2型糖尿病下肢血管病变患者血清总胆红素水平及与血小板参数的关系  

Relationship between serum total bilirubin level,diabetic nephropathy and platelet parameters in patients with T2DM accompanied with peripheral arterial disease

作　　者：晏丕军[1] 冯健[2] 张志红[1] 徐勇[1] 欧阳芳[1] 何建华[1] 李佳[1] 马红艳[1] 

机构地区：[1]泸州医学院附属医院内分泌科,四川泸州646000 [2]泸州医学院附属医院心血管内科

出　　处：《中国老年学杂志》2016年第1期64-67,共4页Chinese Journal of Gerontology

基　　金：国家自然科学基金青年基金(31300946);泸州市科技局基金项目〔2013-S-48(22/30)〕;泸州医学院科研项目(2012QN-29);泸州医学院附属医院科研项目(12295)

摘　　要：目的探讨2型糖尿病(T2DM)下肢血管病变(PAD)患者血清总胆红素(TBIL)水平与糖尿病肾病(DN)和血小板(PLT)参数的关系及其在PAD发病中的作用机制。方法 145例T2DM患者,根据踝肱指数(ABI)分为下肢血管病变组(PAD组,64例)和非下肢血管病变组(NPAD组,81例),采用酶法测定血清TBIL水平,并分析血清TBIL水平与ABI、胱抑素(Cys)-C、尿微量白蛋白/尿肌酐(UACR)、预估肾小球滤过率(e GFR)、PLT参数和血糖、血脂、血压等指标的关系。结果 PAD组血清TBIL水平明显低于NPAD组〔(10.25±3.01)vs(12.68±3.51)μmol/L,P<0.01〕。相关分析显示PAD患者血清TBIL水平与直接胆红素(DBIL)、间接胆红素(IBIL)、血小板(PLT)计数、ABI和e GFR呈明显正相关(P<0.05或P<0.01),与PLT平均体积(MPV)、PLT比容(PCT)、血肌酐(Scr)、Cys-C和UACR呈明显负相关(P<0.05或P<0.01)。多元逐步回归分析显示,ABI、Cys-C和MPV是影响PAD患者血清TBIL水平的独立相关因素。结论 PAD患者血清TBIL与DN、PLT参数有关,其可能通过增加氧化应激、炎症反应和胰岛素抵抗,引起血管内皮功能失调、血栓形成和动脉粥样硬化等,进而参与PAD的发生发展。Objective To investigate the change of serum total bilirubin（ TBIL） level and evaluate the relationship of TBIL with diabetic nephropathy（ DN） and platelet parameters in patients with type 2 diabetes mellitus（ T2DM） accompanied with peripheral arterial disease（ PAD）,and explore the role and mechanisms of TBIL in PAD patients. Methods 145 T2 DM patients were divided into PAD group（ 64 cases） and NPAD group（ 81 cases） according to ankle brachial index（ ABI）. Fasting serum TBIL levels were measured by enzymatic method. The relationship between serum TBIL levels,ABI,cystatin（ Cys）-C,urine microalbuminuria： creatinine ratio（ UACR）,estimated glomerular filtration rate（ e GFR）,platelet parameters,glucose and blood lipid,blood pressure and other parameters were also analyzed. Results PAD patients had lower serum TBIL level than NPAD patients〔（ 10. 25 ± 3. 01） vs.（ 12. 68 ± 3. 51） μmol / L,P〈0. 01〕. Serum TBIL levels were correlated positively with direct bilirubin（ DBIL）,indirect bilirubin（ IBIL）,platelet counting（ PLT）,ABI and e GFR（ P〈0. 05 or P〈0. 01）,and negatively correlated with mean platelet volume（ MPV）,platelet pressure accumulates（ PCT）,serum creatinine（ Scr）,CysC and UACR in PAD patients（ P〈0. 05 or P〈0. 01）. ABI,Cys-C and MPV were independently related factors influencing serum TBIL levels. Conclusions Serum TBIL levels are well correlated with DN and platelet parameters,which might cause vascular endothelial dysfunction,thrombosis and AS through increasing oxidative stress,inflammatory reaction and IR in PAD patients.

关 键 词：糖尿病下肢血管病变 总胆红素 糖尿病肾病 血小板参数 

分 类 号：R587[医药卫生—内分泌]