不同病程的2 型糖尿病患者血清胆红素、 25（OH）D3 水平与胰岛素抵抗的相关性分析

The level of serum bilirubin and 25(OH)D3 in type Ⅱ diabetes mellitus patients with different disease course and its correlation with insulin resistance

摘要:

目的 探讨不同病程的2 型糖尿病（T2DM）患者血清胆红素、25（OH）D3 水平与胰岛素 抵抗（IR）的相关性。方法 选取2016 年5 月—2018 年8 月于秦皇岛市第一医院内分泌科就诊的171 例 T2DM 患者作为研究对象。根据糖尿病病程分为T2DM-1 组、T2DM-2 组及T2DM-3 组，分别测定 TBIL、IBIL、DBIL、25（OH）D3 等指标水平。采用Pearson 相关性分析上述各指标与稳态胰岛素评价指数 （HOMA-IR）的相关性，并采用多元线性回归分析IR 的危险因素。结果 T2DM-3 组病程、SBP、DBP、 LDL、FPG、2hPG、HbA1c、HOMA-IR 及CRP 较T2DM-1 组和T2DM-2 组高（P <0.05），FINS、TBIL、 DBIL、IBIL 及25（OH）D3 较T2DM-1 组和T2DM-2 组低（P <0.05）。Pearson 相关性分析显示，HOMAIR 与BMI、CRP 呈正相关（r =0.199 和0.178，P <0.05），与25（OH）D3、DBIL 呈负相关（r =-0.373 和 -0.346，P <0.05）。多元线性回归分析显示，25（OH）D3、DBIL 是影响HOMA-IR 的独立因素（P <0.05）。 结论 病程5 ～ 10 年的T2DM 患者存在IR、血脂及血压紊乱，患心血管疾病风险增加，DBIL、维生素 D 水平下降，CRP 升高，机体慢性低度炎症水平升高，且25（OH）D3、DBIL 是影响该类患者IR 的独立 因素。

Abstract:

Objective To investigate the level of serum bilirubin and 25(OH)D3 as well as its relationship with insulin resistance (IR) in type Ⅱ diabetes mellitus (T2DM) with different disease course. Methods This study included 171 T2DM patients who were divided into T2DM-1 (45), T2DM-2 (62) and T2DM-3 (64) groups according to the disease course. Serum total bilirubin (TBIL), indirect bilirubin (IBIL), direct bilirubin (DBIL) and 25(OH)D3 were measured. Pearson analysis was used to analyze the correlation between aforementioned indicators and HOMAIR. Multiple linear regression was used to analyze the risk factors of IR. Results Compared with the T2DM-1 group and the T2DM-2 group, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), 2-hour plasma glucose (2 hPG), low density lipoprotein cholesterol (LDL) and C-reactive protein (CRP) in the T2DM-3 group were significantly higher (P < 0.05), while the level of fasting insulin concentration (FINS), TBIL, DBIL, IBIL, and 25(OH)D3 were significantly lower (P < 0.05). Pearson correlation analysis showed that DBIL (r = -0.373), 25(OH)D3 (r = -0.346) were negatively correlated with HOMA-IR (P < 0.05), but BMI (r = 0.199) and CRP (0.178) were positively correlated (P < 0.05). Multiple linear regression analysis showed that the level of DBIL and 25(OH)D3 were the risk factors for IR (P < 0.05). Conclusions Disorders in blood lipid, blood pressure and IR could be seen in T2DM patients with disease course ranging between 5 to 10 years, who might be prone to cardiovascular disease with decreased levels of DBIL and vitamin D but increased levels of CPR and chronic lowgrade inflammation. Moreover, 25(OH)D3 and DBIL could be established as the independent factors for IR.