钢铁工人夜光暴露与非酒精性脂肪肝的剂量反应关系

王镇德; 王涵; 杨荔; 薛超; 王永斌; 张生奎; 袁聚祥

doi:10.16462/j.cnki.zhjbkz.2019.11.011

钢铁工人夜光暴露与非酒精性脂肪肝的剂量反应关系

doi: 10.16462/j.cnki.zhjbkz.2019.11.011

063000 唐山, 华北理工大学公共卫生学院流行病与卫生统计学系

基金项目:

国家科技部重点研发项目 2016YFC0900605

河北省重点职业病防治技术研究 13277709D

河北省研究生创新项目 2019S09

详细信息

通讯作者:
袁聚祥, E-mail: yuanjx@ncst.edu.cn

中图分类号: R575
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出版历程
- 收稿日期: 2019-04-17
- 修回日期: 2019-09-30
- 刊出日期: 2019-11-10

Dose-response relationship between light at night and nonalcoholic fatty liver in steel workers

Department of Epidemiology and Health Statistics, School of Public Health, North China University of Technology, Tangshan 063000, China

Funds:

National Key Projects of Research and Development of China 2016YFC0900605

Prevention and Control Technology of Key Occupational Diseases in Hebei Province 13277709D

Graduate Innovation Project in Hebei Province 2019S09

More Information

Corresponding author: YUAN Ju-xiang, E-mail: yuanjx@ncst.edu.cn

摘要

摘要: 目的探讨钢铁工人夜光暴露（light at night，LAN）与非酒精性脂肪肝（nonalcohol fatty liver disease，NAFLD）的关系。方法采用现况研究，通过收集某钢铁企业员工的问卷、体检和血生化指标信息，采用限制性立方样条模型（restricted cubic spline，RCS）结合多因素Logistic回归分析LAN对NAFLD的影响。结果该企业工人NAFLD患病率为33.8%（2 594/7 664），在调整年龄、性别、婚姻、教育程度、吸烟、饮酒、体重指数、生活中夜光强度、肝酶代谢、血脂水平、体力活动、饮食、睡眠时间、倒班、高温、噪声、粉尘、一氧化碳暴露情况后，RCS模型结果显示：LAN与NAFLD之间存在非线性剂量反应关系（整体关联性检验χ²=71.59，P < 0.001；非线性检验χ²=16.92，P < 0.001）；多因素Logistic回归分析结果显示，在校正相关混杂因素后，以LAN为0~1 178 d组为参照，LAN在1 178 d~2 017 d和2 017 d~组时，钢铁工人NAFLD患病风险的比值比和95%可信区间分别为1.217（1.027~1.441）和1.479（1.240~1.763）。结论夜光暴露与钢铁工人NAFLD之间存在非线性剂量反应关系。
- 夜光暴露 /
- 非酒精性脂肪肝 /
- 钢铁工人 /
- 限制性立方样条
Abstract: Objective To explore the relationship between light at night (LAN) and nonalcoholic fatty liver (NAFLD) in steel workers. Methods Relevant information was collected through questionnaires, physical examinations and blood biochemical analysis. Using restricted cubic spline (RCS) and mutiple Logistic regression model to explore the relationship between LAN and NAFLD based on a cross-sectional study. Results The prevalence of NAFLD was 33.8% (2 594/7 664) in steel workers. After adjusting for age, sex, marriage, educational level, smoking, drinking, body mass index, luminous intensity in life, liver enzyme metabolism, blood lipid level, physical activity, diet, sleep duration, shift work, high temperature, noise, dust, and carbon monoxide exposure, the RCS model showed a nonlinear dose-response relationship between LAN and NAFLD (χ²=71.59, P < 0.001 for overall association test and χ²=16.92, P < 0.001 for nonlinear test); Multivariate Logistic regression model showed that after adjusting for all confounding factors, when the LAN in the 1 178 d~2 017 d and 2 017 d~group, the prevalence of NAFLD increased by 21.7% (OR=1.217, 95% CI: 1.027-1.441) and 47.9% (OR=1.479, 95% CI: 1.240-1.763), respectively, when compared with the group LAN < 1 178 d. Conclusion There is a nonlinear dose-response relationship between LAN and NAFLD in steel works.
- Light at night /
- Nonalcoholic fatty liver /
- Steel workers /
- Restricted cubic spline

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图 1 LAN与NAFLD的剂量-反应关系

Figure 1. Dose-response relationship between LAN and NAFLD

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图 2 LAN与NAFLD的剂量-反应关系(敏感性分析)

Figure 2. Dose-response relationship between LAN and NAFLD(sensitivity analysis)

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表 1 NAFLD影响因素的单因素分析[n(%)]

Table 1. Single factor analysis of NAFLD[n(%)]

