成年人昼夜节律综合征与白蛋白尿的关联研究

doi:10.3877/cma.j.issn.2095-3216.2025.05.004

目的

探讨成年人昼夜节律综合征(circadian syndrome，CircS)和白蛋白尿之间的关系。

方法

采用横断面研究设计，利用2007至2016年美国国家健康与营养调查(National Health and Nutrition Examination Survey，NHANES)的数据。CircS诊断标准为以下条件中至少满足4项：腰围升高、高血糖、甘油三酯升高、高密度脂蛋白胆固醇降低、高血压、睡眠时间短和抑郁症状。依据受试者的白蛋白尿状态将其分为正常组和白蛋白尿组，通过加权逻辑回归和亚组分析探讨CircS和白蛋白尿之间的关系；使用加权逻辑回归模型分析CircS与大量白蛋白尿之间的关联以检验结果的敏感性。

结果

本研究共纳入10 828例受试者，白蛋白尿患病率为9.89%。加权多因素逻辑回归分析发现，校正混杂因素后，与没有CircS的受试者相比，存在CircS的受试者患白蛋白尿风险更高(OR＝2.031，95%CI：1.675~2.461，P<0.01)。亚组分析发现年龄和性别与CircS存在交互作用(P<0.01)，可能影响白蛋白尿的风险；排除冠心病患者后，在所有亚组中CircS和白蛋白尿之间的关联显著(P均<0.01)。敏感性分析支持CircS与大量白蛋白尿的正向关系(OR＝2.287，95%CI：1.419~3.688，P<0.01)。

结论

成年人CircS与白蛋白尿之间存在正向关联，提示在临床实践中应尽早识别CircS人群并针对其加强白蛋白尿筛查。

关键词: 昼夜节律, 白蛋白尿, 肾脏, 横断面研究

Objective

To investigate the relationship between circadian syndrome (CircS) and albuminuria in adults.

Methods

A cross-sectional study design was applied, utilizing data from the American National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016. The diagnostic criteria for CircS were meeting no less than 4 of the following components: increased waist circumference, hyperglycemia, elevated triglycerides, reduced high-density lipoprotein cholesterol, hypertension, short sleep duration, and depressive symptoms. Participants were stratified into a normal group and an albuminuria group based on their albuminuria status. Weighted logistic regression and subgroup analysis were employed to investigate the association between CircS and albuminuria. A weighted logistic regression model was then used to analyze the relationship between CircS and macroalbuminuria, in order to test the sensitivity of the results.

Results

A total of 10, 828 participants was included in this study, with a prevalence of albuminuria of 9.89%. Weighted multivariable logistic regression analysis revealed that, after adjusting for confounding factors, the participants with CircS had a higher risk of albuminuria compared to those without CircS (OR=2.031, 95%CI: 1.675-2.461, P<0.01). Subgroup analysis revealed that age and gender interacted with CircS (P<0.01), potentially influencing the risk of albuminuria. Excluding those with coronary heart disease, the association between CircS and albuminuria was significant in all the subgroups (P<0.01 in all cases). Sensitivity analysis revealed that CircS was still positively associated with macroalbuminuria (OR=2.287, 95%CI: 1.419-3.688, P<0.01).

Conclusion

CircS was robustly associated with albuminuria in adults, indicating that CircS populations should be identified early in clinical practice, in whom albuminuria screening should be strengthened.

Key words: Circadian rhythm, Albuminuria, Kidney, Cross-sectional study

图1 受试者筛选流程图

表1 按是否有白蛋白尿划分的受试者特征

特征	总体	正常组	白蛋白尿组	P值
人数[例(%)]	10 828(100)	9 402(90.11)	1 426(9.89)
年龄(岁)	50.05±0.29	49.21±0.31	57.76±0.56	<0.01
性别[例(%)]				0.809
男性	6 186(52.72)	5 083(52.77)	812(52.25)
女性	4 642(47.28)	4 319(47.23)	614(47.75)
家庭收入贫困比[例(%)]				<0.01
<1.3	3 306(19.86)	2 788(18.95)	518(28.21)
1.3~3.5	4 025(34.91)	3 421(34.25)	604(40.86)
>3.5	3 497(45.23)	3 193(46.80)	304(30.93)
吸烟[例(%)]				<0.01
从不	5 137(49.00)	4 565(49.93)	572(40.53)
现在	2 402(20.76)	2 073(20.58)	329(22.40)
戒烟	3 289(30.24)	2 764(29.49)	525(37.07)
酗酒[例(%)]	1 949(16.82)	1 616(16.27)	333(21.82)	<0.01
每日坐姿时间[例(%)]				0.051
<4 h	2 719(21.61)	2 388(21.68)	331(20.97)
4~6 h	2 649(24.12)	2 339(24.56)	310(20.12)
6~8 h	1 770(16.81)	1 504(16.54)	266(19.26)
>8 h	3 690(37.46)	3 171(37.22)	519(39.65)
合并冠心病[例(%)]	635(5.06)	462(4.35)	173(11.51)	<0.01
昼夜节律综合征[例(%)]	4 381(37.21)	3 457(34.60)	924(60.96)	<0.01
昼夜节律综合征组分[例(%)]
腰围升高	6 409(59.59)	5 422(58.49)	987(69.61)	<0.01
血糖升高	5 317(46.11)	4 360(44.22)	957(63.37)	<0.01
甘油三酯升高	5 147(45.92)	4 247(44.26)	900(61.03)	<0.01
HDL-C降低	5 574(49.73)	4 627(48.10)	947(64.58)	<0.01
血压升高	5 497(45.65)	4 392(42.89)	1 105(70.83)	<0.01
短睡眠时长	1 541(11.53)	1 290(11.15)	251(15.00)	<0.01
抑郁症状	2 703(22.93)	2 224(34.60)	479(60.96)	<0.01

