2型糖尿病患者血清胆红素水平与糖尿病视网膜病变的相关性研究

目的探讨不同性别2型糖尿病患者血清胆红素水平与糖尿病视网膜病变(DR)患病风险的相关性。方法共纳入1304例2型糖尿病患者,收集其临床资料,并均进行眼底检查。根据眼底检查结果分为DR组与非DR(NDR)组,分析血清总胆红素、直接胆红素、间接胆红素水平与DR发生的相关性。结果与NDR组相比,DR组总胆红素、直接胆红素、间接胆红素水平显著降低。单因素分析显示,在女性中总胆红素与DR的发生呈负相关(P<0.05),间接胆红素、直接胆红素与DR的发生无明显相关性;在男性中,总胆红素、间接胆红素与DR的发生呈负相关(P<0.01)。调整相关混杂因素后,平滑曲线拟合显示在女性中,总胆红素、间接胆红素水平与DR发生风险呈U型关系;在男性中,总胆红素、间接胆红素与DR发生风险呈负相关。多元回归分析结果显示,调整混杂因素后,在男性中,总胆红素每增加1μmol/L,DR的发生风险降低8%(OR=0.92,95%CI 0.88~0.98,P<0.01);间接胆红素每增加1μmol/L,DR的发生风险降低9%(OR=0.91,95%CI 0.84~0.96,P<0.01)。在女性中,当总胆红素<12.8μmol/L时,总胆红素每增加1μmol/L,DR发生风险降低17%(OR=0.83,95%CI 0.72~0.95,P<0.01);当总胆红素≥12.8μmol/L时,每增加1μmol/L,DR发生风险增加10%(OR=1.10,95%CI 1.01~1.20,P<0.05)。当间接胆红素<9.8μmol/L时,间接胆红素每增加1μmol/L,DR发生风险降低20%(OR=0.80,95%CI 0.68~0.94,P<0.01);当间接胆红素≥9.8μmol/L时,间接胆红素每增加1μmol/L,DR发生风险增加13%(OR=1.13,95%CI 1.01~1.25,P<0.05)。结论在2型糖尿病女性患者中,总胆红素、间接胆红素水平与DR患病风险存在U型关系,在男性患者中,总胆红素、间接胆红素与DR患病风险呈负相关关系,直接胆红素与DR患病风险无明显相关性。

Association between bilirubin levels and diabetic retinopathy in type 2 diabetes mellitus

Objective To investigate the correlation between serum bilirubin level and the risk of diabetic retinopathy(DR)in patients with type 2 diabetes mellitus of different sexes.Methods A total of 1304 patients with type 2 diabetes mellitus were included in this study.The clinical data were collected and fundus examination was performed.According to the results of fundus examination,the patients were divided into DR group and Non-DR(NDR)group.The correlation between the levels of serum total bilirubin,direct bilirubin,indirect bilirubin,and the occurrence of DR was analyzed.Results The levels of total bilirubin,direct bilirubin,and indirect bilirubin in DR group were significantly lower than those in NDR group.Univariate analysis showed that the levels of total bilirubin and indirect bilirubin were negatively correlated with the occurrence of DR(P<0.01).There was no significant correlation between the level of direct bilirubin and the occurrence of DR.Smooth curve fitting showed that there was a U-shaped relationship between the levels of total bilirubin and indirect bilirubin and the risk of DR in women,while a negative correlation between total bilirubin,indirect bilirubin and the risk of DR in men.The results of multiple regression analysis showed that in men total bilirubin increased by 1μmol/L,the risk of DR decreased by 8%(OR=0.92,95%CI 0.88-0.98,P<0.01).Indirect bilirubin increased by 1μmol/L,and the risk of DR decreased by 9%(OR=0.91,95%CI 0.84-0.96,P<0.01).In women,when total bilirubin<12.8μmol/L,for every 1μmol/L increase in total bilirubin,the risk of DR decreased by 17%(OR=0.83,95%CI 0.72-0.95,P<0.01);When total bilirubin≥12.8 umol/L,for every 1μmol/L increase in total bilirubin,the risk of DR increased by 10%(OR=1.10,95%CI 1.01-1.20,P<0.05);When indirect bilirubin<9.8μmol/L,for every 1μmol/L increase in indirect bilirubin,the risk of DR decreased by 20%(OR=0.80,95%CI 0.68-0.94,P<0.01);When indirect bilirubin≥9.8μmol/L,for every 1μmol/L increase in indirect bilirubin,the risk of DR increased by 13%(OR=1.13,95%CI 1.01-1.25,P<0.05).Conclusion This study shows that there is a U-shaped relationship between the levels of total bilirubin and indirect bilirubin and the risk of DR in female patients with type 2 diabetes mellitus,and there is a negative correlation between total bilirubin,indirect bilirubin and the risk of DR in male patients.However,there was no significant correlation between direct bilirubin and DR risk.