الفهرس 
NON ALCOHOLIC FATTY LIVER DISEASEOnly 14 pages are availabe for public view
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Abstract
N
onalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, ranging from simple steatosis and nonalcoholic steatohepatitis (NASH) to liver cirrhosis, with its complications including hepatocellular carcinoma (HCC). The majority of subjects with NAFLD are clinically asymptomatic during the pre-cirrhotic stage. As the disease progresses, clinical features of liver decompensation can develop.
The diagnosis of NAFLD requires evidence of hepatic steatosis; in the absence of other causes of liver fat accumulation. Liver Biopsy remains the most diagnostic and golden method for diagnosing NAFLD. But is invasive and expensive and cannot be used for screening suspected patients. Imaging techniques to diagnose NAFLD include Ultrasonography, which is recommended as the first-line diagnostic method in assessing steatosis and MRI. But these are costly, time-consuming, and device dependent, this makes it difficult to achieve widespread application.
Many noninvasive and chemical parameters are used in combination to diagnose NAFLD and the extent of fibrosis in the form of mathematical algorithms or scores. The most reliable scores are Fib-4, Apri, NAFLD fibrosis score and Bard score. However, these scores have limited ability to detect early stages and they carry a high false positive rate in advanced fibrosis.
According to the previous limitations there is a need for detecting a new non-invasive dependable biomarker for diagnosing severity of NAFLD.
Liver fibrosis and cirrhosis result from deposition of extracellular matrix. The main structural role in the formation of extracellular matrix is Hyaluronic Acid. That means that the level of HA increases with the severity of liver damage and this is why it has been chosen to study as a reliable noninvasive biomarker for NAFLD diagnosis.
The study was conducted on 63 subjects from the Gastroenterology and Hepatology Department of Ain Shams University Hospital.
They were divided into three different groups as following: a healthy control group, fatty liver and nonalcoholic steatohepatitis (NASH). All patients and controls were subjected to routine laboratory tests and serum Hyaluronic acid test.
The results of our study showed that:
Comparison between groups regarding BMI showed that there was high statistical significant difference in their BMI.
Comparison between groups regarding to liver enzymes showed that there was high statistical significant difference between groups as regard AST and ALT were p<0.001 and regard to Bilirubin were p=0.014. But there was no statistical significant difference between groups as regard Albumin.
Comparison between groups regarding to RBS showed that there was high statistical significant difference between groups as regard RBS were p=0.001.
Comparison between groups regarding to lipid profile showed that there was high statistical significant difference between groups as regard LDH were p<0.001. But there was no statistical significant difference between groups as regard Cholesterol.
Comparison between groups regarding to H.A showed that there was high statistical significant difference between groups as regard H.A were p<0.001.
Comparison between groups regarding to APRI and Fib4 showed that there was high statistical significant difference between groups as regard APRI and Fib4 were p<0.001.
The study showed that there is positive non-significant correlation between either APRI or Fib4 and H.A in fatty liver, and there is also non-significant correlation either APRI or Fib4 and H.A in NASH.
CONCLUSION
H
yaluronic Acid can be reliably used as an accurate and specific noninvasive biomarker for the diagnosis of Nonalcoholic fatty Liver Disease and staging of the severity of disease compared with the traditional known noninvasive scores.