■为了研究血清胆红素在正常范围内的相关性,特别是未结合胆红素(UCB),2型糖尿病(T2DM)患者的糖尿病视网膜病变(DR)。
■在此横截面中,真实世界的研究,根据血清UCB水平将7617名T2DM患者分为四分位数。DR通过数字眼底照相确定,并进一步分为非增生性糖尿病视网膜病变(NPDR)和PDR。采用logistic回归分析研究血清胆红素水平和UCB四分位数与DR的关系。
■在控制了年龄之后,性别,和糖尿病持续时间,DR患病率在血清UCB四分位数中显著降低(40.4%,33.4%,29.7%,每个四分位数的26.6%,分别,趋势p<0.001)。DR患者的血清总胆红素(TB)和UCB较低,而不是结合胆红素(CB),与没有DR的相比(TB的p=0.003,对于UCB,p<0.001,对于CB,p=0.528,分别),而PDR患者的所有三种类型的血清胆红素均明显低于NPDR患者(TB的p=0.006,UCB和CB的p<0.001,分别)。在对混杂因素进行调整后,logistic回归显示血清TB和UCB水平呈负相关,而不是CB,存在DR(对于TB,OR:0.844,95CI:0.774-0.920,p<0.001;对于UCB,OR:0.828,95CI:0.763-0.899,p<0.001;对于CB,OR:0.984,95CI:0.900-1.074,p=0.713,分别)。此外,完全校正分析显示,UCB四分位数与DR之间呈负相关(p<0.001)。
■高正常血清TB和UCB与DR降低的几率密切相关,而所有类型的血清胆红素与T2DM患者的DR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。
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.