الفهرس | Only 14 pages are availabe for public view |
Abstract Long-term complications of non-insulin-dependent diabetes, including retinopathy, nephropathy and neuropathy cause major morbidity and mortality. Many mechanisms have been ·suggested to explain the pathogenesis of diabetic microangiopathies. However, the pathogenesis of diabetic retinopathy is not known. Serum viscosity has been found to increased in diabetes especially with clinical evidence of microangiopathy. This increase in serum viscosity may be caused by many variables, most important is the change in serum protein composition especially globulin elevation. This elevation was dominated by increased levels of serum globulins belonging to the ”acute-phase reactant” group produced by the liver. Increased production of these proteins is so common following injury and in both acute and chonic medical disorders. The major proteins of hepatic origin involved in the acute phase reaction are alpha- I antitrypsin, alpha- I acidglycoprotein, ceruloplasmin, haptoglobin and C-reactive protein. Individual acute-phase protein levels have been found to be elevated in adult diabetes, but normal or nearly normal in childhood and adolescent diabetes .suggesting that their increase might be caused by developing microvascular disease rather than the early metabolic disorder in diabetes or may suggest that serum protein pattern become disturbed as the metabolic abnormality develop. The aim of this study was to : 1- Examine the degree of acute-phase proteins changes in established diabetes with and without microangiopathy. 2- The relation between acute-phase proteins changes and the degree of hyperglycemia, duration of diabetes mellitus, age of the patients and the presence of microangiopathy i.e. retinopathy & microalbuminuria. This work included 45 male subjects classified into 3 equal , groups. GI, non-insulin dependent diabetic patients with evidence of retinopathy, group II, non insulin dependent diabetic patients without evidence of retinopathy and group III, normal healthy non diabetic subjects as a control group. Exclusion criteria included clinical evidence of active inflammatory and infectious diseases. All subjects were submitted to the following: - History taking and general clinical examination. - The following laboratory investigations: Fasting and post prandial blood glucose levels, ESRIWBCS, urine analysis for microalbuminuria, serum albumin and globulin, acute-phase proteins (a-1 antitrypin, a-1 acidglycoprotein, ceruloplasmin. C reactive protein and haptoglobin), and serum viscosity. - Ophthalmoscopic examination was done for the evidence of retinopathy. The results were summarized as the following: The three groups were matched for age, ESR,1WBCS, also both diabetic group were comparable as regards, FBG and PBG levels. - Serum albumin levels were significantly lower while serum globulin levels were significantly higher in both diabetic groups than in control group. These changes were more evidenced in diabetic patients with evidence of retinopathy. - Microalbuminuria was significantly higher in both diabetic groups than in non-diabetic group, with more significant higher values in the presence of retinopathy. - Diabetic patients showed higher values of acute-phase proteins (o:-1 antitrypsin, o:-1 acidglycoprotein, ceruloplasmin, C reactive protein and haptoglobin) than in non-diabetic healthy subjects. However, diabetic patients with retinopathy showed significantly higher values in comparison to patients without retinopathy except C-reactive protein. - Higher serum viscosity values were detected in both diabetic groups than in control group. Higher serum viscosity values were found In diabetic patients with evidence of retlnopathy than In diabetic patients without retinopathy. - A positive correlation was found between fasting blood glucose values and acute-phase proteins and serum viscosity. While , no correlation was found between duration of DM and acute-phase proteins. from our results we can conclude that elevation of acute-phase proteins and depression of albumin were clearly detectable in diabetes especially with microangiopathy, positive correlation between viscosity and acute-phase proteins and no correlation between duration of DM and acute-phase proteins. This gives the magnitude of acute-phase proteins elevation potential importance in the pathogenesis of diabetic microangiopathies. Recommendations : On the basis of our and previous studies, we may recommend : 1- Further studies to determine directly if more aggressive insulin treatment is able to reduce the plasma protein changes shown to be presen t in non-insulin dependent diabetic microangiopathies. 2- The need to alternative approach to prevent the develeopment of long term diabetic complications e.g to inhibit the mechanism (s) by which elevated glucose levels cause complications. |