Abstract. – INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) has become the most common hepatic disease. Liver biopsy is the gold standard for the diagnosis of NAFLD. To overcome the problems with liver biopsy many studies are being performed to find noninvasive methods for the evaluation of hepatic status. AIM: This study aims to study to role of high sensitive CRP and pentraxine 3 in the setting of NAFLD PATIENTS AND METHODS: thirty two NAFLD cases and 34 controls were enrolled. All subjects were studied clinically and blood was drawn for para-clinical studies. Liver biopsy was per- formed for all cases. Levels of hs-CRP and pen- traxine were analyzed to find any significant dif- ference for the stages of steatosis and fibrosis based on pathologic findings. RESULTS: Hs-CRP level was higher in nonal- coholic steatohepatitis (NASH) cases versus non-NASH cases. Its level was also increased in higher levels of fibrosis. Pentraxine 3 had no ef- ficacy in differentiating different levels of NAFLD and fibrosis. CONCLUSIONS: Hs-CRP can be used in com- bination with other biomarkers in the noninva- sive evaluation of NAFLD. Key Words: Non-alcoholic Fatty Liver Disease, Biological Mark- ers, C-reactive protein, Pentraxine. Introduction Nonalcoholic fatty liver disease (NAFLD) is defined as a spectrum of chronic pathological changes in liver, ranging from pure asympto- matic hepatic steatosis to a potentially progres- sive nonalcoholic steatohepatitis (NASH), fibro- sis and, finally, cirrhosis which can lead to hepa- tocellular carcinoma (HCC) 1,2 . Prevalence of European Reviewfor Medical and Pharmacological Sciences High sensitive CRP and pentraxine 3 as noninvasive biomarkers of nonalcoholic fatty liver disease I. MALEKI 1 , A. RASTGAR 2 , V. HOSSEINI 3 , T. TAGHVAEI 3 , A. RAFIEI 4 , M. BARZIN 5 , Z. TORABIZADEH 6 , F. NAGHSHVAR 6 , A. KHALILIAN 7 1 Inflammatory Diseases of Upper Gastrointestinal Tract Research Center, 2 School of Medicine, 3 Inflammatory Diseases of Upper Gastrointestinal Tract Research Center, 4 Molecular and Cell Biology Research Center, 5 Department of Radiology, 6 Department of Pathology, 7 Department of Statistics; Mazandaran University of Medical Sciences, Sari, Iran Corresponding Author: Zhila Torabizadeh, MD; e-mail: zhtorabi@yahoo.com 1583 NAFLD is reported as 25-30% of general popu- lation in western countries, ranked first among chronic liver diseases worldwide 3-5 . This preva- lence is nearly 10% in general population of Asia 6 . NAFLD is more common in patients with metabolic syndrome 7,8 . This figure reaches up to 57.5-74% in obese population 9 . Nineteen percent of obese people are diagnosed with steatohepati- tis 9 . Diagnosis and management of these patients has a huge financial burden on health authorities worldwideandinIran 10 . Determining stage of NAFLD is essential for identifying prognosis and treatment decisions. Distinguishing pure steatosis from steatohepatitis is an important issue, as pure steatosis has benign prognosis while steatohepatitis can potentially lead to liver fibrosis 2,11,12 . Lipid accumulation in hepatocytescanleadtoinflammationwithinthem. Accordingly, significant fibrosis can cause cirrho- sis over a period of 10-20 years 13 , but the patho- physiology is not well understood yet 14 . 2-3% of NAFLDcasescanprogresstoNASH 15 .In25%of cases, NASH can progress to cirrhosis and its’ac- companied related complications. So, early diag- nosis of NAFLD is of great value. Currently, per- cutaneous liver biopsy remains the gold standard in evaluating liver histology and diagnosis of NAFLD. However, there are some limitations re- garding performing biopsy such as being invasive, expensive, carrying sampling errors 16,17 (only 1/50,000 of the whole liver is examined via biop- sy) 13 , having inter and intra-observer disparities of 10 to 20% is reported in assessing samples caus- ing either under or over estimation of the prob- lem 13,18 , needing hospitalization as well as liver biopsy associated risks like pain, hypotension, in- tra-peritoneal bleeding and damage to biliary sys- tem 14 . So, it can’t be considered as a suitable 2014;18:1583-1590