体检人群睡眠质量与代谢相关脂肪性肝病的影响因素分析

doi:10.3969/j.issn.1004-583X.2025.01.005

摘要/Abstract

摘要：

目的研究体检人群睡眠质量与代谢相关脂肪性肝病(metabolically associated fatty liver disease, MAFLD的关联,并探究MAFLD患病的影响因素。方法选取2024年3月-2024年4月于新疆乌鲁木齐市某三甲医院体检中心接受匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表评估并参加健康体检的人群142例。根据排除标准剔除不符合要求的2例,最终共入选140例。依据是否患有MAFLD分为MAFLD组(n=60)与非MAFLD组(n=80)。比较两组临床资料的差异,探究MAFLD患病的影响因素。结果与非MAFLD组比较,MAFLD组男性占比较高,血红蛋白、总胆红素(total bilirubin, T-BIL)、尿白蛋白、总胆固醇、甘油三酯、丙氨酸转氨酶和天冬氨酸转氨酶水平均较高,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平较低,差异有统计学意义(P<0.05)。且两组日间小憩时间、PSQI量表总分、睡眠质量因子得分、睡眠障碍因子得分、催眠药物因子得分差异均有统计学意义(P<0.05)。进一步行多因素logistic回归分析,结果显示,T-BIL、HDL-C、日间小憩时间、睡眠质量得分、睡眠障碍得分是MAFLD的影响因素(P<0.05)。经Pearson相关性分析并绘制散点图可见,PSQI评分与T-BIL、HDL-C、日间小憩时间无相关性(P>0.05),与睡眠质量因子得分、睡眠障碍因子得分存在相关性(P<0.05)。结论在体检人群中,T-BIL水平越高、HDL-C水平越低、日间小憩时间越长、睡眠质量越差、睡眠障碍越严重,罹患MAFLD的风险越高。

关键词: 非酒精性脂肪性肝病, 体检人群, 睡眠质量

Abstract:

Objective To study the association between sleep quality and metabolically associated fatty liver disease (MAFLD) in the physical examination population, and to explore the influencing factors of MAFLD. Methods From March 2024 to April 2024, 142 people who received the assessment of the Pittsburgh Sleep Quality Index (PSQI) and physical examination in the physical examination center of a tertiary hospital in Urumqi, Xinjiang were selected. According to the exclusion criteria, 2 cases that did not meet the requirements were excluded, and a total of 140 cases were finally selected. According to whether they had MAFLD, they were divided into MAFLD group (n=60) and non-MAFLD group (n=80). Clinical data between the two groups were compared to explore the influencing factors of MAFLD. Results Compared with the non-MAFLD group, patients in the MAFLD group had a significantly higher male proportion, hemoglobin, total bilirubin (T-BIL), urine albumin, total cholesterol, triglyceride, alanine aminotransferase and aspartate aminotransferase, and lower high density lipoprotein cholesterol (HDL-C)(P<0.05). There were significant differences in daytime nap time, total PSQI, the score of sleep quality factor, the score of sleep disorder factor and the score of hypnotic drug factor between the two groups (P<0.05). Further multivariate logistic regression analysis showed that T-BIL, HDL-C, daytime nap time, sleep quality score and sleep disorder score were the influencing factors of MAFLD (P<0.05). Pearson correlation analysis and scatter plots showed that PSQI score was not correlated with T-BIL, HDL-C and daytime nap time (P>0.05), but significantly correlated with sleep quality factor score and sleep disorder factor score in MAFLD patients (P<0.05). Conclusion In the physical examination population, higher T-BIL, lower HDL-C, longer daytime nap time, worse sleep quality, and more serious the sleep disorder indicate a higher risk of MAFLD.

Key words: non-alcoholic fatty liver disease, physical examination population, sleep quality

中图分类号:

R575.5

苟彩霞, 张洁, 包依夏姆·阿巴拜克力, 王一鸣, 姚磊, 郑嵘炅, 潘金良, 鲁晓擘. 体检人群睡眠质量与代谢相关脂肪性肝病的影响因素分析[J]. 临床荟萃, 2025, 40(1): 33-38.

