الفهرس 
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Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by
hyperglycemia resulting from defect in insulin secretion, insulin action or
both. The chronic hyperglycemia of diabetes is associated with long term
damage, dysfunction and failure of various organs.
T2DM, which was previously referred to as non insulin dependent
diabetes mellitus, or adult onset diabetes mellitus, accounts for 90–95%
of diabetic patients.
Hypertension is a silent disease. It is insidious and relentless. The
only reliable way to detect hypertension is to regularly check blood
pressure. This should be done as part of a physical exam on every adult.
If hypertension is not treated, there will be organ damage to kidneys,
heart, and brain which is generally not reversible. Death in persons with
hypertension most often occurs from heart failure, chronic renal failure
and stroke.
Essential hypertension (also called primary hypertension or
that by definition, hypertensionidiopathic hypertension) is the form of
has no identifiable cause. It is the most common type of hypertension,
affecting 95% of hypertensive patients.
The best characterised receptor for AGEs is the receptor for
AGEs (RAGE, also known as AGE-specific receptor [AGER]). RAGE
belongs to the immunoglobulin superfamily of cell-surface molecules
and is composed of an extracellular region containing one V-type
and two C-type immunoglobulin domains, a hydrophobic transmembrane domain and a highly charged short cytosolic tail, which
is essential for post- RAGE signaling.
Clinical studies in nondiabetic subjects have shown that higher
levels of endogenous sRAGE may be associated with a lower incidence
of hypertension.
Experimental studies have suggested that esRAGE can act as a
decoy for RAGE ligands and thus have cytoprotective properties
against AGE actions. Studies investigating total circulating level of
sRAGE have shown that sRAGE levels were reduced in non-diabetic
subjects with coronary heart disease and in those with essential
hypertension.
The current study was carried out at the Medical Biochemistry and
Cardiology Departments, Faculty of Medicine, Menofia University.
The aim of the work is to study the role of endogenous secretory
receptor of Advanced Glycation End-Products (esRAGE) as a
biochemical marker for hypertensive patients with type 2 diabetes
mellitus. This study involved 80 individuals , 20 hypertensive patients ,
20 diabetic patients with (T2DM), 20 diabetic hypertensive patients and
20 healthy persons served as controls.
Full history and clinical examination were made to every subject.
Laboratory investigations were also carried out to all individuals
including fasting blood glucose , Lipid profile (total cholesterol,
triglycerides, high density lipoprotein cholesterol, HDLc and low density
lipoprotein cholesterol, LDLc), Kidney function tests(serum urea and
creatinine) and measurement of serum endogenous secretory Receptors
for Advanced Glycation End Products (esRAGE) by enzyme linked
immunosorbent assay (ELISA) technique.The results of the present study can be summerized as follows:
• A significantly higher level of serum total cholesterol, triglyceride
and LDL-Cholesterol concentration were observed in hypertensive
patients , diabetic patients and hypertensive type 2 diabetic patients
in comparison to control group and serum HDL-cholesterol
concentration was significantly lower in all groups in comparison
to healthy control.
• The serum esRAGE concentration was significantly lower in
hypertensive group than in the control group.
• The serum esRAGE concentration was significantly lower in type
2 diabetic patients group than in the control group.
• The serum esRAGE concentration was significantly lower in
hypertensive with type 2 diabetic patients group than in the control
group.
• The serum esRAGE is significantly higher in hypertensive patients
than hypertensive type 2 diabetic patients .As well as reporting
that esRAGE is significantly higher in diabetic patients than in
hypertensive type 2 diabetic patients.
• There is significant negative correlation between serum esRAGE
and each of systolic and diastolic blood pressure ,serum
triglyceride, serum total cholesterol and serum LDLc in the patient
group.
• In patient subjects, systolic blood pressure , serum triglyceride ,
total cholesterol (T chol ) and low density lipoproteins cholesterol
(LDLc) were selected as significant independent factor inversely
associated with plasma esRAGE whereas high density lipoproteins cholesterol (HDLc) was selected as significant independent factor
positively associated with plasma esRAGE .