The comparison of pleural fluid TNF-alpha and IL-10 levels with ADA in tuberculous pleural effusion.

OBJECTIVES: Our aim was to evaluate the diagnostic value of pleural fluid TNF-alpha and IL-10 levels in tuberculous pleural effusion (TPE) and compare with that of ADA. MATERIAL AND METHODS: 70 patients were enrolled in the study. Fourteen patients had TPE, 19 patients malignant pleural effusion (MPE), 18 patients complicated parapneumonic effusion (PPE) and 19 patients had transudative pleural effusion. RESULTS: The pleural fluid TNF-alpha levels were significantly higher in TPE than MPE and transudates. There was no significant difference in pleural fluid IL-10 levels between groups. Among exudative effusions, TNF-alpha was significantly higher in tuberculous group, while there was no difference in IL-10 levels between tuberculous and nontuberculous group. The pleural fluid ADA levels were significantly higher in TPE than other groups. ROC analysis was performed and the optimal cut-off points of TNF-alpha and ADA were 13.3 pg/mL and 41.5 U/L, respectively. The sensitivity of TNF-alpha was 71% and specificity was 66% in the diagnosis of TPE. In contrast, the sensitivity and specificity of ADA was 78% and 86% respectively. CONCLUSION: TNF- alpha is a useful marker in the diagnosis of TPE and IL-10 has no diagnostic value. However, the sensitivity and specificity of TNF-alpha is lower than that of ADA.

Diagnostic value of leptin in tuberculous pleural effusions.

It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE). We evaluated the diagnostic value of pleural fluid and serum leptin levels in TPE and compared them with adenosine deaminase (ADA). Forty-five patients, 17 tuberculous effusion and 28 nontuberculous effusion, with exudative pleural effusions were included. Leptin and ADA levels were measured from serum and pleural fluid in all patients. There were no statistically significant differences between tuberculous and nontuberculous groups with respect to the serum ADA activity and pleural fluid/serum leptin ratio. On the contrary, pleural fluid leptin level, pleural fluid ADA activity, serum leptin level and pleural fluid/serum ADA activity ratio were statistically different between tuberculous and nontuberculous groups. When leptin levels were corrected for body mass index, serum leptin levels did not reach statistical significance. Cut-off points to predict tuberculosis were calculated as 9.85 ng/ml and 35.55 U/l for pleural fluid leptin level and pleural fluid ADA activity, respectively. Sensitivity, specificity and area under the curve +/- standard error were 82.4%, 82.1%, 0.83 +/- 0.07 for pleural fluid leptin levels and 100%, 100%, 1.00 +/- 0.00 for pleural fluid ADA activity, respectively; the difference between these curves was significant (p = 0.01). Pleural fluid leptin levels were lower in tuberculous effusions than in other exudates. Pleural fluid leptin has a diagnostic value for TPE but not as good as that of ADA.

[Vascular endothelial growth factor in benign and malignant pleural effusions]. / El factor de crecimiento endotelial vascular en los derrames pleurales benignos y malignos.

OBJECTIVE: Vascular endothelial growth factor (VEGF) is a potent inducer of capillary permeability and its role as a crucial mediator in pleural fluid formation has been established. This study was conducted to assess the usefulness of VEGF for diagnosing malignant and non-malignant pleural effusions of various causes. PATIENTS AND METHODS: VEGF levels in pleural effusions collected from 52 patients (20 with malignant effusion, 12 with tuberculous effusion, 10 with transudative effusion, and 10 with parapneumonic effusion) were assessed by enzyme-linked immunosorbent assay. RESULTS: The median level of VEGF was significantly higher (P = .001) in exudative effusions (10.16 pg/mL) than in the transudative effusions (3.82 pg/mL). Although malignant pleural fluids tended to have higher median and mean levels of VEGF compared to tuberculous effusions, the difference was not statistically significant. Pleural VEGF levels in subtypes of lung cancer and in malignant effusions of different origins were not significantly different. CONCLUSIONS: In conclusion, although VEGF levels in pleural effusions of different origins vary, they were only able to discriminate exudates from transudates significantly in this study. Further studies in larger groups of patients are needed to establish the role of VEGF in diagnosing malignant and/or tuberculous effusions.

El factor de crecimiento endotelial vascular en los derrames pleurales benignos y malignos / Vascular endothelial growth factor in benign and malignant pleural effusions

Objetivo: El factor de crecimiento endotelial vascular (VEGF) es un potente inductor de la permeabilidad capilar y desempeña un papel clave como mediador en la formación del derrame pleural. Este estudio se ha realizado para evaluar la utilidad del VEGF en el diagnóstico de los derrames pleurales malignos y no malignos de diversas causas. Pacientes y métodos: Mediante la técnica de inmunoabsorción ligada a enzimas se determinaron las concentraciones de VEGF en los derrames pleurales correspondientes a 52 pacientes (20 con derrame pleural maligno, 12 con derrame de origen tuberculoso, 10 con derrame de tipo trasudado y 10 con derrame paraneumónico). Resultados: La concentración media del VEGF fue significativamente mayor (p = 0,001) en los derrames pleurales (10,16 pg/ml) de tipo exudado que en los derrames de tipo trasudado (3,82 pg/ml). Aunque los derrames pleurales malignos mostraron una tendencia a las concentraciones medianas y medias mayores de VEGF, en comparación con los derrames de origen tuberculoso, la diferencia no fue estadísticamente significativa. Tampoco fueron significativamente diferentes las concentraciones pleurales de VEGF en los distintos subtipos de cáncer pulmonar, y tampoco en los derrames malignos de distintos orígenes. Conclusiones: Aunque las concentraciones de VEGF son distintas en los derrames pleurales de orígenes diferentes, en nuestro estudio no han permitido discriminar los exudados de los trasudados. Son necesarios nuevos estudios de investigación sobre grupos más numerosos de pacientes con objeto de establecer el papel que puede desempeñar la concentración de VEGF en el diagnóstico de los derrames malignos, tuberculosos o ambos

Objective: Vascular endothelial growth factor (VEGF) is a potent inducer of capillary permeability and its role as a crucial mediator in pleural fluid formation has been established. This study was conducted to assess the usefulness of VEGF for diagnosing malignant and non-malignant pleural effusions of various causes. Patients and Methods: VEGF levels in pleural effusions collected from 52 patients (20 with malignant effusion, 12 with tuberculous effusion, 10 with transudative effusion, and 10 with parapneumonic effusion) were assessed by enzyme-linked immunosorbent assay. Results: The median level of VEGF was significantly higher (P=.001) in exudative effusions (10.16 pg/mL) than in the transudative effusions (3.82 pg/mL). Although malignant pleural fluids tended to have higher median and mean levels of VEGF compared to tuberculous effusions, the difference was not statistically significant. Pleural VEGF levels in subtypes of lung cancer and in malignant effusions of different origins were not significantly different. Conclusions: In conclusion, although VEGF levels in pleural effusions of different origins vary, they were only able to discriminate exudates from transudates significantly in this study. Further studies in larger groups of patients are needed to establish the role of VEGF in diagnosing malignant and/or tuberculous effusions