الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Tuberculosis is a chronic specific bacterial infection caused by bacteria of the Mycobacterium tuberculosis. It remains one of the deadliest diseases in the world. It is the second leading infectious cause of death after HIV infection. The clinical manifestations of tuberculosis are quite variable and depend on a number of factors including host defense mechanism, microbe virulence as well as the interactions between host and pathogen that influence the clinical features of the disease.
The World Health Organization (WHO) estimates that each year more than 9.4 million new cases of tuberculosis occur and approximately 3 million persons die from the disease. Ninety five percent of tuberculosis cases occur in developing countries.
The diagnosis of pulmonary tuberculosis depends on clinical suspicion, response to treatment, chest radiographs, staining for acid fast bacilli, culture for mycobacteria, and more recently, nucleic acid amplification assays.
Adenosine deaminase (ADA) is an enzyme involved in purine catabolism. The enzyme catalyzes the hydrolytic and irreversible deamination of adenosine to inosine and deoxyadenosine to deoxyinosine. ADA has been extensively used in the diagnosis of tuberculous pleural effusion. Two isoenzymes, ADA1 and ADA2 have been described. Its activity is high in lymphocytes and monocytes.
ADA activity is increased in various conditions such as liver disease, tuberculosis, typhoid, infective mononucleosis and certain malignancies, especially those of haematopoietic origin.
The aim of the work was to assess the diagnostic value of adenosine deaminase in pulmonary tuberculosis by comparing levels in sputum and serum.
The present study included 15 patients with active pulmonary tuberculosis,15 patients with pneumonia and 15 patients diagnosed as lung cancer.
After taking a detailed informed consent, all patients were subjected to:
Full history taking, complete clinical examination, including general and local chest examinations, anthropometric measurements, routine laboratory investigations, including complete Blood count (CBC), liver and renal function tests, erythrocyte sedimentation rate (ESR),plain X ray chest, Early morning sputum samples of all patients for detection of the level of ADA using specific immunoassay method and comparison with blood venous samples.
According to the present study there was statistical significant difference between the three studied groups regarding the age. tuberculous group ranged between 18 and 53 years with mean value 29.60±12.27 years , pneumonia group ranged between 23 and 58 years with mean value 37.80±13.20 years and bronchogenic carcinoma ranged between 45 and 72 years with mean value 58.73±7.33 years so the age of tuberculous patients was younger than pneumonia group and bronchogenic carcinoma group and pneumonia patients was younger than bronchogenic carcinoma patients .There was statistical significant negative correlation between age and sputum ADA and Serum ADA.
In the present study there was no statistical significant difference between the three studied groups regarding sex.
In the present study regarding the weight in tuberculous group ranged between 50 and 75 Kg with mean value 65.0±7.76 Kg , in pneumonia group ranged between 65 and 90 Kg with mean value 79.20±7.77 Kg and in bronchogenic carcinoma group ranged between 63 and 79 Kg with mean value 67.53±4.66 Kg so there was statistical significant decrease in weight in tuberculous group than pneumonia group and there was statistical significant decrease in weight in bronchogenic carcinoma group than pneumonia group while there was no statistical significant difference between tuberculous group and bronchogenic carcinoma group regarding the weight .There was a significant negative correlation between weight and sputum and serum ADA.
In the present study there was no statistical significant difference between the three studied groups regarding WBCs. In tuberculous group WBCs ranged between 9200 and 21692/ul with mean value 14349.67±3590.16/ul, in pneumonia group WBCs ranged between 8816 and 20600/ul with mean value 13995.87±4011.04/ul and in bronchogenic carcinoma WBCs ranged between 3430 and 17780 /ul with mean value 12987.73±4398.45/ul. WBCs had a positive significant correlation with both sputum and serum ADA.
