Serum total bilirubin levels and prevalence of diabetic retinopathy in a Chinese population (中国人群血清总胆红素水平与糖尿病视网膜病变相关性的研究)

Background Patients with type 2 diabetes (T2D) are at a high risk of developing microvascular complications, such as diabetic retinopathy (DR). Previous studies have shown that low serum bilirubin concentrations in T2D patients may increase the risk of diabetic complications. Thus, the aim of the present was to investigate the association between the prevalence of DR and serum concentrations of total bilirubin in a Chinese population. Methods The present study was a population-based cross-sectional study on 1761 T2D patients aged ≥40 years from the Jiading district of Shanghai, China. Fundus photographs were taken to confirm the presence and severity of DR. Subjects were assigned to quartiles based on serum total bilirubin concentrations (Quartile (Q) 1 0.99 mg/dL). Logistic regression models were used to explore the association between bilirubin concentrations and the prevalence of DR. Results The prevalence of DR in the entire study population was 9.6%. The prevalence of DR was significantly lower in Q4 compared with the other three quartiles (Ptrend = 0.004). After adjustment for multiple confounding factors, T2D patients in Q4 (i.e. serum bilirubin >0.99 mg/dL) were less likely (odds ratio 0.55; 95% confidence interval 0.33–0.91) to suffer from DR than patients in Q1 (i.e. serum bilirubin <0.60 mg/dL). Conclusion Serum bilirubin concentrations were inversely associated with DR in an elderly Chinese population, independent of traditional risk factors for microvascular complications. 摘要 背景 2型糖尿病患者的微血管并发症如糖尿病视网膜病变的发生风险增高。既往研究表明，糖尿病患者中低血清胆红素水平会增加糖尿病视网膜病变的风险。本次研究旨在探讨中国人群中血清总胆红素水平与糖尿病视网膜病变患病率的相关性。 方法 本研究是基于人群的横断面研究，调查对象包括1761名上海市嘉定区40岁及以上的糖尿病患者。采用眼底摄片确认是否存在糖尿病视网膜病变并了解其严重程度。根据血清总胆素四分位水平（Q1： 0.99 mg/dL），将调查对象分为四组。使用Logistic回归模型分析胆红素水平与糖尿病视网膜病变的相关性。 结果 糖尿病视网膜病变的总患病率为9.6%。血清胆红素水平位于第四分位的糖尿病患者的视网膜病变患病率显著低于另外3组（趋势P = 0.004）。校正多种混杂因素后，与血清胆红素水平位于第一分位的患者相比，血清胆红素水平位于第四分位的糖尿病患者的视网膜病变患病风险显著降低（OR = 0.55，95%置信区间CI：0.33-0.91）。 结论 在中国中老年人群中，血清胆红素水平与糖尿病视网膜病变患病率存在显著的负相关，该相关性独立于微血管病变的其他传统危险因素。