The value of combining <i>Mycobacterium tuberculosis</i> immunoglobulin G with adenosine deaminase and D-dimer on the diagnostic accuracy of tuberculous pleurisy

Chong Liang; Jie Chen; Chungang Wu; Chunhong Qiu; Guangge Feng; Chong Liang; Jie Chen; Chungang Wu; Chunhong Qiu; Guangge Feng

doi:10.3934/medsci.2026005

AIMS Medical Science

2026, Volume 13, Issue 1: 57-66. doi: 10.3934/medsci.2026005

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Research article

The value of combining Mycobacterium tuberculosis immunoglobulin G with adenosine deaminase and D-dimer on the diagnostic accuracy of tuberculous pleurisy

1.
Department of Laboratory Medicine, Red Cross Hospital of Yulin City, Yulin, China
2.
Department of Oncology Hematology, The First People's Hospital of Yulin, Yulin, China
3.
Department of Laboratory Medicine, The Second Yulin People's Hospital, Yulin, China
These two authors contributed equally.

Received: 23 September 2025 Revised: 09 March 2026 Accepted: 18 March 2026 Published: 23 March 2026

This study aimed to investigate the association between adenosine deaminase (ADA), Mycobacterium tuberculosis immunoglobulin G (MTB-IgG), and d-dimer (D-D) levels in pleural fluid, as well as to assess the diagnostic value of their combined detection in tuberculous pleurisy. A total of 255 patients admitted between July 2022 and July 2024 were included in the study and categorized into two groups: tuberculous pleural (TBP) group (148 cases, 57.6%) and nontuberculous pleural (non-TBP) group (107 cases, 42.4%). Correlation analysis was conducted on adenosine deaminase (ADA), Mycobacterium tuberculosis immunoglobulin G (MTB-IgG), and D-dimer (D-D) in tuberculosis patients. The diagnostic outcomes of these three biological indicators alone as well as in combination were compared by setting the lowest threshold of different biomarkers. The levels of ADA (60.78 ± 27.58 U/L vs. 38 ± 4.96 U/L) and D-D (6.18 ± 5.38 mg/L vs. 1.29 ± 0.69 mg/L) in TBP patients were found to be significantly elevated compared to non-TBP patients (P < 0.001). When the MTB-IgG test was positive, the diagnostic accuracy was as high as 77.4% in TBP patients, while non-TBP patients showed a low immune characteristic, and the MTB-IgG negative rate was as high as 80.4%. When combined with ADA + MTB-IgG (−), D-D + MTB-IgG (−), and ADA + D-D + MTB-IgG (−), the diagnostic accuracy of non-TBP patients can be significantly improved. The combined detection of pleural effusion ADA, D-D, and MTB-IgG can enhance the diagnostic accuracy of tuberculous pleurisy.
- tuberculous pleural,
- adenosine deaminase,
- mycobacterium tuberculosis immunoglobulin G,
- D-dimer,
- diagnosis
Citation: Chong Liang, Jie Chen, Chungang Wu, Chunhong Qiu, Guangge Feng. The value of combining Mycobacterium tuberculosis immunoglobulin G with adenosine deaminase and D-dimer on the diagnostic accuracy of tuberculous pleurisy[J]. AIMS Medical Science, 2026, 13(1): 57-66. doi: 10.3934/medsci.2026005

