切换至 "中华医学电子期刊资源库"
高级检索
中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (09) : 1004 -1009. doi: 10.3877/cma.j.issn.1674-0785.2023.09.012

临床研究

研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响
薛念余, 张盛敏, 吴凌恒, 沙蕾, 童揽月, 沈崔琴, 李朝军†(), 杜联芳   
  1. 315010　宁波，宁波市第一医院超声科;200080　上海，上海交通大学附属第一人民医院超声医学科
    315010　宁波，宁波市第一医院超声科
    200080　上海，上海交通大学附属第一人民医院超声医学科;55000　宁德，福建医科大学附属闽东医院超声科
    208038　上海，上海市第一人民医院嘉定分院超声科
    200080　上海，上海交通大学附属第一人民医院超声医学科;208038　上海，上海市第一人民医院嘉定分院超声科
    200080　上海，上海交通大学附属第一人民医院超声医学科
  • 收稿日期:2022-10-11 出版日期:2023-09-15
  • 通信作者: 李朝军
  • 基金资助:
    上海市自然科学基金(21ZR1451400); 上海市嘉定区卫生和计划生育委员会基金(2021-KY-10)

Effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes

Nianyu Xue, Shengmin Zhang, Lingheng Wu, Lei Sha, Lanyue Tong, Cuiqin Shen, Zhaojun Li†(), Lianfang Du   

  1. Department of Ultrasound, the Ningbo First Hospital, Ningbo 31010, China;Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
    Department of Ultrasound, the Ningbo First Hospital, Ningbo 31010, China
    Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China;Department of Ultrasound, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, China
    Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai 208038, China
    Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China;Department of Ultrasound, Jiading Branch of Shanghai General Hospital, Shanghai 208038, China
    Department of Ultrasound, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
  • Received:2022-10-11 Published:2023-09-15
  • Corresponding author: Zhaojun Li
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

薛念余, 张盛敏, 吴凌恒, 沙蕾, 童揽月, 沈崔琴, 李朝军, 杜联芳. 研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(09): 1004-1009.

Nianyu Xue, Shengmin Zhang, Lingheng Wu, Lei Sha, Lanyue Tong, Cuiqin Shen, Zhaojun Li, Lianfang Du. Effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(09): 1004-1009.

目的

研究2型糖尿病患者心脏结构发生改变前，血清胆红素对其心肌功能的影响。

方法

选取符合入选标准的2型糖尿病受试者89例作为糖尿病组，随机选取2020年12月~2022年6月于上海市第一人民医院嘉定分院就诊的无糖尿病和心脑血管疾病史的受试者67例为对照组。分别获取受试者年龄、体质量指数（BMI）、收缩压（SBP）、总胆固醇（TC）、总甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹血糖（FPG）、总胆红素（TBIL）、直接胆红素（DBIL）和间接胆红素（IBIL）；左心室舒张末期（LVEDD）和收缩末期内径（LVESD）、室间隔厚度（IVSD）、左心室后壁厚度（LVPWD）；E/e'、e'/a'、左心室射血分数（LVEF）、左心室心肌分层环向应变（GCSendo、GCSmid和GCSepi）等。比较两组之间各项指标的差异；采用多因素相关分析胆红素与血生化指标及左心室结构和功能指标的相关性。

结果

与对照组相比，糖尿病组受试者的年龄、BMI、SBP、TG、FPG和IBIL均较大（P均<0.05）。与对照组相比，糖尿病组受试者左心室舒张功能受损，E/e'较高，而e'/a'较低（P均<0.05），糖尿病组受试者左心室心肌分层环向应变指标GCSendo、GCSmid和GCSepi均较低（P均<0.05）。多因素线性回归分析提示：GCSmid、GCSepi是TBIL、DBIL、IBIL独立影响因素（P均<0.05）；HDL和血红蛋白是TBIL的独立影响因素（P均<0.05）；LDL是DBIL独立影响因素（P<0.05）；血红蛋白是IBIL独立影响因素（P<0.05）。Bland-Altman分析显示心肌分层环向应变测量重复性较好。

结论

心肌分层环向应变可以早期发现糖尿病患者心肌受损，胆红素对糖尿病早期心肌损害有保护作用。

关键词: 超声心动图, 2型糖尿病, 胆红素, 环向应变, 二维斑点追踪技术
Objective

To preliminarily study the effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes.

