摘要目的 探讨2型糖尿病(T2DM)患者血清胆红素与心血管自主神经病变(CAN)的相关性.方法 纳入2017年4月至2018年10月于东部战区总医院内分泌科住院的T2DM患者369例,其中男226例,女143例,年龄(54.6±12.1)岁.根据标准心血管反射试验(CARTs)分为糖尿病非CAN(Non CAN)组149例,糖尿病CAN组220例,比较两组患者血清胆红素水平的差异.胆红素三分位分组后比较组间CARTs各指标的差异及CAN的发生率.采用多因素logistic回归进一步分析血清胆红素与CAN的相关性.结果 CAN组患者血清总胆红素[(9.28±2.74)μmol/L比(11.08±2.98)μmol/L,P<0.001]、直接胆红素[(3.17±1.20)μmol/L比(3.71±1.24)μmol/L,P<0.001]和间接胆红素[(6.11±1.89)μmol/L比(7.37±2.10)μmol/L,P<0.001]水平均低于Non CAN组.伴随血清胆红素水平的升高,CAN的发生率下降(P<0.01).多因素logistic回归分析结果显示,血清总胆红素(OR=0.819,95％CI:0.744～0.901,P<0.001)、直接胆红素(OR=0.739,95％CI:0.601～0.908,P=0.004)及间接胆红素(OR=0.749,95％CI:0.653～0.860,P<0.001)水平均与CAN的发生呈现独立负相关.结论 生理水平范围内,较低的血清胆红素水平与糖尿病CAN的发生风险呈独立负相关,在血清胆红素相对偏低的糖尿病人群中更需要重点筛查CAN.

abstractsObjective To investigate the correlation between serum bilirubin and cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus patients. Methods A total of 369 patients with type 2 diabetes mellitus who were hospitalized at the Department of Endocrinology, Nanjing Jinling Hospital from April 2017 to October 2018 were enrolled, including 226 males and 143 females, with an average age of (54.6 ± 12.1) years. According to cardiovascular reflex tests (CARTs), all the patients were divided into Non CAN group(149 patients without CAN) and CAN group (220 patients complicated with CAN). The difference of serum bilirubin levels between the two groups was compared. The differences of CARTs and the incidence of CAN were compared by tertiles of serum bilirubin levels. The binary logistic regression was used to analyze the risk factors for diabetic cardiovascular autonomic neuropathy. Results The serum total bilirubin [(9.28±2.74)μmol/L vs (11.08±2.98) μmol/L, P<0.001], direct bilirubin [(3.17±1.20) μmol/L vs (3.71±1.24) μmol/L, P<0.001] and indirect bilirubin levels [(6.11±1.89) μmol/L vs (7.37±2.10) μmol/L, P<0.001] in CAN group were significantly lower than that in Non CAN group. With the increase of serum bilirubin, the incidence of CAN decreased (P<0.01). Multivariate Logistic regression analysis showed that serum total bilirubin (OR=0.819, 95％CI: 0.744-0.901, P<0.001), direct bilirubin (OR=0.739, 95％CI:0.601-0.908, P=0.004) and indirect bilirubin (OR=0.749, 95％CI: 0.653-0.860, P<0.001) were inversely correlated with the incidence of CAN. Conclusions Within the physiological range, lower level of serum bilirubin is inversely correlated with the incidence of CAN. It is noteworthy to screen diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus who had a lower serum bilirubin level.