2023 年第 3 期 第 18 卷

血清胆红素与中年男性2型糖尿病患者颈部动脉粥样硬化的相关性研究

Relationship between serum bilirubin and carotid atherosclerosis in middle-aged male patients with type 2 diabetes mellitus

作者：陈敏柯亭羽

英文作者：Chen Min Ke Tingyu

单位：昆明医科大学第二附属医院内分泌科，昆明650101

英文单位：Department of Endocrinology the Second Affiliated Hospital of Kunming Medical University Kunming 650101 China

关键词：2型糖尿病；血清胆红素；颈部动脉粥样硬化

英文关键词：Type2diabetesmellitus;Serumbilirubin;Carotidatherosclerosis

• 摘要：

• 目的 探讨血清胆红素与中年男性2型糖尿病患者颈部动脉粥样硬化的相关性。方法 回顾性收集2018年1月至2021年12月于昆明医科大学第二附属医院内分泌科住院的男性2型糖尿病患者85例的临床资料。患者年龄40~60岁，有15~30年吸烟史且不超过20支/d，均无饮酒史或饮酒折合乙醇量<140 g/周。根据颈部血管超声检查结果，将颈部动脉内膜中层厚度（IMT）≥1.0 mm或合并有明显斑块者定义为颈部动脉粥样硬化（粥样硬化组，41例），IMT<1.0 mm以及动脉管壁光滑者定义为无颈部动脉粥样硬化（对照组，44例）。记录2组患者的年龄、糖尿病病程等临床资料。采用Spearman相关性分析模型分析各指标与颈部动脉IMT的相关性。采用二元Logistic回归方程分析中年男性2型糖尿病患者颈部动脉粥样硬化的影响因素。结果 粥样硬化组年龄、糖尿病病程、血红蛋白水平均高于/长于对照组，血清总胆红素、直接胆红素水平均低于对照组［（12±5）μmol/L比（14±4）μmol/L、3.10（2.45，4.25）μmol/L比4.05（3.63,4.50）μmol/L］，差异均有统计学意义(均P<0.05)。Spearman相关性分析结果显示，血清总胆红素(r=-0.251，P=0.020)、直接胆红素(r=-0.299，P=0.006)与颈部动脉IMT呈负相关，血红蛋白(r=0.270，P=0.012）与颈部动脉IMT呈正相关。二元Logistic回归分析结果显示，糖尿病病程、血红蛋白是中年男性2型糖尿病患者颈部动脉粥样硬化的危险因素，血清总胆红素、直接胆红素是其保护因素(均P<0.05)。结论 中年男性2型糖尿病患者血清总胆红素和直接胆红素与颈部动脉IMT呈负相关，二者是颈部动脉粥样硬化的保护因素。

• Objective  To investigate the relationship between serum bilirubin and carotid atherosclerosis in middle-aged male patients with type 2 diabetes mellitus. Methods  From January 2018 to December 2021, clinical data of 85 male patients with type 2 diabetes mellitus admitted to Department of Endocrinology, the Second Affiliated Hospital of Kunming Medical University were retrospectively collected. They were 40-60 years old and had a history of smoking for 15-30 years, within 20 cigarettes/d, and they never drunk alcohol or the equivalent amount of alcohol was less than 140 g/week. According to carotid artery ultrasonography, patients with intima-media thickness (IMT) ≥1.0 mm or combined with obvious plaque were defined as carotid atherosclerosis (atherosclerosis group, 41 cases), and patients with IMT<1.0 mm and smooth arterial wall were defined as non-carotid atherosclerosis (control group, 44 cases). The clinical data such as age and course of diabetes mellitus were recorded in two groups. Spearman correlation analysis was used to analyze the relationship between clinical indexes and carotid IMT. Binary Logistic regression equation analysis was used to analyze the influencing factors of carotid atherosclerosis in middle-aged male patients with type 2 diabetes mellitus. Results  The age, course of diabetes mellitus and the level of hemoglobin in the atherosclerosis group were higher/longer than those in the control group, and serum levels of total bilirubin and direct bilirubin in the atherosclerosis group were lower than those in the control group ［（12±5）μmol/L vs （14±4）μmol/L, 3.10（2.45，4.25）μmol/L vs 4.05（3.63,4.50）μmol/L］(all P<0.05). Spearman correlation analysis showed that serum total bilirubin (r=-0.251, P=0.020) and direct bilirubin (r=-0.299, P=0.006) were negatively correlated with carotid IMT, and hemoglobin was positively (r=0.270, P=0.012) correlated with carotid IMT. Binary Logistic analysis showed the course of diabetes mellitus and hemoglobin were risk factors of carotid atherosclerosis in middle-aged male patients with type 2 diabetes mellitus, and serum total bilirubin and direct bilirubin were protective factors (all P<0.05). Conclusions  erum levels of total bilirubin and direct bilirubin are negatively correlated with carotid atherosclerosis in middle-aged male patients with type 2 diabetes mellitus, and both are protective factors of carotid atherosclerosis.