2型糖尿病增殖期视网膜病变与血清胆红素水平关系的研究

目的研究2型糖尿病长病程的无糖尿病视网膜病变患者(病程≥10年)与增殖期糖尿病视网膜病变患者之间胆红素水平的差异。方法 2010年3月至2011年12月于首都医科大学附属北京同仁医院内分泌科门诊或住院治疗的2型糖尿病患者。其中病程≥10年且无糖尿病视网膜病变(non-diabetic retinopathy,NDR)的患者253例(男女比例为136/117),增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的患者218例(男女比例为98/120)。比较两组患者之间胆红素水平有无差异,对两组之间有差异的参数进行logistic回归分析。结果 NDR组中直接胆红素较PDR组高,2组之间差异有统计学意义(P<0.05)。糖尿病视网膜病变危险因素的Logistic回归分析中发现,年龄及直接胆红素是糖尿病视网膜病变的保护性因素,而收缩压、糖化血红蛋白(HbA1c)是糖尿病视网膜病变的危险因素。结论长病程2型糖尿病无糖尿病视网膜病变组与增殖期糖尿病视网膜病变组的直接胆红素水平差异有统计学意义。胆红素作为体内的生理性抗氧化剂,可能在糖尿病视网膜病变的发生发展中起到保护性作用。

Relationship between serum bilirubin and diabetic retinopathy in patients with type 2 diabetes

Objective To investigate the difference of serum bilirubin between non-diabetic retinopathy(NDR) in long-standing type-2 diabetes mellitus and proliferative diabetic retinopathy(PDR). Methods Type-2 diabetic patients who were out-patient or who attended the department of endocrinology at Capital Medical University affiliated Tongren Hospital between March 2010 and December 2011 were recruited. Of all the patients, 253 had diabetic duration longer than 10 years and non-diabetic retinopathy(NDR)(male female ratio: 136/117), and 218 had proliferative diabetic retinopathy(PDR) and diabetic duration was not restricted(male female ratio: 98/120). Comparing the level of serum bilibubin between the two groups and the significant parameters were taken to the logistic regression formula. Results Both total bilirubin and indirect bilirubin were not significantly different between the two groups(P>0.05), however, patients with NDR had higher direct bilirubin than those with PDR(P<0.05). Concerning sex, male patients in NDR group had higher direct bilirubin than those with PDR. But in female patients, no significant diffenence was found. In the logistic regression analysis about diabetic retinopathy risk factors, age and direct bilirubin were protective factors; and systolic blood pressure, HbA1c were risk factors. Conclusion The level of direct bilirubin between the NDR group with diabetic duration longer than 10 years and PDR was different. Bilirubin is a natural anti-oxidant, and can play a protective role in the onset and development of diabetic retinopathy.