血清总胆红素与糖尿病肾病因果关系分析  

Casual analysis between serum total bilirubin and diabetic nephropathy

作　　者：夏淼 王敏珍[1] 赵增毅 邢玉微[2] 赵维丽[2] 杨洪燕 刘赞朝[2] XIA Miao;WANG Minzhen;ZHAO Zengyi;XING Yuwei;ZHAO Weili;YANG Hongyan;LIU Zanchao(Department of Epidemiology and Statistics,School of Public Health,Lanzhou University,Lanzhou 730000,China;Hebei Province Key Laboratory of Basic Medicine for Dia-betes,Department of Endocrinology,The Second Hospital of Shijiazhuang City,Shijiazhuang 050051,China)

机构地区：[1]兰州大学公共卫生学院流行病与卫生统计学研究所,兰州730000 [2]河北省糖尿病基础医学研究重点实验室,河北省石家庄市第二医院内分泌科,石家庄050051

出　　处：《中华疾病控制杂志》2023年第5期551-556,568,共7页Chinese Journal of Disease Control & Prevention

基　　金：河北省卫生厅科研基金项目重点科技研究计划(20190156)。

摘　　要：目的采用断点回归设计(regression discontinuity design,RDD)探讨血清总胆红素(total bilirubin,TBIL)与糖尿病肾病(diabetic nephropathy,DN)的因果关系。方法以石家庄市第二医院就诊2型糖尿病(type 2 diabetes mellitus,T2DM)患者为研究对象,分析其DN患病现状,应用logistic回归分析模型探讨DN影响因素,建立风险预测模型,得出DN个体患病概率值,以TBIL为分组变量,DN风险概率为结局变量,进行RDD分析。结果4173例糖尿病患者中,DN 507例,检出率12.15%。在DN风险预测模型中,预测因素为高脂血症、吸烟、饮酒、饮食控制、运动情况、降糖药物使用、糖尿病病程、尿素氮、SBP、TBIL。DN风险预测模型受试者工作特征(receiver oper⁃ating characteristic,ROC)曲线下面积(area under curve,AUC)为0.758(95%CI:0.736~0.779)。TBIL是DN的保护因素(OR=0.967,95%CI:0.948~0.987);当TBIL=8μmol/L时,DN风险下降5.02%(P=0.004)。结论TBIL是DN的保护因素;当TBIL=8μmol/L时,患DN风险降低。Objective To explore the causal relationship between serum total bilirubin(TBIL)and diabetic nephropathy(DN)using a regression discontinuity design(RDD)approach.Methods We analyzed data from 4173 participants with type 2 diabetes mellitus(T2DM)at the Second Hospital of Shijiazhuang City.The prevalence of DN was assessed,and significant influencing factors were selected through logistic regression analysis.A risk prediction model was established,and individual DN risk was calculated.RDD was performed using TBIL as the grouping variable and individual DN risk as the out⁃come variable.Results Of the 4173 patients with T2DM,507 had DN(12.15%).The DN risk predic⁃tion model identified hyperlipidemia,smoking,drinking,diet control,physical exercise,hypoglycemic drugs,diabetes course,blood urea nitrogen,systolic blood pressure and TBIL as predictive factors.The area under the curve(AUC)for the model was 0.758(95%CI:0.736-0.779).TBIL was found to be an protective factor for DN(OR=0.967,95%CI:0.948-0.987);at TBIL=8μmol/L,the risk of DN sig⁃nificantly decreased by 5.02%(P=0.004).Conclusions TBIL is a protective factor for DN,and when TBIL=8μmol/L,the risk of developing DN sharply declines.

关 键 词：血清总胆红素 糖尿病肾病 断点回归设计 风险预测 

分 类 号：R181.1[医药卫生—流行病学]