血清胆红素水平与2型糖尿病肾病肾衰竭患者左室舒张功能的相关性
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摘要
目的探讨血清胆红素水平与2型糖尿病肾病(DKD)肾衰竭患者左室舒张功能的关系。方法选择2型DKD肾衰竭患者103例(观察组),根据尿白蛋白/肌酐比值水平,患者分为正常白蛋白尿组(NA组)34例、微量白蛋白尿组(MA组)39例和大量蛋白尿组(OA组)30例;依据左心室舒张功能不全(LVDD)的诊断标准,患者分为LVDD组43例和非LVDD组60例。选择健康志愿者58例为对照组。采用全自动生化分析仪检测各组血清总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)水平,采用彩色多普勒超声诊断仪检测左室质量指数(LVMI)、舒张末期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)及左室舒张末容积(LVEDV)、舒张早期最大血流速度E峰/舒张晚期A峰(E/A),分析血清TBIL、DBIL和IBIL水平与左室舒张功能的相关性。结果与对照组相比,观察组血清TBIL、DBIL和IBIL水平均明显下降(P均<0.05);与NA组相比,MA组和OA组血清胆红素水平均降低,同时OA组血清胆红素水平低于MA组(P均<0.05);LVDD组胆红素水平明显低于非LVDD组(P均<0.05)。观察组患者的LVMI、LVPWT、LVEDD及IVST水平明显高于对照组(P均<0.05),而LVEF、LVEDV及E/A水平显著低于对照组(P均<0.05)。DKD患者血清中TBIL水平与IVST、LVEF及E/A呈负相关(r分别为-0.708、-0.716、-0.703,P均<0.05),与LVMI、LVPWT、LVEDD呈正相关(r分别为0.727、0.729、0.732,P均<0.05);血清DBIL水平与IVST及E/A呈负相关(r分别为-0.721、-0.719,P均<0.05),与LVMI及LVPWT呈正相关(r分别为0.706、0.698,P均<0.05);血清IBIL水平与IVST、LVEF及E/A呈负相关(r分别为-0.705、-0.702、-0.651,P均<0.05),与LVMI、LVPWT及LVEDD呈正相关(r分别为0.713、0.719、0.723,P均<0.05)。结论血清胆红素水平可以用于反映2型DKD肾衰竭患者的疾病状态,并且与左室舒张功能密切相关。
Objective To investigate the relationship between serum bilirubin level and left ventricular diastolic function in patients with type 2 diabetic nephropathy( DKD) combined with renal failure. Methods Totally 103 cases of patients with type 2 DKD and renal failure were selected as the observation group. According to the level of urinary albumin/creatinine ratio( UACR),the patients were divided into the normal albuminuria group( NA group,n = 34),microalbuminuria group( MA group,n = 39) and macroalbuminuria group( OA group,n = 30). On the basis of diagnostic criteria of left ventricular diastolic dysfunction( LVDD),patients were divided into patients with LVDD( LVDD group,n = 43) and patients without LVDD( non-LVDD group,n = 60). In addition,58 cases of health volunteers were taken as the control group. The levels of serum total bilirubin( TBIL),direct bilirubin( DBIL),and indirect bilirubin( IBIL) in each group were analyzed by Automatic biochemical analyzer. Meanwhile,the left ventricular mass index( LVMI),end-diastolic ventricular septal thickness( IVST),left ventricular posterior wall thickness( LVPWT),left ventricular end-diastolic diameter( LVEDD),left ventricular ejection fraction( LVEF),and left ventricular end-diastolic volume( LVEDV),and early diastolic blood flow velocity E peak/diastolic late A peak( E/A) were measured by color Doppler ultrasonography. Then,we analyzed the correlation between serum TBIL,DBIL,IBIL levels and left ventricular diastolic function. Results Compared with the control group,the levels of serum TBIL,DBIL and IBIL of the observation group significantly decreased( all P <0. 05). Compared with the NA group,the levels of serum bilirubin of MA group and OA group were significantly lower( P< 0. 05),the level of serum bilirubin in the OA group was lower than that of the MA group( all P < 0. 05),and the level of serum bilirubin in the LVDD group was lower than that of the non-LVDD group( P < 0. 05). The levels of LVMI,LVPWT,LVEDD and IVST of the observation group were significantly higher than those of the control group( all P < 0. 05),while the levels of LVEF,LVEDV and E/A were significantly lower than those of the control group( all P < 0. 05). The serum TBIL level was negatively correlated with IVST,LVEF and E/A of patients with DKD( r =-0. 708,-0. 716,-0. 703,respectively; all P < 0. 05),and was positively correlated with LVMI,LVPWT,and LVEDD( r = 0. 727,0. 729,0. 732,respectively; all P < 0. 05). Serum DBIL level was negatively correlated with IVST and E/A( r =-0. 721,-0. 719; both P < 0. 05),and was positively correlated with LVMI and LVPWT( r = 0. 706,0. 698; both P < 0. 05). Serum IBIL level was negatively correlated with IVST,LVEF and E/A( r =-0. 705,-0. 702,-0. 651,respectively; all P< 0. 05),and was positively correlated with LVMI,LVPWT and LVEDD( r = 0. 713,0. 719,0. 723,respectively; all P <0. 05). Conclusion The level of serum bilirubin could reflect the state of disease in type 2 DKD patients with renal failure,which is closely related to left ventricular diastolic function.
