心膜液中adenosine deaminase（ADA）活性値が高値を示した結核性心膜炎の1例

A case of tuberculous pericarditis with marked high level of adenosine deaminase (ADA) activity in pericardial effusion

　心膜炎の原因は多岐にわたり，その基礎疾患を明らかにすることが臨床上必要である。とくに結核性心膜炎の診断は困難であるが，致命率が高く，早期診断が望まれる。

　著者らは心タンボナーデを呈した結核性心膜炎と思われる症例を経験し，本症の心膜液中のADA活性値が増加していることを認めたので，若干の検討を加えて報告する。

　A 71-year-old female was admitted to our hospital because of malaise and weightloss. Echocardiogram disclosed much pericardial effusion. Pericardial aspiration confirmed marked high level of ADA (adenosine deaminase activity), 38.6 IU/l in bloody effusion. Therapeutic trials of tuberculostat resulted in response and she was diagnosed tuberculous pericarditis.

　We once measured ADA in pericardial effusion of carcinomatous pericarditis complicated with lung cancer and ADA value was low, 10.8 IU/l. In the case of pleuritis, it is well known that measurement of ADA in pleural effusion is useful for the differential diagnosis of tuberculous and carcinomatous pleuritis. Namely, high level of ADA in pleural effusion suggests tuberculous pleuritis and comparatively low level of ADA suggests carcionomatous and others. We speculated that same thing might be said in pericarditis and above two cases support our speculation. Of course, we need more cases in number and further study to establish our speculation.