الفهرس 
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Abstract
Insulin resistance is a clinical condition characterized by a decrease in sensitivity and responsiveness to the metabolic actions of insulin, so that a given concentration of insulin produces a less-than expected biological effect. As a result, higher levels of insulin are needed to maintain normal glucose tolerance. In addition, Insulin resistance is implicated in several pathologic conditions, such as T2DM, obesity and dyslipidemia and it is also a prominent component of hypertension, coronary heart disease, and atherosclerosis.
Obesity is a state of chronic low-grade systemic inflammation. This chronic inflammation is characterized by abnormal cytokine production and activation of inflammatory signaling pathways in adipose tissues, which contributes to insulin resistance and its related diseases such as T2DM and metabolic syndrome.
Among ANGPTLs, ANGPTL-2 is abundantly expressed in visceral adipose tissue and has been demonstrated to be involved in adipose tissue remodeling, such as angiogenesis and extracellular matrix remodeling, ultimately leading to adipogenesis and adipocyte hypertrophy, increasing excess energy storage in adipose tissue.
Moreover, over-expression of ANGPTL-2 in adipose tissues leads to chronic adipose tissue inflammation, resulting in metabolic diseases such as obesity-related insulin resistance and T2DM.
The present study was aiming to assess the correlation between angiopoietin-like protein 2 (ANGPTL-2) and insulin resistance in T2DM patients and obese persons.
This study was conducted on 80 subjects their mean age was 51±6 years old. The patients were recruited from the diabetes and Internal medicine clinics of Ain Shams University Hospitals, and they were divided into four groups. group (I) Included 20 obese type 2 diabetic patients, group (II) Included 20 obese non-diabetic patients, group (III) Included 20 lean type 2 diabetic patients and group (IV) Included 20 lean non-diabetic subjects as control.
All subjects in this study were subjected to full medical history taking, thorough physical examination, anthropometric measurements, fundus examination, abdominal ultrasound, Fasting blood glucose Glycated hemoglobin (HbA1c %), lipid profile, ALT, AST, Creatinine, BUN, HCV antibody, HBs Ag, Urinary protein creatinine ratio (P/C ratio), HOMA IR, Serum angiopoietin-like protein II level (ANGPTL-2) and high sensitive CRP (hs-CRP).
The results were statistically analyzed and the following was observed:
• Comparison between the four studied groups
As regards ANGPTL-2, there was a high statistical significant difference between the studied groups, being the highest in group I (mean 12.6 ± 4.1 ng/ml) followed by group III (9.5±3.8 ng/ml), group II (7.6±3.2 ng/ml) and group IV (5.6±1.8 ng/ml) (P value <0.001).
As regards hs-CRP, there was a high statistical significant difference among the 4 studied groups, being the highest in group I (mean 7.3 ± 4.3 mg/l) followed by group III (mean 5.8±3.9 mg/l), group II (mean 4.9±2.9 mg/l) and group IV (mean 2.2±1.9 mg/l) (P value <0.001).
• On comparison between obese and non-obese subjects as regards serum ANGPTL-2:
There was a highly statistically significant difference between obese and non obese subjects regarding serum ANGPTL-2 levels, being higher in obese subjects (10.1±4.4 ng/ml) than non-obese subjects (7.5±3.6 ng/ml) (P value <0.001).
• On comparison between diabetic and non-diabetic subjects as regards serum ANGPTL-2:
There was a high statistical significant difference between type 2 diabetic and non-diabetic subjects regarding serum ANGPTL-2 levels (p value ˂0.001), being higher in type 2 diabetic subjects (11±4.2 ng/ml) than the non-diabetic subjects (6.6±2.8 ng/ml).
• On comparison between Subjects with and without insulin resistance regarding ANGPTL-2:
ANGPTL-2 was significantly higher in subjects with insulin resistance (mean 11.9±3.6 mg/l) than Subjects without insulin resistance (mean 5.8±1.9 mg/l) (P value <0.001).
• On conducting multivariable binary logistic regression analysis, ANGPTL-2 was found to be an independent predictor for insulin resistance and T2DM (P-value <0.001), but not for obesity (P-value>0.05).
• ROC curve analysis for the diagnostic value of ANGPTL-2 in discrimination between subjects with or without insulin resistance showed that ANGPTL-2 had an excellent predictive value for insulin resistance with P value <0.0001 (AUC 0.93, 95%CI 0.85-97). The best cutoff value for ANGPTL-2 level was >9.3 ng/ml which had sensitivity 79.49% and specificity 92.68%.
• Correlation between ANGPTL-2 other different parameters among the 4 studied groups showed that ; there was a high significant positive correlation between ANGPTL-2 and age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, HbA1c, duration of DM, Fasting plasma glucose, urinary protein creatinine ratio, ALT, fasting insulin, HOMA-IR and hs-CRP (P value <0.001) and a significant positive correlation between ANGPTL-2 and TAG and AST (P value <0.05), but there was a non significant negative correlation between ANGPTL-2 and HDL-c (P value >0.05).