Objective To investigate the relationship between serum bilirubin level and left ventricular diastolic function in patients with type 2 diabetic nephropathy( DKD) combined with renal failure. Methods Totally 103 cases of patients with type 2 DKD and renal failure were selected as the observation group. According to the level of urinary albumin/creatinine ratio( UACR),the patients were divided into the normal albuminuria group( NA group,n = 34),microalbuminuria group( MA group,n = 39) and macroalbuminuria group( OA group,n = 30). On the basis of diagnostic criteria of left ventricular diastolic dysfunction( LVDD),patients were divided into patients with LVDD( LVDD group,n = 43) and patients without LVDD( non-LVDD group,n = 60). In addition,58 cases of health volunteers were taken as the control group. The levels of serum total bilirubin( TBIL),direct bilirubin( DBIL),and indirect bilirubin( IBIL) in each group were analyzed by Automatic biochemical analyzer. Meanwhile,the left ventricular mass index( LVMI),end-diastolic ventricular septal thickness( IVST),left ventricular posterior wall thickness( LVPWT),left ventricular end-diastolic diameter( LVEDD),left ventricular ejection fraction( LVEF),and left ventricular end-diastolic volume( LVEDV),and early diastolic blood flow velocity E peak/diastolic late A peak( E/A) were measured by color Doppler ultrasonography. Then,we analyzed the correlation between serum TBIL,DBIL,IBIL levels and left ventricular diastolic function. Results Compared with the control group,the levels of serum TBIL,DBIL and IBIL of the observation group significantly decreased( all P <0. 05). Compared with the NA group,the levels of serum bilirubin of MA group and OA group were significantly lower( P< 0. 05),the level of serum bilirubin in the OA group was lower than that of the MA group( all P < 0. 05),and the level of serum bilirubin in the LVDD group was lower than that of the non-LVDD group( P < 0. 05). The levels of LVMI,LVPWT,LVEDD and IVST of the observation group were significantly higher than those of the control group( all P < 0. 05),while the levels of LVEF,LVEDV and E/A were significantly lower than those of the control group( all P < 0. 05). The serum TBIL level was negatively correlated with IVST,LVEF and E/A of patients with DKD( r =-0. 708,-0. 716,-0. 703,respectively; all P < 0. 05),and was positively correlated with LVMI,LVPWT,and LVEDD( r = 0. 727,0. 729,0. 732,respectively; all P < 0. 05). Serum DBIL level was negatively correlated with IVST and E/A( r =-0. 721,-0. 719; both P < 0. 05),and was positively correlated with LVMI and LVPWT( r = 0. 706,0. 698; both P < 0. 05). Serum IBIL level was negatively correlated with IVST,LVEF and E/A( r =-0. 705,-0. 702,-0. 651,respectively; all P< 0. 05),and was positively correlated with LVMI,LVPWT and LVEDD( r = 0. 713,0. 719,0. 723,respectively; all P <0. 05). Conclusion The level of serum bilirubin could reflect the state of disease in type 2 DKD patients with renal failure,which is closely related to left ventricular diastolic function.
引文
[1]高珊,张艳,李辉,等.血清直接胆红素与2型糖尿病肾病的相关性分析[J].河北医药,2016,38(5):669-671.
[2]Liu ZH.Nephrology in china[J].Nat Rev Nephrol,2013,9(9):523-528.
[3]张玲明,圈启芳.血清胆红素与糖尿病肾病的关系[J].糖尿病新世界,2016,19(22):130-133.
[4]韦翔,葛平,陶慧,等.2型糖尿病肾病患者血D-二聚体及胆红素水平的变化及意义[J].临床输血与检验,2015,17(6):492-495.
[5]Singh A,Ramnath RD,Foster RR,et al.Reactive oxygen species modulate the barrier function of the human glomerular endothelial glycocalyx[J].PLo S One,2013,8(2):e55852.