In the present study regarding temperature, in tuberculous group temperature ranged between 38.2 and 39.0°C with mean value 38.6±0.13°C, in pneumonia group ranged between 38.1and 38.8°C with mean value 38.56±0.058°C and in bronchogenic carcinoma ranged between 36.3 and 37.0°C with mean value 36.5±0.132°C. There was no statistical significant difference between tuberculous group and pneumonia group regarding temperature while there was statistical significant increase in temperature in tuberculous group than bronchogenic carcinoma group and there was statistical significant increase in temperature in pneumonia group than bronchogenic carcinoma group .Temperature showed a positive significant correlation with both sputum and serum ADA.
In the present study there was a significant increase in tuberculous group than both pneumonia group and bronchogenic carcinoma group regarding incidence of cough and dyspnea.
In the present study there was significant increase in tuberculous group than pneumonia group regarding hemoptysis and significant increase in bronchogenic carcinoma groupe than pneumonia group regarding hemoptysis and there was no significant difference between tuberculous and bronchogenic carcinoma group.
In the present study there was no statistical significant difference between the three studied groups regarding ESR. ESR 1st hr in tuberculous group ranged between 80 and 135 mm/h with mean value 116.67±21.72 mm/h, in pneumonia group ranged between 70 and 120 mm/h with mean value 111.33±13.85 mm/h and in bronchogenic carcinoma group ranged between 70 and 115 mm/h with mean value 109.40±11.62 mm/h. ESR 2nd hr in tuberculous group ranged between 100 and 150 mm/h with mean value 127.67±20.25 mm/h , in pneumonia group ranged between 90 and 150 mm/h with mean value 126.67±21.85 mm/h and in bronchogenic carcinoma group ranged between 90 and 130 mm/h with mean value 119.67±13.43 mm/h .ESR at 1st and 2nd hr showed a positive significant correlation with both sputum and serum ADA.
In the present study there was statistical significant difference between the three studied groups regarding sputum ADA. Sputum ADA in tuberculous patients ranged between 125.4 and 180.3 IU/L with mean value 159.76±16.95 IU/L, in pneumonia patients ranged between 72.5 and 95.3 IU/L with mean value 84.34±6.87 IU/L and in bronchogenic carcinoma patients ranged between 51.8 and 83.2 IU/L with mean value 67.30±7.47 IU/L so there was a significant increase in sputum ADA in tuberculous group than pneumonia group, while tuberculous group showed a significant increase in sputum ADA than bronchogenic carcinoma group and there was a significant increase in sputum ADA in pneumonia group than bronchogenic carcinoma group.
In the present study there was statistical significant difference between the three studied groups regarding serum ADA, Serum ADA in tuberculous group ranged between 17.7 and 54.1 IU/L with mean value 31.99±8.85 IU/L, in pneumonia group ranged between 18.3 and 29.8 IU/L with mean value 24.15±4.22 IU/L and in bronchogenic carcinoma group ranged between 11.3 and 19.2 IU/L with mean value 14.84±2.43 IU/L so there was a significant increase in serum ADA in tuberculous group than pneumonia group, while tuberculous group showed a significant increase in serum ADA than bronchogenic carcinoma group and pneumonia group showed a significant increase than bronchogenic carcinoma group.
In the present study there was no statistical significant difference between the three studied groups regarding ratio ADA sputum/serum .The ratio ADA sputum/serum in tuberculous group ranged between 3.30 and 9.25 with mean value 5.31±1.47, in pneumonia group ranged between 2.99 and 4.84 with mean value 3.59±0.67 and in bronchogenic carcinoma group ranged between 3.82 and 6.09 with mean value 4.57±0.64. There was a statistically significant positive correlation between sputum and serum ADA.
In the present study the cut off value of sputum ADA was 93.4 IU/L, if the value was more than this cut off value the disease was present by 100.0%, while if the value was less than 93.4 IU/L, the disease was absent by about 93.2%. i.e. the sensitivity of this marker was 100.0% and the specificity was 93.2%.
On the other hand the cut off value of serum ADA was 17.9 IU/L , if the value was more than this cut off value the disease was present by 93.3%, while if the value was less than 17.9 IU/L, the disease was absent by about 51.0%. i.e. the sensitivity of this marker was 93.3% and the specificity was 51.0%. The sputum ADA was more sensitive and detective than serum ADA.