[1]裴翔 欧阳茹 陈铅琴.2型糖尿病患者血清胆红素水平 与糖尿病足的相关性[J].国际内分泌代谢杂志,2020,40(02):81-86.[doi:10.3760/cma.j.issn.1673-4157.2020.02.003]
　Pei Xiang,Ouyang Ru,Chen Qianqin.Correlation between serum bilirubin level and diabetic foot in patients with type 2 diabetes mellitus[J].International Journal of Endocrinology and Metabolism,2020,40(02):81-86.[doi:10.3760/cma.j.issn.1673-4157.2020.02.003]
点击复制

2型糖尿病患者血清胆红素水平 与糖尿病足的相关性()
分享到：

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
40
期数:
2020年02期
页码:
81-86
栏目:
论著
出版日期:
2020-03-20

文章信息/Info

Title:
Correlation between serum bilirubin level and diabetic foot in patients with type 2 diabetes mellitus
作者:
裴翔 欧阳茹 陈铅琴
海南省第三人民医院内分泌科,三亚 572000
Author(s):
Pei Xiang;  Ouyang Ru;  Chen Qianqin
Department of Endocrinology, The Third People's Hospital of Hainan Province, Sanya 572000, China
关键词:
胆红素;  糖尿病足;  2型糖尿病
Keywords:
Bilirubin;  Diabetic foot;  Type 2 diabetes mellitus
DOI:
10.3760/cma.j.issn.1673-4157.2020.02.003
摘要:
目的 探讨2型糖尿病(T2DM)患者血清胆红素水平与糖尿病足的关系。方法 选取2009—2015年海南省第三人民医院收治的1 269例T2DM患者,根据糖尿病足的诊断标准分为糖尿病足组(578例)和非糖尿病足组(NDF组,691例),同时根据Wagner分级将糖尿病足组分为低级别组(40例,Wagner 0级或1级)、中级别组(425例,Wagner 2级或3级)、高级别组(113例,Wagner 4级或5级)。再将578例糖尿病足患者根据是否截肢分为非截肢组(446例)和截肢组(132例)。所有患者入院时检测血清总胆红素、直接胆红素(D-BIL)和间接胆红素(I-BIL)水平, 以及白细胞计数、肌酐、收缩压、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)、尿酸、总胆固醇、甘油三酯、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、HbA1c和血红蛋白。收集糖尿病足患者的Wagner分级和截肢手术资料。进行二元或有序多元logistic回归分析,以确定T2DM患者糖尿病足及截肢的危险因素。结果 与NDF组相比,糖尿病足组患者年龄、吸烟和饮酒患者的比例、大血管并发症患者的比例均较高(χ2=3.852～474.272, P均<0.05); 白细胞计数、肌酐、收缩压水平升高(U=6.485、35.421、36.155,P均<0.05),总胆红素、D-BIL、I-BIL、ALT、AST、GGT、尿酸、总胆固醇、甘油三酯、HDL-C、LDL-C、HbA1c、血红蛋白和高脂血症患者的比例降低(U=3.145～68.119,P均<0.05)。血清I-BIL水平≥6.0 μmol/L与糖尿病足呈负相关(OR=0.751,95% CI:0.570～0.980,P<0.05)。血清总胆红素>10.0 μmol/L与Wagner评分较低有关(OR=0.506,95% CI:0.298～0.857,P<0.05),血清I-BIL≥6.0 μmol/L是Wagner评分较低的保护因素(OR=0.280, 95% CI:0.147～0.538, P<0.05)。总胆红素≥10.0 μmol/L是截肢的保护因素(OR=0.474,95% CI: 0.243～0.921,P<0.05)。结论 T2DM患者血清胆红素水平下降与糖尿病足的严重程度以及截肢事件独立相关。
Abstract:
Objective To explore the relationship between serum bilirubin level and diabetic foot(DF)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 1 269 patients with T2DM in the Third People's Hospital of Hainan Province in 2009-2015 were divided into diabetic foot group(DF group, n=578)and non-DF group(NDF group, n=691)according to the diagnostic standard of DF, and patients in DF group were divided into low grade group(40 cases, Wagner 0 grade or 1 grade), intermediate group(425 cases, Wagner 2 or 3 grade), senior group(113 cases, Wagner 4 or 5 grade)according to Wagner classification. Furthermore, patients in DF group were divided into non-amputated group(n=446)and amputation group(n=132)according to whether they were amputated. The levels of serum total bilirubin(T-BIL), direct bilirubin(D-BIL)and indirect bilirubin(I-BIL), white blood cell count, creatinine, systolic blood pressure, alanine aminotransferase(ALT)and aspartate aminotransferase(AST), γ-glutamyl transpeptidase(GGT), uric acid, total cholesterol, triglyceride, high-density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol(LDL-C), HbA1c and hemoglobin were detected in all patients. Wagner classification and amputation data of patients with DF were collected. Binary or sequential multiple logistic regression analysis was performed to determine the risk factors for DF and amputation in patients with T2DM.Results Compared with NDF group, age, the proportion of smoking and drinking, the proportion of patients with macrovascular complications were higher(χ2=3.852-474.272, all P<0.05), and white blood cell count, the levels of creatinine, systolic blood pressure were increased(U=6.485, 35.421, 36.155, all P<0.05), T-BIL, D-BIL, I-BIL, ALT, AST, GGT, uric acid, total cholesterol, triglyceride, HDL-C, LDL-C, HbA1c, hemoglobin and the proportion of patients with hyperlipidemia were decreased(U=3.145-68.119, all P<0.05)in DF group. Serum I-BIL level was negatively correlated with diabetic foot(OR=0.751, 95% CI: 0.570-0.980, P<0.05). Serum T-BIL>10.0 μmol/L was correlated with lower Wagner score(OR=0.506, 95% CI: 0.298-0.857,P<0.05). Serum I-BIL≥6.0 μmol/L was a protective factor of lower Wagner score(OR=0.280, 95% CI: 0.147-0.538, P<0.05), serum T-BIL ≥10.0 μmol/L was a protective factor of lower extremity amputation(OR=0.474, 95% CI: 0.243-0.921, P<0.05).Conclusion The decrease of serum bilirubin level is independently associated with the presence and severity of DF and amputation events in patients with T2DM.

