SESSION TITLE: Disorders of the Pleura
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM
PURPOSE: To evaluate the utility of pleural fluid Interferon gamma (IFN- γ), Tumor necrosis factor-alpha (TNF-α), Adenosine deaminase (ADA) levels with T cells subsets in differential diagnosis of malignant (MPE) and tuberculous pleural effusions (TPE).
METHODS: Forty patients with pleural effusion (20 tuberculous and 20 malignant) were included in the study. The percentages of CD3+ lymphocytes, CD4 + lymphocytes and Treg (CD4 + CD25+ ) cells in pleural effusion from patients with tuberculous and malignant PE were determined by flow cytometry. The concentrations of IFN-γ, TNF-α, and ADA were simultaneously determined in pleural fluids by enzyme linked immunosorbent assay and colorimetric methods.
RESULTS: IFN- γ, TNF- α and ADA concentrations were significantly higher in TPE than MPE (2.26±1.62 vs. 0.3±0.20 IU/ml: P<0.0001, 122.45±47.69 vs. 35.03±31.88 pg/ml: P < 0.0001 and 84.22±41.47 vs. 23.19±17.93 U/l: P<0.0001 respectively). T-cells markers (CD3+ T-cells, CD4+ T-cells and T reg cells) were significantly higher in TPE than MPE (76.46% vs. 65.29%; P 0.004, 51.21% vs. 43.50%; P 0.044 and 14.60% vs. 12.43%; P 0.032 respectively). CD3+ plus CD4+ as well as CD3+ plus CD4+ plus T reg combinations were all 100% specific for discriminating TPE from MPE. TNF-α plus IFN-γ, TNF-α plus ADA, as well as IFN-γ plus TNF-α plus ADA, were 100% specific for discriminating TPE from MPE. Furthermore, the specificity of combined-diagnostic value of IFN- γ, TNF- α and ADA with T cells subsets was > 95 %.
CONCLUSIONS: The combinations of pleural fluid IFN- γ, TNF- α and ADA levels and T cells subsets could effectively address the challenge of distinguishing tuberculous pleural effusion from malignant pleural effusion.
CLINICAL IMPLICATIONS: The present study was the first attempt to combine these all methods for diagnosis of pleural TB. The measurement of TNF-α plus IFN-γ, TNF-α plus ADA, as well as TNF-α plus IFN-γ plus ADA, were 100% specific for discriminating TPE from MPE. Interestingly, CD3+ plus CD4+ as well as CD3+ plus CD4+ plus T reg combinations were all 100% specific for discriminating TPE from MPE. Furthermore, the specificity of combined-diagnostic value of IFN-γ, TNF-α, ADA with T cells subsets was > 95 %. These data suggest that combinations of biochemical parameters and T cells subsets are valuable markers for the differential diagnosis of TPE from MPE.
DISCLOSURE: The following authors have nothing to disclose: Abdellah Ali, Tamer Mohmoud
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