断、改善预后和减少疾病传播,因此应将其纳入疑似结核病患者的常规检查。
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