Chatla Chakrapani, Mishra Neetu, Jojula Malathi, Adepu Rajesham, Puttala Mallikarjun
Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, Maharashtra; Department of Microbiology, Sri Shivani College of Pharmacy, Warangal, Telangana, India.
Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India.
Lung India. 2021 Jan-Feb;38(1):64-73. doi: 10.4103/lungindia.lungindia_574_19.
Sputum smear microscopy (SSM), though regarded as an inexpensive and popular method for detecting tuberculosis (TB), lacks adequate sensitivity, specifically in adult people living with HIV/AIDS (PLHIV). Urine lipoarabinomannan (LAM) is a promising diagnostic tool among PLHIV with CD4 cell count < 200 cells/μl. We attempted to review all the studies undertaken in identifying the utility of urine LAM in diagnosing TB, especially among PLHIV. We searched PubMed, Google Scholar, and MEDLINE databases for studies reporting diagnostic utility of urine LAM status in PLHIV, published in the last 20 years till December 2019. The keywords used for searching were "Tuberculosis," "HIV/AIDS," "Diagnosis," "Screening" "Lipoarabinomannan," and "Urine." Our search resulted in 137 shortlisted citations, of which 67 related manuscripts were identified for detailed study. Based on inclusion and exclusion criteria, 37 studies were reviewed in detail. Average sample size of these studies was 464 (range = 81-2528; SD = 427). Crude average sensitivity of urine LAM in culture-confirmed TB cases was 44.1% (range = 8.3-93) while that of SSM was 38.6% (range = 14-65). However, sensitivity of urine LAM + SSM was 60.4% (range = 38.3-92.7), demonstrating the utility of SSM + urine LAM combination for detecting TB. Specificity was similar between urine LAM and SSM with 92.7% (range = 76-100) and 97.9% (range = 93.9-100), respectively. Majority of the studies demonstrated higher sensitivity of urine LAM in those with lesser the CD4 count, with immunocompromised and with debilitation who cannot produce self-expectorated sputum. We conclude that urine LAM is a potential diagnostic test in the algorithms involving immunocompromised, debilitated patients and specifically in PLHIV whose CD4 count is ≤100 cells/μl.
痰涂片显微镜检查（SSM）虽被视为检测结核病（TB）的一种廉价且常用的方法，但其敏感性不足，在成年艾滋病毒/艾滋病感染者（PLHIV）中尤为如此。尿脂阿拉伯甘露聚糖（LAM）是CD4细胞计数<200个细胞/微升的PLHIV中有前景的诊断工具。我们试图回顾所有关于确定尿LAM在诊断结核病中的效用的研究，特别是在PLHIV中。我们在PubMed、谷歌学术和MEDLINE数据库中搜索了2019年12月之前的20年里发表的报告尿LAM状态在PLHIV中的诊断效用的研究。搜索使用的关键词是“结核病”“艾滋病毒/艾滋病”“诊断”“筛查”“脂阿拉伯甘露聚糖”和“尿液”。我们的搜索产生了137篇入围引文，其中67篇相关手稿被确定进行详细研究。根据纳入和排除标准，对37项研究进行了详细审查。这些研究的平均样本量为4447（范围=81-2528；标准差=427）。在培养确诊的结核病病例中，尿LAM的粗平均敏感性为44.1%（范围=8.3-93），而SSM的粗平均敏感性为38.6%（范围=14-65）。然而，尿LAM+SSM的敏感性为60.4%（范围=38.3-92.7），证明了SSM+尿LAM联合检测结核病的效用。尿LAM和SSM的特异性相似，分别为92.7%（范围=76-100）和97.9%（范围=93.9-100）。大多数研究表明，在CD4计数较低、免疫功能低下和身体虚弱无法自行咳出痰液的患者中，尿LAM的敏感性更高。我们得出结论，在涉及免疫功能低下、身体虚弱患者的诊断算法中，特别是在CD4计数≤100个细胞/微升的PLHIV中，尿LAM是一种潜在的诊断检测方法。
