الفهرس 
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and it comprises a spectrum of hepatic abnormalities from simple hepatic steatosis to steatohepatitis, fibrosis, cirrhosis, and liver cancer.
Simple steatosis (i.e., NAFL) rarely progresses to advanced disease whereas, in approximately 20% of patients with NASH, it progresses to fibrosis and cirrhosis and potentially to hepatocellular carcinoma over a 15-year time period.
NAFLD is present in 30% of the general adult population and found predominantly in obese people with high-fat diets and inactive lifestyles.
The majority of patients with NAFLD have accompanying insulin resistance that plays a central role in the metabolic syndrome.
NAFLD is also deemed to be hepatic manifestation of metabolic syndrome. Recently, several non-invasive markers such as serum ferritin have emerged as possible predictors for the presence of NASH versus simple steatosis.
A variety of pathogenesis mechanisms have been defined for iron including production of reactive oxygen species, disturbed insulin signaling, and altered lipid metabolism in hepatic tissue and their resultant damage also increased serum ferritin has been found to be correlated with hepcidine level.
Since CRP did not correlate with serum ferritin in the general population CRP expression is increased in liver and in adipose tissue of obese patients. Adipose tissue contributes to the production of pro-inflammatory molecules, and the increase in their production participates in the metabolic syndrome.
The aim of this study is to study the relation between serum ferritin and CRP levels and severity of non-alcoholic fatty liver disease NAFLD and non alcoholic steatohepatitis NASH.
This case control study was conducted on patients attending the Hepatology Outpatient Clinic at Ain Shams University Hospital between December 2019 to May 2020.
The study subjects were divided into 2 groups:
Fourteen subjects who included in this study were divided as follows:
group A: (20) patients with nonalcoholic fatty liver disease NAFLD.
group B: (20) patients with nonalcoholic steato hepatitis NASH.
All of the study participants were subjected to detailed medical history full clinical and abdominal examination, laboratory investigations, radiological study as abdominal ultrasound and Calculation of the following for all the patients:
NAFLD fibrosis score = -1.675 + 0.037 × age (year) + 0.094 × BMI (kg/m2) + 1.13 × IFG/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio - 0.013 × platelet count (×109/L) - 0.66 × albumin (g/dL).
The results of this study showed:
In group A there is significant correlation between ferritin and age, ALT, AST, albumin, CRP, LDL, BMI, cholesterol, triglycerides and NAFLD fibrosis score.
But there is no significant correlation between ferritin and Hb, platelets, HDL and fasting blood sugar FBS in group A.
In group B there is significant correlation between ferritin and ALT.
Ferritin has cutoff point of >168 with 80% sensitivy & 80% specificity.
In group A there is significant correlation between CRP and age, BMI, ALT, AST, albumin, LDL, cholesterole, triglycerides and NAFLD fibrosis score.
In group A there is no significant correlation between CRP and Hb, platelets, FBS and HDL.
While in group B there is significant correlation between CRP and BMI, ALT, albumin, LDL, cholesterol and triglycerides.
CRP cutoff point of >1.3 with specificity 90% but sensitivity 35%.