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    • The difference in the mean values of

    2023-02-20

    The difference in the mean values of serum ADA in sputum positive PTB and controls was found to be highly significant (P<0.00). The difference in the mean values of serum ADA in sputum negative PTB and controls was also found to be highly significant (P<0.00). However, no statistically significant difference was observed when mean serum ADA values of sputum positive and sputum negative patients were compared. Serum ADA levels were measured at the start of treatment and again after completion of IP in PTB patients. The fall in the levels of serum ADA was found to be statistically significant in both smear positive and smear negative patients at the end of follow up at 2 months (P<0.00 and P<0.008 respectively) (Fig. 2). The mean serum ADA levels were compared in cases showing different bacterial load shown in terms of sputum positivity. The results are shown in Table 2. The mean values of serum ADA did not show any statistically significant differences in relation to the bacterial load (P=0.722). Sensitivity and specificity was calculated by the help of ROC curves. Area under curve was found to be 0.801. ROC analysis showed that the cut off values for serum ADA to differentiate between PTB from healthy controls were found to be 14.6IU/L with sensitivity of 78% and specificity of 76% (Fig. 3). When the cut off values of 14.6IU/L were applied to our study population, 75.8% of patients of pulmonary tuberculosis were found to be above the cut off value.
    Discussion Tuberculosis is a major health problem in India, and out of all its forms PTB is the commonest. A definite diagnosis of PTB can be made with the presence of Rimonabant fast bacilli on sputum smear examination of a patient. Chest radiograph provides only a probable diagnosis and culture for tubercle bacilli is a sophisticated and time consuming process. To overcome this difficulty various biochemical tests have been tried from time to time which may help confirm the diagnosis of pulmonary tuberculosis. In the present study, mean levels of serum ADA in patients of tuberculosis were found to be 35.29±30.94IU/L, as compared to 11.81±8.02IU/L in healthy controls. The difference between the ADA levels in the two groups was found to be statistically significant (P=0.00). Diagnostic value of serum ADA in patients of pulmonary tuberculosis has been estimated only in a few studies and similar results have been found.12, 13 Previous numerous studies have reported an increase in ADA levels in pleural effusion pericardial effusion, peritoneum and CNS fluids.14, 15, 16 However, the literature on the levels of ADA in serum is limited. The main reason for the increased ADA levels in pleural effusion is the movement of T lymphocytes towards this area. Increase in ADA levels is the result of inflammatory reaction caused by monocytes and macrophages.13, 14 When alveolar macrophages are infected by mycobacterium, this enzyme could be found in serum during active pulmonary disease, which was the main reason for planning out this study. In concordance with other studies,12, 13 the encouraging results so obtained can help us use it as a supplementary diagnostic tool in ‘difficult to diagnose’ PTB patients. In the present study serum ADA levels were estimated twice in the patients of pulmonary tuberculosis, once at the time of enrolment and next at the end of IP of treatment. A significant decrease in the mean value of ADA was found after treatment in the patients of pulmonary tuberculosis and was consistent with other studies.12, 13 This gives an indication that serum ADA can act as a prognostic marker. A serial follow up of ADA levels can help in particularly those patients where sputum microscopy is not of much reliability because of poor patient related factors. Also, they can prove helpful in sputum smear negative patients, as in these patients it is very difficult to decide whether they need to be shifted from intensive to continuation phase, or IP needs to be extended. In the present study, the optimum cut off point for serum ADA levels for diagnosis of pulmonary tuberculosis was found to be 14.6IU/L, using the ROC curve with sensitivity of 75% and specificity of 76%, a positive predictive value of 75.8% and a negative predictive value of 75.2%. The results of present study are in line with the available literature.17, 18, 19 They suggest that serum values of ADA can be used as an aid to diagnosis of PTB but cannot replace the gold standard sputum smear microscopy.