Department of Phthisiopulmonology, Northern State Medical University, Arkhangelsk, Russia.
Department of Infectious Diseases, Imperial College London, London, UK.
Expert Rev Respir Med. 2022 Jun;16(6):615-621. doi: 10.1080/17476348.2022.2090341. Epub 2022 Jun 21.
Sputum-based tuberculosis diagnosis does not address the needs of certain categories of patients. Active development of a noninvasive urine-based diagnosis could provide an alternative approach. We reviewed publications covering more than 30 urine biomarkers proposed as significant for TB diagnosis. Analytical approaches were heterogeneous in design and methods; few studies on diagnostic outcome prediction described a formal specificity and sensitivity analysis.
This review describes studies of non-sputum diagnostic approaches of pulmonary TB based on urine using specific TB biomarkers. The search was performed until December 2021, using terms [Tuberculosis] + [urine] + [biomarkers] in PubMed and Cochrane databases. Publications concerning LAM urine diagnostics were excluded as they have been described elsewhere.
Microbiological culture of sputum is considered to be the 'gold standard' diagnostic for pulmonary TB but the methodology is slow due to the slow growth of the TB bacteria. Urine provides a large volume of sample. Investigators have evaluated urine for either TB pathogen biomarkers or host biomarkers with some success as the review demonstrates. Detection sensitivity remains a significant problem. In future, combination of host and pathogen biomarkers could increase the sensitivity and specificity of TB diagnosis.
基于痰液的结核病诊断无法满足某些类别的患者的需求。积极开发非侵入性的尿液诊断方法可能是一种替代方法。我们回顾了涵盖 30 多种被提议作为结核病诊断有意义的尿液生物标志物的出版物。分析方法在设计和方法上存在差异；很少有关于诊断结果预测的研究描述了正式的特异性和敏感性分析。
本综述描述了使用特定的结核病生物标志物基于尿液的非痰液诊断方法在肺结核方面的研究。检索于 2021 年 12 月之前在 PubMed 和 Cochrane 数据库中使用了术语[Tuberculosis]+[urine]+[biomarkers]进行。由于 LAM 尿液诊断已在其他地方描述过，因此排除了有关尿液 LAM 诊断的出版物。
痰液的微生物培养被认为是肺结核的“金标准”诊断方法，但由于结核细菌生长缓慢，该方法耗时较长。尿液提供了大量的样本。正如综述所示，研究人员已经成功地评估了尿液中的结核病病原体生物标志物或宿主生物标志物。检测灵敏度仍然是一个重大问题。未来，宿主和病原体生物标志物的联合可能会提高结核病诊断的灵敏度和特异性。
