الفهرس 
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Abstract
This study is a cross - sectional one which was done in the period from January 2016-December 2018. in diabetes and endocrine out-patient clinic of Minia university hospital.
Our aim is to investigate the relationship between ascorbic acid level and anti-oxidants parameters in blood and endothelial dysfunction using clinical, echocardiography and duplex findings of brachial artery in patients with type 2 diabetes mellitus.
The study was conducted on 85 subjects, divided into 2 groups.
The control group (groupI): (25 volunteers) who were healthy participants and patient group (groupII ) which included 60 diabetic type 2 patients of matched age and gender with the control with no past history of any chronic medical illnesses.
All subjects (Patients and control) were subjected to: full Clinical history and physical examination.
Laboratory studies were done including:
• Lipid peroxidation (TBARS)
• Glutathione peroxidase
• Superoxide dismutase,
• Catalase,
• Plasma ascorbate concentration,
• Urinary albumin creatinine ratio
• A lipid panel,
• Fasting plasma insulin,
• Fasting blood glucose,
• HOMA-IR
Duplex study :to estimate (Flow Mediated Dilatation), Brachial artery diameter and blood velocity (V mean), Percent FMD, and Reactive hyperemia.
Echocardiography
To Determine intima-media thickness of aorta, ejection fraction of left ventricle- left ventricular diameter in diastole. Left ventricular diameter in systole and Left ventricle hypertrophy.
Results:
It was found that:
1-Plasma levels of ascorbate, SOD, catalase and glutathione were highly significantly decreased, while plasma lipid peroxidation levels were highly significantly raised in patients’ group than those of control (p< 0.01). Urinary ACR, plasma total cholesterol and LDL were highly significantly raised in patients’ group than that of control group (p< 0.001). The Plasma TG was insignificantly raised in diabetic patients’ group in relation to the control (P<0.5).
3- Fasting plasma insulin was highly significantly decreased in diabetic patients than control (p< 0.001) and did not correlate with FMD
4-Simple logistic analysis predicting ED in diabetic patients showed that increased FBS (p-0.001), T. cholesterol (p-0.003) and LDL (p-0.002) had highly significant predictive value in diagnosis of ED. Meanwhile; in simple discriminant functional analysis; plasma SOD Catalase, Glutathione and ascorbate showed (100%) diagnostic accuracy but lipid peroxidation and IM thickness showed less diagnostic accuracies (89.7% and 74.4% respectively) for ED
5-Brachial volume blood flow and mean velocity were highly significantly decreased in patients’ group than those of control (p-0.005 & p- 0.002) respectively. Meanwhile; brachial artery diameter, reactive hyperemia and FMD showed insignificant difference with those of control.
6-FMD showed highly significant correlation with plasma ascorbate level and BMI (p= 0.005 and p= 0.007 respectively) meanwhile; showed inverse significant correlation with plasma lipids (p= 0.01).
7-FMD in patients’ group showed insignificant inverse correlation with urinary ACR (p=0.72), patients’ ages (p=0.39), and duration of diabetes (p=0.2).
The simple linear regression analysis showed that total cholesterol and LDL levels can predict FMD significantly (p=0.01). However, lipid peroxidation showed insignificant correlation with FMD (p=0.367) and HOMA –IR (p=0.94).
8-IM thickness of aorta was highly significantly increased in diabetic patients than control (0.3 ± 0.1 Vs 0.2±0.1, p-0.001) and the simple linear regression analysis showed that IMT can significantly predict FMD (p= 0.02) also can predict ED in diabetic patients. It showed diagnostic accuracy only 74.4% (p- 0.002) for prediction of ED.
9- Simple logistic regression analysis for prediction of endothelial dysfunction in type 2-DM showed that velocity mean2 (p-0.002), FBS (p-0.001), urinary ACR (p-0.001), total cholesterol (p-0.003), and LDL (p-0.002), showed the highest predictive values while; Waist circumference (P-0.03), systolic BP. (p-0.01), diastolic BP. (P-0.03), brachial volume blood flow (p-0.01), and velocity mean1 (P-0.01), showed the least predictive value.
10-ROC curve analysis of variables for prediction of endothelial dysfunction showed that plasma ascorbate, SOD, Catalase, glutathione, urinary ACR and lipid peroxidation had the highest diagnostic accuracy (96.1-100%) while waist circumference, diastolic BP., velocity mean 1, intima/media thickness and brachial volume blood flow 2 showed the lowest diagnostic accuracy (62.8 – 74.4%).
11- LT ventricular diameter in diastole was significantly raised in patients’ group than control (p=0.034). Simple linear regression analysis showed that ejection fraction of Lt ventricle can highly significantly predict FMD (p=0.004). In simple linear regression it showed significant value in prediction of ED in diabetic patients (p= 0.05).
12- simple logistic analysis in patients showed that urinary ACR (P-0.001) is highly significant in prediction of endothelial dysfunction in diabetic patients (P-0.001).
13- ROC curve analysis of variables for prediction of diabetes with endothelial dysfunction showed that urinary ACR highest diagnostic accuracy (96.1-100%).