变量	非NAFLD[n(%)]	NAFLD[n(%)]	χ²/Z值	P值
年龄(岁)			32.27	＜0.001
20~	354	(6.98)	183	(7.05)
30~	1 262	(24.89)	786	(30.30)
40~	1 903	(37.53)	954	(36.78)
50~	1 551	(30.60)	671	(25.87)
性别			64.03	＜0.001
男	4 560	(89.94)	2 471	(95.65)
女	510	(10.06)	123	(4.35)
婚姻状况			2.40	0.120
已婚	4 720	(93.10)	350	(69.31)
未婚	2 439	(6.90)	155	(30.69)
文化程度			0.04	0.978
初级	61	(1.20)	30	(1.15)
中级	3 854	(76.02)	1 939	(74.74)
高级	1 155	(22.78)	625	(24.11)
吸烟			18.94	< 0.001
从不吸	2 203	(43.45)	993	(28.28)
曾经吸	375	(7.40)	205	(7.90)
现在吸	2 492	(49.15)	1 396	(63.82)
饮酒			6.33	0.040
从不饮	3 025	(59.66)	1 472	(56.74)
曾经饮	271	(5.34)	141	(5.43)
现在饮	1774	(35.00)	981	(37.81)
血脂水平			441.77	< 0.001
正常	3 642	(71.83)	1 230	(47.41)
异常	1 428	(28.17)	1 364	(52.59)
现在倒班			20.96	< 0.001
否	1 959	(38.64)	864	(33.30)
是	3 111	(61.36)	1 730	(66.69)
体力活动水平			6.01	0.043^b
低	1 301	(25.66)	713	(27.48)
中	2 371	(46.77)	1 138	(43.87)
高	1 398	(27.57)	743	(28.64)
DASH饮食得分^a			2.84	< 0.001^b
12~	883	(17.42)	501	(19.31)
20~	1 574	(31.05)	840	(32.38)
22~	1 494	(29.47)	729	(28.10)
24~	1 119	(22.06)	524	(20.21)
LAN(d)^a			-2.65	< 0.001^b
0~	1 340	(25.72)	576	(22.20)
1 475~	1 235	(24.36)	681	(26.25)
2 384~	1 238	(24.42)	678	(26.14)
3 193~	1 257	(24.79)	659	(25.41)
生活中夜光强度			-2.48	0.012^b
最暗	2 343	(46.21)	1 140	(43.94)
中等	2 003	(39.51)	1 031	(39.70)
最亮	724	(14.28)	423	(16.36)
BMI(kg/m²)			-38.96	< 0.001^b
< 24	2 323	(50.88)	248	(10.70)
24~	1 880	(41.17)	1 155	(49.85)
>28	356	(7.95)	914	(39.45)
肝酶代谢			426.67	< 0.001
正常	4 045	(87.72)	1 589	(66.40)
异常	596	(12.28)	804	(33.60)
睡眠时间(h)			29.85	< 0.001
< 7	2 242	(48.62)	1 108	(46.30)
7~	2 084	(45.19)	1 033	(43.16)
>8	315	(6.19)	252	(10.54)
噪声暴露			1.66	0.197
是	2 389	(51.81)	1 193	(49.85)
否	2 252	(48.19)	1 200	(50.15)
粉尘暴露			1.82	0.177
是	2 958	(64.31)	1 486	(62.09)
否	1 683	(35.69)	907	(37.91)
高温暴露			0.99	0.32
是	2 279	(49.10)	1 205	(50.35)
否	2 362	(50.90)	1 188	(49.65)
一氧化碳暴露			3.91	0.047
是	1 980	(42.66)	1 080	(45.13)
否	2 661	(57.34)	1 313	(33.04)
注：^a表示使用四分法分组；^b表示使用趋势χ²检验。

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表 2 LAN与NAFLD的多因素Logistic回归分析

