Abstract: Objective To explore the clinical significance of keratin fragments CK-18 (M30), and insulin resistance index (HOMA-insulin resistance, HOMA-IR) detection in the non-alcoholic fatty liver disease（NAFLD） CT grading diagnosis. Methods 71 cases of non-alcoholic fatty liver disease detected by CT were divided into, mild group (24 cases), moderate group (22 cases) and severe group (25 cases). The CK-18 (M30), fasting blood glucose and insulin in NAFLD and 66 normal controls were measured by using ELISA, glucose oxidase, and chemiluminescence assay respectively. Results The concentrations of CK-18 (M30) in mild, moderate, severe NAFLD group and normal controls were 138.55 ± 40.48 ng/L, 209.87 ± 58.62 ng/L, 261.72 ± 71.39 ng/L, and 97.63 ± 23.28 ng/L respectively. The HOMA-IR in mild, moderate, severe NAFLD group and normal controls were 2.18 ± 0.94 ng/L, 3.54 ± 1.19 ng/L, 4.60 ± 1.57 ng/L, and 1.63 ± 0.81 ng/L respectively. The values of CK-18 (M30) and insulin resistance index were highly correlated with CT grading of non-alcoholic fatty liver disease activity. Conclusion The CK-18 (M30) and insulin resistance index could be used as index in evaluation of nonalcoholic liver disease progression.