在成年人群中，较高的血清总胆红素浓度与较低的肾功能不全风险相关。
Higher serum total bilirubin concentration is associated with lower risk of renal insufficiency in an adult population.
作者信息
Lee Ang-Tse, Wang Ya-Yu, Lin Shih-Yi, Liang Jiin-Tsae, Sheu Wayne Huey-Herng, Song Yuh-Min, Chang Wen-Dau
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital Taichung, Taiwan.
Department of Family Medicine, Taichung Veterans General HospitalTaichung, Taiwan; Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing UniversityTaichung, Taiwan; School of Medicine, National Yang Ming UniversityTaipei, Taiwan.
出版信息
Int J Clin Exp Med. 2015 Oct 15;8(10):19212-22. eCollection 2015.
BACKGROUND
Chronic inflammation is proposed to play a central role in the pathogenesis of chronic kidney disease (CKD), and serum bilirubin has antioxidant and anti-inflammatory effects. We investigated the association between serum total bilirubin (Tb) concentration and renal function in an adult population.
METHODS
We conducted a cross-sectional study and collected anthropometric measurements, fasting blood tests, lifestyle habits and medical history of 3876 subjects attending a health examination. Renal insufficiency was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) calculated by using the CKD-EPI equation.
RESULTS
Serum Tb concentrations were higher in subjects without renal insufficiency than in those with renal insufficiency. Multivariable linear regression analysis showed that Tb concentration was positively associated with eGFR after adjusting for important CKD risk factors (P=0.04). Multivariable logistic regression analysis also revealed that higher Tb concentration (each increment of 1.71 μmol/L) (0.1 mg/dL) was associated with a reduced risk of renal insufficiency: odds ratios were 0.94 (P=0.005) for men and 0.90 (P=0.015) for women, respectively. When subjects were divided into quartiles of serum Tb, multivariable-adjusted odds ratios for renal insufficiency comparing the fourth to the first Tb quartile were 0.49 (P=0.001) for men and 0.35 (P=0.003) for women. A stepwise exclusion of subjects, first those with possible liver disease and second, those with CKD stage 4 and 5, showed consistent results.
CONCLUSION
Higher serum Tb concentration was associated with lower risk of renal insufficiency, regardless of other conventional CKD risk factors.
背景
慢性炎症被认为在慢性肾脏病（CKD）的发病机制中起核心作用，而血清胆红素具有抗氧化和抗炎作用。我们在成年人群中研究了血清总胆红素（Tb）浓度与肾功能之间的关联。
方法
我们进行了一项横断面研究，收集了3876名参加健康体检者的人体测量数据、空腹血液检查结果、生活习惯和病史。肾功能不全定义为使用CKD-EPI方程计算的估计肾小球滤过率（eGFR）<60 mL/min/1.73 m²。
结果
无肾功能不全者的血清Tb浓度高于肾功能不全者。多变量线性回归分析显示，在调整了重要的CKD危险因素后，Tb浓度与eGFR呈正相关（P = 0.04）。多变量逻辑回归分析还显示，较高的Tb浓度（每增加1.71 μmol/L，即0.1 mg/dL）与肾功能不全风险降低相关：男性的比值比为0.94（P = 0.005），女性为0.90（P = 0.015）。当将受试者按血清Tb四分位数分组时，比较第四四分位数与第一四分位数，男性肾功能不全的多变量调整比值比为0.49（P = 0.001），女性为0.35（P = 0.003）。逐步排除受试者，首先排除可能患有肝病的受试者，其次排除CKD 4期和5期的受试者，结果一致。
结论
无论其他传统的CKD危险因素如何，较高的血清Tb浓度与较低的肾功能不全风险相关。
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