Table 2. Multi-factor Logistic regression analysis of LAN and NAFLD

影响因素	β	s_x^-	Wald χ²值	OR(95% CI)值	P值
LAN(d)
0~				1.000
1 178~	0.000	0.050	8.981	1.217(1.027~1.441)	< 0.001
2 017~	0.195	0.052	14.373	1.479(1.240~1.763)	< 0.001
血脂水平
正常				1.000
异常	0.712	0.061	138.283	2.039(1.811~2.296)	< 0.001
年龄(岁)
20~				1.000
30~	0.124	0.065	3.621	0.977(0.724~1.318)	0.057
40~	-0.173	0.057	9.323	0.726(0.537~0.981)	0.002
50~	-0.098	0.066	2.199	0.782(0.572~1.071)	0.138
BMI(kg/m²)
< 24				1.000
≥24	0.023	0.040	0.333	4.255(3.677~4.924)	< 0.001
>28	1.402	0.051	766.841	16.898(14.113~20.233)	< 0.001
性别
男				1.000
女	-0.169	0.067	6.285	0.713(0.548~0.929)	0.012
婚姻状况
未婚				1.000
已婚	0.081	0.070	1.324	1.175(0.893~1.546)	0.250
文化程度
初级				1.000
中级	0.127	0.096	1.742	1.460(0.852~2.501)	0.187
高级	0.125	0.105	1.400	1.457(0.834~2.544)	0.237
吸烟
从不吸				1.000
曾经吸	0.020	0.076	0.067	0.990(0.778~1.258)	0.796
现在吸	-0.050	0.049	1.048	0.923(0.808~1.055)	0.306
饮酒
从不饮				1.000
曾经饮	-0.059	0.091	0.420	0.900(0.684~1.184)	0.517
现在饮	0.012	0.056	0.044	0.966(0.847~1.101)	0.833
现在倒班
是				1.000
否	-0.020	0.038	0.269	0.962(0.83~1.114)	0.604
体力活动水平
低				1.000
中	-0.108	0.041	6.863	0.935(0.813~1.076)	0.009
高	0.149	0.045	10.886	1.209(1.038~1.410)	0.001
DASH饮食得分
12~				1.000
20~	0.167	0.054	9.626	1.193(1.011~1.408)	0.002
22~	-0.038	0.048	0.615	0.972(0.835~1.132)	0.433
24~	-0.120	0.060	4.022	0.895(0.746~1.074)	0.045
生活中夜光强度
最暗				1.000
中等	0.090	0.042	4.548	1.191(1.049~1.352)	0.033
最亮	-0.006	0.054	0.012	1.081(0.911~1.284)	0.913
肝酶代谢
正常				1.000
异常	0.447	0.036	153.220	2.443(2.121~2.814)	< 0.001
睡眠时间(h)
< 7				1.000
7~	-0.259	0.048	29.661	1.036(0.915~1.174)	0.679
>8	0.553	0.071	60.896	2.331(1.876~2.898)	< 0.001
噪声暴露
否				1.000
是	-0.140	0.032	18.982	0.757(0.667~0.858)	< 0.001
粉尘暴露
否				1.000
是	-0.103	0.032	10.115	0.814(0.716~0.924)	0.002
高温暴露
否				1.000
是	-0.052	0.031	2.754	0.902(0.798~1.019)	0.097
一氧化碳暴露
否				1.000
是	0.068	0.030	4.996	1.145(1.017~1.289)	0.250

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参考文献(21)

