倒班和睡眠时间对钢铁工人肝功能异常的影响

李庆林; 王涵; 张晓红; 薛超; 秦盛; 张生奎; 袁聚祥

doi:10.16462/j.cnki.zhjbkz.2021.11.020

倒班和睡眠时间对钢铁工人肝功能异常的影响

doi: 10.16462/j.cnki.zhjbkz.2021.11.020

063210 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:

国家科技部重点科研项目 2016YFC0900605

河北省重点职业病防治技术研究 13277709D

详细信息

通讯作者:
袁聚祥，E-mail: yuanjx@ncst.edu.cn

中图分类号: R181.3+1
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出版历程
- 收稿日期: 2020-12-31
- 修回日期: 2021-03-19
- 网络出版日期: 2021-12-04
- 刊出日期: 2021-11-10

Effects of rotating night shift work and sleep duration on liver dysfunction among steelworkers

Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China

Funds:

National Key Projects of Research and Development of China 2016YFC0900605

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

More Information

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

摘要

摘要: 目的探讨倒班、平均睡眠时间及其联合作用对钢铁工人肝功能异常的影响，为保护钢铁工人肝脏提供理论依据。方法采用横断面研究，以某钢铁公司6 907名工人作为研究对象, 并收集信息。采用非条件Logistic回归分析模型和限制性立方样条函数进行分析。结果肝功能异常的检出率为18.0%，且男性高于女性(19.2% vs. 5.1%)。调整混杂因素后，倒班年限和肝功能异常之间存在非线性剂量反应关系。倒班和平均倒班频率＞7夜/月患肝功能异常的风险分别增加1.24倍(OR=1.24, 95% CI: 1.04~1.49)和1.29倍(OR=1.29, 95% CI: 1.07~1.56)。以倒班状态分层，在倒班工人中平均睡眠时间较短(≤5 h/d)和较长(＞7 h/d)患肝功能异常的风险分别增加1.19倍(OR=1.19, 95% CI: 1.01~1.43)和1.22倍(OR=1.22, 95% CI: 1.02~1.44)。且平均睡眠时间较长或较短均与倒班存在正向相乘的交互作用。根据平均睡眠时间分层后，平均睡眠时间＞5~7 h/d的各倒班指标与肝功能异常的联系无统计学意义。结论倒班工作和睡眠时间较长或较短联合作用会增加钢铁工人肝功能异常的风险，倒班工作对肝功能异常的独立作用也不容忽视。
- 倒班工作 /
- 睡眠时间 /
- 肝功能异常 /
- 横断面研究
Abstract: Objective To investigate the effects of rotating night shift work and average sleep duration and their combined effects on liver dysfunction of steelworkers, and to provide theoretical basis for liver protection of steelworkers. Methods In this cross-sectional study, a total of 6 907 workers from a steel company were recruited, and their indicators were collected. These indicators were analyzed by the unconditional Logistic regression model and the restricted cubic spline function. Results The detection rate of liver dysfunction was 18.0%, which was significantly higher in males than in females (19.2% vs. 5.1%). After adjusting for the confounding factors, there was a non-linear dose-response relationship between duration of night shifts and liver dysfunction, and the odds of liver dysfunction in night shift workers and average frequency of night shifts > 7 nights/month were increased by 1.24 (OR=1.24, 95% CI: 1.04-1.49) and 1.29 (OR=1.29, 95% CI: 1.07-1.56), respectively. When stratified by current shift status, compared with the average sleep duration of > 5-7 h/d, the odds of liver dysfunction in shorter sleep duration (≤5 h/d) and longer sleep duration (> 7 h/d) were increased by 1.19 (OR=1.19, 95% CI: 1.01-1.43) and 1.22 (OR=1.22, 95% CI: 1.02-1.44) among night shift workers. And there was a positive interaction between longer or shorter average sleep duration and current shift status. After stratified by average sleep duration, only in the layer with an average sleep duration of > 5-7 h/d, there was no statistically significant relationship between different exposure metrics of night shift work and liver function. Conclusion The combined effects of rotating night shift work and longer or shorter sleep duration increases the risk of liver dysfunction, and the independent effects of rotating night shift work cannot be ignored.
- Rotating night shift work /
- Sleep duration /
- Liver dysfunction /
- Cross-sectional study

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图 1 倒班年限与肝功能异常的限制性立方样条模型

注: 调整了性别、年龄、饮酒、吸烟、体力活动水平、DASH评分、BMI、血脂异常、高血压、糖尿病、肾功能损伤、以及职业有害因素(高温、噪声、粉尘和CO)的接触情况。

