Kim Eun Sook, Lee Sung Won, Mo Eun Young, Moon Sung Dae, Han Je Ho
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
The Catholic University of Korea Incheon St. Mary's Hospital, Incheon, Korea.
Endocrine. 2015 Nov;50(2):405-12. doi: 10.1007/s12020-015-0583-0. Epub 2015 Apr 7.
Several studies have suggested that bilirubin, a potent innate antioxidant, plays a protective role against cardiovascular and microvascular disease. This study investigated the association between serum concentrations of total bilirubin (TB) and the presence of diabetic peripheral neuropathy (DPN) in Korean diabetic patients. This cross-sectional study involved 1207 patients aged more than 30 years with type 2 diabetes. DPN was assessed according to clinical symptoms and physical examinations using Michigan Neuropathy Screening Instrument examination score, 10-g monofilament sensation, and current perception threshold. The subjects were stratified into gender-specific tertiles based on TB values, and the relationship between the TB values and DPN was analyzed. Compared with patients within the lowest TB tertile, those with higher TB levels consisted of patients with shorter duration of diabetes, lower HbA1c, better renal function, and less autonomic neuropathy, retinopathy, and albuminuria. Serum TB levels were inversely associated with DPN. In multivariate analysis for the development of DPN after adjusting for potential confounding factors including retinopathy, albuminuria, and autonomic neuropathy, the TB levels were inversely associated with the presence of DPN, both as a continuous variable [odds ratio (OR) per log standard deviation (SD) 0.79; 95% confidence interval (CI) 0.65-0.97; P = 0.022] and when categorized in tertiles (the highest vs. the lowest tertile; OR 0.63; 95% CI 0.40-0.99; P = 0.046). Low serum bilirubin levels are significantly associated with DPN, independently of classic risk factors and other microvascular complications. Further investigation is necessary to determine whether serum bilirubin has a prognostic significance on DPN.
多项研究表明，胆红素作为一种强大的内源性抗氧化剂，对心血管和微血管疾病具有保护作用。本研究调查了韩国糖尿病患者血清总胆红素（TB）浓度与糖尿病周围神经病变（DPN）的关系。这项横断面研究纳入了1207例年龄超过30岁的2型糖尿病患者。根据临床症状和体格检查，使用密歇根神经病变筛查仪器检查评分、10克单丝感觉和电流感觉阈值对DPN进行评估。根据TB值将受试者按性别分为三分位数，并分析TB值与DPN之间的关系。与TB最低三分位数内的患者相比，TB水平较高的患者包括糖尿病病程较短、糖化血红蛋白（HbA1c）较低、肾功能较好以及自主神经病变、视网膜病变和蛋白尿较少的患者。血清TB水平与DPN呈负相关。在对包括视网膜病变、蛋白尿和自主神经病变等潜在混杂因素进行校正后，对DPN发生的多变量分析中，TB水平与DPN的存在呈负相关，无论是作为连续变量[每对数标准差（SD）的比值比（OR）为0.79；95%置信区间（CI）为0.65 - 0.97；P = 0.022]，还是按三分位数分类时（最高三分位数与最低三分位数相比；OR为0.63；95%CI为0.40 - 0.99；P = 0.046）。低血清胆红素水平与DPN显著相关，独立于经典危险因素和其他微血管并发症。有必要进一步研究以确定血清胆红素对DPN是否具有预后意义。