参考文献/References:

[1] Khanna HK,Stevens AC. Diabetic myonecrosis: a rare complication of diabetes mellitus mimicking deep vein thrombosis[J].Am J Case Rep,2017,18:38-41.DOI:10.12659/ajcr.900903.
[2] 张晓凡,张会娟.血清胆红素与 2 型糖尿病患者糖代谢及早期糖尿病肾病的关系[J]. 实用糖尿病杂志,2014,10(2):43-45.
[3] Cavanagh P,Attinger C,Abbas Z,et al.Cost of treating diabetic foot ulcers in five different countries[J].Diabetes Metab Res Rev,2012,28(Suppl 1):107-111.DOI:10.1002/dmrr.2245.
[4] 张景义,许颖,张会芬,等.糖尿病足患者血清胆红素水平变化[J].山东医药,2015,55(3):84-85.DOI:10.3969/j.issn.1002-266X.2015.03.034.
[5] Toya K,Babazono T,Hanai K,et al.Association of serum bilirubin levels with development and progression of albuminuria, and decline in estimated glomerular filtration rate in patients with type 2 diabetes mellitus[J].J Diabetes Investig,2014,5(2):228-235.DOI:10.1111/jdi.12134.
[6] Chan KH,O'Connell RL,Sullivan DR,et al.Plasma total bilirubin levels predict amputation events in type 2 diabetes mellitus:the Fenofibrate Intervention and Event Lowering in Diabetes(FIELD)study[J].Diabetologia,2013,56(4):724-736.DOI:10.1007/s00125-012-2818-4.
[7] Kim ES,Mo EY,Moon SD,et al.Inverse association between serum bilirubin levels and arterial stiffness in Korean women with type 2 diabetes[J].PLoS One,2014,9(10):e109251.DOI:10.1371/journal.pone.0109251.
[8] McAlister FA,Ezekowitz J,Tarantini L,et al.Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula[J].Circ Heart Fail,2012,5(3):309-314. DOI:10.1161/CIRCHEARTFAILURE.111.966242.
[9] Schaper NC,Van Netten JJ,Apelqvist J,et al.Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents[J].Diabetes Metab Res Rev,2016,32(Suppl 1):7-15. DOI:10.1002/dmrr.2695.
[10] Zhang B,Adesanya TM,Zhang L,et al.Delivery of placenta-derived mesenchymal stem cells ameliorates ischemia induced limb injury by immunomodulation[J].Cell Physiol Biochem,2014,34(6):1998-2006.DOI:10.1159/000366395.
[11] Nishimura T,Tanaka M,Sekioka R,et al.Serum bilirubin concentration is associated with eGFR and urinary albumin excretion in patients with type 1 diabetes mellitus[J].J Diabetes Complications,2015,29(8):1223-1227.DOI:10.1016/j.jdiacomp.2015.07.007.
[12] Sano K,Nakamura H,Matsuo T. Mode of inhibitory action of bilirubin on protein kinase C[J].Pediatr Res,1985,19(6):587-590.DOI:10.1203/00006450-198506000-00017.
[13] Abo-Salem OM,Harisa GI,Ali TM,et al.Curcumin ameliorates streptozotocin-induced heart injury in rats[J].J Biochem Mol Toxicol,2014,28(6):263-270.DOI:10.1002/jbt.21562.
[14] Wang J,Wu X,Li Y,et al.Serum bilirubin concentrations and incident coronary heart disease risk among patients with type 2 diabetes:the Dongfeng-Tongji cohort[J].Acta Diabetol,2017,54(3):257-264.DOI:10.1007/s00592-016-0946-x.

