HEPATIC HEMODYNAMICS AND SERUM MARKERS OF FIBROSIS IN NON-ALCOHOLIC FATTY LIVER DISEASE AND NON-ALCOHOLIC STEATOHEPATITIS

Mohamed A. Bedewi* and Sanaa M. Kamal

ABSTRACT

Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver disease all over the world. The current study assessed the ability of several panels to influence prognosis and diagnosis for non-invasive serum markers and Duplex Doppler ultrasound in monitoring NAFLD and non-alcoholic steatohepatitis (NASH).Our study enrolled patients at different stages of NAFLD and NASH. NAFLD liver fat score (NAFLD-LFS)”, “Fatty Liver Index (FLI)” “Hepatic Steatosis Index (HSI), the risk score ox NASH, NASHT est, Tumor necrosis factor-alpha (TNF-a), tumor growth factor beta 1 (TGF beta) caspase-generated CK18 fragment levels (CK-18), and YKL-40 (YKL-40) were measured in patients and control subjects. Doppler indices were estimated for the following arteries were assessed: hepatic artery, superior mesenteric artery, and the splenic artery. Results: TNF alpha, CK-18, TGF-b and YKL-40 showed statistically significant higher results in patients with NAFLD compared to control subjects. CK-18, TGF-b and YKL-40 were highest among NASH patients with liver fibrosis. TGF-beta, CK-18, and YKL-40 had the highest sensitivity, specificity, PPV and NPV in predicting of liver disease. Adirect correlation was observed between each of TGF-beta, CK-18, and YKL-40 with the NAFLD fibrosis score (r = 0.87, r = 0.63, r=0.69 respectively). Significantly higher SMA RI, HA PSV and SA RI values was noted in NAFLD patients compared to control group ((P>0.001). No significant statistical difference was found between the mean PV velocity in NAFLD patients and the control group. Conclusion, TGF-beta, TNF-alpha and cytokeratin-8 can be reliable non-invasive markers for detection of NAFLD and monitoring of NASH. NAFLD correlated positively with the following parameters, liver span, portal vein diameter, SA RI and SMA RI, PSV of the HA, SMA, and SA.

Keywords: non-alcoholic fatty liver disease, ultrasound, Doppler.