الفهرس 
Fatty Liver DiseaseOnly 14 pages are availabe for public view
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Abstract
NAFLD is a chronic liver disease characterized by excessive accumulation of fat in the liver. It has a spectrum of disorders including simple steatosis, steatohepatitis, fibrosis, and cirrhosis (Ye et al., 2016).
NAFLD is the most common liver disorder in the Western industrialized countries (Basaranoglu et al., 2013). It is closely related to the increased frequency of overweight or obesity. It has recognised association with metabolic syndrome. Central obesity, diabetes mellitus, dyslipidemia are commonest risk factors (Karim et al., 2015).
Liver fibrosis is the final pathological result of various chronic liver diseases. (Zhou et al., 2014). Fibrosis is a main prognostic factor that determines the risk of development of liver cirrhosis and its related complications (Younossi et al., 2011).
Liver biopsy is considered to be the gold standard for diagnosis of NAFLD as well as differentiating simple fatty liver from non-alcoholic steatohepatitis (Karim et al., 2015).
Liver biopsy has a number of drawbacks such as invasiveness, sampling error, cost, and inter-/intra-observer variability (Kaswala et al., 2016). It requires sufficiently trained physicians and pathologists to obtain correct results (Rousselet et al., 2005).
The drawbacks of the liver biopsy led to the importance of developing new non-invasive techniques for the evaluation of liver fibrosis (Rousselet et al., 2005).
This study was conducted to assess the diagnostic value of fibrotest, transient elastography by fibroscan, NAFLD fibrosis score and FIB_4 score as non invasive biomarkers to detect and quantify liver fibrosis.
The present study was conducted on 60 patients with non alcoholic fatty liver disease who have either abnormal serum transaminases, or steatosis detected by ultrasonography, or have one or more of the features of the metabolic syndrome.
All subjects included in the study undergone percutaneous liver biopsy using a 16G biopsy needle. The fibrosis score was assessed according to the on a five-point Metavir staging scale as follows:
F0 = no fibrosis, F1 = portal fibrosis without septa, F2 = few septa, F3 = numerous septa without cirrhosis and F4 = cirrhosis.
Participants of the study were further categorized into patients with mild fibrosis who were having metavir stage f0-f1, and patients with moderate to severe fibrosis who were having f2-f4 metavir stages on liver biopsy.
As regards laboratory investigations, patients with moderate to severe fibrosis have statistically higher significant differences than patients with mild fibrosis as regards serum alanine aminotransferase, aspartate aminotransferase and total bilirubin levels.
As regards values of fibrotest, transient elastography, NAFLD fibrosis score and FIB_4 score, patients with moderate to severe fibrosis have statistically higher significant differences than patients with mild fibrosis.
The diagnostic accuracy of fibrotest at a cutoff value 0.44 in the detection of metavir stage f2 and higher was 96.3% with a sensitivity and specificity 89.4% and 95.1% respectively, while the diagnostic accuracy of transient elastography (fibroscan) at a cutoff value 7.3 kpa in the detection of metavir stage f2 and higher was 97.8% with a sensitivity and specificity 100% and 87.8% respectively.
The diagnostic accuracy of NAFLD fibrosis score at a cutoff value 0.46 in the detection of metavir stage f2 and higher was 94.7% with a sensitivity and specificity 89.4% and 90.2% respectively, while the diagnostic accuracy of FIB_4 score at a cutoff value 1.43 in the detection of metavir stage f2 and higher was 99.2% with a sensitivity and specificity 94.7% and 97.6% respectively.