在 HIV 高发环境中，住院患者尿液脂阿拉伯甘露聚糖检测对结核病的诊断准确性。
Diagnostic accuracy of a urine lipoarabinomannan test for tuberculosis in hospitalized patients in a High HIV prevalence setting.
机构信息
Department of Medicine, Johns Hopkins University Center for Tuberculosis Research, Baltimore, MD 21231, USA.
出版信息
J Acquir Immune Defic Syndr. 2009 Oct 1;52(2):145-51. doi: 10.1097/QAI.0b013e3181b98430.
BACKGROUND
Effective tuberculosis (TB) control in HIV-prevalent settings is hindered by absence of accurate, rapid TB diagnostic tests. We evaluated the accuracy of a urine lipoarabinomannan (LAM) test for TB diagnosis in South Africa.
METHODS
Hospitalized adults with signs and/or symptoms of active TB were enrolled. Sputum smear microscopy and mycobacterial culture, mycobacterial blood culture, and HIV testing were performed. A spot urine specimen was tested for LAM.
RESULTS
Four hundred ninety nine participants were enrolled; 422 (84.6%) were HIV infected. In microbiologically confirmed TB patients, the LAM test was positive in 114 of 193 [sensitivity 59%, (95% confidence interval: 52 to 66)], including 112 of 167 [67% (59 to 74)] who were HIV infected. Among individuals classified as "not TB", the LAM test was negative in 117 of 122 [specificity 96% (91 to 99)], including 83 of 88 [94% (87 to 98)] who were HIV infected. In confirmed TB patients, the LAM test was more sensitive than sputum smear microscopy (42%, 82 of 193, P < 0.001) and detected 56% (62 of 111) of those who were sputum smear negative. HIV infection [adjusted odds ratio (AOR 13.4)], mycobacteremia (AOR 3.21), and positive sputum smear (AOR 2.42) were risk factors for a positive LAM test.
CONCLUSIONS
The urine LAM test detected a subset of HIV-infected patients with severe TB in whom sputum smear microscopy had suboptimal sensitivity. The combination of urine LAM testing and sputum smear microscopy is attractive for use in settings with high HIV burden.
背景
在艾滋病毒流行地区，有效的结核病（TB）控制受到缺乏准确、快速的 TB 诊断测试的阻碍。我们评估了南非尿液脂阿拉伯甘露聚糖（LAM）检测对 TB 诊断的准确性。
方法
纳入有活动性 TB 症状和/或体征的住院成人。进行痰涂片镜检和分枝杆菌培养、分枝杆菌血培养和 HIV 检测。检测了一份尿液标本的 LAM。
结果
共纳入 499 名参与者；422 名（84.6%）感染了 HIV。在微生物学确诊的 TB 患者中，193 例中有 114 例[敏感性 59%（95%置信区间：52 至 66）]，包括 167 例中有 112 例[67%（59 至 74）]HIV 感染。在分类为“非 TB”的个体中，122 例中有 117 例[特异性 96%（91 至 99）]，包括 88 例中有 83 例[94%（87 至 98）]HIV 感染。在确诊的 TB 患者中，LAM 检测比痰涂片镜检更敏感（42%，193 例中的 82 例，P<0.001），并且检测到 56%（111 例中的 62 例）痰涂片阴性的患者。HIV 感染[调整后的比值比（AOR 13.4）]、菌血症（AOR 3.21）和阳性痰涂片（AOR 2.42）是 LAM 检测阳性的危险因素。
结论
尿液 LAM 检测到了一组 HIV 感染的严重 TB 患者，这些患者的痰涂片镜检敏感性较差。尿液 LAM 检测与痰涂片镜检相结合，在 HIV 负担高的地区很有吸引力。
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