الفهرس 
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition characterized by fatty infiltration of liver cells resembling that of alcohol-induced liver injury but occurring in patients who do not abuse alcohol.
The spectrum of NAFLD ranges from fatty liver alone to steatohepatitis, and may progress to end-stage liver disease. NAFLD is strongly associated with obesity, type 2 diabetes, and dyslipidemia.
Thus, NAFLD shares many features of the metabolic syndrome (MetS), a highly atherogenic condition, and its presence could signify a substantial cardiovascular risk above and beyond that conferred by individual risk factors.
The possible relationship between hepatic steatosis and carotid lesions might have important practical consequences, considering the frequent incidental finding of bright hepatomegaly in subjects undergoing abdominal ultrasound for any reason or hepatic steatosis by liver biopsy. In these subjects, an ultrasound assessment of carotid arteries might also be advisable.
This study was designed to assess the co-incidence and prevalence between NAFLD as a cardiovascular risk factor and carotid atherosclerosis. It was conducted in co-operation between Tropical Medicine Department, Ain Shams University and Tropical Medicine Department, EL-Sahel Teaching Hospital.
The current study included 72 patients who fulfilled the pre-designed inclusion criteria which were adult patients ≥ 20years and less than 50 years old with clinical, biochemical and ultra-sonographic criteria NAFLD.
All the studied cases were subjected to the following; full history taking, thorough clinical examination, laboratory investigations, complete blood picture. Liver profile tests including [ALT, AST, total and direct bilirubin, serum albumin, prothrombin time and international randomization ratio (INR)]. Hepatitis markers (HCV Abs and HBV sAg). Lipid profile (serum cholesterol, LDL, HDL, and serum triglyceride). Glucose profile (fasting blood sugar, 2 hours postprandial, HbA1c in diabetic patient). Abdominal ultrasound and carotid ultrasonagraphy were also done. As well as, Liver biopsy was done only in 26 cases.
There was male predominance being 53 (73.6%) male patients and 19 (26.4%) female patient. Their age ranged between 20 and 50 years.
The clinical presentations of NAFLD group with predisposing factors was Easy fatigability found in 46 (88.5%) patients and 13 (65.0%) in NAFLD alone, Abdominal distension in NAFLD group with predisposing factors was 48 (92.3%) patient and 14 (70.0%) patient in NAFLD alone, while tender hepatomegally in NAFLD group with predisposing factors was 28 (53.8%) patient, and 4 (20.0%) patient in NAFLD alone.
Concerning abdominal ultrasound findings bright liver in NAFLD with predisposing factors was 39 (75.0%) patient and 11(55.0%) patient in NAFLD alone. Hepatomegaly in NAFLD with predisposing factors was 36 (69.2%) patient and 6 (30.0%) patient in NAFLD alone. While gall bladder stone in NAFLD with predisposing factors was 12 (23.1%) patient and 2 (10.0%) patient in NAFLD alone. While there was bright liver in 9 (60.0%) obese patient and 8 (53.3%) hyperlipediemic cases and hepatomegaly in 9 (60.0%) of obese patient and 8 (53.3%) hyperlipediemic cases.
Carotid intimal thickness in NAFLD with predisposing factors was 0.72±0.14 mm and 0.63±0.18 mm in NAFLD alone. It was 0.72±0.10 mm in obese patient and 0.67±0.20 in hyperlipediemic cases.
In this series, histopathological examination of liver biopsy in some cases (26 patients) revealed that in cases with mild steatosis in NAFLD with predisposing factors and NAFLD alone, the CIMT was 0.59±0.9 mm and 0.53±0.13 mm, respectively. While, Cases with moderate steatosis in NAFLD with predisposing factors and NAFLD alone, the CIMT was 0.78±0.6 mm and 0.79±0.13 mm, respectively.
There was no significant correlation between NAFLD Obese patients and Hyperlipediemic patients as regards abdominal ultrasound and carotid douplex ultrasonography.
However, there was significant positive correlation between NAFLD and Carotid intimal thickness especially NAFLD with other predisposing factors, also between grades of hepatic steatosis and carotid intimal thickness.