摘要
目的 探讨总胆红素水平与糖尿病黄斑水肿(DME)发病及严重程度的相关性。方法 本研究共纳入82例2型糖尿病伴有糖尿病视网膜病变的患者。根据DME严重程度分级标准,将患者分为3组:无DME组22例(黄斑区中心凹厚度处于正常值范围)、早期DME组25例(黄斑区中心凹厚度高于正常上限值但等于或低于正常值上限130%)、晚期DME组35例(黄斑区中心凹厚度高于正常值上限130%以上)。患者眼底检查及荧光素眼底血管造影结果由2位经验丰富的眼底病专家独立进行分级。收集所有患者性别、年龄、糖尿病病程、体重指数(BMI)等基本参数,以及血液学指标——中性粒细胞数、系统免疫炎症指数[SII,(中性粒细胞数×血小板数)/淋巴细胞数]、空腹血糖、糖化血红蛋白(HbA1c)、总胆红素、尿酸等。使用Pearson相关分析探讨总胆红素水平与各种临床指标的相关性。采用多因素Logistic回归分析探索2型糖尿病患者DME的危险因素。建立受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析总胆红素对2型糖尿病患者DME的诊断效能。结果 无DME组、早期DME组及晚期DME组患者的糖尿病病程、BMI、中性粒细胞数、淋巴细胞数、中性粒细胞数/淋巴细胞数、SII、HbA1c、总胆红素、直接胆红素、尿酸、囊肿分级、视网膜下液之间的差异均有统计学意义(均为P<0.05)。总胆红素水平与DME的发生具有相关性(P<0.05),且在晚期DME组,随着总胆红素水平的升高,DME发生率明显下降。Logistic回归分析显示:糖尿病病程长、SII值大、HbA1c水平高、尿酸含量高、总胆红素水平低均为2型糖尿病患者发生DME的独立危险因素。ROC曲线分析结果显示:单独总胆红素诊断DME的AUC为0.678,糖尿病病程、HbAlc、尿酸、SII联合诊断DME的AUC为0.762,总胆红素、糖尿病病程、HbAlc、尿酸、SII联合诊断DME的AUC为0.783。结论 总胆红素水平升高是DME的保护性因素,两者存在负相关;总胆红素可能是诊断DME的生物学标志物;总胆红素联合其他血液学指标对DME有更好的诊断效能。
Objective To investigate the potential correlation between the level of total bilirubin(TBIL) and the occurrence and severity of diabetic macular edema(DME). Methods A total of 82 patients with type 2 diabetes mellitus and diabetic retinopathy(DR) were enrolled. According to the presence or absence of DME and its severity, patients were divided into the non-DME group(n-DME group, n=22), early-DME group(e-DME group, n=25), and late-DME group(l-DME group, n=35). The patients in the n-DME group had a normal central foveal thickness, patients in the e-DME group showed a central foveal thickness exceeding the upper limit of the normal range by less than or equal to 130%, while patients in the l-DME group had a central foveal thickness exceeding the upper limit of the normal range by more than 130%. The results of fundus examination and fundus fluorescein angiography were graded independently by 2 experienced fundus disease experts. Basic parameters, such as gender, age, diabetes course, and body mass index(BMI), as well as hematological indicators, such as neutrophil count, systemic immunoinflammatory index [SII,(neutrophil count × platelet count)/lymphocyte count], fasting blood glucose, glycosylated hemoglobin(HbA1c), TBIL, and uric acid, were collected.Pearson correlation analysis was used to explore the correlation between TBIL and various clinical indicators. Multivariate logistic regression analysis was used to explore the risk factors of DME in patients with type 2 diabetes mellitus. The receiver operating characteristic curve(ROC) was established and the area under the curve(AUC) was calculated to analyze the predictive ability of TBIL to DME in patients with type 2 diabetes mellitus. Results There were statistically significant differences in the diabetes course, BMI, neutrophil count, lymphocyte count, neutrophil count/lymphocyte count, SII, HbA1c, TBIL, direct bilirubin, uric acid, cyst grade and subretinal fluid in the three groups(all P<0.05). The level of TBIL was correlated with the occurrence of DME(P<0.05). In the l-DME group, the incidence rate of DME significantly decreased with the increase of TBIL. Logistic regression analysis showed that the long diabetes course, large SII, high HbA1c, high content of uric acid and low TBIL were independent risk factors of DME in patients with type 2 diabetes mellitus. The ROC analysis showed that the AUC of diagnosing DME by TBIL alone was 0.678, the AUC of diagnosing DME by combining the diabetes course, HbAlc, uric acid and SII was 0.762, and the AUC of diagnosing DME by combining the TBIL, diabetes course, HbAlc, uric acid and SII was 0.783. Conclusion Studies have shown that increased TBIL is a protective factor for DME, and there is a negative correlation between them. TBIL may be a biomarker to identify DME, and TBIL combined with other hematological indicators shows a stronger ability to predict DME.
作者
许慕东
朱妍
蔡骐
贺梦璇
李盼盼
李晶晶
尹卞宇
宋愈
XU Mudong;ZHU Yan;CAI Qi;HE Mengxuan;LI Panpan;LI Jingjing;YIN Bianyu;SONG Yu(Department of Ophthalmology,the Second Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu Province,China)
出处
《眼科新进展》
CAS
北大核心
2023年第3期216-220,共5页
Recent Advances in Ophthalmology
基金
南通市卫生健康委员会课题项目(编号:QNZ2022014,QA2021018)
南京医科大学康达学院2022年度科研发展基金课题重点项目(编号:KD2022KYJJZD017,KD2022KYJJZD018)。
