title: Combination of Aspartate Aminotranferase and Tumor Necrosis Factor-α as Non Invasive Diagnostic Tools for Non Alcoholic Steatohepatitis (NASH).
abstract: OBJECTIVE
  to develop a non-invasive diagnostic test for non-alcoholic steatohepatitis NASH.
  
  
  METHODS
  this is a cross-sectional study on non-alcoholic fatty liver disease (NAFLD) subjects. Sample was taken by consecutive sampling method. Diagnostic criteria of NAFLD were confirmed by liver biopsy. Clinical variables include metabolic syndrome, aspartate aminotransferase (AST), alanine aminotransferase (ALT), adiponectine, TNF-, insulin, homeostatic model assessment insulin resistance (HOMA-IR) index and liver biopsy. Patients were divided into two groups based on their liver biopsy, group 1: Non-NASH (NAFLD activity score <3) and group 2: NASH (NAFLD activity score of >4). Statistical analyses were performed using Student's t-test, Mann Whitney U, chi-square, the ROC curve, sensitivity and specificity test.
  
  
  RESULTS
  fifty NAFLD patients were recruited, 30 males and 20 females. Among these patients, 12 (24%) had type 2 diabetes, 36 (72%) had metabolic syndrome, the remaining 2 (4%) did not fulfilled metabolic syndrome. Liver biopsy confirmed 21 (42%) non- NASH and 29 (58%) NASH respectively. Level of AST and ALT, plasma level of adiponectine and TNF- were statistically different between two groups. The AST level (>25 U/L) in combination with TNF- (>3.28 pg/cc) demonstrated a good diagnostic accuracy for NASH (Accuracy 82%, Sensitivity 76%, Specificity 90%, PPV 92%, and NPV 73%).
  
  
  CONCLUSIONS
  the combined diagnostic tests of AST and TNF- plasma levels demonstrated a good accuracy for the detection of NASH among NAFLD patients. This combination test can be used as a noninvasive method to diagnose NASH.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine Universitas Diponegoro - dr. Kariadi Hospital, Semarang, Indonesia.
authors.forename: Hery D
authors.initials: HD
authors.lastname: Purnomo
authors.forename: Farmaditya E P
authors.initials: FE
authors.lastname: Mundhofir
authors.lastname: Kasno
authors.forename: Eddy
authors.initials: E
authors.lastname: Sudijanto
authors.lastname: Darmono
authors.lastname: Daldiyono
authors.forename: R
authors.initials: R
authors.lastname: Djokomoeljanto
authors.forename: Sultana M H
authors.initials: SM
authors.lastname: Faradz
mesh_terms: D052242:Adiponectin / Q000097:blood; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D052242:Adiponectin; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase