T2DM患者不同亚型血清胆红素水平与糖尿病肾病的相关性研究  

Correlation between serum bilirubin levels of different subtypes and diabetic nephropathy in patients with type 2 diabetes mellitus

作　　者：阙秋纯 陆春丽[1] 孙明谨[1] 王海燕[1] QUE Qiuchun;LU Chunli;SUN Mingjin;WANG Haiyan(Department of Endocrinology,Suizhou Central Hospital Affiliated to Hubei Medical University,Suizhou 441300,Hubei,China)

机构地区：[1]湖北医药学院附属随州市中心医院内分泌科,湖北随州441300

出　　处：《中国现代医生》2024年第15期18-23,41,共7页China Modern Doctor

基　　金：湖北省科技计划立项项目(2022BCE033)。

摘　　要：目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者不同亚型血清胆红素水平与糖尿病肾病(diabetic nephropathy,DN)的相关性。方法回顾性分析湖北医药学院附属随州市中心医院2019年1月至2023年5月住院的494例T2DM患者的临床资料,按是否为DN将其分为DN组(175例)和非DN组(319例)。分析血清总胆红素(total bilirubin,TBil)、直接胆红素(direct bilirubin,DBil)、间接胆红素(indirect bilirubin,IBil)水平与DN发生的相关性。结果两组患者的年龄、糖尿病病程、高血压、冠心病、吸烟、饮酒、TBil、DBil、IBil、丙氨酸转氨酶(alanine aminotransferase,ALT)、血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、尿酸(uric acid,UA)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、高密度脂蛋白(high density lipoprotein,HDL)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、体质量指数(body mass index,BMI)、收缩压、空腹血糖(fasting plasma glucose,FPG)、估算的肾小球滤过率比较差异均有统计学意义(P<0.05)。年龄、糖尿病病程、高血压、冠心病、TBil、DBil、IBil、ALT、BUN、SCr、UA、TC、TG、HDL、LDL、HbA1c、BMI和FPG是女性T2DM患者发生DN的影响因素(P<0.05),年龄、糖尿病病程、高血压、冠心病、吸烟、饮酒、TBil、DBil、IBil、ALT、BUN、SCr、UA、TC、TG、HDL、LDL、HbA1c、BMI和FPG是男性T2DM患者发生DN的影响因素(P<0.05)。T2DM患者中,TBil、DBil、IBil与DN发生显著相关(P<0.001),随着TBil(1~15μmol/L)、IBil(1~10μmol/L)、DBil(1~4μmol/L)范围内升高,DN发生风险逐渐降低,但在TBil>15μmol/L、IBil>10μmol/L、DBil>4μmol/L后,TBil、DBil、IBil水平增高不再降低DN发病风险。结论T2DM患者的TBil、DBil、IBil水平均与DN患病风险存在非线性关联,一定水平范围内TBil、DBil、IBil是DN发生的独立保护因素,达到一定水平不再降低DN的发生风险;不同性别�Objective To investigate correlation between serum bilirubin levels of different subtypes and diabetic nephropathy(DN)in patients with type 2 diabetes mellitus(T2DM).Methods Clinical data of 494 patients with T2DM admitted to Suizhou Central Hospital Affiliated to Hubei Medical University from January 2019 to May 2023 were retrospectively analyzed,and they were divided into DN group(175 cases)and non-DN group(319 cases)according to whether they had DN.Correlation between levels of total bilirubin(TBil),direct bilirubin(DBil),indirect bilirubin(IBil)in serum and the occurrence of DN were analyzed.Results There were statistically significant differences on age,course of diabetes,hypertension,coronary heart disease,smoking,drinking,TBil,DBil,IBil,alanine aminotransferase(ALT),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),glycosylated hemoglobin(HbA1c),body mass index(BMI),systolic blood pressure,fasting plasma glucose(FPG)and estimated glomerular filtration rate between two groups.Age,course of diabetes,hypertension,coronary heart disease,TBil,DBil,IBil,ALT,BUN,SCr,UA,TC,TG,HDL,LDL,HbA1c,BMI and FPG were influencing factors of DN in female T2DM patients(P<0.05).Age,course of diabetes,hypertension,coronary heart disease,smoking,alcohol consumption,TBil,DBil,IBil,ALT,BUN,SCr,UA,TC,TG,HDL,LDL,HbA1c,BMI and FPG were influencing factors of DN in male T2DM patients(P<0.05).TBil,DBil and IBil were significantly correlated with development of DN in patients with T2DM(P<0.001).Risk of developing DN gradually decreased with increasied TBil(1-15μmol/L),IBil(1-10μmol/L)and DBil(1-4μmol/L),but after TBil>15μmol/L,IBil>10μmol/L and DBil>4μmol/L,increased in TBil,DBil and IBil levels no longer reduced risk of developing DN.Conclusion There is a non-linear correlation between levels of TBil,DBil,IBil and risk of DN in patients with T2DM.Within a certain range,TBil,DBil and IBil are independent protective factors fo

关 键 词：2型糖尿病 总胆红素 间接胆红素 直接胆红素 糖尿病肾病 

分 类 号：R587[医药卫生—内分泌]