Gou Caixia, Zhang Jie, Baoyixiamu·Ababaikeli , Wang Yiming, Yao Lei, Zheng Rongjiong, Pan Jinliang, Lu Xiaobo. Analysis of influencing factors of sleep quality and metabolically associated fatty liver disease in the physical examination population[J]. Clinical Focus, 2025, 40(1): 33-38.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.005

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/33

图/表 9

表1 两组一般资料比较

Tab.1 General information between groups

项目	非MAFLD组 ( $n$ =80)	MAFLD组 ( $n$ =60)	χ²/ $t$ 值	$P$ 值
年龄(岁)	43.03±10.99	46.62±11.05	1.753	0.080
性别[例(%)]
男女	32(40.0) 48(60.0)	37(61.7) 23(38.3)	6.439	0.011
高血压[(%)]
无有	71(88.7) 9(11.3)	48(80.0) 12(20.0)	2.059	0.151

表1 两组一般资料比较

Tab.1 General information between groups

项目	非MAFLD组 ( $n$ =80)	MAFLD组 ( $n$ =60)	χ²/ $t$ 值	$P$ 值
年龄(岁)	43.03±10.99	46.62±11.05	1.753	0.080
性别[例(%)]
男女	32(40.0) 48(60.0)	37(61.7) 23(38.3)	6.439	0.011
高血压[(%)]
无有	71(88.7) 9(11.3)	48(80.0) 12(20.0)	2.059	0.151

表2 两组实验室资料比较

Tab.2 Laboratory data between groups

指标	非MAFLD组 ( $n$ =80)	MAFLD组( $n$ =60)	$Z$ / $t$ 值	$P$ 值
HGB(g/L)	143.76±15.46	152.75±12.98	-3.435	0.001
PLT(×10⁹ g/L)	248.36±53.74	249.58±70.66	-0.048	0.961
ALB(g/L)	44.95(43.54, 46.65)	45.65±2.23	-1.295	0.195
T-BIL(μmol/L)	13.56±4.01	16.46±6.02	-2.684	0.007
CR(μmol/L)	76.41(68.49, 87.98)	80.53±11.99	-1.192	0.233
UA(μmol/L)	281.48(239.75, 355.72)	369.01±91.85	-4.114	0.000
CK(U/L)	86.34±29.82	102.86±56.12	-1.916	0.055
CK-MB(U/L)	8.22(6.29, 11.42)	8.59(6.53, 10.73)	-0.423	0.672
GLU(mmol/L)	4.81(4.36, 6.26)	5.19(4.52, 7.64)	-0.973	0.061
TG(mmol/L)	1.04(0.79, 1.32)	1.65(1.29, 2.38)	-5.512	0.000
TC(mmol/L)	4.56±0.80	4.84±0.86	-2.103	0.035
HDL-C(mmol/L)	1.47(1.24, 1.86)	1.13(0.95, 1.44)	-4.672	0.000
ALT(U/L)	16.94(12.60, 23.85)	24.06(16.91, 36.87)	-4.057	0.000
AST(U/L)	19.55(16.45, 22.45)	21.1(17.72, 26.47)	-2.080	0.038
甲胎蛋白(μg/L)	3.11(2.36, 4.62)	3.39(2.52, 5.26)	-1.126	0.260

