RESUMO
Impaired trace elements metabolism may be involved in some of the metabolic dysfunctions, and contribute to the development of vascular complications in diabetic patients. Copper is one of the trace elements which was essential and integral component of many metalloenzymes, including ceruloplasmin which is one of the acute phase reactant protein and may play a role in the antioxidant defense. Prospective studies have reported associations among various markers of inflammation as ceruloplasmin and incidence of diabetes and its complications. This study was conducted to evaluate the state of serum and urinary copper and ceruloplasmin in type 2 diabetes mellitus and their relation to different degrees of diabetic nephropathy. The study included 60 patients divided into 4 groups: group I included 15 healthy volunteers, the other 3 groups included 45 patients with type 2 diabetes mellitus, group II included 15 diabetic patients with normoalbuminuria, group 111 included 15 diabetic patients with microalbuminuria, group IV included 15 diabetic patients with macroalbuminuria. The results showed that there was no significant difference in serum copper levels between control subjects, normoalbuminuric, microalbuminuric and macroalbuminuric patients. Serum ceruloplasmin was significantly higher in the microalbuminuric and macroalbuminuric patients than control subjects and normoalbuminuric patients [P <0.05 for each group] while no significant difference was found between control subjects and normoalbuminric patients, also no significant difference was found between microalbuminuric patients and macroalbuminuric patients. Urinary copper was significantly higher in the macroalbuminuric patients than control, normoalbuminuric and microalbuminuric patients [P <0.001] for each group, while no significant difference was found between control subjects and normoalbuminuric and macroalbuminuric patients. In conclusion, serum copper levels are normal in diabetic patients and are not related to the degree of diabetic nephropathy. While, serum ceruloplasmin levels are significantly higher in diabetic nephropathy and may indicate a role of oxidative stress and inflammation in the pathogenesis of this complication. However, the very high levels of urinary copper in macroalbuminuric patients may suggest that copper overloading to the renal tubular cells in these patients may produce cytotoxic effects on these tubular cells and contribute to the progression of diabetic nephropathy
RESUMO
Spontaneous bacterial peritonitis [SBP] is one of the most common complications attending the onset of ascites in patients with liver cirrhosis. Granulocyte elastase [GE] is the powerful proteolytic enzyme that is released by PMNs when degranulated in infectious processes. The aim of this study was to measure GE in ascitic fluid and plasma of cirrhotic patients with SBP comparing them with the standard test in diagnosis of SBP; ascitic fluid polymorphonucleocytic count [PMN count]. Eighty five cirrhotic patients with ascites were included in the study 35 of them have SBP [ascitic PMN> 250/mm[3] and/or ascitic ascitic white blood cell count> 500/mm[3] with or without positive culture], the other 50 didn't have SBP at the time of diagnosis. GE level in the ascitic fluid and plasma was measured. Infectious group further divided into two groups according to the result of ascitic fluid culture; poitive culture spontaneous bacterial peritonitis [CP-SBP] group [contained 25 patients] and negative culture spontaneous bacterial peritonitis [CN-SBP] group [contained 10 patients]. The result showed that there was significant difference between SBP subgroups [CP-SBP and CN-SBP] in one hand and cirrhotic group without SBP in the other hand as regard the ascitic fluid WBC count [p<0.01], PMN count/mm[3] [p<0.01], and highly significant difference as regard GE micro g/ml [p<0.0001], meanwhile there was no significant difference as regard ascitic fluid protein. After treatment of the infectious group; there was statistically significant change in plasma GE [p<0.01] and highly significant difference Was recorded in ascitic fluid GE [p<0.001]. Also there was significant drop for raised serum creatinine after treatment [p<0.01]. These findings suggest that GE in the ascitic fluid is highly valuable than the ascitic fluid PMN in the diagnosis of SBP. In addition more valuable for follow up response to treatment. Lastly GE level either in plasma or ascitic fluid could be responsible for deterioration of renal function and raised creatinine level in patients with SBP