体型肥胖2型糖尿病患者血清胆红素、胆汁酸、25(OH)D3水平及与胰岛素抵抗的关系研究

摘要 目的：探讨体型肥胖2型糖尿病（T2DM）患者血清胆红素、胆汁酸（BA）、25羟维生素D325(OH)D₃]水平及其与胰岛素抵抗（IR）的关系。方法：选取2018年1月-2019年12月我院就诊的240例T2DM患者，根据体重指数（BMI）将患者分为T2DM-N组84例，T2DM-OW组92例，T2DM-OB组64例。分别测定总胆红素（TBIL）、间接胆红素（IBIL）、直接胆红素（DBIL）、胆汁酸（BA）、25(OH)D₃等指标。以胰岛素抵抗指数（HOMA-IR）为因变量，行多元线性回归，分析IR的危险因素。结果：T2DM-OB组BMI、BA、甘油三酯（TG）、空腹血糖（FPG）、餐后2小时血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、C反应蛋白（CRP）高于T2DM-N组，DBIL、25(OH)D₃低于T2DM-N组，差异均有统计学意义（P<0.05）。Pearson相关性分析显示，HOMA-IR与BMI、BA呈正相关（P<0.05)，与DBIL、25(OH)D₃呈负相关（P<0.05)；多元线性回归分析显示BMI升高，25(OH)D₃、DBIL下降为IR的危险因素（P<0.05）。结论：肥胖的T2DM患者存在IR及血脂紊乱，心血管疾病患病风险增加，BA水平升高，DBIL、25(OH)D₃水平下降，机体慢性低度炎症水平升高，除了BMI，25(OH)D₃、DBIL水平下降亦有可能是体型肥胖T2DM患者IR的重要危险因素。

Study on the Relationship between Serum Bilirubin, BA, 25(OH)D3 and Insulin Resistance in T2DM Patients with Obesity

ABSTRACT Objective: To explore the relationship between serum bilirubin, bile acid (BA), 25 hydroxyvitamin D325(OH)D₃] and insulin resistance (IR) in type 2 diabetes mellitus (T2DM) with obesity. Methods: From January 2018 to December 2019, 240 T2DM patients were divided into T2DM-N group (84 cases), T2DM-OW group (92 cases) and T2DM-OB group (64 cases). TBIL, IBIL, DBIL, BA and 25(OH)D₃ were measured respectively.HOMA-IR was used as the dependent variable to analyze the risk factors of IR. Results: BMI, BA, TG, FPG, 2hPG, HbA1c, FINS, HOMA-IR, CRP were higher in T2DM-OB group than in T2DM-N group, and DBIL, 25(OH)D₃ were lower in T2DM-N group (P<0.05). Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI and BA (P<0.05), negatively correlated with DBIL and 25(OH)D₃ (P<0.05). Multiple linear regression analysis showed that BMI increased, 25(OH)D₃ and DBIL decreased were the risk factors of IR(P<0.05). Conclusion: T2DM with obesity have IR and lipid disorders, increased risk of cardiovascular disease, increased levels of BA, decreased levels of DBIL and 25(OH)D₃, and increased levels of chronic low grade inflammation, in addition to BMI, the decrease of 25(OH)D₃ and DBIL may also be an important risk factor for IR in T2DM with obesity.