الفهرس 
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Abstract
• Non‐alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. some patients with NAFLD progress to liver fibrosis, cirrhosis and hepatocellular carcinoma. Therefore, the precise diagnosis and staging of NAFLD patients is clinically important .
• tumor necrosis factor alpha is a cell signaling protein (cytokine) involved in systemic inflammation and is one of the cytokines that make up the acute phase reaction. It appears to play a central role in the development of hepatic steatosis. It is a proinflammatory cytokine that mediates hepatic inflammation, oxidative stress, and apoptosis or necrosis of liver cells .
• Neutrophil lymphocytic ratio (NLR) is used as a marker of sub clinical inflammation that can be easily obtained from the differential WBC count . It is an indicator of the overall inflammatory status of the body and a higher ratio may be found in NAFLD patients with more advanced diseases.
• In the present study, we assess the value of TNF-α and N/L ratio as a non-invasive biomarker for diagnosis of NAFLD and NASH.
All patients enrolled in the study fulfilled the mentioned inclusion criteria. They all were subjected to history taking and clinical examination upon admission.
An informed consent was taken from all patients before enrollment in the study. Privacy of the participants and confidently of the data is preserved . Any unexpected risk appeared during the course of the study were being cleared to the participants and ethical committee on time.
• This study showed that :
Patients with NASH had lower platelet count, higher INR, higher total bilirubin, higher serum AST, and higher serum ALT, lower serum albumin than normal controls and NAFLD patients. Likewise, patients with NAFLD had lower platelet count, higher INR, higher total bilirubin, higher serum AST, and higher serum ALT, lower serum albumin than normal controls.
Patients with NASH had higher serum FBS and serum cholesterol, higher NAFLD score than normal controls and NAFLD patients. Likewise, patients with NAFLD had higher serum FBS and serum cholesterol, higher NAFLD score than normal controls.
Patients with NASH had significantly higher values of TNF-α and N/L ratio.