الفهرس 
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Abstract
Diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion as in type1 diabetes mellitus, or resistance to insulin action, or both as in type 2 diabetes mellitus. Diabetes mellitus has a high mortality rate due to its complications. Most diabetic complications arise from damage to blood vessels that affect either small blood vessels (microvascular complications) or large blood vessels (macrovascular complications).
The metabolic syndrome is a constellation of several metabolic derangements that is often associated with cardiovascular morbidity and mortality. It is characterized by the presence of central obesity, glucose intolerance, hypertension, dyslipidemia and proinflammatory state.
Patients with metabolic syndrome have two- to three-fold increased risk for the development of cardiovascular morbidity and mortality. In nearly 20–25% of apparently healthy individuals and in 45% of patients with clinical manifestations of atherosclerosis metabolic syndrome is present. It has been studied that in low and middle income countries nearly 80% of deaths happens due to cardiovascular diseases.
The adipokine adipocyte fatty acid-binding protein (A-FABP, also known as FABP4 or aP2) is not abundantly expressed in adipocytes, but also produced in macrophages, endothelial cells and glial cells. A-FABP functions as a lipid chaperone that regulates trafficking, fluxes and signaling of FFAs, and has an important role in linking lipid metabolism with inflammation. Although A-FABP was originally identified as an abundant cytoplasmic protein in adipocytes, a portion of A-FABP is released into bloodstream and acts as a humoral factor to regulate glucose and lipid metabolism. Circulating A-FABP is elevated in obese individuals and correlates positively with the features of the metabolic syndrome, and the incidence of atherosclerosis and cardiovascular diseases
In order to study the association between serum levels of A-FABP and the presence of metabolic syndrome (MetS) in type 2 diabetes mellitus, as well as its evaluation as a predictor marker for MetS, serum levels of A-FABP were measured in sixty adult diabetic patients (thirty diabetic patients without MetS and thirty diabetic patients with MetS) and thirty adults neither diabetic nor metabolic syndrom patients, apparently healthy age- and sex- matched subjects serving as a control group. Metabolic syndrome was diagnosed by National Cholesterol Education Program ATP-III. Assay of serum A-FABP was carried out using an enzyme-linked immunosorbent assay (ELISA) technique.
The results of the present study showed a highly significant increase in serum A-FABP levels in diabetic subjects with MetS, when compared to diabetic patients without MetS and healthy control group. Furthermore, elevated serum A-FABP levels were positively correlated with markers of MetS weight and BMI.
In addition, we detected a highly significant statistical difference between sub-group Ib and control group as regard F. Insulin, hsCRP, HOMAIR and serum A-FABP. Moreover A-FABP showed highly significant statistical difference between patient’s sub- group Ia and Ib, while mean HOMAIR and hsCRP had non significant statistical difference between patients sub- groups, that indicate that A-FABP is early predictor marker for the development of MetS in the studied population.
Furthermore, we evaluated the diagnostic performance of serum A-FABP in the diabetic patients with metabolic syndrome to find that the cut-off value of A-FABP was 8 ng/mL with diagnostic sensitivity of 76.7%, specificity 96.7%, PPV 92%, NPV 89.2% and efficacy 90% with AUC 0.904, but when A-FABP was combined with TG at cut-off level 88mg/dL, reaching the best diagnostic performance in discriminating patients with MetS from those without, with diagnostic sensitivity of 100%, specificity 98.3%, PPV 96.8%, NPV 100% with AUC 0.987.