表2 两组实验室资料比较

Tab.2 Laboratory data between groups

指标	非MAFLD组 ( $n$ =80)	MAFLD组( $n$ =60)	$Z$ / $t$ 值	$P$ 值
HGB(g/L)	143.76±15.46	152.75±12.98	-3.435	0.001
PLT(×10⁹ g/L)	248.36±53.74	249.58±70.66	-0.048	0.961
ALB(g/L)	44.95(43.54, 46.65)	45.65±2.23	-1.295	0.195
T-BIL(μmol/L)	13.56±4.01	16.46±6.02	-2.684	0.007
CR(μmol/L)	76.41(68.49, 87.98)	80.53±11.99	-1.192	0.233
UA(μmol/L)	281.48(239.75, 355.72)	369.01±91.85	-4.114	0.000
CK(U/L)	86.34±29.82	102.86±56.12	-1.916	0.055
CK-MB(U/L)	8.22(6.29, 11.42)	8.59(6.53, 10.73)	-0.423	0.672
GLU(mmol/L)	4.81(4.36, 6.26)	5.19(4.52, 7.64)	-0.973	0.061
TG(mmol/L)	1.04(0.79, 1.32)	1.65(1.29, 2.38)	-5.512	0.000
TC(mmol/L)	4.56±0.80	4.84±0.86	-2.103	0.035
HDL-C(mmol/L)	1.47(1.24, 1.86)	1.13(0.95, 1.44)	-4.672	0.000
ALT(U/L)	16.94(12.60, 23.85)	24.06(16.91, 36.87)	-4.057	0.000
AST(U/L)	19.55(16.45, 22.45)	21.1(17.72, 26.47)	-2.080	0.038
甲胎蛋白(μg/L)	3.11(2.36, 4.62)	3.39(2.52, 5.26)	-1.126	0.260

表3 两组睡眠状况比较

Tab.3 Sleep status between groups

项目	非MAFLD组 ( $n$ =80)	MAFLD组 ( $n$ =60)	χ²值	$P$ 值
睡眠时长[例(%)]
<4 h	0	0
4~6 h	34(42.5)	28(46.7)	0.244	0.885
6~8 h	43(53.8)	30(50.0)
>8 h	3(3.7)	2(3.3)
睡眠质量[例(%)]
好(PSQI量表总分<5分)	15(18.8)	8(13.3)
PSQI量表总分=5分	16(20.0)	10(16.7)	1.221	0.543
差(PSQI量表总分>5分)	49(61.2)	42(70.0)
日间小憩时间[例(%)]
0	35(43.7)	15(25.0)
>0~30 min	38(47.5)	28(46.7)	11.050	0.004
31~60 min	7(8.8)	17(28.3)
≥61 min	0	0

表3 两组睡眠状况比较

Tab.3 Sleep status between groups

项目	非MAFLD组 ( $n$ =80)	MAFLD组 ( $n$ =60)	χ²值	$P$ 值
睡眠时长[例(%)]
<4 h	0	0
4~6 h	34(42.5)	28(46.7)	0.244	0.885
6~8 h	43(53.8)	30(50.0)
>8 h	3(3.7)	2(3.3)
睡眠质量[例(%)]
好(PSQI量表总分<5分)	15(18.8)	8(13.3)
PSQI量表总分=5分	16(20.0)	10(16.7)	1.221	0.543
差(PSQI量表总分>5分)	49(61.2)	42(70.0)
日间小憩时间[例(%)]
0	35(43.7)	15(25.0)
>0~30 min	38(47.5)	28(46.7)	11.050	0.004
31~60 min	7(8.8)	17(28.3)
≥61 min	0	0

表4 两组睡眠状况构成

Tab.4 Composition of sleep status between groups

项目	非MAFLD组 ( $n$ =80)	MAFLD组 ( $n$ =60)	$Z$ 值	$P$ 值
睡眠时长(h)	7.00(6.00, 7.50)	7.00(6.00, 7.50)	-0.334	0.738
日间小憩时间(min)	20(0, 30)	30(10, 40)	-3.083	0.002

表4 两组睡眠状况构成

Tab.4 Composition of sleep status between groups

项目	非MAFLD组 ( $n$ =80)	MAFLD组 ( $n$ =60)	$Z$ 值	$P$ 值
睡眠时长(h)	7.00(6.00, 7.50)	7.00(6.00, 7.50)	-0.334	0.738
日间小憩时间(min)	20(0, 30)	30(10, 40)	-3.083	0.002

表5 两组PSQI评分及各睡眠因子得分比较(分)

