2型糖尿病患者血清胆红素与骨质疏松的相关性研究

doi:10.3969/j.issn.1006-7795.2026.01.022

摘要/Abstract

摘要： 目的分析2型糖尿病（type 2 diabetes mellitus, T2DM）患者血清胆红素浓度与骨密度（bone mineral density, BMD）及骨质疏松（osteoporosis, OP）的关系。方法回顾性分析1 514例于首都医科大学附属北京同仁医院住院T2DM患者，年龄50～94岁，平均年龄 (63.49±8.11)岁，检测血清总胆红素（total bilirubin, TBIL）及直接胆红素（direct bilirubin, DBIL）浓度，根据四分位数分为Q1~Q4 4组。应用双能X线吸收检测法测定BMD。腰椎、全髋、股骨颈任意部位BMD的T值≤-2.5为OP。采用多因素Logistic回归和线性回归模型分析T2DM患者血清TBIL及DBIL与OP及BMD的关系。结果 OP与非OP组血清TBIL及DBIL浓度差异有统计学意义。经过多因素校正后，TBIL-Q4组比Q1组OP患病率显著增高（OR=1.952, 95%CI： 1.041~3.659, P=0.037），腰椎BMD显著降低（β =-0.038, 95%CI：-0.072~-0.004, P=0.027）；与DBIL-Q1组相比，DBIL-Q2组及Q3组在股骨颈及髋部的BMD均显著降低（P<0.05）。亚组分析显示，TBIL及DBIL对OP的影响在年龄≤65岁及糖化血红蛋白(glycosylated hemoglobin, HbA1c) ≤7.0%组更为显著；女性患者的TBIL浓度与腰椎BMD呈负相关（β= -0.019, 95%CI：-0.034~-0.005, P=0.009）。结论胆红素浓度升高与OP患病率增加及BMD下降有关，尤其在年龄≤65岁及 HbA1c ≤7.0%亚组更为显著。

关键词: 2型糖尿病, 总胆红素, 直接胆红素, 骨密度, 骨质疏松, 骨代谢

Abstract: Objective To examine the association between serum bilirubin levels and bone mineral density (BMD), as well as osteoporosis (OP) in patients with type 2 diabetes mellitus(T2DM). Methods A retrospective analysis was conducted in 1 514 T2DM patients of Beijing Tongren Hospital, Capital Medical University. The age of the patients ranged from 50 to 94 years, with a mean age of (63.49±8.11) years. Serum total bilirubin (TBIL) and direct bilirubin (DBIL) levels were measured, and then was classified as Q1-Q4 groups based on quartiles. BMD was assessed by using dual-energy X-ray absorptiometry. OP was defined according to the diagnostic criteria of the World Health Organization, which indicated a T-score ≤ -2.5 for lumbar spine, total hip or femoral neck. Multivariable Logistic regression and linear regression models were used to analyze the relationship between serum bilirubin (TBIL and DBIL) levels and BMD, OP in T2DM patients. Results There were significant differences in serum TBIL and DBIL levels between the OP and non-OP groups. After multivariable adjustment, the TBIL-Q4 group had a significantly higher prevalence of OP (OR=1.952, 95% CI: 1.041-3.659,P=0.037) and a significant decrease in lumbar spine BMD (β =-0.038, 95% CI :-0.072--0.004, P=0.027) compared to the TBIL-Q1 group. Compared to the DBIL-Q1 group, the DBIL-Q2 and DBIL-Q3 groups showed significant decreases in BMD at the femoral neck and total hip (P<0.05). Subgroup analysis showed that the impact of TBIL and DBIL on OP was more significant in the age ≤ 65 years and glycosylated hemoglobin (HbA1c) ≤ 7.0% groups. In female patients, TBIL levels were negatively correlated with lumbar spine BMD (β= -0.019, 95% CI:-0.034--0.005, P=0.009). Conclusion Elevated bilirubin levels are associated with an increased prevalence of OP and decreased BMD, especially in subgroups of age ≤ 65 years and HbA1c ≤ 7.0%.

Key words: type 2 diabetes mellitus, total bilirubin, direct bilirubin, bone density, osteoporosis, bone metabolism

中图分类号:

R587.1

原晶, 贾璞, 刘薇. 2型糖尿病患者血清胆红素与骨质疏松的相关性研究[J]. 首都医科大学学报, 2026, 47(1): 168-179.

Yuan Jing, Jia Pu , Liu Wei. Relationship between serum bilirubin and osteoporosis in patients with type 2 diabetes[J]. Journal of Capital Medical University, 2026, 47(1): 168-179.

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