Analysis of influencing factors of sleep quality and metabolically associated fatty liver disease in the physical examination population

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

Abstract

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

CLC Number:

R575.5

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

Figures/Tables 9

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References 22

[1]	Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis[J]. J Hepatol, 2019, 71(4): 793-801. doi: S0168-8278(19)30393-9 pmid: 31279902
[2]	黄饺饺, 易默, 史丽萍. 代谢相关性脂肪性肝病的相关影响因素[J]. 临床医学进展, 2022, 12(1):331-336.
[3]	王治兰, 李良平. 脂肪肝的营养处方[J]. 肝博士, 2016(4):51-53.
[4]	Huang T, Behary J, Zekry A. Non-alcoholic fatty liver disease: A review of epidemiology, risk factors, diagnosis and management[J]. Intern Med J, 2020, 50(9): 1038-1047. doi: 10.1111/imj.14709 pmid: 31760676
[5]	Younossi ZM. Non-alcoholic fatty liver disease-a global public health perspective[J]. J Hepatol, 2019, 70(3): 531-544. doi: S0168-8278(18)32517-0 pmid: 30414863
[6]	Fouad Y, Waked I, Bollipo S, et al. What's in a name? Renaming ‘NAFLD’to ‘MAFLD’[J]. Liver Int, 2020, 40(6): 1254-1261.
[7]	中华医学会肝病学分会. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 中华肝脏病杂, 2024, 32(5):418-434.
[8]	韩琳, 谢欢, 孙颖, 等. 代谢相关脂肪性肝病的诊断与评估现状[J]. 肝脏, 2021, 26(2): 205-210.
[9]	Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement[J]. J Hepatol, 2020, 73(1): 202-209. doi: S0168-8278(20)30201-4 pmid: 32278004
[10]	范建高. 代谢相关脂肪性肝病现已成为我国第一大慢性肝病[J]. 中华医学信息导报, 2021, 36(6): 6.
[11]	崔月萌. 睡眠障碍与非酒精性脂肪肝病相关性研究进展[J]. 现代医药卫生, 2022, 38(22):3899-3903.
[12]	Miyake T, Kumagi T, Furukawa S, et al. Short sleep duration reduces the risk of nonalcoholic fatty liver disease onset in men:A community-based longitudinal cohort study[J]. J Gastroenterol, 2015, 50(5):583-589.
[13]	Okamura T, Hashimoto Y, Hamaguchi M, et al. Short sleep duration is a risk of incident nonalcoholic fatty liver disease:A population-based longitudinal study[J]. J Gastrointestin Liver Dis, 2019, 28(1):73-81. doi: 10.15403/jgld.2014.1121.281.alc pmid: 30851175
[14]	Lou TW, Yang RX, Fan JG. The global burden of fatty liver disease: The major impact of China[J]. Hepatobiliary Surg Nutr, 2024, 13(1):119-123.
[15]	Ghevariya V, Sandar N, Patel K, et al. Knowing what’s out there: Awareness of non-alcoholic fatty liver disease[J]. Front Med (Lausanne), 2014, 1: 4.
[16]	Maurice J, Manousou P. Non-alcoholic fatty liver disease[J]. Clin Med (Northfield Il), 2018, 18(3):245-250.
[17]	Wu T, Ye J, Mo S, et al. Impact of nomenclature as metabolic associated steatotic liver disease on steatotic liver disease prevalence and screening: A prospective population survey in Asians[J]. J Gastroenterol Hepatol, 2024, 39(8):1636-1647.
[18]	Zhou J, Zhou F, Wang W, et al. Epidemiological features of NAFLD from 1999 to 2018 in China[J]. Hepatology, 2020, 71(5):1851-1864. doi: 10.1002/hep.31150 pmid: 32012320
[19]	劳雪莲, 沈丽丽, 陈艳红, 等. 不同年龄非酒精性单纯性脂肪肝患者受控衰减参数、血脂、肠道菌群与颈动脉粥样硬化的关系[J]. 中国老年学杂志, 2023, 43(11):2619-2623.
[20]	Yang J, Luo S, Li R, et al. Sleep factors in relation to metabolic dysfunction-associated fatty liver disease in middle-aged and elderly Chinese[J]. J Clin Endocrinol Metab, 2022, 107(10):2874-2882.
[21]	石丽敏, 孙剑. 2型糖尿病合并非酒精性脂肪性肝病患者血清铁蛋白、胆红素水平与代谢指标的相关性研究[J]. 中国医药科学, 2024, 14(14):159-162, 170.
[22]	石红宾, 李中南, 陈明月, 等. 2型糖尿病合并痛风性关节炎患者单核细胞高密度脂蛋白胆固醇比值与非酒精性脂肪肝关系研究[J]. 中国实用内科杂志, 2024, 44(5):397-402.