الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Nonalcoholic fatty liver disease (NAFLD) has a prevalence of 25% worldwide and is described as the leading cause of chronic liver disease. Liver disease was found to be the third leading cause of death among persons with NAFLD. Its prevalence is increasing in conjunction with metabolic syndrome due to engaged risk factors, which include high body mass index and abdominal obesity, type 2 diabetes, dyslipidemia (high triglycerides and/or low high-density-lipoproteins), age, male sex, and alcohol consumption.
Although ultrasound and magnetic resonance are helpful for the diagnosis of NAFLD, liver biopsy is still the gold standard. New insights and diagnostic improvements in NAFLD such as transient elastography and FibroScan are exciting alternatives. However, we targeted focusing on noninvasive, cheap, and useful biomarkers in clinical practice. In this way, the role of circulating biomarkers related to endothelial dysfunction and the severity of underlying liver disease need to be investigated.
Endocan is a proteoglycan with increased expression in endothelial cells during even the first stage of atherosclerosis, which makes this biomarker a convenient parameter of atherosclerosis risk. Not only that it is secreted by endothelial cells, but endocan also stimulates these cells to secrete other inflammation markers (i.e. cytokines), contributes to leukocytes migration, and has an impact on permeability of blood vessels, all of which further aggravate inflammation and increase cardiovascular disease (CVD) risk burden.
This study was conducted at Ain Shams University hospitals to evaluate the role of serum endocan as a diagnostic biomarker for NAFLD. We included a total of 100 subjects who were divided into two equal groups; group 1 included 50 patients with NAFLD, and group 2 included 50 healthy controls.
All subjects were subjected to complete history taking, thorough physical examination and routine anthropometric measurements. Additionally, laboratory investigations were ordered for all participants including CBC, liver function tests, kidney function tests, blood sugar, HbA1c, ferritin, lipid profile along with serum endocan level. Pelviabdominal US was ordered for all subjects, and NAFLD index, FIB-4 and APRI scores were calculated for all of them.
Our study showed the following findings:
• Age and gender distribution showed no significant difference between cases and controls.
• Both BMI and waist circumference showed a significant increase in cases compared to controls.
• There was no statistically significant difference in the prevalence of smoking and hypertension between the cases of the two study groups.
• The prevalence of DM in the NAFLD group was 36% which was statistically significantly higher as compared with the control group.
• The mean SBP was statistically significantly higher in the NAFLD group, while DBP showed comparable findings.
• the mean liver size as detected by US was statistically significantly higher in the NAFLD group as compared with the control group, while spleen size didn’t reveal a statistically significant difference between the two groups.
• The mean fasting blood glucose, mean HbA1C, mean post-prandial glucose, mean cholesterol level, mean TGs, mean LDL, mean ALT and mean AST, mean ALP, mean GGT and mean ferritin level were statistically significantly higher in the NAFLD group as compared with the control group.
• The mean HDL level was statistically significantly lower in the NAFLD group as compared with the control group.
• Other laboratory variables were comparable between the two groups.
• The mean serum endocan level was statistically significantly higher in the NAFLD group as compared with the control group (54.58 ± 18.61 and 30.69 ± 6.49 respectively).
• Each of APRI, FIB-4 and NAFLD scores showed significant difference between the two groups.
• There was a statistically significant positive correlation between endocan level with BMI, waist circumference, SBP, HbA1C, fasting glucose, PP glucose, TGs level, ALT, AST, ALP, GGT, ferritin, liver size, APRI score, and FIB-4 score. Other variables didn’t show a statistically significant correlation with endocan level.
The best cut off point of endocan level to identify cases with NAFLD was > 33.2 with 84% sensitivity, 62% specificity, 78% PPV, 86% NPV and accuracy of 76%.
Conclusion and recommendations
Based on the previous findings, one can conclude that:
• Serum endocan may act as a surrogate marker for the diagnosis of NAFLD as it was significantly elevated in cases compared to controls. As well as detection of disease severity as it has a positive correlation with APRI, FIB-4 score yet still further studies on larger scales are required
• This confirms the state of endothelial dysfunction associated with this disease
• NAFLD is associated with impaired lipid profile, impaired liver functions, and higher incidence of diabetes compared to controls.