الفهرس 
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Abstract
Diabetes mellitus represents one of the most important health problems worldwide. The global prevalence of T2DM has reached epidemic proportions over the past few years due to global rise in the prevalence of obesity and unhealthy lifestyle. Increased morbidity and mortality in patients with Type II diabetes (T2DM) is associated with large prevalence of atherosclerosis and cardiovascular diseases, chronic kidney disease and cancer, but also to a wide spectrum of chronic hepatic diseases ultimately able to lead to hepatic cirrhosis and hepatocellular carcinoma (HCC). MAFLD, previously termed as nonalcoholic fatty liver disease (NAFLD), is now identified as the most common cause of chronic liver disease in the world, affecting more than 30% of the global population. Due to the similarity in pathogenesis, MAFLD is often associated with other lifestylerelated disorders such as hypertension, dyslipidemia and most importantly T2DM. When MAFLD/NAFLD only involves liver steatosis without significant damage to the hepatocytes, nonalcoholic steatohepatitis (NASH) involves inflammation of liver cells with varying degrees of hepatocyte destruction, which may lead on the cirrhosis and end stage liver failure. Our cross sectional study aimed to assess the potential role of collagen type IV 7S and ultrasound elastography as non-invasive methods for assessment of liver fibrosis in type II diabetes mellitus patients with metabolic associated fatty liver disease. We included 200 patients suspected to have metabolic fatty liver disease according to criteria of diagnosis, selected from out-patient clinic and in patient wards of Internal Medicine Department at Tanta University Hospitals. The study protocol was approved by the institutional ethics committee and informed consents were obtained from the patients. The patients were divided into 2 groups: • group 1: 100 patients with metabolic fatty liver disease and type two diabetes mellitus. • group 2: 100 patients with metabolic fatty liver disease without diabetes mellitus. Inclusion criteria: • All patients will have metabolic fatty liver disease. • Half of the patients have type two diabetes mellitus associated with metabolic fatty liver disease. Exclusion criteria: • Patients with liver cirrhosis • Patients with viral hepatitis. • Autoimmune liver disease. • Metabolic liver diseases. • Type one diabetes mellitus patients. All patients in this study were subjected to: • History taking. • Complete clinical examination including: - Waist circumference. - Body mass index (BMI). • Laboratory investigations including: - Complete blood count. - Liver enzymes (ALT and AST) - Serum urea and creatinine. - Fasting and post prandial blood glucose level - Lipid profile. - Serum albumin. - C-reactive protein (CRP) - HOMA-IR. • Specific measurements including - Pelvi-abdominal ultrasound. - Hepatic Steatosis Index (HSI). - NAFLD Fibrosis Score (NFS). - Fib-4 index. - Type IV collagen 7S measurement. - CA fibrosis index. - Fibroscan. The main findings can be summarized as the following: - Type IV collagen 7S and CA fibrosis index measurements might be the best non-invasive tests to predict fibrosis of MAFLD either in MAFLD with or without T2DM and it would be a useful tool in routine clinical practice. The diagnostic accuracy of conventional NITs, such as the Hepatic Steatosis Index, NAFLD Fibrosis Score and Fib-4 index is inferior to that of Type IV Collagen 7S and CA fibrosis index in detection of fibrosis in MAFLD patients either diabetic or not. - Moreover, our study shows a highly significant positive correlation between hepatic fibrosis detected by transient elastography, Type IV collagen 7S and CA fibrosis index measurements and could thus be used to reduce the burden of liver biopsies. - Although TE is a simple, non-invasive, inexpensive, painless and operator/machine-independent method and displays good application prospects, it has restricted value in obese patients and patients with ascites and false positive values in patients with acute hepatitis, cholestasis and heart failure.