2型糖尿病患者血清直接胆红素与血脂的相关性研究

A correlation study between serum direct bilirubin and lipid in type 2 diabetic patients

目的 探讨2型糖尿病患者正常范围内血清DBil水平与血脂的相关性.方法 收集2012年6月-2013年6月在解放军总医院收治的979例2型糖尿病患者临床资料,记录DBil、TC、TG、HDL-C、LDL-C.将DBil按四分位数分为Q1组（＜2.2μmol/L）、Q2组（2.2～＜2.9 μmol/L）、Q3组（2.9 ～ ＜3.9 μmol/L）、Q4组（≥3.9μmol/L）,分析血清DBil水平与血脂的相关性.结果 （1）协方差分析中,调整年龄、性别、糖尿病病程、BMI、吸烟、饮酒、糖化血红蛋白（HbA1c）、空腹血糖、药物治疗、ALT、AST和脂肪肝因素后,Q4组TC、TG、LDL-C水平明显低于Q1～ Q3组,各组间HDL-C水平差异无统计学意义（P=0.65）;（2） Pearson相关分析显示,DBil与TC（r=-0.33,P＜0.01）、TG （r=-0.23,P＜0.01）、LDL-C（r=-0.18,P＜0.01）呈负相关,仅在男性中与HDL-C呈正相关（r=0.14,P＜0.01）;多元线性回归分析显示DBil是TC、TG、LDL-C的独立影响因素;（3）采用logistic回归分析,以Q1组为对照,调整年龄、性别、糖尿病病程、BMI、吸烟、饮酒、HbA1c、空腹血糖、药物治疗、ALT、AST和脂肪肝因素后,Q2 ～ Q4组血脂异常患病风险OR值分别为0.54（95％CI0.35 ～ 0.82,P＜0.01）、0.56（95％ CI0.37 ～0.85,P＜0.01）和0.44 （95％CI0.29～0.69,P＜0.01）;此外,男性、年龄＜55岁、HbA1c≥6.5％、BMI＜ 25 kg/m2和无脂肪肝的患者中Q4组血脂异常患病风险较Q1组显著降低.结论 2型糖尿病患者中正常范围内血清DBil水平与血脂密切相关,可能是血脂异常的独立保护因素.

Objective To investigate the association between DBil with normal range and serum lipid in type 2 diabetic patients.Methods A total of 979 subjects with type 2 diabetes admitted to the Department of Endocrinology of Chinese PLA General Hospital from June 2012 to June 2013 were included for the study.Serum DBil,TC,TG,HDL-C and LDL-C levels were collected for the analyses.Subjects were divided into four groups based on the DBil levels：Q1 group （〈2.2 μmol/L）,Q2 group（2.2-〈 2.9 μmol/L）,Q3 group （2.9-〈 3.9 μmol/L） and Q4 group （≥3.9 μmol/L）.Results （1）TC,TG,LDL-C levels were significantly lower in Q4 group than those in the other three Q groups after adjustment of age,gender,duration of diabetes,BMI,smoking,drinking,glycosylated hemoglobin A1 c （HbA1 c）,fasting plasma glucose（FPG）,medication,ALT,AST and fatty liver.No difference could be viewed in HDL-C level between each group （P =0.65）.（2） Pearson correlation analyses showed that DBil was inversely correlated withTC （r=-0.33,P〈 0.01）,TG （r=-0.23,P〈 0.01）,LDL-C（r =-0.18,P〈 0.01）,and positively correlated with HDL-C level in men （r =0.14,P 〈 0.01）,respectively.Multiple linear regression analyses showed DBil was an independent impact factor for TC,TG and LDL-C.（3） Compared with Q1 group,the odds ratio （OR） for dyslipidemia was 0.54 （95% CI 0.35-0.82,P 〈 0.01）,0.56 （95%CI0.37-0.85,P〈0.01） and 0.44 （95%CI0.29-0.69,P〈0.01） in Q2,Q3 and Q4 group,respectively,after age,gender,duration of diabetes,BMI,smoking,drinking,HbA1c,FPG,medication,ALT,AST and fatty liver were adjusted.Moreover,the OR for dyslipidemia was much lower in Q4 man subjects with age 〈 55 years,HbAlc ≥ 6.5%,BMI 〈 25 kg/m2,and with no fatty liver.Conclusion DBil in normal range was closely associated with lipid profile in type 2 diabetes.It might play a protective effect in dyslipidemia.