2型糖尿病患者血清胆红素水平与糖尿病病程负相关

Increased duration of diabetes is associated with lower serum bilirubin concentration in type 2 diabetic patients

目的分析2型糖尿病患者生理范围内血清胆红素水平与糖尿病病程的相关性。方法收集2013年1月至2015年6月在宁波市第一医院收治的1272例2型糖尿病患者临床资料及生化指标。将病程按四分位数分为Q1组（〈5年）、Q2组（5~9年）、Q3组（10~14年）和Q4组（≥15年）。采用协方差分析计算校正后的各组总胆红素、直接胆红素和间接胆红素水平并比较组间变化趋势。采用Pearson相关分析和多元线性回归分析胆红素和糖尿病病程的相关性。结果在校正了年龄、性别、血红蛋白、吸烟、饮酒、血压、肝酶、血脂、体重、血糖和使用他汀类药物等因素后，三种胆红素水平均随病程的延长而逐步下降。Pearson相关分析显示病程与总胆红素、直接胆红素、间接胆红素呈负相关（r=-0.24、-0.23、-0.21，均P〈0.01）。多元线性回归分析显示，糖尿病病程和胆红素存在独立的相关关系（总胆红素：β=-0.087，95%CI：0.135^-0.040；直接胆红素：β=-0.037，95%CI：-0.057^-0.017；间接胆红素：β=-0.051，95%CI：-0.084^-0.018）。病程每增加1年，血清总胆红素下降0.087mmol/L，直接胆红素下降0.037mmol/L，间接胆红素下降0.051mmol/L。结论2型糖尿病患者血清胆红素水平与糖尿病病程呈负相关。

Objective To investigate the association between physiological serum bilirubin concentration and duration of type 2 diabetes. Methods A total of 1 272 patients with type 2 diabetes admitted to the Department of Endocrinology of Ningbo First Hospital from January 2013 to June 2015 were included for the study. Clinic parameters were collected from electronic medical records. All subjects were classified into four groups by diabetes duration quartiles （〈5 years, 5-9 years, 10-14 years and≥15 years）. The adjusted concentration of three types of bilirubin were calculated and compared using covariance analysis. Pearson correlation analysis and multiple linear regression analysis were adopted to examine the relationship between duration of diabetes and serum bilirubin. Results With increase of diabetes duration from the lowest quartiles to the highest quartiles, serum total bilirubin, direct bilirubin and indirect bilirubin concentration tended to decrease. This trend persisted after adjustment for age, gender, hemoglobin, smoking, drinking, blood pressure, lipid profile, weight, ALT, AST, HbA1c and statin use. The adjusted mean concentration of total bilirubin from the lowest quartiles to the highest quartiles for diabetes duration was 13.26, 12.36, 12.07 and 11.71mmol/L （F=4.36, P=0.005）. The direct bilirubin was 5.01, 4.67, 4.47 and 4.35mmol/L （F=4.63, P=0.003）.The indirect bilirubin was 8.25, 7.69, 7.60 and 7.37 μmol/L（F=2.96, P=0.033）. Pearson correlation analysis showed that total bilirubin concentration （r=-0.241, P〈0.01）, direct bilirubin concentration （r=-0.23,P〈0.01）, and indirect bilirubin concentration （r=-0.21,P〈0.01） were inversely correlated with duration of diabetes. Multiple linear regression analysis showed that an increment of one year in diabetes duration was associated with 0.087mmol/L decrease in total bilirubin, 0.037mmol/L in direct bilirubin and 0.051mmol/L in indirect bilirubin separately. Conclusion Serum bilirubin concentration is negatively correlated with duration of type 2 diabetes mellitus in Chinese patients.