title: Alkaline phosphatase: can it be considered as an indicator of liver fibrosis in non-alcoholic steatohepatitis with type 2 diabetes?
abstract: OBJECTIVE
  While isolated hepatosteatosis is a benign disease, in minority of cases non-alcoholic steatohepatitis (NASH) may even lead to cirrhosis in long-term. In order to find the stage of the disease and determine the prognosis, a liver biopsy is indicated. In this study, we studied the relationship of liver histopathological findings with serum levels of hepatic enzymes.
  
  
  METHODS
  We recruited 52 cases of NASH with Type 2 diabetes mellitus. Diagnosis of NASH was made based on biochemical tests, ultrasound images and liver biopsy.
  
  
  RESULTS
  Steatosis was mild in 57.7%, moderate in 30.8%, and severe in 11.6% of patients. While no infiltration was found in 78.8% of cases, there was a grade-1 infiltration in 15.4% and a grade-2 infiltration in 5.8% of cases. Similarly, no fibrosis was found in 42.3% of patients, but there was a stage-1 fibrosis in 50%, and a stage-2 fibrosis in 7.7% of cases. In patients with severe steatosis, serum levels of AST were higher than mild or moderate stage steatosis. Accordingly, in patients with no inflammation, serum levels of ALT were higher than in patients with inflammation. However, in patients with fibrosis, triglycerides levels were significantly lower and ALP was significantly higher than in patients without fibrosis. The correlation analysis indicated a positive association between serum levels of ALP and C-peptide.
  
  
  CONCLUSIONS
  In addition to conventional risk factors such as age, presence of diabetes, female sex; higher levels of ALP may be considered as a risk factor linked to hepatic fibrosis in patients with NASH and type 2 diabetes (Tab. 6, Ref. 8).
authors.affiliation: Department of Endocrinology, Faculty of lstanbul Medicine, Istanbul University, Istanbul, Turkey. gonenckocabay@yahoo.com
authors.forename: G
authors.initials: G
authors.lastname: Kocabay
authors.forename: A
authors.initials: A
authors.lastname: Telci
authors.forename: Y
authors.initials: Y
authors.lastname: Tutuncu
authors.forename: B
authors.initials: B
authors.lastname: Tiryaki
authors.forename: S
authors.initials: S
authors.lastname: Ozel
authors.forename: U
authors.initials: U
authors.lastname: Cevikbas
authors.forename: A
authors.initials: A
authors.lastname: Okten
authors.forename: I
authors.initials: I
authors.lastname: Satman
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001707:Biopsy, Needle; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005234:Fatty Liver / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase