RESUMO
Diabetes mellitus is the most common endocrine and metabolic disorder in childhood and adolescents, with no cure. In this work, we studied the serum levels of the soluble leucocyte adhesion molecules, vascular adhesion molecules -1 [sVCAM-1], intercellular adhesion molecules -1 [Svcam-1], intercellular adhesion molecules [sICAM-1, sICAM-2], and sE-selectin. Also, we studied the lipoprotein phenotype including: serum triglyceride, serum cholesterol, HDL. VLDL, LDL, apoA, and apoB in the serum of 27 children [13 male 14 female] with type 1 diabetes mellitus with and without vascular complications. Their ages ranged from [2.25-20 years] with a mean 15.6 +/- 5.2 years. They were divided into two groups, group [Ia]comprised 14 patients without vascular complications and group [Ib], 13 patients with vascular complications [microalbuminuria, neuropathy, hypertension and retinopahy] presenting with vaying degrees of metabolic control and disease duration and were compared with age, sex matched healthy subjects [n=22, 10 male, 12 female] mean age 14.9 +/- 4.8 yeas. There were significantly higher concentration of soluble sVCAM-1 [mean 1866.7 +/- 631.6ng/mL], sICAM-1 [mean 581.6 +/- 387.1ng/mL], sICAM-2 [mean 425.1 +/- 215.6ng/mL] in type 1 diabetic patients versus age, sex matched control [mean 947.3 +/- 469.6. 184.8 +/- 62.3, and 193.1 +/- 66.6 ng/mL] respectively, p<0.001. As regards sE-selectin there was no significant differences in the concentration in both diabetic and control groups. Significant positive correlations were found between [sICAM-1, sICAM-2] and HbAlc [r=0.44, r=0.37] respectively p<0.05, but no correlations were found between sVCAM-1 or sE selectin and glycosylated hemoglobin. There was a significant increase in sVCAM-1 serum of diabetic children with vascular complications as compared to diabetic children without vascular complications [mean 2183.6 +/- 600.3 versus 1590.4 +/- 584.2ng/mL] [p<0.05]. In diabetic children with positive microalbuminuria there were significant higher levels of sVCAM-1 concentration when compared with the normoalbuminuric diabetic patients [mean 2343.2 +/- 572.7 versus 1709.4 +/- 576.7 ng/mL] p<0.05. While no significant difference were found in the levels of sICAM-1, sICAM-2 and sE-selectin between both groups of diabetic children with and without vasacular complications. As regard lipid profile there were significant increase in serum triglycerides [mean 140.6 +/- 40.9, p<0.01], serum cholesterol [mean 190.6 +/- 25.7, p<0.001], VLDL [mean 26.2 +/- 7.9, p<0.05], LDL [mean 121.8 +/- 29.6 p<0.001], apoA [mean 208.1 +/- 47.4, p<0.001 and apoB [mean 175.9 +/- 54.8, p<0.001] in diabetic patients as compared with control group [mean 100.7 +/- 32.5, 152.5 +/- 26.7, 20.1 +/- 6.5, 78.7 +/- 29.9, 148.5 +/- 42.9 and 84.53 +/- 33.2] respectively. There was a decrease in HDL in diabetic patients as compared to control group but it was not statistically significant. Correlations between circulating adhesion molecules and lipid profile revealed that there was a significant correlations between sVCAM-1 and serum triglyceride, serum cholesterol, HDL. LDL in diabetic children with vascular complications [r=0.56, r=0.53 p<0.01, r=0.43, r=0.46 p<0.05] respectively. In diabetic children without complication there was a significant correlation between sVCAM-1 and cholesterol. VLDL [r=0.37, r=0.39 respectively p<0.05]. Also, there was a significant positive correlation between sICAM-1 and VLDL [r=0.46, p<0.05], and there was a significant correlation between sICAM-2 and LDL [r=0.37, p<0.05] in diabetic children with vascular complications. But there was no significant correlation between sVCAM-1 and sICAM-1, sICAM-2 and sE-sellectin levels in both groups of diabetic patients and their age, disease duration, mean blood glucose, insulin dose, or frequency of diabetic ketoacidosis or hypoglycemic attack which reflect extreme variation in the glycemic control. In patient with microalbujminuria, there was a significant positive correlation between sVCAM-1 and serum triglycerides, serum cholesterol, LDL [r=0.45, p<0.05, r=0.48 p<0.01, r=0.37 p<0.05] respectively. Also a significant positive correlation was found between intercellular adhesion molecules sICAM-2 and LDL [r=0.39, p<0.05]. sICAM-1 has a positive correlation with triglyceride [r=0.39, p<0.05] and a significant negative correlation with HDL [r=0.4, p<0.05], was identified as well. We concluded that in respective of actual metabolic control, serum concentration of sVCAM-1 sICAM-1 and sICAM-2 but not sE-selection are elevated in patients with type I diabetes mellitus, reflecting ongoing endothelial cell stimulation and leucocyte activation even in the absence of clinically detectable angiopathy. Our results suggest an important role of sVCAM-1 in micro and macrovascular complications which may serve as the basic for further evaluation of circulating sVCAM-1 as a potential serum marker for vascular complications. Also sICAM-1, sICAM-2, seem to be good and reliable indicators of glycemic control. Our finding proved an important relationship between adhesion molecules and dyslipidemia exists in type 1 diabetic patients with vascular complications. It is recommended to screen diabetic children regularly for sole adhesion molecules, lipid profile and microalbuminurea levels for early detection of diabetic vascular complications