| 叶一鸣,朱明智,刘立宾,计仁华,李召东.尿液脂阿拉伯甘露聚糖在HIV阴性活动性肺结核患者中的诊断效能评价[J].浙江中西医结合杂志,2023,33(8): |
| 尿液脂阿拉伯甘露聚糖在HIV阴性活动性肺结核患者中的诊断效能评价 |
| Evaluation of diagnostic efficacy of urinary lipogenic arabinomannan in patients with HIV-negative active pulmonary tuberculosis |
| 投稿时间：2023-03-16 修订日期：2023-07-24 |
| DOI： |
| 中文关键词: 肺结核 尿液阿拉伯甘露聚糖（LAM）；诊断效能；HIV阴性； |
| 英文关键词:Tuberculosis, incipient tuberculosis Active tuberculosis Urine arabinomannan (LAM) Diagnostic effectiveness HIV negative |
| 基金项目:杭州市生物医药和健康产业发展扶持专项（2022WJC261） |
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| 中文摘要: |
| 目的 评价尿液脂阿拉伯甘露聚糖（LAM）在 HIV阴性肺结核（PTB）诊断中的价值。方法 纳入浙江大学医学院附属杭州市胸科医院PTB患者131例，非结核病患者42例。收集所有患者的晨尿，测定尿液LAM。两组同时进行呼吸道样本抗酸染色涂片镜检、BACTEC MGIT 960培养（MGIT 960）、Gene Xpert MTB/RIF检测（Xpert）以评价尿液LAM对HIV阴性肺结核的诊断效能。结果 PTB组尿液LAM的荧光值/阈值（S/CO）与对照组相比有显著性差异[1.11(0.93-1.77)比(0.73（0.71- 0.75）), P<0.01]，在131例肺结核患者中，尿液LAM的敏感性是48.9%，高于抗酸染色涂片镜检21.4%和MGIT 960培养35.8%,低于Xpert 72.5%。尿液LAM在抗酸染色涂片镜检阴性、MGIT 960阴性、Xpert阴性的临床确诊患者中，检出率分别为39.8%、42.9%、22.2%；与Xpert联合检测的灵敏度为90.0%，特异性85.7%，AUC达0.935。结论 尿LAM有较好的诊断效能，非常适用于基层实验室；对Xpert MTB/RIF检测阴性的样本仍有一定检出率，其与XpertMTB/RIF联合检测具有很高的诊断效能。 |
| 英文摘要: |
| To evaluate the diagnostic value of urinary lipogenic arabinomannan (LAM) in HIV negative pulmonary tuberculosis (PTB). Methods 131 patients with PTB and 42 patients without TB were enrolled in the Hangzhou Chest Hospital Affiliated to Zhejiang University School of Medicine. Morning urine of all patients was collected, and urine LAM was measured. The diagnostic efficacy of urine LAM for HIV-negative pulmonary tuberculosis was evaluated by acid-fast staining smear, BACTEC MGIT 960 culture (MGIT 960) and Gene Xpert MTB/RIF test (Xpert). Results The fluorescence value/threshold (S/CO) of urine LAM in the PTB group was significantly different from that in the control group [1.11(0.93-1.77) vs. 0.73 (0.71-0.75)), P<0.01], In 131 patients with pulmonary tuberculosis, urine LAM sensitivity was 48.9%, higher than acid fast staining smear microscopy 21.4% and MGIT 960 culture 35.8%，lower than Xpert 72.5%.The detection rates of urine LAM were 39.8%, 42.9% and 22.2% in the acid-fast staining smear negative, MGIT 960 negative and Xpert negative patients. The sensitivity, specificity and AUC of urine LAM combined with Xpert were 90.0%, 85.7% and 0.935 respectively. Conclusion Urinary LAM has good diagnostic efficacy and is suitable for primary laboratories. The detection rate of Xpert negative samples is still certain, and the combined detection with Xpert has a high diagnostic efficiency. |
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