目的  探讨血清胆红素水平与糖尿病视网膜病变（DR）之间的关系。方法  选取2型糖尿病患者293例，依据眼底检查分为糖尿病无视网膜病变组（NDR）（n=146）、糖尿病视网膜病变组（DR）（n=147），将DR组分为非增殖期糖尿病视网膜病变组（NPDR）（n=103）、增殖期糖尿病视网膜病变组（PDR）（n=44）。对NDR、NPDR、PDR 3组患者临床资料进行分析比较。依据总胆红素四分位数分为Q1、Q2、Q3、Q4组，分析总胆红素与DR患病率的关系。结果  与NDR组比较，NPDR组和PDR组中的病程、收缩压均升高（P＜0.05），且PDR组中的病程、收缩压高于NPDR组（P＜0.05）。与NDR组比较，NPDR组和PDR组中总胆红素（TBIL）、直接胆红素（DBIL）、餐后2小时C肽（2 hCP）均减低，且PDR组中TBIL、DBIL、间接胆红素（IBIL）、2 hCP低于NPDR组（P＜0.05）。与NDR组比较，PDR组中IBIL低于NDR组（P＜0.05）。与NDR组比较，NPDR组和PDR组中FPG、2 hPG、HbA1c、TC均升高，且PDR组中FPG、2 hPG、HbA1c、γGGT高于NPDR组（P＜0.05）。与NDR组比较，PDR组中γGGT高于NDR组（P＜0.05）。多元有序Logistic回归分析：TBIL、2 hCP是DR的保护性因素；病程、收缩压、FPG、2 hPG、HbA1c、γGGT是DR的危险因素。不同TBIL水平DR的患病率存在差异，随着TBIL水平的升高，DR的患病率呈现下降趋势（P＜0.05）。结论  TBIL水平的降低与DR发病风险增加显著相关，可作为预测DM患者发生DR风险的潜在性生物标志物。对于血清胆红素偏低的患者，密切监测2 hCP水平以及加强监控管理血糖、HbA1c、SBP、γGGT，对DR的预防具有重要意义。

Objective  To explore  the relationship between serum levels of bilirubin  and diabetic retinopathy (DR).Methods  293 patients with type 2 diabetes admitted to  the hospital and diagnosed were selected. According to the fundus examination,  the patients were divided into nondiabetic retinopathy group (NDR) (n=146)  and diabetic retinopathy group (DR) (n=147). DR group was divided into nonproliferative diabetic retinopathy group (NPDR) (n=103) and  proliferative diabetic retinopathy group(PDR)  (n=44).The clinical data of  NDR, NPDR and PDR  groups  were analyzed and compared. According to the quartile of  total bilirubin, the groups were divided into Q1, Q2, Q3 and Q4, and the relationship between total bilirubin(TBIL) and DR prevalence was analyzed.Results  Compared with  NDR group, both  disease duration and systolic blood pressure in  NPDR group and PDR group were increased (P<0.05), and the disease duration and systolic blood pressure in PDR group were higher than those in  NPDR group (P<0.05).  Compared with  NDR group, TBIL, direct bilirubin(DBIL) and  Cpeptide 2 hours meal(2 hCP) in NPDR group and PDR group were  all decreased, and TBIL, DBIL, indirect bilirubin(IBIL) and 2 hCP  in  PDR group were lower than those in NPDR group (P<0.05). Compared with NDR group, IBIL of PDR group was lower than that of NDR group(P<0.05).Compared with NDR group, FPG, 2 hPG, HbA1c and  TC in NPDR group and PDR group were all  increased, and  FPG, 2 hPG, HbA1c and  γGGT in PDR group were higher than those in NPDR group (P<0.05).  Compared with NDR group, γGGT  in  PDR group was higher than that in  NDR group (P<0.05). Multiple  ordered  Logistic regression analysis  showed that  TBIL and 2 hCP were protective factors for DR. Duration of disease, systolic blood pressure, FPG, 2 hPG, HbA1c and γGGT were the risk factors for DR.The prevalence of DR varied with different TBIL levels. With the increase of TBIL levels, the prevalence  of   DR showed a decreasing trend(P<0.05).Conclusion  The decrease of  TBIL level is  correlated with the increased risk of DR, and can be used as a potential biomarker to predict the risk  of DR  in DM patients.For patients with low serum bilirubin, close monitoring of  2 hCP level and strengthening monitoring and management of blood glucose, HbA1c, SBP and  γGGT  are of great significance for the prevention of DR.