[1]	Perlemuter G, Bigorgne A, Cassard-Doulcier AM, et al. Nonalcoholic fatty liver disease: from pathogenesis to patient care[J]. Nat Clin Pract Endocrinol Metab, 2007, 3(6): 458-469. DOI: 10.1038/ncpendmet0505.
[2]	Andronescu CI, Purcarea MR, Babes PA. Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications[J]. J Med Life, 2018, 11(1): 20-23.
[3]	Pais R, Lebray P, Rousseau G, et al. Nonalcoholic fatty liver disease increases the risk of hepatocellular carcinoma in patients with alcohol-associated cirrhosis awaiting liver transplants[J]. Clin Gastroenterol Hepatol, 2015, 13(5): 992-999. DOI: 10.1016/j.cgh.2014.10.011.
[4]	Bechtold DA, Gibbs JE, Loudon AS. Circadian dysfunction in disease[J]. Trends Pharmacol Sci, 2010, 31(5): 191-198. DOI: 10.1016/j.tips.2010.01.002.
[5]	Teboul M, Guillaumond F, Gréchez-Cassiau A, et al. The nuclear hormone receptor family round the clock[J]. Mol Endocrinol, 2008, 22(12): 2573-2582. DOI: 10.1210/me.2007-0521.
[6]	Russart KLG, Nelson RJ. Light at night as an environmental endocrine disruptor[J]. Physiol Behav, 2017, 190: 82-89. DOI: 10.1016/j.physbeh.2017.08.029.
[7]	陈思枝, 刘庆凤, 伍健芝, 等. 倒班作业男性工人代谢综合征患病情况调查[J]. 中国工业医学杂志, 2018, 31(5): 356-359, 363. DOI: 10.13631/j.cnki.zggvvx.2018.05.017. Chen SZ, Liu QF, Wu JZ, et al. Investigation on prevanlence of metabolic syndrome among male shift-workers[J]. Chinese J Ind Med, 2018, 31(5): 356-359, 363. DOI: 10.13631/j.cnki.zggvvx.2018.05.017.
[8]	Turner PL, Mainster MA. Circadian photoreception: ageing and the eye's important role in systemic health[J]. Br J Ophthalmol, 2008, 92(11): 1439-1444. DOI: 10.1136/bjo.2008.141747.
[9]	Aubrecht TG, Jenkins R, Nelson RJ. Dim light at night increases body mass of female mice[J]. Chronobiol Int, 2015, 32(4): 557-560. DOI: 10.3109/07420528.2014.986682.
[10]	李英卓, 李琳, 李咏梅, 等. 非酒精性脂肪肝发病率与体重指数及年龄的关系[J]. 河北医药, 2017, 39(24): 3693-3696. DOI: 10.3969/j.issn.1002-7386.2017.24.003. Li YZ, Li L, Li YM, et al. The correlation between the incidence rate of non alcohol fatty liver disease and body mass index as well as patient's age[J]. Hebei Medical Journal, 2017, 39(24): 3693-3696. DOI:0.3969/j.issn.1002-7386.2017.24.003.
[11]	张生奎, 王镇德, 杨荔, 等. 倒班作业与高尿酸血症的剂量反应关系研究[J]. 中华疾病控制杂志, 2018, 22(11): 1123-1127. DOI: CNKI:SUN:JBKZ.0.2018-11-010. Zhang SK, Wang ZD, Yang L, et al. Dose-response relationship between shift work and hyperuricemia[J]. Chin J Dis Control Prev, 2018, 22(11): 1123-1127. DOI: CNKI:SUN:JBKZ.0.2018-11-010.
[12]	罗剑锋, 金欢, 李宝月, 等. 限制性立方样条在非线性回归中的应用研究[J]. 中国卫生统计, 2010, 27(3): 229-232. DOI: 10.3969/j.issn.1002-3674.2010.03.002. Luo JF, Jin H, Li BY, et al. Research on the application of restricted cubic splines in nonlinear regression. [J]. Chinese Journal of Health Statistics, 2010, 27(3): 229-232. DOI: 10.3969/j.issn.1002-3674.2010.03.002.
[13]	Buhr ED, Takahashi JS. Molecular components of the mammalian circadian clock[J]. Handb Exp Pharmacol, 2013, (217): 3-27. DOI: 10.1007/978-3-642-25950-0_1
[14]	周雅, 范方. 倒班相关睡眠障碍与倒班耐受性[J]. 中国临床心理学杂志, 2016, 24(6): 1126-1131. DOI: 10.16128/j.cnki.1005-3611.2016.06.037. Zhou Y, Fan F. Shift work sleep disorder and shift work tolerance[J]. Chinese Journal of Clinical Psychology, 2016, 24(6): 1126-1131. DOI: 10.16128/j.cnki.1005-3611.2016.06.037.
[15]	Kivimäki M, Batty GD, Hublin C. Shift work as a risk factor for future type 2 diabetes: evidence, mechanisms, implications, and future research directions[J]. Plos Med, 2011, 8(12): e1001138. DOI: 10.1371/journal.pmed.1001138.
[16]	石嫦娥. 褪黑素对细菌脂多糖引起小鼠肝脏脂质沉积的保护作用[D]. 合肥: 安徽医科大学, 2012. Shi CE. Melatonin alleviates lipopolysaccharide-induced hepatic lipid zccumulation in mice[D]. Hefei: Anhui Medical University, 2012.
[17]	Nguyen J, Wright KP Jr. Influence of weeks of circadian misalignment on leptin levels[J]. Nat Sci Sleep, 2010, 2: 9-18. DOI: 10.2147/NSS.S7624.
[18]	杨凌辉, 刘志民. 褪黑素与能量代谢[J]. 药学服务与研究, 2004, 4(4): 362-365. DOI: 10.3969/j.issn.1671-2838.2004.04.024. Yang LH, Liu ZM. Melatonin and energy metabolism[J]. Pharmaceutical Care and Research, 2004, 4(4): 362-365. DOI: 10.3969/j.issn.1671-2838.2004.04.024.
[19]	Touitou Y, Reinberg A, Touitou D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption[J]. Life Sci, 2017, 173: 94-106. DOI: 10.1016/j.lfs.2017.02.008.
[20]	殷杰, 李万平. 非酒精性脂肪肝的发病机制研究进展[J]. 四川生理科学杂志, 2012, 34(3): 126-130. DOI: 10.3969/j.issn.1671-3885.2012.03.012. Yin J, Li WP. Progress in the pathogenesis of nonalcoholic fatty liver[J]. Sichuan Journal of Physiological Sciences, 2012(3): 126-130. DOI: 10.3969/j.issn.1671-3885.2012.03.012.
[21]	Chou YT, Cheng HJ, Wu JS, et al. The association of sleep duration and sleep quality with non-alcoholic fatty liver disease in a Taiwanese population[J]. Obes Res Clin Pract, 2018, 12(6): 500-505. DOI: 10.1016/j.orcp.2018.05.002.