الفهرس 
Path physiology of chronic complications of Diabetes mellitusOnly 14 pages are availabe for public view
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Abstract
Vaspin (a visceral adipose tissue-derived serine proteaseinhibitor) is a novel adipocytokine that
was reported to bespecifically expressed in VAT of Otsuka Long-Evans Tokushima Fatty (OLETF)
rats.
Vaspin has recently been identified as novel adipokine with high expression in adipose tissue of
obese and type 2 diabetic subjects and with potentially insulin sensitizing properties .
Diabetic subjects with good glycemic control have lower levels of vaspin than those with poor
glycemic control. Thus, the use of serum vaspin level as a marker, evaluating patients for diabetic
complications seems appropriate.
Vaspin has insulin-sensitizing effects, as well as additional beneficial effects on metabolic diseases.
However, little is known about the direct effects of vaspin on vascular complications mediated by
diabetes.
Vaspinhave been shown toinhibit hyperglycemia-induced vascular smooth muscle cells (VSMCs)
proliferation.
Atherosclerosis has a forefront role in the pathogenesis of stroke. Inflammation has an important
place in the formation of atherogenesis and atherosclerosis. Vaspin associated with obesity and
diabetes and also has a proinflammatory characteristic.
Vaspin protected endothelial cells from proinflammatory cytokines induced inflammation by
inhibition of nuclear factor-kappa B (NF-κB) and its downstream molecules byinhibited tumor
necrosis factor-α (TNF-α) and interleukin-1 (IL-1), mediated activation of NF-κB and its
downstream molecules in a concentration-dependent manner.
In this study, we aimed to evaluate serum vaspin levels in relation to glycemic status and the
presence of macro vascular complications in groups of type 2 diabetic patients.
Our study was conducted on sixty patients diagnosed as Type 2 diabetes mellitus were classified
into three groups and the fourth group formed of twenty normal persons: group I formed of 20
diabetic patients with coronary artery disease , group II formed of 20 diabetic patients with recent
cerebro vascular stroke , group III formed of 2o diabetic patients with diabetic patients without
complication and group IV formed of 20 normal volunteer persons .
All subjects recruited in the study were subjected to history taking and full clinical assessment in
addition to core laboratory parameters that included FBS, PPBS and HbA1c%, lipid profile,
microalbuminuria and serum Vaspin. Also radiological assessment included echocardiography and
Carotid duplex to measure intimal thickness, Computerized Tomography brain (CT brain) for patients
with cerebrovascular stroke.The results were statistically analyzed and we observed the following :Our results showed an insignificant difference in serum vaspin level between diabetic patients with IHD
or CVS (P>0.05), yet the mean of vaspin in IHD and C.V.S. was lower than in healthy group.
In our study, the serum vaspin level was found to be significantly positively correlated with diabetes
duration where the mean diabetes duration of the subjects involved in this study was less than 10 years
(P<0.01).
Our results showed that there was no difference in serum vaspin level between both sexes, and also
showed that there is a positive correlation between age and vaspin concentration (P<0.01).
In the current study serum vaspin level was found to be significantly positive correlated with FBS, 2hpp
& HbA1c in all studied groups (P<0.01).In addition, our study recorded positive correlation between
serum vaspin level & serum cholesterol, TG, LDL & HDL in all studied groups (P<0.01).
In our study intimal medial internal carotid thickness & percent of stenosis on the Rt. side was found to
be significantly higher in diabetic cases with IHD compared to diabetic patients without complications or
healthy control subjects (P<0.01), however, this difference did not reach a statistical significance on the
left internal carotid artery(P>0.05), but the percent of internal carotid stenosis on either sideswas
significantly higher in diabetic cases with IHD compared to diabetic cases without complications &
healthy control subjects , also there was high significant correlation between serum vaspin & Rt intimal
medial internal carotid thickness & percent of stenosis on both Rt and Lt sides (P<0.01) but there was no
significant correlation between serum vaspin & the left internal carotid artery in diabetic patients with
IHD(P>0.05).
In the present work, Rt internal carotid thickness was found to be significantly higher in diabetic cases
with C.V.S compared to either diabetic cases without complications or healthy control group (P<0.01),
however, this difference did not reach a statistical significance on the left internal carotid artery intimal
medial internal carotid thickness(P>0.05), but the percent of internal carotid stenosis on either sides was
significantly higher in diabetic cases with C.V.S compared to diabetic cases with IHD, also there was
high significant positive correlation between serum vaspin and intimal medial internal carotid thickness
on both Rt and Lt sides and also in percent of stenosis on both Rt and Lt sides in diabetic patients Furthermore, our study reported a significant positive correlation between the serum vaspin level and Rt
internal carotid intimal thickness and both Rt and Lt sides percent of internal carotid stenosis in patients
with T2DM(P<0.01).