الفهرس | Only 14 pages are availabe for public view |
Abstract on-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide, with a prevalence of 15%-30% in Western populations. Non-alcoholic fatty liver disease (NAFLD) has emerged as the most important cause of chronic liver disease related to the increase in incidence of obesity and diabetes mellitus type II in the population. The spectrum of NAFLD ranges from fatty liver alone to steatohepatitis, and may progress to end-stage liver disease. NAFLD is strongly associated with obesity, type II diabetes, and dyslipidaemia. Thus, NAFLD shares many features of the metabolic syndrome (MetS), a highly atherogenic condition, and its presence could signify a substantial cardiovascular risk above and beyond that conferred by individual risk factors. The possible relationship between hepatic steatosis and carotid lesions might have important practical consequences, considering the frequent incidental finding of bright hepatomegaly in subjects undergoing abdominal ultrasound for any reason or hepatic steatosis by liver biopsy. In these subjects, an ultrasound assessment of carotid arteries might also be advisable. This study was designed to assess the correlation between NAFLD as a cardiovascular risk factor and carotid atherosclerosis.It was conducted in in Internal Medicine and Hepatology inpatient and outpatient ward, Faculty of Medicine, Ain Shams University, in the period from Mar 2015 to Seb 2015. The current study included 60 patients who fulfilled the pre-designed inclusion criteria which were adult patients > 37years and less than 59 years old with clinical, biochemical and ultra-sonographic criteria NAFLD. All the studied cases were subjected to the following; full history taking, thorough clinical examination, laboratory investigations, complete blood picture. Liver profile tests including [ALT, AST, total and direct bilirubin, serum albumin, prothrombin time and international randomization ratio (INR)]. Hepatitis markers (HCV Abs and HBV sAg). Lipid profile (serum cholesterol, LDL, HDL, and serum triglyceride). Glucose profile (fasting blood sugar, HbAlc). Abdominal ultrasound, carotid ultrasonography were also done. Liver biopsywas done only for group 1 and 2. There was female predominance being 38 (63.33%) female patients and 22 (36.67%) male patient. Their age ranged between 37 and 59 years. Our study revealed a significant increase in carotid IMT in diabetic patients with NAFLD (0.695 ± 0.226mm) than non diabetic patients with fatty liver (0.655±0.216mm) after controlling of confounding factors, the differences between two groups of diabetics and non diabetics with fatty liver were not statistically significant (P value <0.792). CIMT in the healthy group was significantly and independently less than two other groups. This means that the patients with NAFLD may be at risk of early Atherosclerosis and independent to metabolic syndrome. We found a strong association between the increase of liver enzymes level and increase of carotid IMT in patients of NAFLD which was highly significant (P value <0.001). So it is important to consider not only degree of fatty infiltration in abdominal ultrasound but also at the laboratory level regarding liver enzymes. This study shows that the grade of NAFLD has a great effect on severity of atherosclerosis. In conclusion, our findings support the hypothesis that the presence of NAFLD is strongly associated with early carotid atherosclerosis. |