الفهرس 
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Abstract
Summary
There is an agreement amongst all professionals that ASD is one of the most puzzling diseases. A dramatic rise in incidence of ASDs has occurred in the past 25 years but it is unclear whether this is an indicative of a true increase in incidence of the disorders or due to broader diagnostic criteria and increased awareness.
There is a growing consensus among scientists and clinicians that ASDs ensue from an interaction between genetic, immunological and environmental factors.
The aim of the present study was to measure the level of TGFβ1 in an Egyptian sample of autistic children comparing them with age and sex matched controls as well as correlating their levels with the clinical outcomes of the disease.
This study comprised 74 children. They were classified into two groups. group I (Autistic patients): It included 42 children diagnosed as having one of the autistic disorders according to the DSM-V (2013) criteria. They were 32 males (76.2%) and 10 females (23.8%). Their ages ranged from 3.6 to 15 years with mean age 6.6, SD ± 2.6 years, and group II (Control group) which included 32 clinically healthy children of comparable age and sex. They were 17 males (53%) and 15 females (47%). Their ages ranged from 3 to 10 years with mean age 5.9, SD ± 1.8 years.
To all studied cases, full history, clinical examination, psychiatric evaluation and measurement of plasma level of transforming growth factor beta 1 (TGF-β1) using ELISA technique were done.
In the current study several risk factors for autism were evaluated. The results showed that 38% of the studied autistic patients had positive history of parental consanguinity and 9.5% of the autistic cases had positive family history of autoimmune diseases, while
higher percent of maternal infection, drugs intake, diseases and bleeding during pregnancy in the autistic cases than controls, and the autistic cases mean maternal age at conception was 27.7 ± 4.4 years while mean birth weight was 3.2 ± 0.6 kg. However On comparing between the studied autistic cases and the control group there was no statistically significant differences as regards the previously mentioned factors; p > 0.05 for all.
On comparing between the autistic patients and controls as regards breast feeding, there was statistically significant difference; p = 0.05, while the artificial feeding and age of onset of weaning had no statistically significant difference; p > 0.05. The current study also revealed 59.5 % of the studied autistic patients had recurrent infections on comparison to 6.2% of controls; p = 0.00. As regards geographical distribution, 81% of the studied autistic cases, while 59.5% of controls were living in urban areas; p = 0.04.
On comparing between the studied autistic patients & the control group in the current study as regards the passive smoking, vaccination, postnatal ICU admission and epilepsy, there were no statistical significance; P > 0.05.
A delay in motor development among autistic patients was documented compared to their matched controls however it was not statistically significant; p = 0.27. Also failure of development of sphincteric control was significantly more prevalent among the autistic patients (45.2%) compared to (22 %) in the controls (p = 0.037). Stereotyping, hyperactivity, sleep problems and GIT problems were significantly more encountered among the autistic patients with statistical significance; p < 0.05 for all, meanwhile lethargy had no statistical significance between the two groups; p > 0.05. The mean IQ of the studied cases (50.2 ± 10.8) was significantly lower than that of the control group (96.8 ± 6.6).
In the current study, the mean of serum transforming growth factor beta 1 (TGF-β1) level in the autistic patients (0.3 ± 0.23) was significantly lower than that of the controls (0.58 ± 0.37); p = 0.000. These levels of TGF-β1 were correlated with autism severity evaluated by CARS with statistical significance; p = 0.046.
On studying the different variables of the studied autistic cases, they showed that recurrent infections were significantly higher in studied cases with lower TGF-β1 level; p = 0.05, also autistic children who received hyperbaric oxygen therapy had significantly higher level of TGF-β1; P < 0.01. As regards geographical distribution, the positivity rate of TGF-β1 was significantly higher in autistic cases living in urban areas than rural; p = 0.04.
Meanwhile there was no statistically significant relationship between TGF-β1 level and other variables, like age, sex, consanguinity, family history of autoimmune diseases, infections during pregnancy, drugs intake during pregnancy, diseases during pregnancy, bleeding during pregnancy, vaccination, passive smoking, EEG, epilepsy and postnatal ICU admission, among the studied cases (p > 0.05 for all). Several clinical characteristics of the autistic cases like lethargy, stereotyping, sleep problems, GIT problems, inappropriate speech and sphincteric control had no statistically significant difference with serum level of TGF-β1; p > 0.05 for all, meanwhile hyperacticivity and eye contact had statistically significant difference with serum level of TGF-β1; p < 0.05 for all.
The current study also revealed a statistically significant positive correlation between serum TGF-β1 level in the autistic cases and IQ; p = 0.03. Also, there was statistically significant negative correlation between serum TGF-β1 protein level and CARS score in the autistic cases; p = 0.04. Meanwhile no significant correlation between serum TGF-β1 protein levels in the autistic cases and age, maternal age, breast feeding duration (months), artificial feeding duration (months),
onset of weaning (months) and number of sessions of oxygen therapy, p > 0.05 for all.
On comparing between autistic patients as regards ATEC subscales, it was found a statistically significant negative correlation between serum level of TGF-β1 and sensory/ cognitive awareness subscale, health/ physical/ behavior subscale and total score of ATEC; p = 0.05 & 0.03 & 0.047 respectively. No statistically significant correlation between serum level of TGF-β1 and speech/ language/ communication subscale and sociability subscale of ATEC; P > 0.05 for all.
The present study showed a statistically significant negative correlation between serum level of TGF-β1 in the autistic children who received hyperbaric oxygen therapy and Health/Physical/ Behavior subscale of ATEC, p= 0.02. No statistically significant correlation between serum level of TGF-β1 protein and Speech/Language/Communication subscale, Sociability subscale, Sensory/Cognitive Awareness subscale of ATEC and ATEC totals in both groups of autistic children regardless recieving hyperbaric oxygen therapy or not; p > 0.05 for all.
Conflict of interest:
No funds and conflicts of interest
Conclusion