Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Nuffied Department of Medicine, University of Oxford, Oxford, UK.
BMJ Open. 2020 Mar 31;10(3):e032890. doi: 10.1136/bmjopen-2019-032890.
Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.
We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).
We studied a population cohort in South-Western Uganda.
Data were available for 8099 adults (median age 30 years; 56% female).
The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.
Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
在撒哈拉以南非洲地区，肝脏疾病是导致发病率和死亡率的主要原因之一，但该地区肝脏疾病的流行程度、分布情况和病因尚未得到充分研究。因此，我们旨在研究一个非洲农村人群的肝功能检查（LFTs）和肝纤维化评分。
我们进行了一项 LFTs 的横断面调查。我们根据美国和非洲的参考范围来判断异常的 LFT。我们推导了纤维化评分（天门冬氨酸氨基转移酶（AST）/血小板比值指数（APRI）、纤维化 4 指数（fibrosis-4）、γ-谷氨酰转移酶（GGT）/血小板比值（GPR）、红细胞分布宽度/血小板比值和 S 指数）。我们收集了关于饮酒、感染人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的信息。
我们研究了乌干达西南部的一个人群队列。
共有 8099 名成年人（中位数年龄 30 岁；56%为女性）的数据可用。
HBV、HCV 和 HIV 的感染率分别为 3%、0.2%和 8%。基于美国参考范围，异常 LFTs 的患病率高于基于非洲参考范围（例如，AST 分别为 13%和 3%）。AST/ALT 比值升高与自我报告的饮酒显著相关（p<0.001），AST/ALT 比值>2 的总体患病率为 11%（提示酒精性肝炎）。纤维化的最高患病率由 GPR 评分预测，人群中 24%的人超过了纤维化的阈值。HIV 或 HBV 的存在与升高的 GPR（p=0.005）和 S 指数（p<0.001）相关。通过多变量分析，升高的 LFTs 和纤维化评分与年龄较大、男性、体重不足、HIV 或 HBV 感染和饮酒最一致相关。
需要进一步研究来确定该环境下 LFTs 的正常参考范围，评估纤维化评分的特异性和敏感性，并确定肝脏疾病的病因。
