The Relation Between Elevated Liver Enzymes and Nonalcoholic Fatty Liver Disease

الملخص

Non alcoholic fatty liver disease has a broad spectrum ranging from pure steatosis to steatohepatitis and it is a
common condition which is a fast assuming importance as a possible precursor of serious liver disorders including
cirrhosis and hepatocelluler carcinoma.
The present study was aimed to assess the role of elevated aminotranseferase levels as a prerequisite to suspect
nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease.
Thirty patients with ultrasonographic finding of fatty liver were enrolled in this study which was started in June
2007‚ all patients were negative for HBsAg‚ anti HCV‚ HIV.
By liver biopsy mild steatosis and mild ballooning of hepatocytes was diagnosed in 33.4%‚ moderate in 30%‚
and sever in 36.6%, acute lobular inflammation was present in 26.6%‚ chronic in 73.4%. Seventeen patients had
pericellular fibrosis‚ focal in 66.7% and extensive in 33.3%. Periportal fibrosis was present in 56.6%‚ focal in 50%
and extensive in 6.6%. No evidence of bridging fibrosis and no cirrhosis.
The mean Aspartate amino transferase (AST) was 27.8%, only eight patients (5 females and 3 males) had high
AST (26.6%) and twenty-two patients had normal AST (73.4%). The mean Alanine aminotransferase (ALT) was
42.5%‚ nine patients (4 females and 5males) had high ALT (30%) and twenty-one patients had normal ALT (70%).
The mean AST/ALT ratio was 0.65‚ twenty patients (66.6%) with AST/ALT ratio < 1and ten patients (33.4%) with
AST/ALT ratio ≥ 1.
Conclusion: Non Alcoholic steatohepatitis can be associated with normal ALT or AST and a liver biopsy is the
golden standard method in diagnosis. However, liver biopsy is not being justified if the patient has normal enzymes.