Methods

Eighty-nine patients with type 2 diabetes mellitus who met the inclusion criteria were selected as a diabetes group, and 67 subjects without a history of diabetes mellitus or cardiovascular and cerebravascular diseases were randomly selected from those who visited Jiading Branch of Shanghai First People's Hospital from December 2020 to June 2022 as a control group. The subjects' age, body mass index (BMI), systolic blood pressure (SBP), total cholesterol (TC), total triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), fasting plasma glucose (FPG), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL); left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), interventricular septal dimensions (IVSD), and left ventricular posterior wall dimensions (LVPWD); and E/e', e'/a', left ventricular ejection fraction (LVEF), and left ventricular myocardial layered circumferential strain (GCSendo, GCSmid, and GCSepi) were compared between the two groups. Multivariate correlation analysis was used to analyze the correlation of bilirubin with blood biochemical indexes and left ventricular structure and function indexes.

Results

Compared with the control group, the subjects in the diabetes group were older in age and had higher BMI, SBP, TG, FPG, and IBIL; had impaired left ventricular diastolic function, higher E/e', and lower e'/a'; and had lower GCSendo, GCSmid, and GCSepi (P<0.05 for all). Multivariate linear regression analysis showed that GCSmid and GCSepi were independent influencing factors of TBIL, DBIL, and IBIL; HDL and hemoglobin were independent influencing factors of TBIL; LDL was an independent influencing factor of DBIL; and hemoglobin was an independent influencing factor of IBIL (P<0.05 for all). Bland-Altman analysis showed that the measurement repeatability of the circumferential strain of myocardial stratification was good.

Conclusion

Myocardial layered circumferential strain can be used to assess myocardial damage in diabetic patients at an early stage before the cardiac structure and LVEF are significantly damaged, and bilirubin has a protective effect on early myocardial damage in diabetes.

