老年2型糖尿病、糖尿病肾病患者血清总胆汁酸水平及其相关因素分析  

Analysis of serum total bile acid level and its related factors in elderly patients with type 2 diabetes mellitus and diabetic nephropathy

作　　者：别甜敏 汪海娅 蔡华杰[1] Bie Tianmin;Wang Haiya;Cai Huajie(Department ofGeriatrics,RenjiHospital,School ofMedicine of Shanghai JiaotongUniversity,Shanghai,200001;Department of Geriatrics,The Ninth People's Hospital,School of Medicine of Shanghai Jiaotong University,Shanghai,200011,P.R.China)

机构地区：[1]上海交通大学医学院附属仁济医院老年科,上海200001 [2]上海交通大学医学院附属第九人民医院老年科,上海200011

出　　处：《老年医学与保健》2020年第4期567-571,593,共6页Geriatrics & Health Care

基　　金：上海申康医院发展中心临床科技创新项目(SHDC20153178)。

摘　　要：目的探讨2型糖尿病(T2DM)、糖尿病肾病(DKD)患者血清总胆汁酸(TBA)水平的变化和影响TBA水平的相关因素。方法选取2017年1月-2018年10月在仁济医院住院的老年T2DM的445例患者作为DM组,同期非2型糖尿病患者作为对照组(NDM组,n=449)。进一步将DM组分成非糖尿病肾组(NDKD组,n=280)与糖尿病肾病组(DKD组,n=165)组。收集研究对象的年龄、性别、身高、体重等一般资料、TBA和其他生化指标,及患者腰围(WC)、糖尿病病程(DD),分析影响TBA的相关因素和各组间临床资料差异性,并分析T2DM合并DKD的危险因素。结果在总人群中,血清TBA水平与年龄、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、糖化白蛋白(GA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、三酰甘油(TG)呈正相关,与高密度脂蛋白胆固醇(HDL-C)呈负相关(均P<0.05)。在校正其他影响因素后,DM组血清TBA水平明显高于NDM组,3.90(95%CI:3.68~4.13)mol/L vs 2.91(95%CI:2.68~3.13)mol/L,P<0.05;DKD组比NDKD组患者血清TBA水平降低,3.10(95%CI:2.71~3.49)vs 4.39(95%CI:4.09~4.69)mol/L,P<0.05。在T2DM组中,以是否合并DKD为因变量,进行多因素Logistic回归分析,结果显示TBA是DKD的保护因素(OR=0.807,95%CI:0.728~0.894,P<0.05)。结论血清TBA水平与胰岛素抵抗水平呈正相关。T2DM患者血清TBA水平升高,但T2DM患者合并DKD时,血清TBA水平降低,胆汁酸(BA)可能是糖尿病肾病的保护因素。Objective To investigate the changes of serum total bile acid(TBA)levels in elderly patients with type 2 diabetes mellitus(T2DM)and diabetic nephropathy(DKD)and the related factors affecting the level of TBA.Methods 445 elderly T2DM patients hospitalized in Renji hospital from January 2017 to October 2018 were selected as DM group,and nontype 2 diabetic patients were selected as control group(NDM group,n=449).The DM group was further divided into nondiabetic nephropathy group(NDKDgroup,n=280)and diabetic nephropathy group(DKDgroup,n=165)group.The general information such as age,gender,height,weight,waist circumference(WC),TBA and other biochemical indicators of all subjects,as well as the diabetes course(DD)were collected.The related factors influencing TBA and the differences of clinical data among groups were analyzed,and the risk factors of T2DM combined with DKD were analyzed.Results Among all the subjects,serumTBA level was positively correlated with age,insulin resistance index(HOMA-IR),glycosylated hemoglobin(HbA1c),glycosylated albumin(GA),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and triacylglycerol(TG),and negatively correlated with high-density lipoprotein cholesterol(HDL-C)(all P<0.05).After adjusting for other influencing factors,the serum TBA level of the DM group was significantly higher than that of the NDM group(P<0.05),the serumTBA levelwas lower than that of theNDKDgroup(P<0.05).In the T2DMgroup,with orwithoutDKD as the dependent variable,a multivariate logistic regression analysis was performed.The results showed that TBA was a protective factor for DKD(OR=0.807,95%CI 0.728~0.894,P<0.05).Conclusion SerumTBA level is positively correlatedwith insulin resistance level.The level of serum TBA increased in T2DM patients,but decreased in T2DM patients with DKD.Bile acid may be a protective factor for diabetic nephropathy.

关 键 词：老年 2型糖尿病 糖尿病肾病 总胆汁酸 胰岛素抵抗 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]