糖尿病肾脏疾病患者总胆红素、血尿酸与动脉粥样硬化相关性分析

Correlation Analysis of Total Bilirubin,Serum Uric Acid and Atherosclerosis in Patients with Diabetic Kidney Disease

目的探讨糖尿病肾脏疾病(DKD)患者总胆红素、血尿酸与颈动脉粥样硬化(AS)的关系。方法选取2019年2月-2022年5月聊城市人民医院肾内科收治的90例DKD患者为研究对象,按照慢性肾脏病(CKD)分期分为CKD1~2期、CKD3~4期、CKD5期组,各30例,另选同期健康成年人20名为对照组。记录临床及生化指标,彩超检测颈动脉内膜-中层厚度(CCA-IMT)及粥样硬化斑块(CP)情况,比较各组临床生化及超声指标,分析DKD患者临床生化指标与AS的相关性。结果各组空腹血糖(FBG)、尿素氮(BUN)、肌酐(Cr)、总胆红素(TBIL)、血尿酸(SUA)、收缩压(SBP)、甘油三酯(TG)、IMT、CP比较,差异有统计学意义(P<0.05);单因素相关性分析显示,TBIL与肾小球滤过率(eGFR)呈正相关,与SBP、舒张压(SBP)、BUN、Cr、SUA、IMT呈负相关,SUA与SBP、DBP、BUN、Cr、IMT呈正相关,与TBIL、eGFR呈负相关;多因素线性回归分析显示,TBIL、SUA、总胆固醇(TC)、SBP、eGFR是DKD患者发生AS的危险因素。结论低胆红素血症和高尿酸血症是糖尿病肾脏疾病患者动脉粥样硬化的独立危险因素,这些因素参与了动脉粥样硬化的进展。

Objective To investigate the relationship between total bilirubin,serum uric acid and carotid atherosclerosis in patients with diabetic kidney disease(DKD).Methods A total of 90 patients with DKD admitted to the Department of Nephrology,Liaocheng People's Hospital from February 2019 to May 2022 were selected as the research objects.According to the stage of chronic kidney disease(CKD),they were divided into CKD1-2 group,CKD3-4 group and CKD5 group,with 30 patients in each group.The clinical and biochemical indexes were recorded,and the carotid intima-media thickness(CCA-IMT)and atherosclerotic plaque(CP)were detected by color Doppler ultrasound.The clinical biochemical and ultrasonic indexes of each group were compared,and the correlation between clinical biochemical indexes and atherosclerosis(AS)in DKD patients was analyzed.Results There were significant differences in fasting blood glucose(FBG),urea nitrogen(BUN),creatinine(Cr),total bilirubin(TBIL),serum uric acid(SUA),systolic blood pressure(SBP),triglyceride(TG),IMT and CP among the groups(P<0.05).Univariate correlation analysis showed that TBIL was positively correlated with glomerular filtration rate(eGFR),and negatively correlated with SBP,diastolic blood pressure(SBP),BUN,Cr,SUA and IMT;SUA was positively correlated with SBP,DBP,BUN,Cr and IMT,and negatively correlated with TBIL and eGFR.Multivariate linear regression analysis showed that TBIL,SUA,total cholesterol(TC),SBP and eGFR were risk factors for AS in DKD patients.Conclusion Hypobilirubinemia and hyperuricemia are independent risk factors for atherosclerosis in patients with diabetic kidney disease,and these factors are involved in the progression of atherosclerosis.