Circulating antibodies to lipoarabinomannan in relation to sputum microscopy, clinical features and urinary anti-lipoarabinomannan detection in pulmonary tuberculosis
Circulating antibodies to lipoarabinomannan in relation to sputum microscopy, clinical features and urinary anti-lipoarabinomannan detection in pulmonary tuberculosis
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DOI：
10.1080/00365540110077263
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发表时间：
2002-01-01
影响因子：
--
通讯作者：
Bjorvatn, B
中科院分区：
文献类型：
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作者：
Tessema, TA;Bjune, G;Bjorvatn, B
采用酶联免疫吸附试验(EL ISA)检测了抗酸杆菌(AFB)阳性肺结核、AFB阴性肺结核及非结核呼吸道症状患者血清中抗阿拉伯甘露糖(LAM)抗体水平。以尿LAM检测和临床诊断评分(DS)系统为参照，进一步评价抗LAM结果。以痰AFB为参照，139例AFB阳性肺结核患者抗LAM抗体阳性率为66.9%，61例AFB阴性肺结核患者抗LAM抗体阳性率为34.4%，800例非结核患者抗LAM抗体阳性率为23.5%，50例健康人LAM抗体阳性率为8%。阳性预测值为48.7%，阴性预测值为48.7%。和87.4%。以DS为参照，其敏感性和特异性分别为50.5%和78.3%，而尿LAM阳性和阴性的准确率分别为45.8%和77.9%。在结核病流行地区，抗LAM抗体阴性可能具有实用价值，特别是在结核病的其他指标为阴性的情况下。用这些方法中的任何一种作为参考，积极的反LAM会在大约四分之一的案件中产生误导。如果3种方法全部结合，且至少有2项阳性试验，则90.6%。在AFB阳性肺结核中，52.5%的AFB阴性肺结核和94.9%的非结核病患者将被正确诊断。除了艾滋病毒可能的影响外，目前检测的准确性较低可能是由于血管内形成LAM-抗LAM复合体、潜伏的结核病或环境分枝杆菌感染。
An enzyme-linked immunosorbent assay (ELISA)-based investigation of anti-lipoarabinomannan (LAM) antibody levels in the sera of patients with acid-fast bacilli (AFB)-positive pulmonary tuberculosis (PTB), AFB-negative PTB and non-TB respiratory tract symptoms was conducted. The anti-LAM results were further evaluated using urine LAM detection and a clinical diagnostic score (DS) system as references. Using sputum AFB as a reference, positive anti-LAM was found in 66.9% of 139 AFB-positive PTB, 34.4%, of 61 AFB-negative PTB and 23.5% of 800 non-TB patients and in 8% of 50 healthy individuals. The positive and negative predictive values were 48.7%. and 87.4%, respectively. Using the DS as a reference, the sensitivity and specificity were 50.5% and 78.3%, respectively, whereas 45.8% of urine LAM positives and 77.9%) of urine LAM negatives were correctly identified by the anti-LAM ELISA. In TB endemic areas a negative anti-LAM could be of practical value, particularly when other indicators of PTB are negative. Using any of these methods as a reference, a positive anti-LAM would mislead in about one-quarter of cases. Had all the 3 methods been combined and at least 2 positive tests sufficed, 90.6%. of AFB-positive PTB, 52.5% of AFB-negative PTB and 94.9% of non-TB patients would have been correctly diagnosed. Apart from the possible impact of HIV, the low accuracy of the current assay could be due to intravascular formation of LAM-anti-LAM complexes, latent TB or environmental mycobacterial infections.