الفهرس 
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Abstract
Diabetes mellitus is a disease that affects a rapidly increasing number of patients. Most patients with diabetes mellitus develop vascular complications. This may be microvascular disease, such as nephropathy, retinopathy or polyneuropathy, and also macrovascular disease. Carotid artery stiffness and intima-media thickness measured by ultrasonography are correlated with atherosclerosis and cardiovascular disease in patients with type 1 diabetes.The interaction of advanced glycation end prouducts with their cellular receptor (RAGE) is implicated in the pathogenesis of diabetic vascular complications. Soluble RAGE (sRAGE) might exert a protective role against the development of cardiovascular disease.
The aim of the present study was to evaluate sRAGE level in children and adolescents with type1 diabetes mellitus and its possible relation to glycemic control, diabetic vascular complications as well as carotid intima-media thickness as a marker of atherosclerosis.
This study was carried in the period from April 2010 to April 2011 on 60 children and adolescents with diabetes mellitus recruited from the Pediatric Diabetes Specialized Clinic, Ain Shams University Hospitals. Their age ranged from 6-18 years with mean age 14.4±3.4 years, they were 40 females and 20 males and 30 age and sex matched healthy individuals. Their age ranged from 7-18 years with mean age of 13.4±3.4, they were 15 males and 15 females.
The patients were further subdivided into two groups according to the presence or absence of micro-vascular complications into:
Group I: Thirty patients with diabetic microvascular complications (nephropathy n=10, retinopathy n=6, and /or neuropathy n=24).Their ages ranged from 9-18 years with mean age of 14.9±2.8 years they were 8 males and 22 females.
Group II: Thirty patients without diabetic micro-vascular complications .their age ranged from 6-18 years with mean age of 13.8±3.8 they were 18 females and 12 males.
All patients were subjected to detailed history taking, thorough clinical examination, and measuring of:
1- Mean random blood
2- Glycosylated Hemoglobin
3-Urinary albumin excretion
4-Fasting serum lipid profile
5-Measurement of sRAGE by ELISA
6-Assessment of carotid intima-media thickness by Carotid Dopplex Ultrasound.
The study revealed:
- Total cholesterol, LDL, TG were significantly higher in patients than controls while HDL was significantly lower (P < 0.001).
- Diabetic patients displayed significant increase sRAGE levels than controls (P<0.001).
- sRAGE level was higher among non complicated patients than in complicated patients but this didn’t reach statistical significance and for the individualized microvascular complications. Its level was higher among those without retinopathy (P=0.019) or neuropathy (P=0.142) while it was higher among those with nephropathy (P=0.805).
- Significant direct correlation between sRAGE and HDL in patients while there was no significant correlation between sRAGE and LDL, triglyceride or cholesterol.
- No correlation between sRAGE and SBP or DBP in diabetic patients, while sRAGE was inversely correlated with SBP in controls.
- Significant positive correlation between sRAGE and cIMT in controls (P=0.036) while there was no significant association between sRAGE and cIMT in patient group.
- Significant direct correlation between sRAGE and age in controls.
- No significant correlation between sRAGE and duration of DM, insulin dose, frequency of monitoring and frequency of hospitalization, metabolic control parameter (HbAlC), hypoglycemia or DKA.
- Significant increase in cIMT in diabetic patients compared to normal controls (P<0.001) the increase was higher in males than females (P=0.003) and 13.3% of the studied patients had carotid wall abnormalities in the form of atheroma in the wall causing stenosis, and intraintimal cystic lesions.
- cIMT was higher in complicated patients than in non complicated but this didn’t reach statistical significance.
- No significant difference in cIMT among individualized microvascular complications neuropathy, retinopathy or nephropathy.
- Significant direct correlation between cIMT and UAE and also SBP, DBP in diabetic patients.
- Significant direct correlation between cIMT and cholesterol, LDL and significant inverse correlation with HDL in both cases and controls while cIMT was directly correlated to triglycerides only in controls.
- Significant inverse correlation between cIMT and insulin dose and frequency of monitoring while there was no correlation between mean cIMT and duration of diabetes mellitus.
- No significant correlation between mean cIMT and parameter of metabolic control (HbAlC) as well as there was no correlation to acute diabetic complications including hypoglycemia and DKA.
- cIMT was directly correlated with age in patients (r=0.264, P=0.042), weight (r=0.4, P=0.002) and BMI (r=0.397, P=0.002).