血清胆红素水平与2型糖尿病视网膜病变的关系研究
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摘要
目的:探讨血清胆红素水平与2型糖尿病(T2DM)视网膜病变(DR)的关系。方法:选取2016年1月至2017年12月广西医科大学第三附属医院收治的180例T2DM患者,分为3组:无DR组(NDR组)、非增生期DR组(NPDR组)及增生期DR组(PDR组),每组60例。另选取在本院行体格检查的60例健康志愿者作为对照组。记录研究对象血清总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、血红蛋白(HB)、糖化血红蛋白(HBa1C)、尿酸(UA)水平等生化指标水平。采用多因素Logistic回归分析方法分析DR发生、发展的影响因素。结果:与对照组比较,NPDR组和PDR组血清TBIL、IBIL、HB、TG、LDL水平显著下降(P<0.05),FBG、2 h PBG、HBa1C水平明显升高(P<0.05);与NDR组比较,NPDR组和PDR组血清TBIL、DBIL、IBIL、HB水平显著下降,且PDR组血清IBIL、HB、HBa1C水平低于NPDR组(P<0.05)。PDR组UA水平显著高于对照组和NDR组(P<0.05)。有序Logistic回归分析结果显示:TBIL、IBIL、HB、FBG、HBa1C为DR发生、发展的保护因素(OR=0.491、0.417、0.975、0.928、0.883,均P<0.05),而UA可能为DR发生、发展的危险因素(OR=1.003,P<0.05)。结论:血清TBIL、IBIL可能在DR的发生、发展中起到保护性作用。
Objective:To investigate the correlation between serum bilirubin level and type 2 diabetic retinopathy(DR).Methods:From January 2016 to December 2017,180 type 2 diabetes patients in our hospital were selected,and divided into 3 groups:NDR group(patients without DR),NPDR group(patients with non-proliferative DR) and PDR group(patients with proliferative DR),with 60 cases in each group.60 healthy volunteers who underwent physical examination in our hospital were selected as a control group.The serum total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),hemoglobin(HB),glycosylated hemoglobin(HBa1 C) and uric acid(UA) levels were recorded.The influence factors of DR occurrence and development were analyzed by multiple logistic regression analysis.Results:Compared with the control group,the serum TBIL,IBIL,HB and HBa1 C levels in NPDR group and PDR group were significantly lower than those in the control group(P<0.05).Compared with NDR group,the serum TBIL,DBIL,IBIL and HB levels in NPDR group and PDR group were significantly lower than those in NPDR group,and the serum IBIL,HB and HBa1 C levels in PDR group were lower than those in NPDR group(P<0.05).The level of UA in PDR group was significantly higher than that in control group and NDR group(P<0.05).Multiple logistic regression analysis showed that TBIL,IBIL,HB,FBG and HBa1 C was the protective factor for the occurrence and development of DR(OR=0.491,0.417,0.975,0.928 and 0.883,P<0 05),and UA might be a risk factor for the occurrence and development of DR(OR=1.003,P<0 05).Conclusion:Serum TBIL and IBIL might play a protective role in the development of DR.
Objective:To investigate the correlation between serum bilirubin level and type 2 diabetic retinopathy(DR).Methods:From January 2016 to December 2017,180 type 2 diabetes patients in our hospital were selected,and divided into 3 groups:NDR group(patients without DR),NPDR group(patients with non-proliferative DR) and PDR group(patients with proliferative DR),with 60 cases in each group.60 healthy volunteers who underwent physical examination in our hospital were selected as a control group.The serum total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),hemoglobin(HB),glycosylated hemoglobin(HBa1 C) and uric acid(UA) levels were recorded.The influence factors of DR occurrence and development were analyzed by multiple logistic regression analysis.Results:Compared with the control group,the serum TBIL,IBIL,HB and HBa1 C levels in NPDR group and PDR group were significantly lower than those in the control group(P<0.05).Compared with NDR group,the serum TBIL,DBIL,IBIL and HB levels in NPDR group and PDR group were significantly lower than those in NPDR group,and the serum IBIL,HB and HBa1 C levels in PDR group were lower than those in NPDR group(P<0.05).The level of UA in PDR group was significantly higher than that in control group and NDR group(P<0.05).Multiple logistic regression analysis showed that TBIL,IBIL,HB,FBG and HBa1 C was the protective factor for the occurrence and development of DR(OR=0.491,0.417,0.975,0.928 and 0.883,P<0 05),and UA might be a risk factor for the occurrence and development of DR(OR=1.003,P<0 05).Conclusion:Serum TBIL and IBIL might play a protective role in the development of DR.
