Diagnostic role of inflammatory and anti-inflammatory cytokines and effector molecules of cytotoxic T lymphocytes in tuberculous pleural effusion.

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 ≥ 75 pg/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.

• Authors: Chin-Chung Shu, Jann-Yuan Wang, Chia-Lin Hsu, Li-Ta Keng, Kochung Tsui, Jeng-Feng Lin, Hsin-Chih Lai, Chong-Jen Yu, Li-Na Lee, Kwen-Tay Luh
• Journal: Respirology (Carlton, Vic.) (Respirology) Vol. 20 Issue 1 Pg. 147-54 (Jan 2015) ISSN: 1440-1843 [Electronic] Australia
• PMID: 25355638 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Asian Pacific Society of Respirology.

Chemical References

• Biomarkers
• Receptors, Tumor Necrosis Factor, Member 6b
• Receptors, Tumor Necrosis Factor, Type I
• Perforin
• Interferon-gamma
• Adenosine Deaminase

Topics

• Adenosine Deaminase (metabolism)
• Aged
• Biomarkers (metabolism)
• Female
• Humans
• Inflammation (metabolism, pathology)
• Interferon-gamma (metabolism)
• Male
• Middle Aged
• Mycobacterium tuberculosis (isolation & purification, pathogenicity)
• Perforin (metabolism)
• Pleural Effusion (diagnosis, etiology, metabolism, physiopathology)
• ROC Curve
• Receptors, Tumor Necrosis Factor, Member 6b (metabolism)
• Receptors, Tumor Necrosis Factor, Type I (blood)
• Sensitivity and Specificity
• T-Lymphocytes, Cytotoxic (pathology)
• Tuberculosis, Pleural (complications, diagnosis, metabolism, physiopathology)