直接胆红素在老年2型糖尿病合并冠心病诊断中的预测价值

Predictive value of direct bilirubin in diagnosis of CHD in senile T2DM patients

目的探讨直接胆红素在老年2型糖尿病(type 2 diabetes mellitus,T2DM)合并冠心病(coronary heart di-sease,CHD)诊断中的预测价值。方法回顾性分析2022年10月1日至2023年10月31日在徐州医科大学附属医院住院治疗并行冠状动脉造影的老年患者412例,将确诊为T2DM-CHD患者210例分为T2DM-CHD组,单纯T2DM患者202例分为单纯T2DM组。同步提取患者一般信息和糖脂代谢、肝肾功能等各项指标。采用二元logistic回归分析和Spearman非参数相关分析各项临床检验指标与T2DM-CHD诊断的相关性,用ROC曲线分析直接胆红素下面积大小。结果与单纯T2DM组比较,T2DM-CHD组年龄、男性、心率、糖化血红蛋白、空腹血糖、肌酐、直接胆红素、载脂蛋白A-Ⅰ、载脂蛋白B显著增高,总胆固醇、低密度脂蛋白胆固醇、白蛋白、间接胆红素显著降低,差异有统计学意义(P<0.05,P<0.01)。多因素二元1ogistic回归分析显示,肌酐、直接胆红素、间接胆红素、载脂蛋白B与诊断分型有关(P<0.05,P<0.01);Spearman非参数相关性分析结果显示,肌酐、直接胆红素与T2DM-CHD呈正相关(r=0.198,P=0.000;r=0.697,P=0.000)。间接胆红素、载脂蛋白B与T2DM-CHD呈负相关(r=-0.141,P=0.003;r=-0.401,P=0.000)。直接胆红素预测T2DM-CHD的曲线下面积显著高于肌酐、间接胆红素和载脂蛋白B(0.902 vs 0.641、0.419、0.268)。结论直接胆红素可作为一个用于识别老年T2DM-CHD、单纯T2DM患者分类的关键预测指标。当T2DM患者直接胆红素>3.89μmol/L时患CHD的可能性大。

Objective To investigate the value of direct bilirubin in predicting the diagnosis of senile diabetes mellitus type 2 complicated with coronary heart disease(T2DM-CHD).Methods A total of 412 senile patients undergoing coronary angiography in Department of Cardiovascular Medicine of Affiliated Hospital of Xuzhou Medical University from October 1,2022 to October 31,2023 were recruited and then divided into T2DM-CHD group(210 patients)and simple T2DM group(202 patients).Their general clinical information,glucose and lipid metabolism,liver and kidney functions and other indicators were collected simultaneously.Binary logistic regression analysis and Spearman non-parametric correlation analysis were used to determine the correlation between clinical indicators and diagnosis of T2DM-CHD,and ROC curve was plotted to analyze the AUC value of direct bilirubin in the diagnosis.Results The T2DM-CHD group exhibited significantly advanced age,larger male proportion,higher heart rate,elevated levels of HbA1c,fas-ting blood glucose,creatinine,direct bilirubin and apolipoprotein A-Ⅰ(ApoA-Ⅰ)and B(ApoB),but,decreased total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),albumin and indirect bilirubin when compared with the T2DM group(P<0.05,P<0.01).Binary logistic regression analysis indicated that creatinine,direct bilirubin,indirect bilirubin,and ApoB were associated with distinct diagnostic categories(P<0.05,P<0.01).Spearman non-parametric correlation analysis revealed that creatinine and direct bilirubin(r=0.198,P=0.000;r=0.697,P=0.000)were positively,while indirect bilirubin and ApoB(r=-0.141,P=0.003;r=-0.401,P=0.000)were negatively correlated with the incidence of T2DM-CHD.Direct bilirubin had an obviously higher AUC value in the prediction of T2DM-CHD than creatinine,indirect bilirubin and ApoB(0.902 vs 0.641,0.419,0.268).Conclusion Direct bilirubin can be used as a key predictor for identifying senile patients of T2DM-CHD and simple T2DM.T2DM patients with direct bilirubin>3.89μmol/L are susceptible to CHD.