Wan Heng, Zhu Hui, Wang Yuying, Zhang Kun, Chen Yi, Fang Sijie, Xia Fangzhen, Wang Ningjian, Zhang Wen, Lu Yingli
Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ther Adv Endocrinol Metab. 2020 Jul 11;11:2042018820937897. doi: 10.1177/2042018820937897. eCollection 2020.
Some studies have reported associations between bilirubin and diabetic microvascular complications. However, these studies focused only on total bilirubin (TBIL) without distinguishing different bilirubin subtypes. In this study, we aimed to investigate the associations of TBIL, direct bilirubin (DBIL) and indirect bilirubin (IBIL) levels with albuminuria/creatinine ratio (ACR) and the prevalence of diabetic retinopathy (DR) among diabetic adults.
We analyzed 4368 individuals out of 4813 diabetic participants enrolled from seven communities in 2018 in a cross-sectional study. Participants underwent several checkups, including the measurement of anthropometric parameters, blood pressure, glucose, lipid profile, TBIL, DBIL, IBIL and ACR. DR was detected by high-quality fundus photographs and was remotely read by ophthalmologists.
Compared with the first quartile of DBIL, participants in the fourth quartile had a lower prevalence of high ACR (odds ratio (OR) 0.76; 95% confidence interval (CI) 0.59, 0.99) ( for trend < 0.05). Neither TBIL nor IBIL was associated with the prevalence of high ACR. In DR, higher DBIL and TBIL by one standard deviation was associated with a 19% (OR 0.81; 95% CI 0.69, 0.94) and a 12% (OR 0.88; 95% CI 0.78, 0.99) lower frequency of DR, respectively (both for trend < 0.05). However, IBIL was not associated with the prevalence of DR. These associations were adjusted for potential confounding factors.
DBIL had a stronger association with high ACR and DR than TBIL or IBIL did in diabetic adults. The effect of DBIL on diabetic complications should be noted and investigated in further studies.
一些研究报道了胆红素与糖尿病微血管并发症之间的关联。然而，这些研究仅关注总胆红素（TBIL），未区分不同的胆红素亚型。在本研究中，我们旨在调查糖尿病成年人中总胆红素（TBIL）、直接胆红素（DBIL）和间接胆红素（IBIL）水平与尿白蛋白/肌酐比值（ACR）及糖尿病视网膜病变（DR）患病率之间的关联。
在一项横断面研究中，我们分析了2018年从7个社区招募的4813名糖尿病参与者中的4368人。参与者接受了多项检查，包括人体测量参数、血压、血糖、血脂谱、TBIL、DBIL、IBIL和ACR的测量。通过高质量眼底照片检测DR，并由眼科医生远程阅片。
与DBIL的第一个四分位数相比，第四个四分位数的参与者高ACR患病率较低（比值比（OR）0.76；95%置信区间（CI）0.59，0.99）（趋势<0.05）。TBIL和IBIL均与高ACR患病率无关。在DR方面，DBIL和TBIL每升高一个标准差，DR发生频率分别降低19%（OR 0.81；95%CI 0.69，0.94）和12%（OR 0.88；95%CI 0.78，0.99）（趋势均<0.05）。然而，IBIL与DR患病率无关。这些关联已针对潜在混杂因素进行了调整。
在糖尿病成年人中，DBIL与高ACR和DR的关联比TBIL或IBIL更强。应注意DBIL对糖尿病并发症的影响，并在进一步研究中进行调查。
