Inflammatory , Hepatic and Renal Markers of The Metabolic Syndrome in Type 2 Diabetes Mellitus

Currently there are a number of definitions of metabolic syndrome, one of them the National Cholesterol Education Program (NCEP-ATP III) has recognized that the metabolic syndrome as a cluster of abnormalities increasing the risk of both cardiovascular disease ( CVD ) and type 2 diabetes individuals that would not otherwise be recognized to be at risk Additionally, metabolic syndrome increases the risk of developing diabetes mellitus and chronic kidney disease and is associated with a number of other disorders.
Aim of the Study:This study was preferred to demonstrate the pattern of biochemical changes (inflammatory and enzymatic) in metabolic syndrome Study the associations and interrelationship of both markers hs –CRP and microalbuminuria with each other, relative to other risk factors Research design: A case-control study involving a study of (96 subjects) divided into 48 patients with metabolic syndrome was carried out between November 2010 and April 2011; all patients were recruited from the Outpatient Diabetes and Endocrinology Clinic at Al-Kadhymia Teaching Hospital, they have hypertension, diabetes mellitus and Dyslipidemia. The age rang (21- 67 years and the mean age was 43.89+9.15 years) for both gender with type 2 diabetes mellitus ; diagnosed according to the ADA definition ( ADA ,2011) according to Metabolic Syndrome and NCEP criteria. In addition 48 apparentally healthy Control subjects and were gender and age matched. All subjects were screened for clinical and biochemical criteria of metabolic syndrome, in addition to hepatic enzymes (AST, ALT, GGT and Alk-P) were serum lipid profile and liver enzyme determined by a spectrophotometric method and hs-CRP as inflammatory marker measured by: ELISA kits; together with microalbuminuria expressed in term of urinary albumin to urinary creatinine ratio. The results The results showed a significant increase in both clinical and biochemical criteria of metabolic syndrome in patients` group as compared to control; moreover the same significant increase in serum level of hepatic enzymes (AST, ALT, GGT and Alk-P), hs-CRP and urinary level of albumin to urinary creatinine ratio icroalbuminuria).
In addition, a significant positive correlation was found between hs-CRP and microalbuminuria on one hand and other mentioned parameters on the other hand It could be hypothesized that raised liver enzymes, especially ALT and GGT levels, are associated with occurrence of metabolic syndrome and correlate positively with novel cardiovascular risk factors such as (CRP); in this aspect they may have a role in diagnosis of metabolic syndrome.It has been observed that hs-CRP level was not significantly associated with the metabolic syndrome but it is significantly associated with the parameters (obesity, hypertension, dyslipidemia, impaired glucose tolerance and raised fasting blood glucose and liver enzymes) suggesting that the metabolic syndrome may precede the development of CRP elevation.The observation of low-grade inflammation, reflected by high serum hs-CRP levels, may play a role in the induction of microalbuminuria, which can be considered as a risk factor of cardiovascular disease. The suggested mechanisms underlying these events were discussed.