铁路职业人群夜班轮班工作与代谢综合征的关联及中介效应分析  

Association and mediation effect analysis of night shift work and metabolic syndrome in railroad occupational population

作　　者：杨波[1] 冯传腾 于文倩 董舒 付瑶 余彬 李至韬 李茂 董朝会 潘佳 黄渠 杨淑娟 曾红莲[1] YANG Bo;FENG Chuan-teng;YU Wen-qian;DONG Shu;FU Yao;YU Bin;LI Zhi-tao;LI Mao;DONG Chao-hui;PAN Jia;HUANG Qu;YANG Shu-juan;ZENG Hong-ian(Affiliated Hospital of Chengdu University,Chengdu,Sichuan 610081,China;不详)

机构地区：[1]成都大学附属医院,四川成都610081 [2]四川大学灾后重建与管理学院 [3]四川大学华西公共卫生学院/华西第四医院 [4]中国铁路成都局集团有限公司

出　　处：《现代预防医学》2023年第2期239-244,262,共7页Modern Preventive Medicine

基　　金：四川省基层卫生事业发展研究中心(SWFZ21-C-104);中国铁路成都局集团有限公司科技研究开发计划课题(CX21088)。

摘　　要：目的夜班轮班工作是铁路职业人群的工作特点,本研究探究铁路职业人群夜班轮班工作与代谢综合征的关联,并探讨可能的中介因素及中介效应,为形成有针对性的铁路职业人群代谢综合征预防策略与措施提供参考依据。方法本研究采用多阶段整群抽样调查在重庆市、四川省和贵州省工作的铁路职工。采用国际体力活动问卷及食物频率问卷等量表获取调查对象的夜班轮班工作情况、生活方式等指标。通过spearman秩相关系数和二元logistic回归分析夜班轮班与代谢综合征各组分之间的关系。采用bootstrap法对吸烟及饮酒的中介效应进行分析。结果共纳入符合纳排标准的6905例研究对象,代谢综合征患病率为20.5%。回归分析发现,夜班轮班工作显著增加代谢综合征发生风险(调整OR=1.102,95%CI:1.002~1.041),还可增加高血压(调整OR=1.159,95%CI:1.050~1.280)和糖尿病发生风险(调整OR=1.134,95%CI:1.010~1.273)。中介分析发现吸烟在夜班轮班与代谢综合征之间的中介效应占比为25.64%,饮酒在夜班轮班与代谢综合征之间的中介效应占比为20.84%。以糖尿病和高血压作为结局进行分析,仅饮酒有显著的中介作用,其在夜班轮班和高血压之间的中介占比为19.55%,在夜班轮班和糖尿病之间的中介占比为19.22%。结论夜班轮班与代谢综合征患病率密切相关,主要通过高血压及糖尿病两个组分来影响代谢综合征。采取有效健康教育,倡导铁路职业人群戒烟限酒,或能成为降低夜班轮班对代谢综合征患病风险影响的关键措施。Objective To explore the relationship between night shift work and metabolic syndrome in railway occupational population, and to discusses the possible mediators and mediating roles, so as to provide reference for the formation of targeted prevention strategies and measures of metabolic syndrome in this population. Methods A total of 8 467 railway workers from Chongqing, Sichuan Province, and Guizhou Province were selected through multi-stage cluster sampling. The international physical activity questionnaire and food frequency questionnaire were used to obtain the night shift work conditions and lifestyle of the workers. The relationship between night shift work and metabolic syndrome was analyzed by spearman ’s rank correlation coefficient and binary logistic regression. Bootstrap method was used to analyze the mediating roles of smoking and drinking. Results According to the inclusion and exclusion criteria, the data of 6 905 subjects were obtained, and the prevalence rate of metabolic syndrome was 20.5%. Night shift work significantly increased the risk of metabolic syndrome(adjusted OR = 1.102, 95%CI: 1.002-1.041), hypertension(adjusted OR = 1.159, 95%CI: 1.050-1.280), and diabetes(adjusted OR = 1.134, 95%CI: 1.010-1.273). The mediating analysis showed that the mediating role of smoking between night shift work and metabolic syndrome was 25.64%, and that between night shift work and metabolic syndrome was 20.84%.Taking diabetes and hypertension as outcomes, only drinking had a significant mediating effect, which was 19.55% between night shift work and hypertension and 19.22% between night shift work and diabetes mellitus. Conclusion Night shift work is closely related to the prevalence of metabolic syndrome, which is mainly affected by hypertension and diabetes mellitus. Taking effective health education and advocating smoking and alcohol restriction among railway occupational population may be the key measures to reduce the risk of metabolic syndrome caused by night shift work.

关 键 词：昼夜节律 夜班轮班 代谢综合征 吸烟行为 饮酒行为 

分 类 号：R589[医药卫生—内分泌]