الفهرس 
NAFLD history and pathogenesisOnly 14 pages are availabe for public view
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Abstract
NAFLD is defined as an excessive accumulation of fat in the liver leads to chronic liver injury in which at least 5 % of hepatocytes display lipid droplets that exceed 5–10 % of liver weight in patients who do not consume significant amounts of alcohol.
It is a heterogeneous disease that may range from a relatively mild and subtle disease (hepatic steatosis) to a much more active and progressive disease, in which significant necro inflammatory fatty infiltration of hepatocytes are involved, designated nonalcoholic steatohepatitis (NASH).
The first step of the pathophysiology of NASH is the lipid accumulation in the liver causing steatosis. This increases the sensitivity of the liver to injury and inflammation. The second step involves cytokines which causing oxidative stress and lipid peroxidation, in time leading to steatohepatitis which eventually might develop cirrhosis and hepatocellular carcinoma.
Obesity, type 2 (non-insulin dependent) diabetes mellitus, and hyperlipidemia are coexisting conditions frequently associated with NAFLD. NASH progression is mediated by an inflammatory process in the liver with concomitant tissue damage and fibrosis. Interleukin 10 (IL-10, CSIF) is an anti-inflammatory cytokine mainly produced by macrophages and Th2 cells. IL-10 functions by inhibiting pro-inflammatory cytokines made by macrophages and regulatory T cells.
Summary
98
In obese patients, the progression of NAFLD to NASH has been recently proposed to associate with the occurrence of systemic inflammation. Obesity-related systemic inflammation is characterized by high circulating levels of inflammatory mediators such as tumor necrosis factor alpha (TNF-a), while also showing low levels of anti-inflammatory factors as is the case of interleukin (IL) 10.
The study is aimed to evaluate the relation between serum levels of IL-10 and NAFLD in Egyptian patients.
This study is A randomized case control cross sectional study, was carried out at Eldemrdash University Hospital, Internal medicine departments, on patients above 18 years old with Hepatic Steatosis Index (HSI) and NAFLD, duration of study about 6 months.
The main results of the study revealed that: Among group A, the mean of age was 28.0 (± 4.7 SD), there were 17 females and 23 males. Among group B, the mean of age was 42.2 (± 9.0 SD), there were 22 females and 18 males. There was high statistically significant difference between studied cases as regard age. Among group A, 0 (0%) had DM, 0 (0%) had Hypertension, 0 (0%) had Metastasis. Among group B, 12 (30%) had DM, 9 (22.5%) had Hypertension, 24 (60%) had Metastasis. There was high statistically significant difference between studied cases as regard DM and Metastasis. There was statistically significant difference between studied cases as regard Hypertension.
Summary
99
Among group A, the mean of height was 178.2 (±7.2 SD), the mean of Weight was 73.1(± 9.8 SD), the mean of BMI was 23.1(±1.9 SD), the mean of Waist circumference was 98.3 (±5.3 SD). Among group B, the mean of height was 172.6 (± 6.8 SD), the mean of Weight was 101.5 (± 14.1 SD), the mean of BMI was 33.4 (± 6.1 SD), the mean of Waist circumference was 113.0 (± 6.5 SD). There was high statistically significant difference between studied cases as regard Weight, BMI and Waist circumference. There was statistically significant difference between studied cases as regard height. Among group A, the mean of SBP was 110.0 (±7.8 SD), the mean of DBP was 72.5 (± 7.1 SD), the mean of MAP was 85.0 (± 6.3 SD). Among group B, the mean of SBP was 113.8 (± 16.0 SD), the mean of DBP was 73.5 (± 8.3 SD), the mean of MAP was 86.9 (± 9.2 SD). There was no statistically significant difference between studied cases. Among group A, the mean of FBS was 87.9 (± 12.8 SD), the mean of Fasting insulin was 17.7 (±21.1 SD), the mean of HbA1c was 4.7 (± 0.5 SD). Among group B, the mean of FBS was 94.8 (± 20.6 SD), the mean of Fasting insulin was 41.9 (± 11.9 SD), the mean of HbA1c was 5.4 (± 1.1 SD). There was high statistically significant difference between studied cases as regard Fasting insulin and HbA1c.
Summary
100
Among group A, the mean of Total cholesterol was 191.2 (± 9.6 SD), the mean of LDL was 115.3 (±12.9 SD), the mean of HDL was 50.4 (± 8.9 SD), the mean of TAG was 148.7 (± 9.3 SD). Among group B, the mean of Total cholesterol was 214.9 (± 17.5 SD), the mean of LDL was 134.7 (± 9.0 SD), the mean of HDL was 46.4 (± 6.2 SD), the mean of TAG was 177.9 (± 19.7 SD). There was high statistically significant difference between studied cases as regard Total cholesterol, LDL and TAG. among group A, the mean of ALT was 19.8 (± 4.5 SD), the mean of AST was 28.4 (± 4.2 SD), the mean of Total bilirubin was 0.9 (± 0.2 SD), the mean of Transferrin saturation was 30.5 (± 7.2 SD), the mean of Serum IgG was 1086.3 (± 253.2 SD), the mean of HSI was 29.0 (± 1.6 2 SD), the mean of LFS was 1.208 (±1.310 SD). Among group B, the mean of ALT was 51.5 (± 19.9 SD), the mean of AST was 40.9 (± 14.5 SD), the mean of Total bilirubin was 0.9 (± 0.2 SD), the mean of Transferrin saturation was 26.4 (± 5.6 SD), the mean of Serum IgG was 1091.3 (± 245.2 SD), the mean of HSI was 45.8 (± 4.3 SD), the mean of LFS was 5.248 (± 2.503 SD). There was high statistically significant difference between studied cases as regard ALT, AST, HSI and LFS. Among group A, the mean of Serum creatinine was 0.89 (± 0.20 SD), the mean of Platelets was 263.4 (± 61.5 SD). Among group B, the mean of Serum creatinine was 0.90 (± 0.20 SD), the mean of Platelets was 263.5 (± 61.5 SD). There was no statistically significant difference between studied cases. Among group A, there were 0 (0.0%) ANA and 0 (0.0%) ASMA. Among group B, there were 0 (0.0%) ANA and 0 (0.0%) ASMA. Among group A, the mean of IL-10 was 884.5 (± 340.3 SD).
Summary
101
Among group B, the mean of IL-10 was 182.3 (±68.8 SD). There was high statistically significant difference between studied cases as regard IL-10. Using ROC curve: the value of IL-10 can be used to discriminate between patients labelled as likely or unlikely to be suffering from NAFLD, AUC= 0.977 (p= <0.0001) with difference (AUC0 = 0.5) was 0.477, standard error was 0.019, Lower bound (95%) was 0.939, Upper bound (95%) was 1.000, Observed value was 24.640 and Critical value was 1.960. After adjustment for the confounding effect of age and sex, there was an independent association between IL-10 and NAFLD (adjusted odds ratio = 0.985, 95% CI = 0.972 to 0.998, P-value = 0.020).
Based on this results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion