Xu Man-Rong, Wang Jun-Wei, Ma Yi-Lin, Wang Yu-Jie, Li Meng-Han, Lu Jun-Xi, Li Lian-Xi
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai, 200233, China.
Heliyon. 2024 Jul 20;10(15):e34946. doi: 10.1016/j.heliyon.2024.e34946. eCollection 2024 Aug 15.
To investigate the association of serum bilirubin within normal range, especially unconjugated bilirubin (UCB), with diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).
In this cross-sectional, real-world study, 7617 T2DM patients were stratified into quartiles based on serum UCB levels. DR was determined by digital fundus photography and further classified into non-proliferative diabetic retinopathy (NPDR) and PDR. The associations of serum bilirubin levels and UCB quartiles with DR were investigated by logistic regression analysis.
After controlling for age, sex, and diabetes duration, the DR prevalence was significantly decreased across the serum UCB quartiles (40.4 %, 33.4 %, 29.7 %, 26.6 % for each quartile, respectively, p < 0.001 for trend). The subjects with DR had lower serum total bilirubin (TB) and UCB, rather than conjugated bilirubin (CB), compared with those without DR (p = 0.003 for TB, p < 0.001 for UCB, and p = 0.528 for CB, respectively), while all three types of serum bilirubin in the subjects with PDR were obviously lower than those with NPDR (p = 0.006 for TB, and p < 0.001 for UCB and CB, respectively). After adjustment for confounding factors, logistic regression demonstrated negative associations of serum TB and UCB levels, rather than CB, with the presence of DR (OR: 0.844, 95%CI: 0.774-0.920, p < 0.001 for TB; OR: 0.828, 95%CI: 0.763-0.899, p < 0.001 for UCB; and OR: 0.984, 95%CI: 0.900-1.074, p = 0.713 for CB, respectively). Additionally, a fully-adjusted analysis revealed a negative correlation between UCB quartiles and DR (p < 0.001).
High-normal serum TB and UCB were closely associated with the decreased odds of DR, while all types of serum bilirubin were negatively correlated with the severity of DR in T2DM patients. Serum bilirubin may be used as a potential indicator to assess the risk and severity of DR in T2DM.
探讨2型糖尿病（T2DM）患者血清胆红素在正常范围内，尤其是非结合胆红素（UCB）与糖尿病视网膜病变（DR）的关系。
在这项横断面的真实世界研究中，7617例T2DM患者根据血清UCB水平分为四分位数。通过数字眼底摄影确定DR，并进一步分为非增殖性糖尿病视网膜病变（NPDR）和增殖性糖尿病视网膜病变（PDR）。通过逻辑回归分析研究血清胆红素水平和UCB四分位数与DR的关系。
在控制年龄、性别和糖尿病病程后，血清UCB四分位数的DR患病率显著降低（四分位数分别为40.4%、33.4%、29.7%、26.6%，趋势p<0.001）。与无DR的患者相比，DR患者的血清总胆红素（TB）和UCB较低，而非结合胆红素（CB）则无差异（TB为p=0.003，UCB为p<0.001，CB为p=0.528），而PDR患者的所有三种血清胆红素均明显低于NPDR患者（TB为p=0.006，UCB和CB分别为p<0.001）。在调整混杂因素后，逻辑回归显示血清TB和UCB水平而非CB与DR的存在呈负相关（OR：0.844，95%CI：0.774-0.920，TB为p<0.001；OR：0.828，95%CI：0.763-0.899，UCB为p<0.001；OR：0.984，95%CI：0.900-1.074，CB为p=0.713）。此外，一项完全调整分析显示UCB四分位数与DR之间存在负相关（p<0.001）。
血清TB和UCB在正常高值时与DR发生几率降低密切相关，而所有类型的血清胆红素与T2DM患者DR的严重程度呈负相关。血清胆红素可作为评估T2DM患者DR风险和严重程度的潜在指标。