[6]于伟红,许毛峰.糖尿病肾病患者心脏舒张功能的分析[J].中国现代药物应用,2013,7(11):70.
[7]周娲,胡文杰,李培芳,等.糖尿病肾病肾功能衰竭患者血清胆红素与左室舒张功能的关系[J].广东医学,2017,38(1):115-117.
[8]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):1-37
[9]周娲,晏慧兰,薛勤,等.糖尿病肾病患者血清胆红素与颈动脉粥样硬化的关系[J].中国中西医结合肾病杂志,2015,16(7):601-603.
[10]Hristovski Z,Projevska-Donegati D,Georgievska-Ismail L.Echocardiographic predictors of chronotropic incompetence to exercise in patients with heart failure with preserved ejection fraction[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2014,35(2):137-145.
[11]Riphagen IJ,Deetman PE,Bakker SJ,et al.Bilirubin and progression of nephropathy in type 2 diabetes:a post hoc analysis of RENAAL with independent replication in IDNT[J].Diabetes,2014,63(8):2845-2853.
[12]薛盛龙,陈绍奉,陈明华,等.高血压合并左室射血分数正常心力衰竭患者的E/E'比值与血浆脑钠肽水平的相关性研究[J].现代实用医学,2013,25(4):392-393.
[13]姚海木,沈德良,赵晓燕,等.血清总胆红素对心绞痛患者经皮冠状动脉介入治疗后的预后价值研究[J].中国全科医学,2015,18(4):408-412.
[14]宋思捷,朱叶芳,党姗姗,等.反式激活蛋白-NEMO结合域抑制核因子-κB活化在胆红素诱导大鼠海马神经元凋亡中的作用[J].南方医科大学学报,2013,33(2):172-176.
[15]袁博,任晖,巩洁,等.射血分数正常的心力衰竭患者血清胆红素水平与舒张功能不全的相关性研究[J].疑难病杂志,2015,14(10):1003-1006.
[2]Liu ZH.Nephrology in china[J].Nat Rev Nephrol,2013,9(9):523-528.
[3]张玲明,圈启芳.血清胆红素与糖尿病肾病的关系[J].糖尿病新世界,2016,19(22):130-133.
[4]韦翔,葛平,陶慧,等.2型糖尿病肾病患者血D-二聚体及胆红素水平的变化及意义[J].临床输血与检验,2015,17(6):492-495.
[5]Singh A,Ramnath RD,Foster RR,et al.Reactive oxygen species modulate the barrier function of the human glomerular endothelial glycocalyx[J].PLo S One,2013,8(2):e55852.
[6]于伟红,许毛峰.糖尿病肾病患者心脏舒张功能的分析[J].中国现代药物应用,2013,7(11):70.
[7]周娲,胡文杰,李培芳,等.糖尿病肾病肾功能衰竭患者血清胆红素与左室舒张功能的关系[J].广东医学,2017,38(1):115-117.
[8]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2010年版)[J].中国糖尿病杂志,2012,20(1):1-37
[9]周娲,晏慧兰,薛勤,等.糖尿病肾病患者血清胆红素与颈动脉粥样硬化的关系[J].中国中西医结合肾病杂志,2015,16(7):601-603.
[10]Hristovski Z,Projevska-Donegati D,Georgievska-Ismail L.Echocardiographic predictors of chronotropic incompetence to exercise in patients with heart failure with preserved ejection fraction[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2014,35(2):137-145.
[11]Riphagen IJ,Deetman PE,Bakker SJ,et al.Bilirubin and progression of nephropathy in type 2 diabetes:a post hoc analysis of RENAAL with independent replication in IDNT[J].Diabetes,2014,63(8):2845-2853.
[12]薛盛龙,陈绍奉,陈明华,等.高血压合并左室射血分数正常心力衰竭患者的E/E'比值与血浆脑钠肽水平的相关性研究[J].现代实用医学,2013,25(4):392-393.
[13]姚海木,沈德良,赵晓燕,等.血清总胆红素对心绞痛患者经皮冠状动脉介入治疗后的预后价值研究[J].中国全科医学,2015,18(4):408-412.
[14]宋思捷,朱叶芳,党姗姗,等.反式激活蛋白-NEMO结合域抑制核因子-κB活化在胆红素诱导大鼠海马神经元凋亡中的作用[J].南方医科大学学报,2013,33(2):172-176.
[15]袁博,任晖,巩洁,等.射血分数正常的心力衰竭患者血清胆红素水平与舒张功能不全的相关性研究[J].疑难病杂志,2015,14(10):1003-1006.