4th Department of Internal Medicine and Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Kateřinská 32, Praha 2, 12000, Prague, Czech Republic.
Arch Biochem Biophys. 2019 Sep 15;672:108062. doi: 10.1016/j.abb.2019.108062. Epub 2019 Jul 31.
Bilirubin is among the most potent of the endogenous antioxidants. Data developed over the last three decades have convincingly demonstrated the protective effects of mildly elevated serum bilirubin concentrations; whereas lower levels of it have been associated with an increased risk of various diseases of civilization, commonly accompanied with increased oxidative stress. Even tiny, micromolar changes of serum bilirubin concentrations have been associated with substantial modulation for the risk of these diseases. However, clinical data published in the current literature are influenced by many confounding factors that have not been properly controlled for. These include the use of improper reference intervals, which are mostly used as common intervals without any partitioning for gender, ethnicity, age, or other important factors (such as smoking). The clinical chemistry methods used for bilirubin determination have not been standardized; in fact, these methods are known to be among the least reliable of any used in clinical chemistry labs. As a result, the data from epidemiological studies are not always comparable. Therefore, it is highly recommended to conduct properly-designed large epidemiological studies. Based on this data, the establishment of decision limits is highly warranted, especially for the lower concentration values of serum bilirubin.
胆红素是内源性抗氧化剂中最有效的一种。在过去的三十年中，数据已经令人信服地证明了血清胆红素浓度轻度升高的保护作用；而其较低水平则与各种文明病的风险增加有关，通常伴随着氧化应激的增加。即使血清胆红素浓度发生微小的、毫摩尔级的变化，也与这些疾病的风险的大幅变化有关。然而，目前文献中发表的临床数据受到许多混杂因素的影响，这些因素没有得到适当的控制。这些因素包括使用不当的参考区间，这些区间大多作为通用区间使用，没有按性别、种族、年龄或其他重要因素（如吸烟）进行划分。胆红素测定所使用的临床化学方法尚未标准化；事实上，这些方法被认为是临床化学实验室中最不可靠的方法之一。因此，流行病学研究的数据并不总是具有可比性。因此，强烈建议进行设计合理的大型流行病学研究。基于这些数据，建立决策界限是非常必要的，特别是对于血清胆红素的较低浓度值。
