الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Diabetes mellitus is a public health problem which has reached epidemic proportions due to the rapidly increasing rates of this disease worldwide. Neuregulin-4 (NRG-4) is a new adipokine released mainly from brown adipose tissue and expressed in different organs.( Pfeifer et al., 2015) Nrg-4 has been suggested to play a role in regulating systemic energy balance and glucose , lipid metabolism and in reducing chronic inflammation. (Yan et al., 2018) The aim of this work was to investigate whether serum NRG-4 concentration could be a marker in patients with type 2 DM Our study was carried out at Tanta University and subjects of this study were classified into two groups: group (I): 50 patients with type 2 diabetes disease. (26 males and 24 females aged from 60-70 years old). group (II):30 healthy individuals with matched age and sex .(15 males and 15 females) to serve as control group. All Patients and controls were subjected to the following assessment: 1- Complete history. 2- Clinical evaluation. 3-Routine laboratory investigations: a. Fasting blood sugar. b. Post prandial blood sugar. c. Glycoslated hemoglobin(Hb A1c). d. Fasting insulin. e. HOMA-IR. f. Lipid profile. g. Serum creatinine and urea. h. Albumin /creatinine ratio i. Liver function test. 4. Specific laboratory investigations: Study of serum level of NRG-4 concentration by enzyme-linked immunosorbent assay (ELlSA) in patients with type 2 diabetes . Blood and urine samples were obtained and written consent will be taken from all patients before carrying out the above mentioned tests. We included patients with type 2 diabetes . We excluded patients with a. Type 1 diabetes or endocrine disorders. b. Type 2 diabetes suffering complications. c. History of use lipid- lowering and antihypertensive drugs . The following results were obtained: The present study showed that The mean values of fasting blood glucose, postprandial blood glucose, HbA1c and HOMA-IR level were significantly increased in diabetic patients type 2 when compared to the control group. Our study also showed that the mean values of serum level of total cholesterol , serum Triglycerides serum LDL-C were significantly increased in diabetic patients type 2 when compared to control group. While the mean values of serum HDL-C showed significant decrease in diabetic patients type 2 when compared to the control group. We was excluded subjects medicated with antihypertensive and lipid -lowering drugs . Also, the mean values of BMI , weight and hight were significantly increased in patients of type2 diabetic when compared to the control group Our study showed that there was no statistical significant difference between patients of type2 diabetic and control group as regared to liver function (AST,ALT and serum albumin) , kidney function (urea and creatinine ) or urine albumin / creatinine ratio as we excluded diabetic patients suffering from complication. Lastly our study showed that the mean values of serum level of NRG-4 was significantly higher in diabetic patients type2 when compared to the control group , p value <0.001 . In addition , there was (positive) significant correlation between serum NRG-4 and each of FBG, 2hpp ,HbA1c ,F. Insulin , HOMA-IR , cholesterol , LDL ,weight and BMI . Moreover the cut off value of NRG-4 was >577.3 , sensitivity was 78.0 , specificity was 73.33 , positive predictive value (PPV) was 83.0 and negative predictive value (NPV) was 66.7 Which means that NRG-4 could play a crucial role in the pathogenesis of T2DM.