表1 按是否有白蛋白尿划分的受试者特征

特征	总体	正常组	白蛋白尿组	P值
人数[例(%)]	10 828(100)	9 402(90.11)	1 426(9.89)
年龄(岁)	50.05±0.29	49.21±0.31	57.76±0.56	<0.01
性别[例(%)]				0.809
男性	6 186(52.72)	5 083(52.77)	812(52.25)
女性	4 642(47.28)	4 319(47.23)	614(47.75)
家庭收入贫困比[例(%)]				<0.01
<1.3	3 306(19.86)	2 788(18.95)	518(28.21)
1.3~3.5	4 025(34.91)	3 421(34.25)	604(40.86)
>3.5	3 497(45.23)	3 193(46.80)	304(30.93)
吸烟[例(%)]				<0.01
从不	5 137(49.00)	4 565(49.93)	572(40.53)
现在	2 402(20.76)	2 073(20.58)	329(22.40)
戒烟	3 289(30.24)	2 764(29.49)	525(37.07)
酗酒[例(%)]	1 949(16.82)	1 616(16.27)	333(21.82)	<0.01
每日坐姿时间[例(%)]				0.051
<4 h	2 719(21.61)	2 388(21.68)	331(20.97)
4~6 h	2 649(24.12)	2 339(24.56)	310(20.12)
6~8 h	1 770(16.81)	1 504(16.54)	266(19.26)
>8 h	3 690(37.46)	3 171(37.22)	519(39.65)
合并冠心病[例(%)]	635(5.06)	462(4.35)	173(11.51)	<0.01
昼夜节律综合征[例(%)]	4 381(37.21)	3 457(34.60)	924(60.96)	<0.01
昼夜节律综合征组分[例(%)]
腰围升高	6 409(59.59)	5 422(58.49)	987(69.61)	<0.01
血糖升高	5 317(46.11)	4 360(44.22)	957(63.37)	<0.01
甘油三酯升高	5 147(45.92)	4 247(44.26)	900(61.03)	<0.01
HDL-C降低	5 574(49.73)	4 627(48.10)	947(64.58)	<0.01
血压升高	5 497(45.65)	4 392(42.89)	1 105(70.83)	<0.01
短睡眠时长	1 541(11.53)	1 290(11.15)	251(15.00)	<0.01
抑郁症状	2 703(22.93)	2 224(34.60)	479(60.96)	<0.01

表2 昼夜节律综合征与白蛋白尿的关系

昼夜节律综合征		无	有
粗模型	OR的95%CI	ref	2.952(2.497~3.490)
	P值		<0.01
模型1	OR的95%CI	ref	2.112(1.737~2.569)
	P值		<0.01
模型2	OR的95%CI	ref	2.084(1.720~2.525)
	P值		<0.01
模型3	OR的95%CI	ref	2.044(1.688~2.476)
	P值		<0.01

表2 昼夜节律综合征与白蛋白尿的关系

昼夜节律综合征		无	有
粗模型	OR的95%CI	ref	2.952(2.497~3.490)
	P值		<0.01
模型1	OR的95%CI	ref	2.112(1.737~2.569)
	P值		<0.01
模型2	OR的95%CI	ref	2.084(1.720~2.525)
	P值		<0.01
模型3	OR的95%CI	ref	2.044(1.688~2.476)
	P值		<0.01

图2 亚组分析和交互作用分析

表3 昼夜节律综合征与大量白蛋白尿的关系

昼夜节律综合征		无	有
粗模型	OR的95%CI	ref	3.506(2.299~5.346)
	P值		<0.01
模型1	OR的95%CI	ref	2.394(1.487~3.855)
	P值		<0.01
模型2	OR的95%CI	ref	2.341(1.441~3.803)
	P值		<0.01
模型3	OR的95%CI	ref	2.287(1.419~3.688)
	P值		<0.01

表3 昼夜节律综合征与大量白蛋白尿的关系

昼夜节律综合征		无	有
粗模型	OR的95%CI	ref	3.506(2.299~5.346)
	P值		<0.01
模型1	OR的95%CI	ref	2.394(1.487~3.855)
	P值		<0.01
模型2	OR的95%CI	ref	2.341(1.441~3.803)
	P值		<0.01
模型3	OR的95%CI	ref	2.287(1.419~3.688)
	P值		<0.01

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Association between circadian syndrome and albuminuria in adults

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Association between circadian syndrome and albuminuria in adults