引文
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[13] 陈芳,黄薇,闫慧娴.血清总胆红素与糖尿病视网膜病变相关性的临床研究[J].中华临床医师杂志,2015,9(14):2665-2668.
[14] 佘新平,朱丹丹,郑志.尿酸在糖尿病视网膜病变中的作用研究现状及进展[J].中华眼底病杂志,2018,34(4):401-404.
[2] YAU J W Y,ROGERS S L,KAWASAKI R,et al.Global prevalence and major risk factors of diabetic retinopathy[J].Diabetes Care,2012(35):556-564.
[3] CHEUNG N,MITCHELL P,WONG T Y.Diabetic retinopathy [J].Lancet,2010,376:124-136.
[4] 高丽涛,柳丽敏,张媛媛,等.糖尿病视网膜病变的危险因素分析[J].眼科新进展,2011,31:742-744.
[5] DORRELLM I, AGUILAR E, JACOBSON R, et al. Maintaining retinal astrocytes normalizes revascularization and prevents vascular pathology as sociated wih oxygen induced retinopathy[J].Glia,2010(58):43-54.
[6] BARANANO D E,RAO M,FERRIS C D,et al.Biliverdin reductase:A major physiologic cytoprotectant[J].Proc Natl Acad Sci U S A,2002,9:16093-16098.
[7] SHIMIZU M,SIKAWA Y,YACHIE A.Role of 18-fluoro-2-deoxyglucose positron emission tomography indetecting acute inflammatory lesions of non-bacterial osteitis in patients with a fever of unknown origin:a comparative study of 18-fluoro-2-deoxyglucose positron emission tomography,bonescan,and magnetic resonance imaging[J].Modern Rheumatology,2016,28(6):1058-1062.
[8] SEDLAK T W,SALEH M,HIGGINSON D S,et al.Bilirubin and glutathione have complementary antioxidant and cytoprotective roles[J].Proc Natl Acad Sci USA,2009,106(13):5171-5176.
[9] LIU J,WANG L,TIAN X Y,et al.Unconjugated bilirubin mediates heme oxygenase-1-induced vascular benefits in diabetic mice[J].Diabetes,2015(64):1564-1575.
[10] SEKIOA R,TANAKA M,NISHIMURA T,et al.Serum total bilirubin concentration is negatively associated with increasing severity of retinopathy in patients with type 2 diabetes mellitus[J].J Diabetes Complications,2015(29):218-221.
[11] DAVE A,KALRA P,GOWDA B H,et al.Association of bilirubin and malondialdehyde levels with retinopathy in type 2 diabetes mellitus[J].Indian J Endocrinol Metab,2015,19:373-377.
[12] YASUDA M,KIYOHARA Y,WANG J J,et al.High serum bilimbin levels and iabetic retinopathy:the Hisayama study[J].Ophthalmology,2011,118(7):1423-1428.
[13] 陈芳,黄薇,闫慧娴.血清总胆红素与糖尿病视网膜病变相关性的临床研究[J].中华临床医师杂志,2015,9(14):2665-2668.
[14] 佘新平,朱丹丹,郑志.尿酸在糖尿病视网膜病变中的作用研究现状及进展[J].中华眼底病杂志,2018,34(4):401-404.