Diagnostic Accuracy of a Urine Lipoarabinomannan Test for Tuberculosis in Hospitalized Patients in a High HIV Prevalence Setting
Diagnostic Accuracy of a Urine Lipoarabinomannan Test for Tuberculosis in Hospitalized Patients in a High HIV Prevalence Setting
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DOI：
10.1097/qai.0b013e3181b98430
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发表时间：
2009-10-01
影响因子：
3.6
通讯作者：
Martinson, Neil A.
中科院分区：
文献类型：
--
作者：
Shah, Maunank;Variava, Ebrahim;Martinson, Neil A.
背景：在艾滋病毒流行的环境中，由于缺乏准确、快速的结核病诊断检测，结核病(TB)的有效控制受到阻碍。我们评估了尿脂阿拉伯甘露聚糖(LAM)试验在南非诊断结核病的准确性。方法：入选有活动性肺结核症状和体征的住院成人。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。结果：499名受试者中，422人(84.6%)为HIV感染者。在微生物确诊的结核病患者中，LAM试验在193例患者中有114例阳性[敏感性为59%，(95%可信区间：52至66)]，包括167例HIV感染者中的112例[67%(59至74)]。在被归类为“非结核病”的人中，LAM检测在122人中有117人呈阴性[特异性96%(91至99)]，包括88名HIV感染者中的83人[94%(87至98)]。在确诊的肺结核患者中，LAM试验比痰涂片镜检更敏感(42%，82/193，P<；0.001)，而在痰涂片阴性者中检出56%(62/111)。HIV感染[调整优势比(AOR)13.4]、分支杆菌血症(AOR 3.21)、痰涂片阳性(AOR 2.42)是LAM试验阳性的危险因素。尿液LAM检测和痰涂片镜检相结合对于在艾滋病毒负担较高的环境中使用是有吸引力的。
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.