糖尿病周围神经病变患者血清总胆汁酸和总胆红素水平变化及其诊断价值分析  

Changes of serum total bile acid and total bilirubin in diabetic peripheral neuropathy patients and their diagnostic value

作　　者：顾冠聪 周懿忆[1] 陈华[1] GU Guancong;ZHOU Yiyi;CHEN Hua(Department of Radioimmunoassay,Luwan Branch of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院放免检验科,上海200025

出　　处：《检验医学与临床》2022年第24期3396-3400,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨糖尿病周围神经病变(DPN)患者血清总胆汁酸(TBA)和总胆红素(TBIL)水平变化及其诊断价值。方法选取2015年1月至2020年9月在该院就诊的2型糖尿病(T2DM)患者363例为研究对象,根据是否发生DPN,分为T2DM组(304例)和T2DM并发DPN组(59例)。比较两组血清TBA、TBIL水平;采用多因素Logistic回归分析T2DM并发DPN的影响因素;采用受试者工作特征(ROC)曲线分析TBA、TBIL水平对T2DM并发DPN患者的诊断价值。结果两组患者年龄、体质量指数、糖尿病病程、空腹血糖、糖化血红蛋白、甘油三酯、载脂蛋白A、TBA、胱抑素C、TBIL、直接胆红素、间接胆红素、尿酸、肌酐、白细胞计数、淋巴细胞计数、血小板计数水平比较,差异有统计学意义(P<0.05)。两组患者糖尿病肾病、糖尿病视网膜病变、外周动脉疾病、糖尿病足溃疡、冠心病比例比较,差异有统计学意义(P<0.05)。血清TBA≤4μmol/L、TBIL≤11μmol/L为T2DM并发DPN的独立危险因素(P<0.05)。TBA诊断T2DM并发DPN的ROC曲线下面积(AUC)为0.634(95%CI 0.560~0.709,P=0.001),灵敏度为86.44%,特异度为35.86%;TBIL诊断T2DM并发DPN的AUC为0.651(95%CI 0.577~0.727,P<0.001),灵敏度为59.32%,特异度为66.12%;TBA联合TBIL对T2DM并发DPN的诊断价值更高,其AUC为0.697(95%CI 0.626~0.769,P<0.001),灵敏度为70.69%,特异度为65.79%。结论低水平的TBA、TBIL可能与DPN有关,TBA和TBIL联合检测对DPN的发生有一定的诊断价值,可能是DPN的潜在生物标志物。Objective To investigate the changes of serum total bile acid(TBA)and total bilirubin(TBIL)levels and their diagnostic value in diabetic peripheral neuropathy(DPN)patients.Methods A total of 363 patients with type 2 diabetes mellitus(T2DM)who were admitted to the hospital from January 2015 to September 2020 were selected as the study subjects.According to whether DPN occurred,they were divided into T2DM group(304 cases)and T2DM with DPN group(59 cases).Serum TBA and TBIL levels were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of T2DM with DPN patients.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of TBA and TBIL in T2DM with DPN patients.Results There were statistically significant differences in age,body mass index,diabetes course,fasting blood glucose,glycosylated hemoglobin,triglyceride,apolipoprotein A,TBA,cystatin C,TBIL,direct bilirubin,indirect bilirubin,uric acid,creatinine,white blood cell count,lymphocyte count and platelet count between two groups(P<0.05).There were statistically significant differences in the proportions of diabetic nephropathy,diabetic retinopathy,peripheral artery disease,diabetic foot ulcer and coronary heart disease between two groups(P<0.05).Serum TBA≤4μmol/L and TBIL≤11μmol/L were independent risk factors for T2DM with DPN(P<0.05).The area under ROC curve(AUC)for TBA diagnosis of T2DM with DPN was 0.634(95%CI 0.560-0.709,P=0.001),the sensitivity was 86.44%,and the specificity was 35.86%.The AUC of TBIL in the diagnosis of T2DM with DPN was 0.651(95%CI 0.577-0.727,P<0.001),the sensitivity was 59.32%,and the specificity was 66.12%.TBA combined with TBIL had a higher diagnostic value for T2DM with DPN,the AUC was 0.697(95%CI 0.626-0.769,P<0.001),the sensitivity was 70.69%,and the specificity was 65.79%.Conclusion Low levels of TBA and TBIL may be related to DPN.Combined detection of TBA and TBIL has certain diagnostic value for the occurrence of DPN,and may be a potential b

关 键 词：糖尿病周围神经病变 2型糖尿病 总胆汁酸 总胆红素 

分 类 号：R587.1[医药卫生—内分泌]