RESUMO
In nonalcoholic fatty liver disease [NAFLD], the high cost of undertaking histological assessment of all persons with asymptomatic elevations of liver enzymes cannot be justified in view of the risks and limited clinical benefits. As the clinicians cannot distinguish steatosis and nonalcoholic Steatohepatitis [NASH], the purpose of this work was to study some of the clinical and laboratory parameters that could be useful as noninvasive predictors of NASH in NAFLD patients. The demographics, clinical, radiological, laboratory, and histopathological features of 40 NAFLD patients with persistently elevated ALT were evaluated. Significant rise of serum glucose, ALT, AST, cholesterol, LDL and TG with significant decrease of HDL was found in NASH versus steatosis patients, and in patients with grade II NASH versus those with grade I. The number of NASH patients was higher among studied diabetic than non-diabetic group and in obese than non obese group. Grade II NASH was found only in diabetic and in obese patients. In NASH patients, the relative risk of hypertriglyceridemia was 17, of obesity 7.13, of diabetes 1.47, but with hypercholesterolemia it was only 1.1. In obese patients particularly those with diabetes, presence of hepatomegaly, sonographically bright liver, persistent rise of transaminases and hypertriglyceridemia are sufficient to diagnose Steatohepatitis and might prove useful in guiding selection of patients for liver biopsy and in targeting therapy