相似文献/References:

[1]李冬梅.高压氧治疗糖尿病足的疗效研究[J].国际内分泌代谢杂志,2014,(05):356.[doi:10.3760/cma.j.issn.1673-4157.2014.05.020]
　Li Dongmei..Therapeutic effects of hyperbaric oxygen on patients with diabetic foot[J].International Journal of Endocrinology and Metabolism,2014,(02):356.[doi:10.3760/cma.j.issn.1673-4157.2014.05.020]
[2]张如意 张桦 王娇 孙嘉 陈容平 杨锐 冉建民 陈宏.超重或肥胖2型糖尿病患者糖尿病足的 患病率及相关危险因素分析[J].国际内分泌代谢杂志,2015,(06):365.[doi:DOI:10.3760/cma.j.issn.1673-4157.2015.06.002]
　Zhang Ruyi*,Zhang Hua,Wang Jiao,et al.Prevalence and risk factors for diabetic foot in overweight or obese type 2 diabetic patients[J].International Journal of Endocrinology and Metabolism,2015,(02):365.[doi:DOI:10.3760/cma.j.issn.1673-4157.2015.06.002]
[3]赵荣亚 王鹏华 张靖航 孙幸幸 侯小丽.血清降钙素原对糖尿病足感染患者 截趾风险的预测价值[J].国际内分泌代谢杂志,2015,(06):370.[doi:DOI:10.3760/cma.j.issn.1673-4157.2015.06.003]
　Zhao Rongya,Wang Penghua,Zhang Jinghang,et al.Predictive value of serum procalcitonin in amputation risk of patients with diabetic foot infection[J].International Journal of Endocrinology and Metabolism,2015,(02):370.[doi:DOI:10.3760/cma.j.issn.1673-4157.2015.06.003]
[4]樊立娜 李鹏辉 王芳 王祯 张雪晴 耿杨.糖尿病足患者血清同型半胱氨酸 及胱抑素C水平变化的研究[J].国际内分泌代谢杂志,2015,(06):374.[doi:DOI:10.3760/cma.j.issn.1673-4157.2015.06.004]
　Fan Lina,Li Penghui,Wang Fang,et al.Serum level of homocysteine and cystatin C in patients with diabetic foot[J].International Journal of Endocrinology and Metabolism,2015,(02):374.[doi:DOI:10.3760/cma.j.issn.1673-4157.2015.06.004]
[5]李津凯,阚世廉,张秀军,等.前列地尔联合胰激肽原酶治疗早期 糖尿病足的疗效观察[J].国际内分泌代谢杂志,2016,36(02):121.[doi:10.3760/cma.j.issn.1673-4157.2016.02.011]
　Li Jinkai*,Kan Shilian,Zhang Xiujun,et al.Curative effect of alprostadil combined with kallidinogenase on early diabetic foot[J].International Journal of Endocrinology and Metabolism,2016,36(02):121.[doi:10.3760/cma.j.issn.1673-4157.2016.02.011]
[6]许颖,孙玉芝,张朝晖,等.CXC趋化因子配体16与糖尿病足的 相关性探讨[J].国际内分泌代谢杂志,2016,36(04):230.[doi:10.3760/cma.j.issn.1673-4157.2016.04.05]
　Xu Ying*,Sun Yuzhi,Zhang Zhaohui,et al.The correlation between CXC chemokine ligand 16 and diabetic foot[J].International Journal of Endocrinology and Metabolism,2016,36(02):230.[doi:10.3760/cma.j.issn.1673-4157.2016.04.05]

备注/Memo

备注/Memo:
通信作者:裴翔, Email:peixiang0506@163.com
Corresponding author: Pei Xiang,Email:peixiang0506@163.com
更新日期/Last Update: 2020-03-20