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

doi:10.3877/cma.j.issn.1674-0785.2023.09.012

Abstract

Abstract:

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 (GCS_endo, GCS_mid, and GCS_epi) 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 GCS_endo, GCS_mid, and GCS_epi (P<0.05 for all). Multivariate linear regression analysis showed that GCS_mid and GCS_epi 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

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.

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Figures/Tables 5

References 25

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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

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

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
GCS_endo（%）	-26.65±5.85	-20.21±7.34	-5.911	<0.001
GCS_mid（%）	-21.60±5.27	-17.03±6.03	-4.944	<0.001
GCS_epi（%）	-17.99±5.51	-13.65±5.13	-5.068	<0.001

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
GCS_endo（%）	-26.65±5.85	-20.21±7.34	-5.911	<0.001
GCS_mid（%）	-21.60±5.27	-17.03±6.03	-4.944	<0.001
GCS_epi（%）	-17.99±5.51	-13.65±5.13	-5.068	<0.001

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
GCS_endo	0.299	0.109	0.336
GCS_mid	-1.077^**	-0.793^*	-1.104^**
GCS_epi	0.765^**	0.669^**	0.651^**

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