不同eGFR的T2DM患者血清总胆红素变化及与胱抑素C的相关性  

Relationship between serum total bilirubin level and Cystatin-C in T2DM patients with different estimate glomerular filtration rate

作　　者：晏丕军[1] 张志红[1] 徐勇[1] 万沁[1] 马红艳[1] 何建华[1] 

机构地区：[1]泸州医学院附属医院内分泌科,泸州646000

出　　处：《安徽医科大学学报》2016年第2期263-267,共5页Acta Universitatis Medicinalis Anhui

基　　金：四川省科技厅基金项目(编号:14JC0158);泸州市科技局基金项目(编号:2013-S-48(22/30));泸州医学院科研项目(编号:2012QN-29);泸州医学院附属医院科研项目(编号:12295)

摘　　要：目的探讨不同预估肾小球滤过率(e GFR)的2型糖尿病(T2DM)患者血清总胆红素(TBIL)与胱抑素C(Cys-c)的关系。方法 1 064例T2DM患者,根据e GFR值分为肾功能正常组(577例)、肾功能轻度减退组(238例)和肾功能中重度减退组(249例),酶法测定血清TBIL水平,分析血清TBIL水平与Cys-c、e GFR和血脂血压等指标的关系。结果肾功能中重度减退组和肾功能轻度减退组血清TBIL水平明显低于肾功能正常组(P<0.05)。肾功能中重度减退组血清TBIL水平低于肾功能轻度减退组(P<0.01)。T2DM伴肾功能减退组患者血清TBIL水平与直接胆红素(DBIL)、间接胆红素(IBIL)、e GFR和高密度脂蛋白胆固醇(HDL-C)呈明显正相关性,与病程、收缩压(SBP)、脉压(PP)、血肌酐(Scr)、Cys-c和血尿素氮(BUN)呈明显负相关性(P<0.05)。校正病程、性别、年龄和体重指数(BMI)后,T2DM伴肾功能减退患者血清TBIL水平与Cys-c仍呈明显负相关性(P<0.01)。性别、BMI、病程、e GFR、PP和HDL-C是影响T2DM伴肾功能减退组患者血清TBIL水平的独立相关因素(P<0.05)。低TBIL组血清Cys-c水平、肾功能中重度减退人数和肾功能减退人数均明显高于高TBIL组,而e GFR明显低于高TBIL组(P<0.01)。结论 TBIL与血清Cys-c水平密切相关,可能在T2DM尤其是肾功能下降的发生发展中具有重要作用,其机制可能与氧化应激、高血压、脂代谢紊乱和炎症反应有关。Objective To investigate the relationship bewteen serum total bilirubin （TBIL） level and Cystatin-C （Cys-c） in type 2 diabetes mellitus （T2DM） patients with different estimate glomerular filtration rate （eGFR）. Methods 1 064 T2DM patients were classified into 3 stages according to eGFR as follows：normal renal function （n = 577 ）, mild renal dysfunction （ n = 238 ）, and moderate or severe renal dysfunction （ n = 249 ）. Fasting serum TBIL levels were measured by enzymatic method. The relationship between serum TBIL levels, Cys-C, eGFR, blood lipid, blood pressure and other parameters were also analyzed. Results Serum TBIL levels were significantly lower in moderate or severe renal dysfunction and mild renal dysfunction groups than those in normal renal function group （P 〈 0.05 ）. Serum TBIL levels were significantly lower in moderate or severe renal dysfunction group than those in mild renal dysfunction group （ P 〈0. 01 ）. Serum TBIL levels were correlated positively with direct biliru- bin （DBIL）, indirect bilirubin （IBIL）, eGFR and high-density lipoprotein cholesterol （HDL-C）, and negatively correlated with disease duration, systolic blood pressure （SBP）, pulse pressure （PP）, serum creatinine （Scr）, Cys-C and blood urea nitrogen（BUN） in T2DM patients with renal dysfunction group （P 〈 0. 05）. Serum TBIL levels in T2DM patients with renal dysfunction were positively correlated with Cys-c after adjusting for disease duration, gender, age and body mass index （BMI） （ P 〈 0. 01 ）. Gender, BMI, disease duration, eGFR, PP and HDL-C were independent related factors influencing serum TBIL levels in renal dysfunction group （P 〈 0. 05 ）. Compared with those of high TBIL levels group, the levels of Cys-c, number of moderate or severe renal dysfunction and number of mild renal dysfunction increased in low TBIL levels group, and eGFR decreased in low TBIL levels group （P 〈 0.01 ）. Conclusion Serum TBIL levels are closely related

关 键 词：预估肾小球滤过率 总胆红素 2型糖尿病 糖尿病肾病 胱抑素C 

分 类 号：R589.1[医药卫生—内分泌]