الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
NAFLD is today considered to be the most common liver disease in adults. The prevalence of NAFLD in general population is very high, in the range of 15%-30% according to various studies, and is even increasing, due to the rising prevalence of diabetes and obesity, (NAFLD) is currently conceptualized as a clinical spectrum that results from a ’multiple-hit’ process which begins with simple steatosis and subsequently renders the hepatocytes susceptible to a variety of insults. Ultimately, more serious liver injuries like nonalcoholic steatohepatitis (NASH) and cirrhosis may develop.
NASH could be present in one third of NAFLD cases and appears to have a higher likelihood of progression to cirrhosis.
Furthermore, an increased risk of hepatocellular carcinoma and endstage liver disease has been reported among patients with NASH Differentiation of simple steatosis from NASH requires histopathologic evaluation. In this regard, liver biopsy remains the most sensitive and specific means of providing important diagnostic and prognostic information. Nonetheless, given that liver biopsy is an invasive procedure, with occasional complications and poor patient acceptance, the search for surrogate markers to replace liver biopsy is highly recommended.
Apoptosis of epithelial hepatocytes plays a pivotal role in acute as well as in chronic liver diseases. The cleavage of cytokeratin- 18 (CK-18) by caspases is an early event in the apoptotic process.
Therefore this study investigated serum levels of CK-18 fragments in non alcoholic fatty liver diseases (NAFLD), chronic hepatitis, acute hepatitis and in healthy volunteers to predict its role as a marker of hepatitis, Enzyme-linked immunosorbent assay (ELISA) was utilized to measure the concentration of M30, a fragment of CK-18 cleaved at Asp396 (M30 neoantigen).
This prospective study was conducted on 79 patients; they were divided into 5 groups:
Group 1: Includes 11 apparently healthy volunteers 6 males and 5 females with age ranged between 21- 55 years with no history of liver diseases with well matched age and sex.
Group 2: Includes 28 patients with Non alcoholic fatty liver disease(NAFLD) with normal aminotransferases, they were 13
males and 15 females with age ranged between 37 -74 years. The diagnosis of NAFLD was based on absence of HBV or HCV infection, absence of alcoholic consumption BMI more than 30 kg/m2 and hepatomegaly with bright liver at ultrasound.
Group 3: Includes 13 patients with fatty liver with elevated aminotransferases aminotransferase, they were 5 males and 6 females with age ranged between 41 -67 years.
Group 4: Which includes 16 patients with chronic hepatitis C diagnosed more than six months ago with typical clinical and laboratory finding including liver function testes ELISA for hepatitis C antibodies and PCR, Abdominal U/S and histopathological examination of liver biopsy, they were 12 males and 4 females with age ranged between 40 -
63 years.Recommendation Group 5: Which includes 13 patients with acute hepatitis A; they were 10 males and 3 females with age ranged between 14-
32 years. Their diagnosis based on typical clinical and laboratory finding including liver function testes and anti-
HAV of the IgM Class. The diagnostic criteria for acute hepatitis was at least a 5-fold elevation of serum alanine aminotransferase (ALT) level without a history of previous liver disease and <6 months of disease duration.
All Patients and control group were subjected to the following:
Complete history taking, thorough clinical examination, body mass index measurements, abdominal ultrasonography, BARD score:
to evaluate the degree of fibrosis in NAFLD patients, Liver biopsy examination for HCV patients, Complete blood count, Fasting and postprandial blood sugar, Liver function tests, Lipid profile, ELISA for hepatitis C antibodies, HBs Ag, HAV IgM Abs, PCR and ELISA for Serum level of Cytokeratin 18.