Real Time Elastography is an Easy Tool for Diagnosis of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged a major challenge and become the leading indication for liver transplantation. We aimed to assess the applicability and performance of real-time elastography (RTE) in diagnosis of liver fibrosis in patients with NAFLD compared with NAFLD fibrosis score (NFS) and FIB-4 index. Patients and Methods: A prospective case-control study was conducted on 260 subjects attended Hepatology, Gastroenterology and Infectious diseases and Internal Medicine departments in Benha University Hospital from Marsh 20, 2018, to September 1, 2019 and divided into group I included 200 cases with NAFLD and group II included 60 healthy control subjects. Results: There was statistically significant increase in FIB-4 scores between two groups (1.39 ± 1.02 and -0.75 ± 0.32 respectively with p < 0.001), also there was statistically significant increase in NAFLD fibrosis score mean ± SD between two groups (-1.74 ± 1.17 and -2.75 ± 0.91 respectively with p < 0.001). Fibrosis stages in NAFLD patients significantly higher than in control group diagnosed by RTE (P = 0.001). There was an agreement between RTE and FIB-4 index (93%) and NAFLD fibrosis score (86%). Diagnostic performance of RTE in advanced liver fibrosis ≥ F3 was assessed in comparing with FIB-4 index show sensitivity 90%, specificity 93.3%, PPV 60%, NPV 98.8% and accuracy 93% with AUC0.917 (p = 0.001) and in comparing with NAFLD fibrosis score sensitivity 52.6%, specificity 93.8%, PPV 66.7%, NPV 98.4% and accuracy 86% with AUC 0.732 (p = 0.002). Conclusion: Real time elastography could be valuable in diagnosis of fibrosis in NAFLD especially in cases more than F3 score.

Assessment of Liver Fatty Acid Binding Protein (L-FABP) as a Diagnostic Marker in Non-Alcoholic Fatty Liver Disease

Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common liver disease worldwide, it causes chronic hepatitis, which leads to cirrhosis and hepatocellular carcinoma. We aimed to assess the value of liver fatty acid binding protein (L-FABP) in the diagnosis of non-alcoholic fatty liver disease in comparison to ultrasonography. Patients and Methods: Ninty subjects were enrolled in this study who attended the Hepatology, Gastroenterology and Internal medicine clinics in Benha University Hospitals between January 2017 and January 2018 and divided into group I included 70 consecutive patients with non-alcoholic fatty liver disease who were diagnosed by ultrasound with or without elevated liver enzymes and group II included 20 healthy control subjects without NAFLD (by ultrasound) with normal liver enzymes. Serum levels of L-FABP were determined by enzyme-linked immunosorbent assay. Results: NAFLD patients were slightly older than healthy subjects as mean age in group I was (37.74 ± 11.7) while in group II was (36.5 ± 11.31). There was a slight increase in NAFLD in males, there was a high prevalence of NAFLD in the urban population. L-FABP levels in NAFLD patients were higher than in the control group (levels were 188.6 ± 34.94 and 137.7 ± 13.05 ng/l respectively). A strong correlation was found between L-FABP and ALT, AST, BMI and glucose levels. Analysis of ROC curve revealed that at a level 151.1 ng/sensitivity, specificity, PPV, NPV and accuracy were 83.3%, 71.8%, 31.3%, 96.6% and 73.3% respectively with AUC 0.839 and at a level 189.5 ng/sensitivity, specificity, PPV, NPV and accuracy were 90%, 90%, 95.4%, 95.4%, 88.9% with AUC was 0.950. Conclusion: Serum L-FABP could be used as a new diagnostic biomarker for detecting NAFLD.