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Abstract

This study aimed to investigate the association between adenosine deaminase (ADA), Mycobacterium tuberculosis immunoglobulin G (MTB-IgG), and d-dimer (D-D) levels in pleural fluid, as well as to assess the diagnostic value of their combined detection in tuberculous pleurisy. A total of 255 patients admitted between July 2022 and July 2024 were included in the study and categorized into two groups: tuberculous pleural (TBP) group (148 cases, 57.6%) and nontuberculous pleural (non-TBP) group (107 cases, 42.4%). Correlation analysis was conducted on adenosine deaminase (ADA), Mycobacterium tuberculosis immunoglobulin G (MTB-IgG), and D-dimer (D-D) in tuberculosis patients. The diagnostic outcomes of these three biological indicators alone as well as in combination were compared by setting the lowest threshold of different biomarkers. The levels of ADA (60.78 ± 27.58 U/L vs. 38 ± 4.96 U/L) and D-D (6.18 ± 5.38 mg/L vs. 1.29 ± 0.69 mg/L) in TBP patients were found to be significantly elevated compared to non-TBP patients (P < 0.001). When the MTB-IgG test was positive, the diagnostic accuracy was as high as 77.4% in TBP patients, while non-TBP patients showed a low immune characteristic, and the MTB-IgG negative rate was as high as 80.4%. When combined with ADA + MTB-IgG (−), D-D + MTB-IgG (−), and ADA + D-D + MTB-IgG (−), the diagnostic accuracy of non-TBP patients can be significantly improved. The combined detection of pleural effusion ADA, D-D, and MTB-IgG can enhance the diagnostic accuracy of tuberculous pleurisy.

Acknowledgments

This research was funded by Yulin Scientific Research and Technology Development Plan, grannumber 20220653.

Ethical approval of the research and informed consent

Written informed consent was obtained from all individuals prior to enrollment.

Conflict of interest

The authors declare no conflict of interest.