Key words: Echocardiography, Type 2 diabetes mellitus, Bilirubin, Circumferential strain, Two-dimensional speckle tracking technique
图1 左心室心肌分层环向应变图。图a为二维应变图；图b为环向应变彩色编码图；图c为环向应变“牛眼”图；图d为环向应变曲线图
表1 糖尿病组与对照组一般资料比较
项目 对照组（67例） DM组（89例） χ2值 P值
性别[例（%）] 0.941 0.410
男性 37（55.22） 56（62.92）
女性 30（44.78） 33（37.08）
年龄（岁，） 55.52±10.24 61.90±10.93 -3.706 <0.001
BMI（kg/m2，） 23.22±3.25 24.54±4.38 -2.072 0.040
SBP（mmHg，） 127.69±20.74 142.45±23.24 -4.111 <0.001
DBP（mmHg，） 77.61±12.31 81.82±14.08 -1.949 0.053
高血压[例（%）] 21（31.34） 43（48.31） 1.543 0.214
TC（mmol/L，） 4.31±1.09 4.50±1.22 -0.963 0.337
TG（mmol/L，） 1.42±0.92 1.74±1.08 -1.990 0.048
HDL（mmol/L，） 1.11±0.30 1.01±0.33 1.918 0.057
LDL（mmol/L，） 2.86±0.99 2.79±1.03 0.437 0.663
FPG（mmol/L，） 5.28±1.27 7.55±2.90 -5.983 <0.001
血红蛋白（g/L，） 135.17±17.32 130.98±21.51 1.288 0.200
TBIL（μmol/L，） 16.69±7.96 14.46±5.68 1.924 0.056
DBIL（μmol/L，） 4.72±2.28 4.01±1.68 1.960 0.052
IBIL（μmol/L，） 12.45±6.74 10.27±4.49 2.121 0.036
表2 糖尿病组与对照组左心室结构功能及环向应变指标比较（）
项目 对照组（67例） DM组（89例） t值 P值
LVEDD（mm） 46.01±5.04 45.93±5.36 0.098 0.922
LVESD（mm） 29.28±3.64 28.93±3.43 0.617 0.538
IVSD（mm） 8.62±0.99 9.46±1.32 -4.393 <0.001
LVPWD（mm） 8.55±0.94 8.95 ±1.35 -2.075 0.040
E/e' 6.56±1.62 8.20±3.08 -3.914 <0.001
e'/a' 1.14±0.50 0.84±0.41 3.976 <0.001
侧壁MPI 0.57±0.18 0.62±0.37 -0.797 0.427
间隔MPI 0.49±0.20 0.53 ±0.16 -0.966 0.337
LVEF 0.59±0.09 0.56±0.09 1.683 0.094
GCSendo（%） -26.65±5.85 -20.21±7.34 -5.911 <0.001
GCSmid（%） -21.60±5.27 -17.03±6.03 -4.944 <0.001
GCSepi（%） -17.99±5.51 -13.65±5.13 -5.068 <0.001
表3 胆红素与血生化指标及左心室结构和功能指标的多因素线性回归相关分析
项目 TBIL DBIL IBIL
年龄 -0.046 0.079 -0.013
BMI 0.115 0.239 0.121
SBP 0.036 -0.027 0.017
DBP -0.014 -0.038 0.007
甘油三酯 0.022 -0.160 -0.001
高密度脂蛋白 0.214* 0.092 0.185
低密度脂蛋白 -0.152 -0.275* -0.031
空腹血糖 -0.152 -0.090 -0.131
血红蛋白 0.274** 0.254 0.288*
E/e' 0.011 -0.049 0.001
e'/a' 0.106 0.138 0.096
侧壁MPI -0.041 -0.033 -0.098
间隔MPI -0.114 -0.155 -0.162
LVEF 0.083 0.029 -0.011
GCSendo 0.299 0.109 0.336
GCSmid -1.077** -0.793* -1.104**
GCSepi 0.765** 0.669** 0.651**
图2 同一医生不同时间分析GCSend的一致性检验：图a为Bland-Altman分析图；图b为线性回归曲线 注：GCSend为左室心内膜下环向应变
1
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版) [J]. 中华糖尿病杂志, 2018, 10(1): 4-67.
2
Li C, Wu W, Song Y, et al. The nonlinear relationship between total bilirubin and coronary heart disease: a dose-response meta-analysis [J]. Front Cardiovasc Med, 2022, 8: 761520.
3
Bulmer AC, Bakrania B, Du Toit EF, et al. Bilirubin acts as a multipotent guardian of cardiovascular integrity: more than just a radical idea[J]. Am J Physiol Heart Circ Physiol, 2018, 315(3): H429-H447.
4
Jain V, Ghosh RK, Bandyopadhyay D, et al. Serum bilirubin and coronary artery disease: intricate relationship, pathophysiology, and recent evidence [J]. Curr Probl Cardiol, 2021, 46(3): 100431.
5
Yan P, Zhang Z, Miao Y, et al. Physiological serum total bilirubin concentrations were inversely associated with diabetic peripheral neuropathy in Chinese patients with type 2 diabetes: a cross-sectional study [J]. Diabetol Metab Syndr, 2019, 11: 100
6
Li C, Wu W, Song Y, et al. The nonlinear relationship between total bilirubin and coronary heart disease: A dose-response meta-analysis [J]. Front Cardiovasc Med, 2022, 8: 761520.
7
Zhang R, Bai Y, Wang R, etc. Elevated serum bilirubin may significantly reduce coronary heart disease risk in females: A prospective cohort study [J]. Nutr Metab Cardiovasc Dis, 2022, 32(3): 648-657.
8
石少敏, 高凌. 2型糖尿病患者血清胆红素与尿白蛋白的相关性分析 [J/OL]. 中华临床医师杂志(电子版), 2017, 11(8): 1353-1356.
9
Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association. Guidelines for echocardioimagedata diagnosis of cardiomyopathy: recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association [J]. Advanced Ultrasound in Diagnosis and Therapy, 2022, 6(2): 72-94.
10
Copur B, Yilmaz N, Topcuoglu C, et al. Relationship between elevated bilirubin level and subclinical atherosclerosis as well as oxidative stress in Gilbert syndrome [J]. Gastroenterol Hepatol Bed Bench, 2020, 13(2): 133-140.
11
Yamamoto M, Nishimori H, Fukutomi T, et al. Dynamics of oxidative stress evoked by myocardial ischemia reperfusion after off-pump coronary artery bypass grafting elucidated by bilirubin oxidation [J]. Circ J, 2017, 81(11): 1678-1685.
