Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
Department of Gastroenterology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
S Afr Med J. 2024 May 31;114(6):e1748. doi: 10.7196/SAMJ.2024.v114i6.1748.
Non-alcoholic fatty liver disease (NAFLD) in South Africa and Africa at large is considered a hidden threat. Our local population is burdened with increased metabolic risk factors for NAFLD. Our setting requires a reasonable approach to screen for and aid the diagnosis of NAFLD.
To investigate serum fructosamine and random spot urine fructose levels as biomarkers for the screening, diagnosis and monitoring of NAFLD. The primary objective of this study was to compare serum fructosamine and random spot urine fructose levels between groups with different levels of NAFLD severity as measured by ultrasound. A secondary objective was to determine the association, if any, between serum transaminases, the aspartate aminotransferase (AST) to platelet ratio index (APRI) score, serum fructosamine and urine fructose in different groups with steatosis.
Using a cross-sectional study design, 65 patients with three different levels of NAFLD, as detected by imaging, were enrolled. The primary exposures measured were serum fructosamine with random spot urine fructose, and secondary exposures were the serum transaminases (AST and alanine aminotransferase (ALT)) and the APRI score. Patients identified at the departments of gastroenterology, general internal medicine and diagnostic radiology were invited to participate.
There were 38, 17 and 10 patients with mild, moderate and severe steatosis, respectively. There was no significant difference between the groups regarding serum fructosamine, measured as median (interquartile range): mild 257 (241 - 286) μmol/L, moderate 239 (230 - 280) μmol/L and severe 260 (221 - 341) μmol/L, p=0.5; or random spot urine fructose: mild 0.86 (0.51 - 1.30) mmol/L, moderate 0.84 (0.51 - 2.62) mmol/L and severe 0.71 (0.58 - 1.09) mmol/L, p = 0.8. ALT (U/L) differed between groups: mild 19 (12 - 27), moderate 27 (22 - 33), severe 27 (21 - 56), p=0.03, but not AST (U/L) (p=0.7) nor APRI (p=0.9). Urine fructose and ALT were correlated in the moderate to severe steatosis group (R=0.490, p<0.05), but not in the mild steatosis group. Serum fructosamine was associated with age in the mild steatosis group but not the moderate-severe steatosis group (R=0.42, p<0.01).
Serum fructosamine and random spot urine fructose did not vary with the severity of NAFLD, indicating that they would not be useful biomarkers in this condition.
在南非和整个非洲，非酒精性脂肪性肝病（NAFLD）被认为是一种隐性威胁。我们当地的人群面临着与 NAFLD 相关的代谢风险因素的增加。我们的环境需要一种合理的方法来筛查和辅助诊断 NAFLD。
探讨血清果糖胺和随机尿果糖水平作为筛查、诊断和监测 NAFLD 的生物标志物。本研究的主要目的是比较不同超声检测到的 NAFLD 严重程度组之间的血清果糖胺和随机尿果糖水平。次要目的是确定血清转氨酶、天门冬氨酸氨基转移酶（AST）与血小板比值指数（APRI）评分、血清果糖胺和不同脂肪变性组中的尿液果糖之间是否存在关联。
采用横断面研究设计，纳入了 65 例经影像学检查诊断为不同程度 NAFLD 的患者。主要暴露因素为血清果糖胺和随机尿果糖，次要暴露因素为血清转氨酶（AST 和丙氨酸氨基转移酶（ALT））和 APRI 评分。邀请在胃肠病学、普通内科和诊断放射学等科室就诊的患者参与。
轻度、中度和重度脂肪变性患者分别为 38、17 和 10 例。各组间血清果糖胺的中位数（四分位距）差异无统计学意义：轻度 257（241-286）μmol/L，中度 239（230-280）μmol/L，重度 260（221-341）μmol/L，p=0.5；或随机尿果糖：轻度 0.86（0.51-1.30）mmol/L，中度 0.84（0.51-2.62）mmol/L，重度 0.71（0.58-1.09）mmol/L，p=0.8。ALT（U/L）在各组间存在差异：轻度 19（12-27），中度 27（22-33），重度 27（21-56），p=0.03，但 AST（U/L）（p=0.7）和 APRI（p=0.9）差异无统计学意义。中重度脂肪变性组中尿果糖和 ALT 呈正相关（R=0.490，p<0.05），但在轻度脂肪变性组中无相关性。在轻度脂肪变性组中，血清果糖胺与年龄相关，但在中重度脂肪变性组中不相关（R=0.42，p<0.01）。
血清果糖胺和随机尿果糖水平与 NAFLD 的严重程度无关，表明它们在这种情况下不是有用的生物标志物。
