Clinical value and research progress of urinary lipoarabinomannan detection in the diagnosis of pediatric tuberculosis

doi:10.19983/j.issn.2096-8493.20260093

Abstract

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

CLC Number:

R52
R725.1

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

Figures/Tables 1

References 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