12
Boon AC, Hawkins CL, Bisht K, et al. Reduced circulating oxidized LDL is associated with hypocholesterolemia and enhanced thiol status in Gilbert syndrome [J]. Free Radic Biol Med, 2012, 52(10): 2120-2127.
13
Ratliff BB, Abdulmahdi W, Pawar R, et al. Oxidant mechanisms in renal injury and disease [J]. Antioxid Redox Signal, 2016, 25(3): 119-146.
14
Wallner M, Bulmer AC, Mölzer C, et al. Haem catabolism: a novel modulator of inflammation in Gilbert's syndrome [J]. Eur J Clin Invest, 2013, 43(9): 912-919.
15
Vogel ME, Idelman G, Konaniah ES, et al. Bilirubin prevents atherosclerotic lesion formation in low-density lipoprotein receptor-deficient mice by inhibiting endothelial VCAM-1 and ICAM-1 signaling [J]. J Am Heart Assoc, 2017, 6(4): e004820.
16
Kolachalama VB, Shashar M, Alousi F, et al. Uremic solute-aryl hydrocarbon receptor-Tissue factor axis associates with thrombosis after vascular injury in humans [J]. J Am Soc Nephrol, 2018, 29(3): 1063-1072.
17
Kundur AR, Singh I, Bulmer AC. Bilirubin, platelet activation and heart disease: a missing link to cardiovascular protection in Gilbert's syndrome? [J]. Atherosclerosis, 2015, 239(1): 73-84.
18
NaveenKumar SK, Thushara RM, Sundaram MS, et al. Unconjugated bilirubin exerts pro-apoptotic effect on platelets via p38-MAPK activation [J]. Sci Rep, 2015, 5(10): 15045.
19
Zhou T, Chen X, Li Z, et al. Relationship between serum bilirubin and left ventricular hypertrophy in patients with essential hypertension [J]. PLoS One, 2015, 10(4): e0125275.
20
Oda E. A decrease in total bilirubin predicted hyper-LDL cholesterolemia in a health screening population [J]. Atherosclerosis, 2014, 235(2): 334-338.
21
Stec DE, John K, Trabbic CJ, et al. Bilirubin binding to PPARα inhibits lipid accumulation [J]. PLoS One, 2016, 11(4): e0153427.
22
Jia G, Hill MA, Sowers JR. Diabetic cardiomyopathy: An update of mechanisms contributing to this clinical entity [J]. Circ Res, 2018, 122(4): 624-638.
23
Li ZJ, Du LF, Luo XH. Evaluation of ventricular-vascular coupling in patients with type 2 diabetes mellitus using 2- dimensional speckle tracking imaging [J]. J Huazhong Univ Sci Technolog Med Sci, 2014, 34(6): 929-934.
24
Paolillo S, Marsico F, Prastaro M, et al. Diabetic cardiomyopathy: definition, diagnosis, and therapeutic implications [J]. Heart Fail Clin, 2019, 15(3): 341-347.
25
Vigneault DM, Yang E, Jensen PJ, et al. Left ventricular strain is abnormal in preclinical and overt hypertrophic cardiomyopathy: cardiac MR feature tracking [J]. Radiology, 2019, 290(3): 640-648.
[1] 何金梅, 尹立雪, 谭静, 张文军, 王锐, 任梅, 廖明娇. 超声心肌做功技术对2型糖尿病患者潜在左心室心肌收缩功能损伤的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1029-1035.
[2] 薛艳玲, 马小静, 谢姝瑞, 何俊, 夏娟, 何亚峰. 左心声学造影在急性心肌梗死合并室间隔穿孔中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1036-1039.
[3] 武玺宁, 欧阳云淑, 张一休, 孟华, 徐钟慧, 张培培, 吕珂. 胎儿心脏超声检查在抗SSA/Ro-SSB/La抗体阳性妊娠管理中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1056-1060.
[4] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1061-1067.
[5] 张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[6] 赵红娟, 赵博文, 潘美, 纪园园, 彭晓慧, 陈冉. 应用多普勒超声定量分析正常中晚孕期胎儿左心室收缩舒张时间指数[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 951-958.
[7] 刘丹妮, 敖梦, 冉海涛, 李世玉, 秦芳. 三维超声心动图及二维斑点追踪成像对持续性心房颤动复律后双心房逆向重构的评估[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 827-835.
[8] 张璟璟, 赵博文, 潘美, 彭晓慧, 毛彦恺, 潘陈可, 朱玲艳, 朱琳琳, 蓝秋晔. 胎儿超声心动图测量McGoon指数在评价胎儿肺血管发育中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 860-865.
[9] 徐鹏, 李军, 高巍伦, 王峥, 庞珅, 李春妮, 朱霆. 快速旋转扫查法在胎儿超声心动图检查中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 761-766.
[10] 应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[11] 吴赤球, 韦曙东, 张辉, 严许清, 梅朵卓嘎, 余丹. 驻不同海拔高度高原人员习服后心脏结构和功能变化的超声心动图评估[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 588-593.
[12] 谭芳, 杨娇娇, 沈玉琴, 李炎菲海, 王海蕊, 范思涵, 纪学芹. 胎儿心脏定量分析技术对正常胎儿心脏形态及收缩功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 598-604.
[13] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[14] 吴群, 张鑫, 李培, 王芳韵, 郑淋, 卫海燕, 马宁. 孤立型主动脉缩窄的超声心动图诊断及术后随访研究[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 642-646.
[15] 谷先勇, 徐娟. 特发性肺纤维化合并T2DM炎症水平与预后相关性分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 721-723.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号