الفهرس 
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Abstract
Dissertation Abstract : Familial Mediterranean Fever (FMF) is one of an autoinflammatory syndromes which are disorders characterized by the hyperactivation of the innate immune system in the absence of microbial infection or autoantibody production (sterile inflammation ( Blood neutrophil-to-lymphocyte (N/L) ratio is used as an indicator of the overall inflammatory status of the body, It gives information about two different immune pathways , the first is related to neutrophils that are responsible for lasting inflammation and the second to lymphocytes that demonstrate the regulatory pathway. An alteration in N/L ratio may be found in patients with familial Mediterranean fever (FMF). Blood N/L ratio is a simple marker of inflammation that can be easily obtained from the differential WBC count. Interleukin-1β is a member of the interleukin 1 family of cytokines. This cytokine is produced by activated macrophages as a proprotein, which is proteolytically processed to its active form by caspase 1 (Interleukin 1 β convertase). This cytokine is an important mediator of the inflammatory response, and is involved in a variety of cellular activities, including cell proliferation, differentiation, and apoptosis. So in this study, we aimed to investigate whether neutrophil/ lymphocyte ratio (NLR) can be used as inflammatory maker for FMF patients. Also, this study is conducted to approve or reject the role of IL-1β in FMF pathogenesis. One hundred and thirty children were enrolled in this study. They are categorized in two groups : group 1 Control group ( 28 age and sex-matched healthy children) , group 2 Case group ( 102 children ) whose are categorized into 3 subgroups : New untreated FMF cases ( 20 children) , FMF cases in attack ( 46 children) and FMF cases in between attack ( 36 children). All cases were subjected to assessment by complete history taking and laboratory investigations as Complete blood count (CBC) , ESR, CRP, IL-1β assay by ELISA . Statistical analysis was done to evaluate the different studied parameters. Our study show the following:- 1- ESR is significantly higher in all groups of FMF patients (untreated , in attacks , inbetween attacks ) versus controls , so ESR can be used as a predictor for inflammation in all groups of FMF patients . However , ESR is not differ significantly between untreated cases versus in attack cases (P4). 2- CRP is significantly higher in all groups of FMF patients (untreated , in attacks , inbetween attacks ) versus controls , so CRP can be used as a predictor for inflammation in all groups of FMF patients . However , CRP is not differ significantly between untreated cases versus in attack cases(P4) and between untreated cases versus in between attack cases(P5). 3- NLR is significantly higher in all groups of FMF patients (untreated , in attacks , inbetween attacks ) versus controls , so NLR can be used as a predictor for inflammation in all groups of FMF patients . However , NLR is not differ significantly between untreated cases versus in between attack cases (P5). 4- MPV is significantly higher in all groups of FMF patients (untreated , in attacks , inbetween attacks ) versus controls , so MPV can be used as a predictor for inflammation in all groups of FMF patients. 5- IL-1β is only significantly higher in untreated and in attack cases versus controls. 6- High level of N/L ratio in active FMF patients (median 6.4) compared to attack free FMF patients (median 3.3 ) and controls (median 2.5 ) confirm that neutrophils have a key role in the inflammatory process of FMF and disease pathophysiology. 7- A cut-off value of > 1.15 in NLR is more sensitive and specific than cut-off value of IL-1β (> 59 pg/ml ). 8- There was significant positive correlation between NLR and ESR ,CRP ,WBC and Neutrophil count and significant negative correlation between NLR and Lymphocyte count . So , NLR is a good predictor for inflammation . 9- There was no significant correlation between IL-1β and ESR , CRP , WBC , Neutrophil count, Lymphocyte count, MPV and NLR.