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1 (2 ) ,,,,,,,, - :... /-/ u/kg. (CRP, : (mg/dl ),ACTH. ACTH TNF-α, IL-8, IL-6, IL-1β) : TNF-α, IL-6,IL-1β.(P</) IL-8 CRP (P</). :.,,,,:, - -, - : :,,, : emrc@tums.ac.ir : 87/12/22 : 86/10/6 : 86/7/15:

2 ... : BMI :. - kg/m2 ) ( <%) ( ( ) ( ) mg/dl <. CBC diff,bun,cr,ast.,alt,alk-ph /-/ u/kg ( Accu-Check ). mg/dl ). mg/dl % cc/h % [] IL-6 TNF- [ ] [] α. -. [-] -.[].[-] [] (DKA) DKA ( IL-8,IL-1B,TNF-α,IL-6) () ( CRP) ) ( ). (.[]. 1 -Diabetic ketoacidosis 2 - Proinflamatory cytokines

3 141 (2 ) BMI ±. kg/m2. mg/dl. ACTH ( ). ( ) (P<0.05) CRP TNF-α,IL-8,IL-6,IL-1B TNF-α, IL-6, IL-1β (P</) IL-8 CRP.().( )(P</) TNF-α.. TNF-α IL-6 IL-1β.(P</) P=/.. ( ) 1 - Counter Regulatory Hormones.( mg/dl mg/dl CRP,TNF-α,IL-8,IL-6,IL-1B ACTH,,,,... EDTA B Jouan - rpm Promokine ELISA Mono Baind(USA) ELISA () LDN EIA Specteria RIA (Germany) IRMA ACTH IRA Immunotech. SPSS ANOVA P / finners adjusted P value, ( ). / P

4 ... : /96± 3/11 2/93± 5/90 5/61± 3/95 92/71± 34/28 822/93± 377/ /67± 27/75 14/88± 5/40 13/61± 5/01 9/79 ± 3/08 11/ 44 ± 4/64 (µg/dl)cortisol 22/62± 14/38 29/28± 47/57 137/64± 68/30 643/00± 363/ /31±20/66 53/02± 67/27 980/64± 1051/37 792/86± 337/ /70± 22/14 71/31± 77/ /71± 1055/55 758/86± 425/ /44± 13/25 19/69± 19/45 541/64± 872/45 762/73± 355/59 GH: Growth Hormone, ACTH: Adrenocorticotropin Hormone, BS: Blood Sugar 39 4/76± 12/63 10/06± 9/39 70/21± 30/37 557/40± 433/11 101/4 (ng/ml) GH (pg/ml) ACTH (nmol/l)adrenalin (pg/ml)noradrenalin Mean±SD ±.(P</) (mg/dl)bs P CRP IL-8, IL-1β, IL-6, TNF-α / ± / / ±/ / ± / / ±/ / ±/ / ± / (pg/ml) TNF-α / ± / /±/ / ± / / ± / / ± / / ± / (pg/ml) IL-6 /± / / ±/ / ±/ / ± / / ± / / ±/ (pg/ml) IL-1B /± / /± / / ±/ /± / /± / /± / (pg/ml) IL-8 / ±/ / ±/ / ± / / ±/ / ±/ / ± / (mg/dl)crp /±/ /±/ /±/ /±/ /±/ /±/ (mg/dl)bs IL-6: Interleukin-6, IL-1B: Interleukin-1B, CRP: c Reactive Protein, BS: Blood Sugar Mean±SD ±.(P</) P pg/dl ٩/٠٠ ٨/٠٠ ٧/٠٠ ۶/٠٠ ۵/٠٠ ۴/٠٠ ٣/٠٠ ١٢٠ ١٠٠ ٨٠ ۶٠ ۴٠ mg/dl TNF-a IL6 IL1B glocose ٢/٠٠ ١/٠٠ ٠/٠٠ ٠ ٣٠ ۴۵ ۶٠ ١٢٠ ٢۴٠ ٢٠ ٠ IL-1β IL-6, TNF-α IL-6: Interleukin-6, IL-1B: Interleukin-1B, TNF-α: Tumor Necrosis Factor-α

5 143 (2 ) CRP: C Reactive Protein IL-8: Interleukin-8 mg/l pg/dl ٠/٢۴۵ ٠/٢۴ ٠/٢٣۵ ٠/٢٣ ٠/٢٢۵ ٠/٢٢ ٠/٢١۵ ٠/٢١ ٠/٢٠۵ ٠/٢ ٠/١٩۵ ١۴ ١٢ ١٠ ٨ ۶ ۴ ٢ ٠ ٠ ٣٠ ۴۵ ۶٠ ١٢٠ ٢۴٠ CRP ٠ ٣٠ ۴۵ ۶٠ ١٢٠ ٢۴٠ IL-8 GLUCOSE CRP GLUCOSE IL-8-3 ١٢٠ ١٠٠ ٨٠ ۶٠ ۴٠ ٢٠ ١٢٠ ١٠٠ ٨٠ ۶٠ ۴٠ ٢٠ 15 ٠ ٠ mg/dl mg/dl - -.[] Mast cell ]. IL6 IL-1βTNF-α.

6 ... : 144 CRP, CRP.[] CRP IL-8..[ ] IL-8. IL-8 (OGTT)..[ ] IL-8 (TNF-α, IL-6, IL-1β) Hyperinsulinemic stepped hypoglycemic glucose clamps TNF-α. IL-10. ( ) Down regulation in vitro ) TNF-α ( IL-1β.[] TNF-α.[.[].[ ] TNF-α IL-6 TNF-α IL-6.[] IL-6.[] CRP. ( ) ) ( BMI CRP. IL-6 TNF-α [] [] [] [] CRP.,.[] CRP

7 145 (2 ) [ ] - ( ) [] [] - - [ ].. IL-10 TNF-α mg/dl.. - IL-8 TNF-α IL-4 IL-13 [].[] IL-8 IL-13 IL-10 IL-4. IL-8 Down regulation [] ( DKA).. (Decompensated. metabolic stat),,.,.

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