Diagnostic accuracy of induced sputum LAM ELISA for tuberculosis diagnosis in sputum-scarce patients.
Diagnostic accuracy of induced sputum LAM ELISA for tuberculosis diagnosis in sputum-scarce patients.
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DOI：
10.5588/ijtld.11.0614
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Dheda K
中科院分区：
文献类型：
--
作者：
Peter JG;Cashmore TJ;Meldau R;Theron G;van Zyl-Smit R;Dheda K
目的：探讨脂阿拉伯甘露聚糖(LAM)酶联免疫吸附试验(ELISA法)是否可用于诊断肺结核患者的诱导痰，以诊断疑似肺结核患者的痰稀少。LAM是从南非一家三级医院呼吸系统诊所连续招募的61名痰稀少的结核病嫌疑人获得的诱导痰样本中测量的。以结核分枝杆菌液体培养阳性为参照标准。接收器工作特性分析用于评估不同的LAM浓度截断值。总共有87%(53/61)的研究患者有有效的结核分枝杆菌培养结果；49%(23/53)是艾滋病毒感染，17%(9/53)是结核分枝杆菌培养阳性。诱导痰涂片镜检和LAM-EL ISA的总敏感性为56%(95%CI 27-81)，而LAM-EL ISA的特异性为48%(95%CI 34-62)，阳性预测值和阴性预测值分别为18%(95%CI 8-36)和84%(95%CI 65-94)。根据受试者的工作特性(LAM浓度和GT；5.73 ng/ml)选择最佳的参照值，将试验的特异度提高到98%，将灵敏度降低到22%。样本总蛋白或细胞计数检测的正常化并没有提高诊断的准确性。在这项概念验证研究中，酶联免疫吸附试验在临床上并不适用于使用诱导痰进行结核病诊断。
To examine whether a lipoarabinomannan (LAM) enzyme-linked immunosorbent assay (ELISA) that offers diagnostic utility using urine in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection can be used in induced sputum to diagnose sputum-scarce patients with suspected TB. LAM was measured in induced sputum samples obtained from 61 consecutively recruited sputum-scarce TB suspects in a tertiary hospital respiratory clinic in South Africa. Liquid culture positivity for Mycobacterium tuberculosis was used as the reference standard. Receiver operating characteristic analysis was used to assess alternative LAM concentration cut-offs. A total of 87% (53/61) of study patients had a valid M. tuberculosis culture result; 49% (23/53) were HIV-infected and 17% (9/53) were culture-positive for M. tuberculosis. Induced sputum smear microscopy and LAM ELISA had an overall sensitivity of 56% (95%CI 27–81); however, the specificity of LAM ELISA was 48% (95%CI 34–62), while the positive and negative predictive values were respectively 18% (95%CI 8–36) and 84% (95%CI 65–94). An optimal rule-in cut-off selected by receiver operating characteristic (LAM concentration > 5.73 ng/ml) increased test specificity to 98% and reduced sensitivity to 22%. Normalisation of the assay for sample total protein or cell count did not improve diagnostic accuracy. In this proof-of-concept study, the ELISA was not clinically useful for TB diagnosis using induced sputum.
影响因子：
3.7
作者：
Cashmore TJ;Peter JG;van Zyl-Smit RN;Semple PL;Maredza A;Meldau R;Zumla A;Nurse B;Dheda K
通讯作者：
Dheda K