老年2型糖尿病患者参考范围内血清胆红素与颈动脉斑块的关系研究OA

Background The relationship between serum bilirubin and carotid plaque in elderly patients with type 2 diabetes mellitus(T2DM)remains unclear.Objective To investigate the association between serum bilirubin levels within the normal range and the risk of carotid plaque in elderly patients with T2DM,and to explore the potential underlying mechanisms.Methods A total of 2 885 elderly T2DM patients(aged≥65 years)with complete clinical data hospitalized in the Department of Endocrinology and Metabolism,Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2003 to December 2012 were recruited in this retrospective study.According to the quintiles of serum unconjugated bilirubin(UCB)levels,the patients were divided into five groups:Q1(UCB<6.0 μmol/L,n=446),Q2(UCB:6.0-7.5 μmol/L,n=717),Q3(UCB:7.6-8.9 μmol/L,n=533),Q4(UCB:9.0-10.1 μmol/L,n=607),and Q5(UCB>10.1 μmol/L,n=582).The detailed clinical data,physical examination findings,carotid ultrasound measurements,and laboratory test results were collected.The prevalence of carotid plaque was compared among the five groups.Partial correlation analysis was performed to examine the associations between serum C-reactive protein(CRP)and bilirubin levels.Binary Logistic regression was used to analyze the association of serum bilirubin including total bilirubin(TB),UCB,and conjugated bilirubin(CB)with the presence of carotid plaque.Results Among 2 885 elderly hospitalized patients with T2DM,1 296 were men(44.9%)and 1 589 were women(55.1%),with a mean age of 72.6±5.3 years.Significant differences were observed among the five groups with respect to age,sex,diabetes duration,smoking status,use of lipid-lowering medications,insulin or insulin analog therapy,diastolic blood pressure,and lipoprotein(a)levels(P<0.05).After adjustment for age,sex,and diabetes duration,the prevalence of carotid plaque in elderly T2DM patients across Q1 to Q5 was 76.9%,71.8%,68.5%,65.9%,and 62.2%,respectively,showing a significant decreasing trend(χ2=30.900,P<0.001).Partial correlation analysis further demonstrated that serum TB(R=-0.090,P<0.001)and UCB(R=-0.100,P<0.001)were inversely correlated with CRP levels after adjustment for age,sex,and diabetes duration.After adjusting for multiple confounders,binary logistic regression analyses showed that serum TB(OR=0.833,95%CI=0.721-0.963,P=0.013)and UCB(OR=0.831,95%CI=0.725-0.952,P=0.008)were independently associated with a lower risk of carotid plaque in elderly patients with T2DM.Conclusion Higher serum bilirubin levels within the normal range are associated with a decreased risk of carotid plaque in elderly patients with T2DM.Lower levels of serum TB and UCB levels are independent risk factors for carotid plaque,which may be related to inflammatory status.