【摘要】 目的探讨糖尿病慢性肾脏疾病(CKD)发展过程中血清总胆红素(TBIL)的变化。 方法   收集125例CKD患者临床资料，记录TBIL、纤维蛋白原(FIB)、白蛋白(ALB)、血红蛋白(Hb)、血肌酐(Scr)、BUN等生化指标。另选取112名健康者作为对照(NC)组。根据24 h U～b将CKD患者分为24 hUAlb 30～299 mg／24 h(挖一41)和24 h UAlb≥300 mg／24 h(n=84)组。24 h UAlb≥300 mg／24 h组再根据eGFR水平分为eGFR≥15 ml／(min·1.73 m²)(n=42)和eGFR<15 ml／(min·1.73 m2)(n=42)两亚组。 结果     24 h UAIb≥300 mg／24 h组TBIL低于24 h UAlb 30～299 mg／24 h组，且24 h UAlb≥300 mg／24 h和24 h UAlb 30～299 mg／24 h组TBIL均低于NC组[(12.01±4.73)vs(10.23±7.74)vs(7.51±2.84)mmol／L，P<0.05]。eGFR<15 ml／(min·1.73 m²)亚组TBIL较eGFR≥15 ml／(min·
1.73 m²)亚组下降[(8.34±3.47)vs(6.92±2.40)mmol／L，P<0.01]。多元回归分析得出回归方程为：y=15.67+2.32X(y为eGFR，X为TBIL)，CKD患者TBIL与eGFR呈正相关，ALB、Hb及FIB与eG-FR无相关性。 结论    CKD患者的TBIL水平较健康人群低，其随着尿蛋白排出增多、eGFR下降而下降。TBIL水平为。肾功能下降的相关危险因素。
      【关键词】糖尿病，2型；糖尿病慢性肾脏疾病；血清总胆红素；尿白蛋白
      【Abstract】 Objective   To investigate the changes of serum total bilirubin level in the progress of chronic kidney disease in T2DM． Methods    A total of 125 T2DM patients with chronic kidney disease were selected and divided into two groups accoMing to their 24 h UAlb levels：30～299 mg／24 h group (n=41) and 24 h UAlb≥300 mg／24 h group (n=84)．The patients in 24 h UAlb≥300 mg／24 h group werefurther divided into two subgroups according to their eGFR levels：eGFR≥15 ml／(min·1.73 m²)
subgroup (n=42) and eGFR<15 ml／(min·1.73 m²)subgroup(n=42)．In addition，another 112 healthy people were selected as normal control (NC group)．Clinical data and biochemical indexes including serum total bilirubin(TBIL)，fibrinogen(FIB)，albumin(ALB)，hemoglobin(Hb)，creatinine (Cr)and blood urea nitrogen(BUN)were measured． Results    Serum TBIL level was significantly lowerin 24 h UAlb≥300 mg／24 h group than in 30～299 mg／24 h group，and the values in both groups were significantly lower than that in NC group[(12.01±4.73)vs(10.23±7.74)VS(7.51±2.84)mmol／L，P<0.053．Moreover，serum TBIL level was also significantly lower in eGFR<15 ml／(rain·1.73 m²) subgroup than in eGFR≥15 ml／(min·1.73 m²)subgroup[(8.34±3.47)vs

(6.92±2.40）mmol／L，P<0．01]．The regression equation obtained by multiple regression analysis was Y=15.67+2.32X(y
represents eGFR and X represents TBIL)．In T2DM patients with chronic kidney disease，serum TBIL level was positively correlated with eGFR．However，there was no correlation between ALB，Hb，FIB andeGFR． Conclusion    Serum TBIL 1evel iS lower in T2DM patients with chronic kidney disease than in healthy people and decreases with increasing of urinary protein excretion and declining of eGFR．SerumTBIL leveliS a risk factor related to renal function．
      【Key words】  Diabetes mellitus，type 2；Chronic kidney disease(CKD)in diabetes；Serum total bilirubin(TBIL)；Urinary albumin