上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2013, Vol. 33 ›› Issue (6): 813-.doi: 10.3969/j.issn.1674-8115.2013.06.023

• 论著（临床研究） • 上一篇    下一篇

2型糖尿病患者血清胆红素水平与糖尿病肾病的关系

吴景程1,2，李晓华1，彭永德1   

  1. 1.上海交通大学附属第一人民医院内分泌代谢科， 上海 200080； 2.江苏大学 临床医学院， 镇江 212013
  • 出版日期:2013-06-28 发布日期:2013-06-28
  • 通讯作者: 彭永德, 电子信箱: pengyongde0908@126.com。
  • 作者简介:吴景程（1976—）， 男， 讲师， 博士; 电子信箱: wjc0487@163.com。
  • 基金资助:

    江苏省自然科学基金项目（BK2011471）；江苏大学高级人才启动基金项目（12JDG047）

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

WU Jing-cheng1, 2, LI Xiao-hua1, PENG Yong-de1   

  1. 1.Department of Endocrinology and Metabolism, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China; 2.Clinical Medicine School of Jiangsu University, Zhenjiang 212013, China
  • Online:2013-06-28 Published:2013-06-28
  • Supported by:

    Natural Science Foundation of Jiangsu Province, BK2011471； Research Foundation for Advanced Talents of Jiangsu University, 12JDG047

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摘要：

目的 探讨2型糖尿病（T2DM）患者血清胆红素水平与糖尿病肾病（DN）的关系。方法 收集461例 T2DM患者（T2DM组）的临床资料，记录空腹血糖、肝肾功能和血脂谱等生化指标，根据尿白蛋白/肌酐比值（ACR）将T2DM组患者再分为正常蛋白尿组（NA组，n=221）、微量白蛋白尿组（MA组，n=191）和大量白蛋白尿组（OA组，n=49），以301名健康体检者作为正常对照组。结果 T2DM患者血清总胆红素（TBIL）和直接胆红素（DBIL）水平显著低于正常对照组，这种差异在校正其他影响因素后仍然存在（P<0.01，P<0.05）。T2DM患者的血清TBIL和DBIL水平，NA组>MA组>OA组，组间比较差异均有统计学意义（P<0.01）。按照血清TBIL水平的三分位点将T2DM患者分为三组进行分析的结果显示：随着血清TBIL水平的升高，ACR逐渐降低（P<0.01），肾小球滤过率则逐渐升高（P<0.05）；多元逐步回归分析提示TBIL是ACR的独立影响因素（β=－0.15，P<0.01）。结论 在T2DM患者中，血清高胆红素水平对DN的发生和发展起保护作用。

关键词: 糖尿病肾病, 血清胆红素, 2型糖尿病

Abstract:

Objective To investigate the relationship between serum bilirubin and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods The clinical data of 461 patients with T2DM (T2DM group) were collected, and biochemical parameters such as fasting blood glucose, liver and renal function and blood lipid profile were recorded. Patients in T2DM group were subdivided into normal albuminuria group (NA group, n=221), microalbuminuria group (MA group, n=191) and overt albuminuria group (OA group, n=49) according to albumin to creatinine ratio (ACR). Besides, 301 healthy people were served as controls. Results The levels of serum total bilirubin (TBIL) and direct bilirubin (DBIL) in T2DM group were significantly lower than those in control group, and the differences still existed after adjustment of other influencing factors (P<0.01, P<0.05). The levels of serum TBIL and DBIL were highest in NA group and lowest in OA group, and there were significant differences among NA group, MA group and OA group (P<0.01). Patients in T2DM group were divided into three groups by the quartile of serum TBIL, and it was revealed that ACR decreased with serum TBIL (P<0.01) while glomerular filtration rate increased with serum TBIL (P<0.05). Multiple stepwise regression analysis indicated that TBIL was independently associated with ACR (β=－0.15, P<0.01). Conclusion Serum bilirubin is a protective factor in the onset and development of DN in patients with T2DM.

Key words: diabetic nephropathy, serum bilirubin, type 2 diabetes mellitus