Relationship Between Serum Total Bilirubin And Diabetic Retinopathy In Type 2 Diabetes Mellitus

Objective:To investigate the relationship between serum total bilirubin and diabetic retinopathy in type 2 diabetes mellitus.Methods:Choose between January 2010 and December 2016,department of endocrinology of our hospital 1676 cases of T2DM patients in hospital were analyzed retrospectively,all cases the data are from record room input data,collect the patient’s general information,such as gender,age,diabetes duration,systolic blood pressure and diastolic blood pressure,etc.Collect related laboratory examination indexes,such as total bilirubin,direct bilirubin,indirect bilirubin,alanine aminotransferase,aspertate aminotransferase,blood urea nitrogen,serum creatinine,uric acid,triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,glycosylated hemoglobin,fasting blood glucose and glomerular filtration rate.Body mass index(BMI)was calculated as BMI=weight(kg)/height squared(m~2).eGFR was calculated as follows:male CCRs=(140-age)*weight(kg)*1.23/serum creatinine(umol/L).Female CCRs=(140-age)*body weight(kg)*1.03/serum creatinine(umol/L).All patients underwent fundus examination and had fundus photography and were divided into DR group and NDR group by ophthalmologists according to the results of fundus photography according to the new international clinical classification standard of diabetic retinopathy in 2002.All data were statistically analyzed using SPSS22.0 software.Results:Comparison between the two groups showed that the serum levels of total bilirubin(12.66±4.20umol/L),direct bilirubin(4.35±2.23umol/L)and indirect bilirubin(8.37±3.29umol/L)in DR group were lower than those in NDR group(13.99±3.90umol/L),(4.72±1.62umol/L)and(9.30±3.01umol/L),and the age,course of disease,systolic blood pressure,urea nitrogen and blood uric acid in DR group were higher than those in NDR group(P<0.05).When the risk factors between the two groups were included in the binary Logistic regression equation,it was found that serum total bilirubin was negatively correlated with DR(OR:0.922,95%CI:0.893-0.952),and the course of disease,systolic blood pressure and urea nitrogen were risk factors for DR(P<0.05).Within the physiological range,when the serum total bilirubin level of all patients was further divided into Q1 group(<11.65umol/L),Q2 group(11.65-15.40umol/L)and Q3 group(>15.40umol/L)according to the trisqule method,the Hb of Q1,Q2 and Q3 were(131.94±16.15g/L),(135.02±15.21g/L)and(140.99±15.12g/L),respectively,and gradually increased.The incidence of DR in Q1,Q2 and Q3 groups was(25.80%),(19.20%)and(13.80%)successively,and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that there was a positive correlation between TBIL and Hb(r=0.255,P=0.000),and a negative correlation between TBIL and disease course(r=-0.098,P=0.000),but no significant correlation with BUN and SBP(P>0.05).Multivariate Logistic regression analysis was performed with TBIL classification as independent variable and DR as dependent variable.After adjusting for gender,age,disease course,SBP,DBP,ALT,BUN,SUA,TG,LDL-C,HDL-C,Hb,and Hb A1c,the OR value of DR in the third quintile compared with the first quintile was 0.455(95%CI:0.328-0.629,P<0.05).Conclusion:There is a negative correlation between serum total bilirubin and DR,and serum total bilirubin may be an early clinical marker to predict the occurrence of DR.For patients with low serum bilirubin level,the levels of urea nitrogen and systolic blood pressure should be closely monitored,which is of great significance for the prevention and treatment of DR.