الفهرس 
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Abstract
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.
Coronary artery disease has been classified by World Health Organization as the disease of 21st century with high prevalence that can occur to almost all population without rationality. CAD can be characterized as a disease with high morbidity, mortality, reduced quality of life and substantial economic burden.
Chemerin is an adipokine secreted mainly from adipose tissue. It was reported that chemerin is produced in peri-aortic, peri-coronary and epicardial adipose tissue in patients with atherosclerosis and in macrophages of aortic and coronary atherosclerotic lesions.
The aim of our present study was to evaluate serum chemerin levels in metabolic syndrome patients. Moreover to elucidate its’ involvement as a risk factor in CAD. This work was conducted at the Department of Clinical pathology and the Department of Cardiology of Ain Shams University Hospital and it included 90 patients; (30 metabolic syndrome patients with coronary artery disease and 30 metabolic syndrome patients without coronary artery disease), whom results were compared with those of 30 age and sex matched apparently healthy controls. Metabolic syndrome was diagnosed by National Cholesterol Education Program Expert Panel. Serum chemerin, fasting blood glucose, CAD-risk and lipid profile were evaluated in all subjects.
In our study, patients showed higher levels of serum chemerin than did healthy subjects. Furthermore, level of serum chemerin was significantly elevated in MS patients with CAD compared with those without CAD and healthy controls.
On comparing the patients’ group (group I) with the control group (group II) concerning BMI, WC and laboratory parameters, significant higher results were found in patient group in all the aspects studied and significant lower results concerning HDL-C and HDL-C/T.Ch% when compared with the control group.
In addition, we detected a highly significant difference between the three groups regarding BMI, waist circumference, total cholesterol, serum triglycerides, HDL-C, LDL-C, HDL-C/T.Ch%, T.Ch/HDL-C ratio, LDL-C/HDL-C ratio and serum chemerin.
Furthermore, we evaluated the diagnostic performance of serum chemerin in the metabolic syndrome to find that the best cutoff value of chemerin in patients with MS was 80 ng/mL with diagnostic sensitivity of 91.7%, specificity 100%, PPV 100%, NPV 85.7% and efficacy 94.4% with AUC 0.986.
In conclusion, high serum chemerin level is strongly associated with metabolic syndrome disorders and coronary artery disease and assessment of its level could be beneficial in diagnosis, early detection and prevention of these pathological states and their unfavorable consequences especially the cardiovascular complications. Hence, this study introduces serum chemerin as a novel marker for diagnosis of the metabolic syndrome to be added to the panel of laboratory parameters of this metabolic abnormality.