الفهرس 
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Abstract
Summary
Increased sCD40L levels have been found in a variety of diseases including; systemic lupus erythematosus, rheumatoid arthritis, hypercholesterolemia, unstable angina, diabetes mellitus and acute coronary syndromes and are predictive of increased risk of cardio-vascular events in clinically healthy individuals.
In light of these data, the aim of the present study was to evaluate sCD40L levels in type 1diabetic patients and its relation to diabetic micro-vascular complications and metabolic control.
This study was conducted on 60 randomly selected children and young adolescents with type 1 diabetes mellitus attending the Pediatric Diabetes Clinic, Beni Suef University from 2016 to 2019. Patients were divided into two groups according to the presence of micro-vascular complications:
30 children with type 1 diabetes presented with micro-vascular complications (complicated cases) and another 30 diabetic children without micro-vascular complications (non-complicated cases). Thirty age- and sex-matched healthy subjects were enrolled as control group.
All patients were subjected to detailed medical history, thorough clinical examination laying stress on disease duration, type and dose of insulin therapy, acute and chronic complications, anthropometric measurements, blood pressure measurement, neurological and fundus examinations. Laboratory investigations included mean fasting and 2-hours postprandial blood glucose in the last month, mean HbA1c% in the last year prior to the study, quantitative determination of urinary microalbumin and determination of serum sCD40L levels by enzyme linked immunosorbent assay (ELISA).
In the current work, sCD40L serum levels were significantly elevated in all diabetic patients (median, 6900 pg/ml for complicated cases and 560 pg/ml for non-complicated) compared with healthy control group (median, 210 pg/ml ) (p<0.001). Serum sCD40L levels were significantly increased in both groups of diabetic patients when compared separately with healthy controls (p<0.001). Notably, complicated cases had significantly higher serum sCD40L concentrations (median, 6900 pg/ml.) at the time of evaluation than patients without micro-vascular complications (median, 560 pg/mL) (p<0.001)
ROC curve analysis revealed that the cutoff value of sCD40L at 315 pg/mL could differentiate complicated from non complicated cases with a sensitivity of 96% and specificity of 90% (area under the curve, 0.96; confidence interval, 0.922–999; p< 0.001) , When this value was assigned in diabetic patients, it was found that 96% of patients above this level presented with complications (p<0.001).
Analysis of the clinico-pathological characteristics in relation to sCD40L revealed that diabetic patients with micro-albuminuria and peripheral neuropathy showed significantly higher level of sCD40L when compared with patients without these complications (p<0.05). Correlation studies revealed significant positive relationships between sCD40L and disease duration, fasting blood glucose, 2-H PPBG and HbA1c as an index of metabolic control (p<0.05).
Conclusion
from this study, we may conclude that:
• Serum sCD40L levels are elevated in children and adolescents with type 1 diabetes compared with healthy controls.
• The increase of sCD40L levels is more evident in diabetic patients with micro-vascular complications especially nephropathy and peripheral neuropathy than non-complicated patients or control subjects.
• Serum sCD40L levels are positively correlated with age, disease duration, FBG, 2-H PPBG and HbA1c suggesting a link between elevated sCD40L and poor metabolic control.