Urine lipoarabinomannan assay for tuberculosis screening before antiretroviral therapy diagnostic yield and association with immune reconstitution disease
Urine lipoarabinomannan assay for tuberculosis screening before antiretroviral therapy diagnostic yield and association with immune reconstitution disease
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DOI：
10.1097/qad.0b013e32832e05c8
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发表时间：
2009-09-10
期刊：
影响因子：
3.8
通讯作者：
Wood, Robin
中科院分区：
文献类型：
--
作者：
Lawn, Stephen D.;Edwards, David J.;Wood, Robin
目的：评估尿液阿拉伯甘露聚糖脂（LAM）检测作为结核病（TB）诊断筛查试验在HIV感染、晚期免疫缺陷和痰涂片阴性肺病高患病率患者中的实用性。设计：横断面调查。未选定的成年人登记接受抗逆转录病毒治疗（ART）在南非的一家诊所，用两份痰液样本进行荧光显微镜检查和分枝杆菌液体培养来筛查结核病。LAM在尿液样本中使用市售的酶联免疫吸附测定法进行测量。结果：痰培养阳性TB被诊断为58例（中位数CD 4细胞计数= 78细胞/μ l）出235例筛选（TB患病率= 0.25）。在平均24天（SD = 9天）后，培养物被鉴定为阳性。痰镜检的敏感性为0.14（特异性= 1.00），而浓缩尿LAM的敏感性为0.38（P < 0.01;特异性= 1.00）。在CD 4细胞计数小于50、50-100和大于150个细胞/μ l的患者中，LAM测定的灵敏度分别为0.67、0.41和0.13。LAM测定和显微镜检查联合使用的相应值分别为0.67、0.53和0.21。在结核病患者中，可检测到的LAM与低CD 4细胞计数和晚期临床分期密切相关。所有发展为TB免疫重建疾病的患者（n = 5）在基线时可检测到尿LAM。结论：LAM检测在CD 4细胞计数小于100个细胞/μ l的患者中作为常规诊断TB筛查试验，对痰液显微镜检查具有显著上级灵敏度。在一半的此类患者中，该测定可将诊断的平均时间缩短约3周。此外，可检测到的尿LAM可预测TB免疫重建疾病的发展。(C)2009年威科健康|利平科特威廉姆斯&威尔金斯
Objective: To assess the utility of urine lipoarabinomannan (LAM) detection as a diagnostic screening test for tuberculosis (TB) in HIV-infected patients with advanced immunodeficiency and high prevalence of sputum smear-negative pulmonary disease.Design: Cross-sectional survey.Methods: Unselected adults enrolling for antiretroviral therapy (ART) in a South African clinic were screened for TB with two sputum samples for fluorescence microscopy and mycobacterial liquid Culture. LAM was measured in urine samples using a commercially available enzyme-linked immunosorbent assay.Results: Sputum culture-positive TB was diagnosed in 58 patients (median CD4 cell count = 78 cells/mu l) Out of 235 patients screened (TB prevalence = 0.25). Cultures were identified as positive after a mean of 24 clays (SD = 9 days). The sensitivity of sputum microscopy was just 0.14 (specificity = 1.00), whereas that of LAM in concentrated urine was 0.38 (P < 0.01; specificity = 1.00). In those with CD4 cell counts of less than 50, 50-100 and more than 150 cells/mu l, the LAM assay sensitivities were 0.67, 0.41 and 0.13, respectively. Corresponding values for the combined use of the LAM assay and microscopy were 0.67, 0.53 and 0.21, respectively. Among TB patients, detectable LAM was very strongly associated with low CD4 cell counts and advanced clinical stage. All patients who developed TB immune reconstitution disease (n = 5) had detectable urinary LAM at baseline.Conclusion: The LAM assay has substantially superior sensitivity to sputum microscopy as a routine diagnostic TB screening test among patients with CD4 cell counts less than 100 cells/mu l. In one half of Such patients, this assay Could reduce the mean time to diagnosis by approximately 3 weeks. Furthermore, detectable urinary LAM may predict the development of TB immune reconstitution disease. (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins