尿液脂阿拉伯甘露聚糖检测对儿童结核病诊断价值的研究进展

doi:10.19983/j.issn.2096-8493.20260093

摘要/Abstract

摘要：

脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)是结核分枝杆菌细胞壁组分,可经尿液无创排出,适用于难以获取痰标本的儿童结核病辅助诊断。近年来,LAM检测技术不断演进,但其在不同儿童结核病亚群中的检测准确性差异显著。故本文对尿液LAM检测在儿童结核病辅助诊断中的生物学基础、检测方法、诊断性能(含HIV阳性和阴性儿童及其他不同亚群)及临床应用进展等方面进行系统综述,旨在梳理现有证据,探讨其与分子生物学检测的横向对比与整合策略,并阐述其临床局限性与尚存争议,为优化儿童结核病无创诊断路径提供参考。

关键词: 儿童, 结核, 阿拉伯糖, 甘露聚糖类, 综述文献(主题)

Abstract:

Lipoarabinomannan (LAM), a cell wall component of Mycobacterium tuberculosis, can be noninvasively excreted in urine, making it suitable as a valuable diagnostic tool for pediatric tuberculosis, particularly in children from whom sputum specimens are difficult to obtain. In recent years, LAM detection technologies have continued to evolve, although their diagnostic accuracy varies considerably among different subgroups of children with tuberculosis. This systematic review comprehensively examines the biological basis, detection methods, diagnostic performance (including in HIV-positive and HIV-negative children and other pediatric subgroups), and recent advances in the clinical application progress of urinary LAM testing for pediatric tuberculosis. It aims to summarize the existing evidence, explore its comparison and strategies for integrating LAM detection with molecular diagnostic approaches, and outline its clinical limitations and remaining controversies, thereby providing a reference for optimizing noninvasive diagnostic strategies for pediatric tuberculosis.

Key words: Child, Tuberculosis, Arabinose, Mannans, Review literature as topic

中图分类号:

R52
R725.1

潘丽华, 詹璐. 尿液脂阿拉伯甘露聚糖检测对儿童结核病诊断价值的研究进展[J]. 结核与肺部疾病杂志,2026, 7(5): 673-678. doi: 10.19983/j.issn.2096-8493.20260093

Pan Lihua, Zhan Lu. Clinical value and research progress of urinary lipoarabinomannan detection in the diagnosis of pediatric tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(5): 673-678. doi: 10.19983/j.issn.2096-8493.20260093

图/表 1

参考文献 33

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检测方法	检测手段	优点	缺点	适应场景	相对成本
涂片镜检	痰液/胃液	操作简便,成本极低	儿童敏感度极低(<10%)^[3],无法区分非结核分枝杆菌	基层医疗机构初步筛查	极低
传统培养	痰液/胃液	诊断“金标准”,可进行药物敏感试验	耗时过长(2~8周)^[2],设备要求高	实验室确诊及药敏监测	中等
分子生物学检测(如GeneXpert MTB/RIF)	呼吸道标本/粪便	敏感度高(>90%),可同时检测耐药性	依赖侵入性呼吸道标本,设备昂贵,基层普及率低(<30%)^[2,10]	资源较好医院的初始诊断	高
尿液LF-LAM(如Alere/Fuji)	尿液	完全无创,30~60min出结果,可床旁操作,不依赖昂贵设备	在普通(HIV阴性)儿童中敏感度较低,存在漏诊风险	高危、重度免疫抑制及难以留痰患儿的快速床旁辅助诊断	低
尿液AIMLAM	尿液	无创,自动化定量分析,敏感度优于普通分子生物学	需要配套的自动化化学发光分析仪	实验室快速无创筛查与诊断	中等