الفهرس 
TYPE 1 DIABETES MELLITUSOnly 14 pages are availabe for public view
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Abstract
Background: In Diabetes, the chronic hyperglycemia and associated complications affecting peripheral nerves are one of the most commonly occurring microvascular complications with an overall prevalence of 50-60%. The cross talk between oxidative stress and inflammation mediates macrophage migration leading to production of proinflammatory cytokines which are responsible for nerve tissue damage and debilitating neuropathies. Neopterin is a marker of inflammation and cellular immune response that is elevated in conditions of T-cell or macrophages activation. Aim: To measure serum neopterin level in 60 children and adolescents with type 1 diabetes mellitus compared with 30 age- and sex-matched healthy controls and to assess its relation to glycemic control as well as its possible association with peripheral neuropathy and nerve conduction studies. Methods: All the included patients were subjected to detailed medical history with special emphasis on age at onset of diabetes, disease duration and insulin therapy. Neurological assessment was done according to neuropathy disability score (NDS) and confirmed by nerve conduction studies for median, ulnar, posterior tibial and common peroneal nerves. Laboratory investigations included measurement of mean fasting and random blood glucose, fasting lipid profile and mean HbA1c%. Determination of serum neopterin levels by enzyme linked immunosorbent assay (ELISA). Results: The frequency of diabetic peripheral neuropathy in patients with type 1 diabetes according to NDS was 40 (66.7%) patients out of 60, while nerve conduction studies detected that 30 (50%) patients out of 60 had this complication. The highest rate of motor abnormality was found in the right and left common peroneal nerves followed by the left tibial nerve while the highest rate of sensory abnormality was found in the left median nerve. Neopterin levels were significantly higher in patients with and without peripheral neuropathy than controls with the highest values were found among those with peripheral neuropathy. Significant positive correlations were found between neopterin levels and HbA1c, serum creatinine and total cholesterol among patients with peripheral neuropathy (n=30). Furthermore, there were significant positive correlations between neopterin levels and motor latency of left tibial nerve, right and left common peroneal nerves, right median nerve and left ulnar nerve among patients with peripheral neuropathy while neopterin was negatively correlated with the motor velocity and/or amplitude of these nerves. Similar results were found between neopterin levels and sensory nerve conduction of right and left median and ulnar nerves. Logistic regression analysis revealed that age, disease duration, HbA1c as well as neopterin levels were independently related to neuropathy in those patients. The cutoff value of neopterin at 32 nmol/L could differentiate patients with and without peripheral neuropathy with a sensitivity of 100% and specificity of 96.7%. Conclusions: Neopterin could be used as a reliable serum biomarker among patients with type 1 diabetes to identify those with peripheral neuropathy.