血清直接胆红素与间接胆红素水平均与糖尿病肾病相关

Serum direct bilirubin and indirect bilirubin levels were both associated with diabetic nephropathy

目的探讨血清胆红素水平包括直接胆红素和间接胆红素与2型糖尿病患者估计肾小球滤过率（eGFR）和尿蛋白排泄率的相关性。方法回顾性观察2016年1月至2017年8月收治的2型糖尿病患者2 390例，收集入院时的总胆红素、直接胆红素、间接胆红素、eGFR、尿微量白蛋白/尿肌酐（UACR）等资料。将总胆红素、直接胆红素和间接胆红素按四分位数分别分组（由低到高T1- T4组、D1- D4组和I1- I4组），分析它们与eGFR和UACR的相关性。结果协方差分析中，T1组的UACR显著高于其他组[18.79（10.67，53.99）mg/g比15.91（9.86，36.12）、16.10（9.35，29.75）和16.38（9.95，33.44）mg/g]（P〈0.01），eGFR显著低于其他组。而D1- D4组间、I1- I4组间的UACR和eGFR也存在着显著差异（P〈0.01）。Pearson相关分析显示，血清总胆红素、直接胆红素、间接胆红素水平均与eGFR呈正相关（总胆红素：P〈0.01，r=0.107；直接胆红素：P=0.001，r=0.076；间接胆红素：P〈0.01，r=0.110），与UACR呈负相关（总胆红素：P〈0.01，r=-0.093；直接胆红素：P〈0.01，r=-0.078；间接胆红素：P〈0.01，r=-0.090）。多元回归分析显示，在校正了年龄、性别、病程、体质量指数、糖化血红蛋白、舒张压之后，血清总胆红素、直接胆红素、间接胆红素与eGFR和UACR的线性关系仍然存在（P〈0.05）。结论血清胆红素水平，包括直接胆红素与间接胆红素，均与eGFR呈正相关，与UACR呈负相关。

ObjectiveTo assess the correlation between serum bilirubin levels （including direct bilirubin and indirect bilirubin） and estimated glomerular filtration rate （eGFR）, urinary albumin excretion in type 2 diabetic mellitus patients. MethodsA total of 2 390 patients with type 2 diabetes were included. Serum total bilirubin, direct bilirubin, indirect bilirubin, eGFR, urine albumin/uric creatinine rate （UACR） and other information were collected retrospectively. Patients were divided into 4 groups based on the total bilirubin, direct bilirubin and indirect bilirubin separately （from low to high T1 to T4 group, D1 to D4 group and I1 to I4 group）. ResultsUACR was significantly higher in T1 group than that in T2, T3 and T4 groups： 18.79 （10.67, 53.99） mg/g vs. 15.91 （9.86, 36.12）, 16.10 （9.35, 29.75） and 16.38 （9.95, 33.44） mg/g （P 〈 0.01）; and eGFR was significantly lower. In D1 to D4 group and I1 to I4 groups, there were statistical differences in UACR and eGFR （P〈0.01）. Pearson correlation analyses showed that serum total bilirubin, direct bilirubin and indirect bilirubin were positively correlated with eGFR （r= 0.107, 0.076 and 0.110; P 〈 0.01）, and inversely correlated with UACR （r=-0.093,-0.078 and-0.090; P 〈 0.01）. Multiple linear regression analysis showed linear relationships between serum total bilirubin, direct bilirubin, indirect bilirubin and eGFR, UACR still existed after adjustment of age, gender, duration of diabetes, BMI, glycosylated hemoglobin A1c and diastolic blood pressure （P 〈 0.05）. ConclusionsSerum total bilirubin, direct bilirubin and indirect bilirubin are all positively correlated with eGFR, and inversely correlated with UACR.