尿液脂阿拉伯甘露聚糖抗原检测对肺外结核的诊断价值  

Diagnostic value of urine lipoarabinomannan antigen detection in extrapulmonary tuberculosis

作　　者：朱明智 邵燕琴 范大鹏[1] 刘立宾[1] 梅宾 戴玲珊 蔡龙[1] Zhu Mingzhi;Shao Yanqin;Fan Dapeng;Liu Libin;Mei Bin;Dai Lingshan;Cai Long(Clinical Laboratory Center,Hangzhou Red Cross Hospital,Hangzhou 310003,China)

机构地区：[1]杭州市红十字会医院临床医学检验实验中心,杭州310003

出　　处：《中国防痨杂志》2025年第4期471-476,共6页Chinese Journal of Antituberculosis

基　　金：杭州市生物医药和健康产业发展扶持科技专项(2022WJC262)。

摘　　要：目的:探讨尿液脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)抗原检测对肺外结核患者的诊断价值。方法:连续收集2023年4月至2024年6月于杭州市红十字会医院就诊的92例疑似肺外结核患者的尿液样本进行LAM抗原检测,且对相应病灶部位样本进行GeneXpert MTB/RIF(简称“Xpert”)检测。以临床综合诊断为参考标准,比较两种方法单独及联合检测对肺外结核的诊断效能。结果:以临床综合诊断结果为标准,尿液LAM抗原和Xpert检测肺外结核的敏感度、特异度和受试者工作特征曲线下面积(area under curve,AUC)分别为49.3%(95%CI:36.8%~61.8%)、92.0%(95%CI:74.0%~99.0%)、0.706(95%CI:0.602~0.797)和49.3%(95%CI:36.8%~61.8%)、100.0%(95%CI:86.3%~100.0%)、0.746(95%CI:0.645~0.831)。尿液LAM抗原联合Xpert检测肺外结核的敏感度为73.1%(95%CI:60.9%~83.2%),高于尿液LAM抗原检测和Xpert检测,差异均有统计学意义(χ^(2)=27.672,P<0.001;χ^(2)=17.576,P<0.001);AUC为0.826(95%CI:0.733~0.897),高于尿液LAM抗原检测和Xpert检测,差异均有统计学意义(Z=1.602,P<0.001;Z=4.175,P=0.037)。结论:尿液LAM抗原检测在肺外结核的诊断中具有一定的应用前景,联合Xpert可以提高检测的敏感度,提升在肺外结核诊断中的应用价值。Objective:To explore the diagnostic value of urinary lipoarabinomannan(LAM)antigen detection in patients with extrapulmonary tuberculosis.Methods:Urine samples of 92 suspected patients with extra pulmonary tuberculosis treated in Hangzhou Red Cross Hospital from April 2023 to June 2024 were continuously collected for LAM antigen detection,and GeneXpert MTB/RIF(Xpert)test detection was performed on the corresponding lesion site samples.Taking the clinical comprehensive diagnosis as the reference standard,the diagnostic efficiency of the two methods alone and in combination for extrapulmonary tuberculosis was compared.Results:Based on the comprehensive clinical diagnosis results,the sensitivity,specificity and area under curve(AUC)of urine LAM antigen and Xpert for the test of extrapulmonary tuberculosis were 49.3%(95%CI:36.8%-61.8%),92.0%(95%CI:74.0%-99.0%),0.706(95%CI:0.602-0.797)and 49.3%(95%CI:36.8%-61.8%),100.0%(95%CI:86.3%-100.0%),0.746(95%CI:0.645-0.831),respectively.The sensitivity of urine LAM antigen combined with Xpert to detect extrapulmonary tuberculosis was 73.1%(95%CI:60.9%-83.2%),which was higher than that of urine LAM antigen(χ^(2)=27.672,P<0.001)and Xpert(χ^(2)=17.576,P<0.001).The AUC was 0.826(95%CI:0.733-0.897),which was higher than that of urine LAM antigen and Xpert detection;and the differences were statistically significant(Z=1.602,P<0.001;Z=4.175,P=0.037).Conclusion:Urine LAM antigen detection has a certain application prospect in the diagnosis of extrapulmonary tuberculosis,and the combination with Xpert can improve the sensitivity of detection and enhance the application value in the diagnosis of extrapulmonary tuberculosis.

关 键 词：肺外结核 尿 甘露聚糖类 核酸扩增技术 诊断 

分 类 号：R52[医药卫生—内科学] R446[医药卫生—临床医学]