References

[1]	Tan Y, Tan Y, Li J, et al. (2021) Combined IFN-γ and IL-2 release assay for detect active pulmonary tuberculosis: a prospective multicentre diagnostic study in China. J Transl Med 19: 1-8. https://doi.org/10.1186/s12967-021-02970-8
[2]	Fenhua J, Daohui W, Hui L, et al. (2021) Diagnostic value of combined pleural interleukin-33, adenosine deaminase and peripheral blood tuberculosis T cell spot detection TB for tuberculous pleurisy. Bmc Infect Dis 21: 861. https://doi.org/10.1186/s12879-021-06575-w
[3]	WHOGlobal Tuberculosis Report 2023 (2023). Available from: https://www.hncdc.com.cn/sitesources/sjk/upload/202312/2023122816363287376.pdf
[4]	Zhang M, Xiong D, Li H, et al. (2018) Diagnostic value of T-Spot TB combined with INF-gamma and IL-27 in tuberculous pleurisy. Exp Ther Med 15: 1871-1874. https://doi.org/10.3892/etm.2017.5464
[5]	Bian Y, Deng M, Zhang Q, et al. (2022) Global trends of research on tuberculous pleurisy over the past 15 years: A bibliometric analysis. Front Cell Infect Microbiol 12: 9937811. https://doi.org/10.3389/fcimb.2022.937811
[6]	Ma Z, Ji X, Yang H, et al. (2020) Screening and evaluation of Mycobacterium tuberculosis diagnostic antigens. Eur J Clin Microbiol 39: 1959-1970. https://doi.org/10.1007/s10096-020-03951-3
[7]	Choe J, Shin SH, Jeon K, et al. (2024) Features which discriminate between tuberculosis and haematologic malignancy as the cause of pleural effusions with high adenosine deaminase. Resp Res 25: 17. https://doi.org/10.1186/s12931-023-02645-6
[8]	Zhang X, Meng Q, Miao R, et al. (2022) The diagnostic value of T cell spot test and adenosine deaminase in pleural effusion for tuberculous pleurisy: A systematic review and meta-analysis. Tuberculosis (Edinb) 135: 102223. https://doi.org/10.1016/j.tube.2022.102223
[9]	Antonangelo L, Faria CS, Sales RK (2019) Response to: Necessity of co-operation between pulmonologists and internists in tuberculous pleurisy diagnosis. Expert Rev Respir Med 13: 1039. https://doi.org/10.1080/17476348.2019.1667235
[10]	Shi H, Yang L, Zhang F, et al. (2023) Diagnostic Value of CD25, CD69, and CD134 on Tuberculosis-Specific Antigen-Stimulated CD4+ T Cells for Tuberculous Pleurisy. J Immunol Res 2023: 5309816. https://doi.org/10.1155/2023/5309816
[11]	Manbenmad V, So-ngern A, Chetchotisakd P, et al. (2023) Evaluating anti-GPL-core IgA as a diagnostic tool for non-tuberculous mycobacterial infections in Thai patients with high antibody background. Sci Rep 13: 1883. https://doi.org/10.1038/s41598-023-45893-8
[12]	Li J, Zhou K, Duan H, et al. (2022) Value of D-dimer in predicting various clinical outcomes following community-acquired pneumonia: A network meta-analysis. Plos One 17: e263215. https://doi.org/10.1371/journal.pone.0263215
[13]	Feng M, Sun F, Wang F, et al. (2019) The diagnostic effect of sequential detection of ADA screening and T-SPOT assay in pleural effusion patients. Artif Cells Nanomed Biotechnol 47: 3272-3277. https://doi.org/10.1080/21691401.2019.1647221
[14]	Li X, Qin Y, Ye W, et al. (2021) Diagnostic performance of D-dimer in predicting pulmonary embolism in tuberculous pleural effusion patients. BMC Pulm Med 21: 177. https://doi.org/10.1186/s12890-021-01546-y
[15]	Dewi DNSS, Mertaniasih NM, Soedarsono, et al. (2023) Antibodies against native proteins of Mycobacterium tuberculosis can detect pulmonary tuberculosis patients. Sci Rep 13: 12685. https://doi.org/10.1038/s41598-023-39436-4
[16]	Rabbi MF, Ahmed MN, Patowary MSA, et al. (2023) Pleural fluid adenosine deaminase to serum C-reactive protein ratio for diagnosing tuberculous pleural effusion. BMC Pulm Med 23: 349. https://doi.org/10.1186/s12890-023-02694-z
[17]	Kang W, Yu J, Du J, et al. (2020) The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study. Plos One 15: e0237753. https://doi.org/10.1371/journal.pone.0237753
[18]	Antonangelo L, Faria CS, Sales RK (2019) Tuberculous pleural effusion: diagnosis & management. Expert Rev Resp Med 13: 747-759. https://doi.org/10.1080/17476348.2019.1637737
[19]	Jiang CG, Wang W, Zhou Q, et al. (2020) Influence of age on the diagnostic accuracy of soluble biomarkers for tuberculous pleural effusion: a post hoc analysis. BMC Pulm Med 20: 178. https://doi.org/10.1186/s12890-020-01219-2
[20]	El-Habashy MM, Elmahalawy II, Sonbol A (2014) Value of D-dimer and alkaline phosphatase in the diagnosis of pleural effusion. Egypt J Chest Dis Tu 63: 869-872. https://doi.org/10.1016/j.ejcdt.2014.07.008
[21]	Huang X, Li D, Liu F, et al. (2021) Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis 21: 14. https://doi.org/10.1186/s12879-020-05700-5
[22]	Matveychuk A, Rashid G, Fridman Z, et al. (2012) Pleural ELFA D-dimer assay: A surrogate marker for malignant pleural effusion. Thromb Res 129: 648-651. https://doi.org/10.1016/j.thromres.2011.07.036
[23]	Kaisermann MC, Sardella IG, Trajman A, et al. (2005) IgA antibody responses to Mycobacterium tuberculosis recombinant MPT-64 and MT-10.3 (Rv3019c) antigens in pleural fluid of patients with tuberculous pleurisy. Int J Tuberc Lung Dis 9: 461-466.
[24]	Cázares-Sosa FR, Hernández-Solís A, Andrés-Dionicio AE, et al. (2019) Comparative analysis of antibodies and lymphocytes in pulmonary tuberculosis patients with negative and positive cultures. J Infect Dev Ctries 13: 28-34. https://doi.org/10.3855/jidc.10583
[25]	Da Silva RJ, Da Silva Corrêa R, Sardella IG, et al. (2019) IgA and IgG antibody detection of mycobacterial antigens in pleural fluid and serum from pleural tuberculous patients. BMC Immunol 20: 36. https://doi.org/10.1186/s12865-019-0315-y

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