Emergency Department, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France ; Department of Occupational Medicine, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France ; Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France ; School of Exercise Science, Australian Catholic University, Melbourne, Victoria, Australia ; Department of Sport Medicine and Functional Exploration, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France.
PLoS One. 2013 Aug 19;8(8):e71658. doi: 10.1371/journal.pone.0071658. eCollection 2013.
Emergency physicians are exposed to greater stress during a 24-hour shift (24 hS) than a 14-hour night shift (14 hS), with an impact lasting several days. Interleukin-8 (IL-8) is postulated to be a chronic stress biomarker. However, no studies have tracked IL-8 over several shifts or used it for monitoring short-term residual stress. The IL-8 response to the shifts may also increase with age. Conveniently, IL-8 can be measured non-intrusively from urine.
We conducted a shifts-randomized trial comparing 17 emergency physicians' urinary IL-8 levels during a 24 hS, a 14 hS, and a control day (clerical work on return from leave). Mean levels of IL-8 were compared using a Wilcoxon matched-pairs test. Independent associations of key factors including shifts, stress, and age with IL-8 levels were further assessed in a multivariable generalized estimating equations model.
Mean urinary IL-8 levels almost doubled during and after a 24 hS compared with a 14 hS or a control day. Furthermore, IL-8 levels failed to return to control values at the end of the third day after the shift despite a rest day following the 24 hS. In the multivariable model, engaging in a 24 hS, self-reported stress, and age were independently associated with higher IL-8 levels. A 24 hS significantly increased IL-8 levels by 1.9 ng (p = .007). Similarly, for every unit increase in self-reported stress, there was a 0.11 ng increase in IL-8 levels (p = .003); and for every one year advance in age of physicians, IL-8 levels also increased by 0.11 ng (p = .018).
The 24 hS generated a prolonged response of the immune system. Urinary IL-8 was a strong biomarker of stress under intensive and prolonged demands, both acutely and over time. Because elevated IL-8 levels are associated with cardiovascular disease and negative psychological consequences, we suggest that emergency physicians limit their exposure to 24 hS, especially with advancing age.
相较于 14 小时的夜班，急诊医生在 24 小时班（24 hS）中承受着更大的压力，其影响持续数天。白细胞介素-8（IL-8）被认为是一种慢性应激生物标志物。然而，尚无研究跟踪 IL-8 跨越多个班次，也没有使用其监测短期残留应激。IL-8 对班次的反应也可能随年龄增长而增加。方便的是，IL-8 可以从尿液中无创地测量。
我们进行了一项班次随机试验，比较了 17 名急诊医生在 24 hS、14 hS 和控制日（休假返回后的文书工作）期间的尿液中 IL-8 水平。使用 Wilcoxon 配对检验比较 IL-8 的平均水平。进一步使用多变量广义估计方程模型评估关键因素（班次、应激和年龄）与 IL-8 水平的独立关联。
与 14 hS 或控制日相比，24 hS 期间和之后尿液中 IL-8 水平几乎翻了一番。此外，尽管在 24 hS 之后的第三天有休息日，但 IL-8 水平仍未恢复到班次前的控制值。在多变量模型中，进行 24 hS、自我报告的压力和年龄与较高的 IL-8 水平独立相关。24 hS 使 IL-8 水平显著增加 1.9ng（p=0.007）。同样，自我报告的压力每增加一个单位，IL-8 水平就会增加 0.11ng（p=0.003）；医生的年龄每增加一岁，IL-8 水平也会增加 0.11ng（p=0.018）。
24 hS 引发了免疫系统的长期反应。尿液中的 IL-8 是高强度和长时间的紧张需求下的应激的有力生物标志物，无论是急性还是长期。由于升高的 IL-8 水平与心血管疾病和负面心理后果相关，我们建议急诊医生限制其暴露于 24 hS，尤其是随着年龄的增长。
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