睡眠障碍与非酒精性脂肪性肝病不同阶段的关联性分析  

Association between sleep disorders and different stages of nonalcoholic fatty liver disease

作　　者：赵静洁[1,5] 赵欣宇 韩超汝 肖开慧 路正昭 秦林燕 许冬[4] 尤红[3,5] ZHAO Jingjie;ZHAO Xinyu;HAN Chaoru;XIAO Kaihui;LU Zhengzhao;QIN Linyan;XU Dong;YOU Hong(Department of Traditional Chinese Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Clinical Epidemiology and EBM Unit,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Liver Research Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Outpatient Service of Beijing Municipal Administrative Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Clinical Center for Metabolic Associated Fatty Liver Disease,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院中医科,北京100050 [2]首都医科大学附属北京友谊医院流行病学与循证医学研究室,北京100050 [3]首都医科大学附属北京友谊医院肝病中心,北京100050 [4]首都医科大学附属北京友谊医院副中心行政办公区门诊部,北京100050 [5]首都医科大学中西医结合代谢相关脂肪性肝病临床诊疗与研究中心,北京100050

出　　处：《临床肝胆病杂志》2024年第7期1354-1359,共6页Journal of Clinical Hepatology

基　　金：首都卫生发展科研专项(首发2022-2-20213,首发2022-1-2021);2023年北京市重大疑难疾病中西医协同攻关项目(2023BJSZDYNJBXTGG-017);北京市高层次公共卫生技术人才建设项目(学科骨干-03-40)。

摘　　要：目的探索睡眠障碍与非酒精性脂肪性肝病(NAFLD)发生发展的关系。方法选取2022年6月—2023年6月北京友谊医院健康体检队列和脂肪肝门诊队列共1868例参与者。收集所有受试者年龄、性别、文化程度和慢性病史等一般资料及生化等实验室指标,受试者独立完成匹兹堡睡眠质量指数(PSQI)量表测评。根据诊断标准将受试者分为非脂肪肝组(non-NAFLD组)(n=1122)和脂肪肝组(NAFLD组)(n=746),其中NAFLD组按照发展阶段分为单纯脂肪肝组(SFL组)(n=624)和脂肪性肝炎组(NASH组)(n=122)。计量资料3组间比较采用单因素方差分析或Kruskal-Wallis H检验。计数资料3组间比较采用χ^(2)检验。采用二元Logistic回归分析睡眠因素与NAFLD的关联性,采用多分类Logistic回归分析睡眠因素与NAFLD不同阶段的关联性,并构建两个多因素模型校正可能的混杂因素,包括年龄性别校正模型和多因素校正模型,多因素校正模型校正了年龄、性别、文化程度、吸烟、糖尿病、高血压、BMI、TG、HDL-C因素。结果non-NAFLD、SFL和NASH组在年龄、性别、BMI、文化程度、吸烟、糖尿病、高血压、ALT、TG、HDL-C的比较,差异均有统计学意义(P值均<0.05)。3组在PSQI量表总评分分级以及7个睡眠成分的0~3分分级中的人数比例比较,差异均有统计学意义(P值均<0.05)。在多因素校正模型中,尚无睡眠障碍成分与SFL患病相关,而入睡时间长(OR=4.04,95%CI:2.33~7.03,P<0.001)、睡眠时间短(OR=3.53,95%CI:1.83~6.82,P<0.001)和睡眠紊乱严重(OR=2.96,95%CI:1.48~5.93,P=0.002)与NASH的患病风险密切相关。结论睡眠整体状况和其包含的睡眠障碍成分与SFL的患病并无明显关联,而入睡时间长、睡眠时间短和睡眠紊乱可增加NASH的患病风险,需要加以关注。Objective To investigate the association of sleep disorders with the development and progression of nonalcoholic fatty liver disease(NAFLD).Methods A total of 1868 participants from the health examination cohort and fatty liver cohort of Beijing Friendship Hospital from June 2022 to June 2023 were enrolled as subjects.Related data were collected from all subjects,including age,sex,education level,chronic medical history,and biochemical parameters,and all subjects completed Pittsburgh Sleep Quality Index(PSQI)scale independently.According to the diagnostic criteria,the subjects were divided into non-NAFLD group with 1122 subjects and NAFLD group with 746 subjects,and according to the stage of progression,the patients in the NAFLD group were further divided into simple fatty liver group(SFL group with 624 subjects)and nonalcoholic steatohepatitis(NASH)group with 122 subjects.A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between three groups.The chi-square test was used for comparison of categorical data between the three groups.The binary Logistic regression analysis was used to investigate the association between sleep factors and NAFLD,and the multinomial Logistic regression analysis was used to investigate the association between sleep factors and the different stages of NAFLD;two multivariate models were constructed for adjustment of potential confounding factors,i.e.,an age-sex adjustment model and a multivariate adjustment model,and the multivariate adjustment model adjusted the factors of age,sex,education level,smoking,diabetes,hypertension,body mass index(BMI),triglyceride(TG),and high-density lipoprotein cholesterol(HDL-C).Results There were significant differences in age,sex,BMI,education level,smoking,diabetes,hypertension,alanine aminotransferase,TG,and HDL-C between the non-NAFLD,SFL,and NASH groups(all P<0.05).There were also significant differences between the three groups in the total score of PSQI scale and the proportion of subjects with a

关 键 词：非酒精性脂肪性肝病 睡眠障碍 回归分析 

分 类 号：R575.5[医药卫生—消化系统] R740[医药卫生—内科学]