Diagnostic role of inflammatory and anti-inflammatory cytokines and effector molecules of cytotoxic T lymphocytes in tuberculous pleural effusion
Journal
Respirology
Journal Volume
20
Journal Issue
1
Pages
147-154
Date Issued
2015
Author(s)
Tsui K.
Lin J.-F.
KWEN-TAY LUH
Abstract
Background and objective Early diagnosis of tuberculous pleural effusion (TPE) remains difficult. While some inflammatory markers in pleural effusion (PE) are helpful in diagnosis, the roles of anti-inflammatory cytokines and effector molecules of cytotoxic T lymphocytes have not been investigated. Methods Lymphocyte-predominant exudative PE samples were assayed for inflammatory and anti-inflammatory cytokines and effector molecules of cytotoxic T lymphocytes. Logistic regression analysis was used to predict the probability of TPE and identify independently associated factors. Receiver operating characteristic (ROC) curve analysis was applied to determine the optimal cut-off value for the predicted probability. Results Of 95 patients enrolled, 35 had TPE, 46 had malignant PE and 14 had PE due to other aetiologies. Interferon-γ (IFN-γ), adenosine deaminase (ADA), decoy receptor (DcR) 3, monocyte chemo-attractant protein (MCP)-1, IFN-induced protein (IP)-10, granzyme A and perforin were higher in TPE than in PE of other aetiologies. By logistic regression analysis, IFN-γ?75pg/mL, ADA ? 40 IU/mL, DcR3 ? 9.3 ng/mL and soluble tumour necrosis factor receptor 1 (TNF-sR1) ? 3.2 ng/mL were independent factors associated with TPE. The predicted probability based on the four predictors had an area under the ROC curve of 0.920, with 82.9% sensitivity and 86.7% specificity under the cut-off value of 0.303. In the TPE group, patients with positive PE/pleural culture for Mycobacterium tuberculosis had higher pleural IFN-γ, MCP-1, IP-10 and perforin than those with positive sputum but negative PE culture. Conclusions While pleural interferon-γ and ADA are conventional markers for diagnosing TPE, simultaneous measurements of DcR3 and TNF-sR1 can improve the diagnostic efficacy. Early diagnosis of tuberculous pleural effusion remains difficult. Measuring pleural interferon-γ, adenosine deaminase, decoy receptor 3 and soluble tumour necrosis factor receptor-1 together can improve the low sensitivity of assaying either interferon-γ or adenosine deaminase alone, and may avoid pleural biopsy which is in some patients a high-risk procedure. ? 2014 Asian Pacific Society of Respirology.
SDGs
Other Subjects
adenosine deaminase; antiinflammatory cytokine; cytokine; decoy receptor 3; gamma interferon; gamma interferon inducible protein 10; granzyme A; inflammatory cytokine; monocyte chemotactic protein 1; perforin; unclassified drug; adenosine deaminase; biological marker; decoy receptor 3; gamma interferon; perforin; tumor necrosis factor receptor 1; adult; aged; Article; bacterium culture; cytotoxic T lymphocyte; diagnostic test accuracy study; effector cell; female; human; human cell; lung cancer; lymphocyte; major clinical study; male; Mycobacterium tuberculosis; pleura effusion; prospective study; receiver operating characteristic; sensitivity and specificity; sputum; tuberculosis; tuberculous pleural effusion; blood; complication; cytotoxic T lymphocyte; inflammation; isolation and purification; metabolism; middle aged; Mycobacterium tuberculosis; pathogenicity; pathology; pathophysiology; Pleural Effusion; Tuberculosis, Pleural; Adenosine Deaminase; Aged; Biomarkers; Female; Humans; Inflammation; Interferon-gamma; Male; Middle Aged; Mycobacterium tuberculosis; Perforin; Pleural Effusion; Receptors, Tumor Necrosis Factor, Member 6b; Receptors, Tumor Necrosis Factor, Type I; ROC Curve; Sensitivity and Specificity; T-Lymphocytes, Cytotoxic; Tuberculosis, Pleural
Type
journal article