Figure 1. Duration of night shifts and odds of liver dysfunction from RCS models

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表 1 研究对象的基本特征分析[n(%)]

Table 1. Basic characteristic of the study subjects [n(%)]

变量	总人口(N=6 907)	肝功能异常		P值
变量	总人口(N=6 907)	否(n=5 664)	是(n=1 243)	P值
性别				< 0.001
女	590(8.5)	560(9.9)	30(2.4)
男	6 317(91.5)	5 104(90.1)	1 213(97.6)
吸烟				< 0.001
从不	3 029(43.9)	2 606(46.0)	423(34.0)
曾经	365(5.2)	296(5.2)	69(5.6)
现在	3 513(50.9)	2 762(48.8)	751(60.4)
饮酒				< 0.001
从不	4 225(61.2)	3 628(64.0)	597(48.0)
曾经	147(2.1)	121(2.2)	26(2.1)
现在	2 535(36.7)	1 915(33.8)	620(49.9)
体力活动水平				0.689
低	127(1.8)	105(1.9)	22(1.8)
中	683(9.9)	568(10.0)	115(9.2)
高	6 097(88.3)	4 991(88.1)	1 106(89.0)
平均睡眠时间(h/d)				0.194
≤5	1 186(17.2)	957(16.9)	229(18.4)
＞5~7	4 155(60.1)	3 435(60.6)	720(57.9)
＞7	1 566(22.7)	1 272(22.5)	294(23.7)
糖尿病				0.726
否	6 171(89.3)	5 057(89.3)	1 114(89.6)
是	736(10.7)	607(10.7)	129(10.4)
高血压				0.799
否	5 031(72.8)	4 122(72.8)	909(73.1)
是	1 876(27.2)	1 542(27.2)	334(26.9)
血脂异常				0.387
否	4 187(60.6)	3 420(60.4)	767(61.7)
是	2 720(39.4)	2 244(39.6)	476(38.3)
肾功能损伤				0.516
否	5 826(84.3)	4 770(84.2)	1056(85.0)
是	1 081(15.7)	894(15.8)	187(15.0)
BMI (kg/m²)				0.050
< 24	2 329(33.7)	1 926(34.0)	403(32.4)
24~ < 28	3 435(49.7)	2 780(49.1)	655(52.7)
≥28	1 143(16.6)	958(16.9)	185(14.9)
高温				< 0.001
否	3 408(49.3)	2 851(50.3)	557(44.8)
是	3 499(50.7)	2 813(49.7)	686(55.2)
噪声				0.362
否	53(0.8)	46(0.8)	7(0.6)
是	6 854(99.2)	5 618(99.2)	1 236(99.4)
粉尘				0.251
否	2 398(34.7)	1 949(34.4)	449(36.1)
是	4 509(65.3)	3 715(65.6)	794(63.9)
CO				0.780
否	3 831(55.5)	3 146(55.5)	685(55.1)
是	3 076(44.5)	2 518(44.5)	558(44.9)
年龄(x±s, 岁)	43.16±8.51	43.15±8.62	43.25±8.00	0.880
DASH评分(x±s, 分)	21.64±2.21	21.71±2.20	21.29±2.21	< 0.001
倒班状态				0.004
从不	1 136(16.4)	966(17.1)	170(13.7)
倒班	5 771(83.6)	4 698(82.9)	1 073(86.3)
倒班年限(年)				0.006
从不	1 136(16.4)	966(17.1)	170(13.7)
≤19	2 805(40.7)	2 302(40.6)	503(40.5)
>19	2 966(42.9)	2 396(42.3)	570(45.8)
平均倒班频率(夜/月)				0.003
从不	1 136(16.4)	966(17.1)	170(13.7)
≤7	2 097(30.4)	1 733(30.6)	364(29.3)
>7	3 674(53.2)	2 965(52.3)	709(57.0)
注: 倒班年限、平均倒班频率的截断点分别是各自变量的中位数。

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表 2 各倒班指标与平均睡眠时间对肝功能异常的影响

Table 2. The effect of different exposure metrics of night shift work and average sleep duration on liver dysfunction

