老年2型糖尿病视网膜病变与血清胆红素、胆汁酸水平的关系

doi:10.3969/j.issn.1003-9198.2021.05.017

摘要/Abstract

摘要： 目的研究老年T2DM病人糖尿病视网膜病变(DR)与血清胆红素、胆汁酸水平的关系。方法回顾性分析我院2018～2019年住院的363例老年T2DM病人资料,其中增殖期糖尿病视网膜病变(PDR)者153例,病史>10年且无糖尿病视网膜病变(NDR)者210例。比较2组基本临床资料、血清胆红素及胆汁酸水平;分别依据血清胆红素、胆汁酸水平将所有病人分为低、中、高水平3组,比较各组PDR发生率;采用多因素Logistic回归分析探讨DR的危险因素。结果 NDR组血清胆红素、胆汁酸水平显著高于PDR组(P<0.05),TC、LDL-C、尿白蛋白排泄率(UAER)显著低于PDR组(P<0.05);随着血清胆红素、胆汁酸水平升高,PDR发生率下降;Logistic 回归分析发现,胆红素及胆汁酸是DR的保护性因素,LDL-C和UAER>20 μg/min是危险因素。结论老年T2DM病人血清胆红素及胆汁酸水平与DR相关,可能为保护性因素。

关键词: 老年人, 2型糖尿病, 糖尿病视网膜病变, 胆红素, 胆汁酸

Abstract: Objective To investigate the relationship between serum bilirubin, bile acid and diabetic retinopathy(DR) in the elderly patients with type 2 diabetes mellitus(T2DM). Methods A total of 363 elderly patients with T2DM in our hospital from January 2018 to December 2019 were retrospectively collected, 153 cases of them presenting with diabetic retinopathy(PDR), 210 cases of them presenting with non-diabetic retinopathy (NDR) with course over 10 years. The basic clinical data, serum levels of bilirubin and bile acid of the two groups were compared. All the patients were divided into three groups according to the serum levels of bilirubin or bile acid (low, medium and high level group), and the incidence rate of PDR in each group were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of DR. Result The serum levels of bilirubin and bile acid in the NDR patients were significantly higher than those in the PDR patients(P<0.05); while the levels of cholesterol, low-density lipoprotein cholesterol(LDL-C) and urinary albumin excretion rate(UAER) were significantly lower (P<0.05). The incidence rate of PDR was decreased while the serum levels of bilirubin and bile acid increased. According to the Logistic regression analysis, serum bilirubin and bile acid were protecting factors of DR, while LDL-C and UAER>20 μg/min were risk factors. Conclusions In the elderly patients with T2DM, serum bilirubin and bile acid show particular relationships with DR, which may to be potential protecting factors.

Key words: aged, type 2 diabetes mellitus, diabetic retinopathy, bilirubin, bile acid

中图分类号:

R 587

苏志燕, 刘薇, 史婷婷, 杨金奎. 老年2型糖尿病视网膜病变与血清胆红素、胆汁酸水平的关系[J]. 实用老年医学, 2021, 35(5): 499-502.

SU Zhi-yan, LIU Wei, SHI Ting-ting, YANG Jin-kui. Relationship between serum bilirubin, bile acid and diabetic retinopathy in elderly patients with type 2 diabetes mellitus[J]. Practical Geriatrics, 2021, 35(5): 499-502.

参考文献

[1] KOWLURUR A, ZHONG Q, KANWAR M. Metabolic memory and diabetic retinopathy:role of inflammatory mediators in retinal pericytes [J].Exp Eye Res, 2010, 90(5):617-623.
[2] 中华医学会糖尿病学分会.中国2型糖尿病防治指南年版[J]. 中华糖尿病杂志, 2018, 10(1):4-67.
[3] LECHNER J, O’LEARY O E, STITT A W. The pathology associated with diabetic retinopathy [J]. Vision Res, 2017, 139:7-14.
[4] GARDNER T W, SUNDSTROM J M. A proposal for early and personalized treatment of diabetic retinopathy based on clinical pathophysiology and molecular phenotyping [J].Vision Res, 2017, 139:153-160.
[5] HAMMES H P. Diabetic retinopathy: hyperglycaemia, oxidative stress and beyond [J]. Diabetologia, 2018, 61(1):29-38.
[6] RAJANI C, JIA W. Bile acids and their effects on diabetes [J]. Front Med, 2018, 12(6): 608-623.
[7] 王保安, 汤敏.T2DM患者血清胆红素、胆汁酸水平与糖尿病视网膜病变的关系研究 [J]. 河北医药, 2017, 39(7):1041-1043.
[8] FRANK R N. Diabetic retinopathy and systemic factors[J]. Middle East Afr J Ophthalmol, 2015, 22(2):151-156.
[9] WAT N, WONG R L, WONG I Y. Associations between diabetic retinopathy and systemic risk factors [J]. Hong Kong Med J, 2016, 22(6):589-599.
[10]DURAISAMYA J, MISHRA M, KOWLURU A, et al. Epigenetics and regulation of oxidative stress in diabetic retinopathy [J]. Invest Ophthalmol Vis Sci, 2018, 59(12):4831-4840.
[11]BREIMER L H, MIKHAILIDIS I P. Does bilirubin protect against developing diabetes mellitus? [J] J Diabetes Complications, 2016, 30(4):728-737.
[12]CHÁVEZ-TALAVERA O, TAILLEUX A, LEFEBVRE P, et al. Bile acid control of metabolism and inflammation in obesity, type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease [J].Gastroenterology, 2017, 152(7):1679-1694.
[13]CHO H C. The relationship among mocysteine, bilirubin, and diabetic retinopathy [J]. Diabetes Metab, 2011, 35(6):595-601.
[14]DRUMMOND G S, BAUM J, GREENBERG M, et al. HO-1 overexpression and Underexpression: Clinical Implications[J]. Arch Biochem Biophys, 2019, 673:108073.
[15]YASUDA M, KIYOHARA Y, WANG J J, et al. High serum bilirubin levels and diabetic retinopathy: the Hisayama Study [J]. Ophthalmology, 2011, 118(7):1423-1428.
[16]JIN L W, ZHENG S B, ZHOU Z H, et al. Correlation between polymorphisms in the serum and coronary artery calcification [J]. Genet Mol Res, 2016, 15(2): gmr8217.
[17]ZHU B, WU X M, NING K.The negative relationship between bilirubin level and diabetic retinopathy:a meta analysis [J]. PLoS One, 2016, 11(8):e0161649.
[18]FERRELL J M, CHIANG J Y L. Understanding bile acid signaling in diabetes: from pathophysiology to therapeutic targets[J]. Diabetes Metab J, 43(3):257-272.
[19]ZABORSKA K E, CUMMINGS B P. Rethinking bile acid metabolism and signaling for type 2 diabetes treatment [J].Curr Diab Rep, 2018, 18(11):109.
[20]SUN W W, ZHANG D, WANG Z Y, et al. Insulin resistance is associated with total bile acid level in type 2 diabetic and nondiabetic population: a cross-sectional study [J]. Medicine (Baltimore), 2016, 95(10):e2778.
[21]SHIMIZU M, SAIKAWA Y, YACHIE A. Role of 18-fluoro-2-deoxyglucose positron emission tomography in detecting acute inflammatory lesions of non-bacterial osteitis in patients with a fever of unknown origin: a comparative study of 18-fluoro-2-deoxyglucose positron emission tomography, bone scan and magnetic resonance imaging [J]. Mod Rheumatol, 2018, 28(6):1058-1062.