Tab.5 PSQI and sleep factors scores between groups

组别	例数	PSQI量表总分	睡眠质量因子得分	入睡时间因子得分	睡眠时间因子得分	睡眠效率因子得分	睡眠障碍因子得分	催眠药物因子得分	日间功能障碍因子得分
MAFLD组	60	7(5, 9)	1(1, 2)	1(1, 1)	1(1, 1)	2(0, 3)	1(1, 1)	0(0, 0)	1(1, 2)
非MAFLD组	80	6(5, 7)	1(1, 1)	1(1, 1)	1(1, 1)	1(0, 3)	1(1, 1)	0(0, 0)	1(1, 2)
$Z$ 值		-2.256	-4.176	-1.420	-0.053	-0.685	-3.182	0.000	-1.349
$P$ 值		0.024	0.000	0.156	0.958	0.493	0.001	0.000	0.177

表5 两组PSQI评分及各睡眠因子得分比较(分)

Tab.5 PSQI and sleep factors scores between groups

组别	例数	PSQI量表总分	睡眠质量因子得分	入睡时间因子得分	睡眠时间因子得分	睡眠效率因子得分	睡眠障碍因子得分	催眠药物因子得分	日间功能障碍因子得分
MAFLD组	60	7(5, 9)	1(1, 2)	1(1, 1)	1(1, 1)	2(0, 3)	1(1, 1)	0(0, 0)	1(1, 2)
非MAFLD组	80	6(5, 7)	1(1, 1)	1(1, 1)	1(1, 1)	1(0, 3)	1(1, 1)	0(0, 0)	1(1, 2)
$Z$ 值		-2.256	-4.176	-1.420	-0.053	-0.685	-3.182	0.000	-1.349
$P$ 值		0.024	0.000	0.156	0.958	0.493	0.001	0.000	0.177

表6 MAFLD的影响因素的logistic回归分析

Tab.6 Logistic regression analysis for influencing factors of MAFLD

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
T-BIL	0.111	0.045	6.055	0.014	1.117	1.070	3.322
HDL-C	-1.934	0.612	9.996	0.002	0.145	-0.105	0.861
日间小憩时间	0.040	0.013	9.204	0.002	1.041	1.006	4.132
睡眠质量因子得分	1.527	0.466	10.752	0.001	4.605	2.362	6.521
睡眠障碍因子得分	1.485	0.639	5.398	0.020	4.413	2.856	7.411
常数	-3.689	1.521	5.886	0.015	0.025	-1.204	0.762

表6 MAFLD的影响因素的logistic回归分析

Tab.6 Logistic regression analysis for influencing factors of MAFLD

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
T-BIL	0.111	0.045	6.055	0.014	1.117	1.070	3.322
HDL-C	-1.934	0.612	9.996	0.002	0.145	-0.105	0.861
日间小憩时间	0.040	0.013	9.204	0.002	1.041	1.006	4.132
睡眠质量因子得分	1.527	0.466	10.752	0.001	4.605	2.362	6.521
睡眠障碍因子得分	1.485	0.639	5.398	0.020	4.413	2.856	7.411
常数	-3.689	1.521	5.886	0.015	0.025	-1.204	0.762

表7 PSAQ量表总分与MAFLD的影响因素间的相关性分析

Tab.7 Correlation between PSQI and influencing factors of MAFLD

变量		T-BIL	HDL-C	日间小憩时间	睡眠质量因子得分	睡眠障碍因子得分
PSQI量表总分	$r$ 值	-0.033	-0.078	0.036	0.623	0.469
	$P$ 值	0.699	0.358	0.671	0.000	0.000

表7 PSAQ量表总分与MAFLD的影响因素间的相关性分析

Tab.7 Correlation between PSQI and influencing factors of MAFLD

变量		T-BIL	HDL-C	日间小憩时间	睡眠质量因子得分	睡眠障碍因子得分
PSQI量表总分	$r$ 值	-0.033	-0.078	0.036	0.623	0.469
	$P$ 值	0.699	0.358	0.671	0.000	0.000

图1 PSQI量表总分与睡眠质量因子得分的相关性

Fig.1 Correlation between the total score of PSQI and sleep quality factor score

图2 PSQI量表总分与睡眠障碍因子得分的相关性

Fig.2 Correlation between the total score of PSQI and sleep disorder factor score

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