变量	人数(N)	OR(95% CI)值
变量	人数(N)	模型1	模型2	模型3
倒班状态
从不倒班	1 136	1.00	1.00	1.00
倒班	5 771	1.30(1.09~1.55)	1.27(1.06~1.52)	1.24(1.04~1.49)
平均倒班频率(夜/月)
从不倒班	1 136	1.00	1.00	1.00
≤7	2 097	1.19(0.98~1.46)	1.18(0.97~1.44)	1.17(0.95~1.43)
>7	3 674	1.36(1.13~1.63)	1.32(1.10~1.58)	1.29(1.07~1.56)
平均睡眠时间(h/d)
≤5	1 186	1.13(0.95~1.33)	1.13(0.96~1.34)	1.11(0.93~1.31)
＞5~7	4 155	1.00	1.00	1.00
＞7	1 566	1.12(0.99~1.30)	1.14(0.98~1.33)	1.16(0.99~1.35)
注: 模型1:没有调整混杂因素；模型2:调整了性别、年龄；模型3:调整了性别、年龄、饮酒、吸烟、体力活动水平、DASH评分、BMI、血脂异常、高血压、糖尿病、肾功能损伤、以及职业有害因素(高温、噪声、粉尘和CO)的接触情况；倒班年限、平均倒班频率的截断点分别是各自变量的中位数。

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表 3 倒班状态与平均睡眠时间对肝功能异常的联合作用

Table 3. Combined effects of current shift status and average sleep duration on liver dysfunction

变量		人数(N)	OR(95% CI)值
变量		人数(N)	模型1	模型2	模型3
倒班状态	平均睡眠时间(h/d)
从不倒班	≤5	122	0.64(0.35~1.16)	0.63(0.35~1.15)	0.61(0.33~1.12)
	＞5~7	660	1.00	1.00	1.00
	＞7	354	0.72(0.50~1.05)	0.76(0.52~1.10)	0.75(0.51~1.10)
倒班	≤5	1 064	1.20(1.01~1.43)	1.22(1.02~1.45)	1.19(1.01~1.43)
	＞5~7	3 495	1.00	1.00	1.00
	＞7	1 212	1.22(1.01~1.43)	1.23(1.01~1.42)	1.22(1.02~1.44)
交互作用1			1.87(1.01~3.47)	1.89(1.02~3.51)	1.92(1.03~3.60)
交互作用2			1.11(1.01~1.22)	1.09(1.02~1.21)	1.10(1.01~1.21)
平均睡眠时间(h/d)	倒班年限(年)
≤5	从不倒班	122	1.00	1.00	1.00
	≤19	397	1.92(1.04~3.52)	1.66(0.89~3.10)	1.74(0.92~3.30)
	>19	667	1.98(1.10~3.56)	2.09(1.15~3.80)	2.07(1.13~3.81)
＞5~7	从不倒班	660	1.00	1.00	1.00
	≤19	1 707	1.05(0.82~1.33)	1.00(0.78~1.29)	1.02(0.79~1.31)
	>19	1 788	1.04(0.82~1.32)	1.04(0.82~1.33)	1.00(0.78~1.29)
＞7	从不倒班	354	1.00	1.00	1.00
	≤19	701	1.51(1.04~2.17)	1.54(1.06~2.24)	1.48(1.01~2.17)
	>19	511	2.18(1.50~3.16)	1.86(1.26~2.74)	1.69(1.13~2.53)
平均睡眠时间(h/d)	平均倒班频率(夜/月)
≤5	从不倒班	122	1.00	1.00	1.00
	≤7	353	1.68(0.90~3.12)	1.71(0.92~3.20)	1.78(0.94~3.37)
	>7	711	2.09(1.17~3.77)	2.02(1.12~3.63)	2.02(1.11~3.68)
＞5~7	从不倒班	660	1.00	1.00	1.00
	≤7	1 245	0.96(0.75~1.24)	0.96(0.74~1.24)	0.95(0.73~1.23)
	>7	2 250	1.09(0.87~1.37)	1.06(0.84~1.34)	1.05(0.82~1.33)
＞7	从不倒班	354	1.00	1.00	1.00
	≤7	499	1.68(1.14~2.46)	1.57(1.07~2.32)	1.53(1.03~2.28)
	>7	713	1.85(1.29~2.65)	1.76(1.22~2.53)	1.59(1.09~2.32)
注: 模型1:没有调整混杂因素；模型2:调整了性别、年龄；模型3:调整了性别、年龄、饮酒、吸烟、体力活动水平、DASH评分、BMI、血脂异常、高血压、糖尿病、肾功能损伤、以及职业有害因素(高温、噪声、粉尘和CO)的接触情况；交互作用1:倒班状态和平均睡眠时间(≤5 h/d与>5~7 h/d相比)；交互作用2:倒班状态和平均睡眠时间(>7 h/d与>5~7 h/d相比)。

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