尿液脂阿拉伯甘露聚糖 (LAM) 在诊断结核病和预测 HIV 有和无的死亡率方面的效用：来自泰国大城市结核病研究网络的前瞻性结核病队列。

Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network.

机构信息

Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand.

出版信息

Int J Infect Dis. 2017 Jun;59:96-102. doi: 10.1016/j.ijid.2017.04.017. Epub 2017 Apr 27.

DOI:10.1016/j.ijid.2017.04.017

PMID:28457751

Abstract

OBJECTIVES

To evaluate the applicability and accuracy of the urine lipoarabinomannan (LAM) test in tuberculosis (TB)/HIV co-infected patients and HIV-negative patients with disseminated TB.

METHODS

Frozen urine samples obtained at baseline from patients in the TB research cohort with proven culture-positive TB were selected for blinded urine LAM testing. One hundred and nine patients were categorized into four groups: (1) HIV-positive patients with TB; (2) HIV-negative patients with disseminated TB; (3) HIV-negative immunocompromised patients with TB; and (4) patients with diseases other than TB. The sensitivity of urine LAM testing for culture-positive TB, specificity of urine LAM testing for patients without TB, positive predictive value (PPV), and negative predictive value (NPV) were assessed.

RESULTS

The sensitivity of the urine LAM test in group 1 patients with a CD4 T-cell count of >100, ≤100, and ≤50 cells/mm was 38.5%, 40.6%, and 45%, respectively. The specificity and PPV of the urine LAM test were >80%. The sensitivity of the test was 20% in group 2 and 12.5% in group 3, and the specificity and PPV were 100% for both groups. A positive urine LAM test result was significantly associated with death.

CONCLUSIONS

This promising diagnostic tool could increase the yield of TB diagnosis and may predict the mortality rate of TB infection, particularly in TB/HIV co-infected patients.

摘要

目的

评估尿液脂阿拉伯甘露聚糖（LAM）检测在结核分枝杆菌（TB）/人类免疫缺陷病毒（HIV）合并感染患者和HIV 阴性播散性结核患者中的适用性和准确性。

方法

从经培养证实为阳性的结核患者的 TB 研究队列中选择基线时获得的冷冻尿液样本进行盲法尿液 LAM 检测。将 109 例患者分为 4 组：（1）TB/HIV 阳性患者；（2）HIV 阴性播散性结核患者；（3）HIV 阴性免疫功能低下合并结核患者；（4）TB 以外疾病患者。评估尿液 LAM 检测对培养阳性 TB 的敏感性、对无 TB 患者的特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

CD4 T 细胞计数＞100、≤100 和≤50 个/mm3 的组 1 患者中尿液 LAM 检测的敏感性分别为 38.5%、40.6%和 45%。尿液 LAM 检测的特异性和 PPV ＞80%。组 2 患者的检测敏感性为 20%，组 3 患者的检测敏感性为 12.5%，两组患者的特异性和 PPV 均为 100%。阳性尿液 LAM 检测结果与死亡显著相关。