Li Jian, Bidlingmaier Martin, Petru Raluca, Pedrosa Gil Francisco, Loerbroks Adrian, Angerer Peter
1Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.
2Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany.
J Occup Med Toxicol. 2018 Aug 14;13:23. doi: 10.1186/s12995-018-0204-y. eCollection 2018.
Cumulative epidemiological evidence suggests that shift work exerts harmful effects on human health. However, the physiological mechanisms are not well understood. This study aimed to examine the impact of shift work on the dysregulation of the hypothalamic-pituitary-adrenal axis, i.e. diurnal cortisol rhythm.
Seventy physicians with a mean age 30 years participated in this one-year longitudinal study. Working schedules, either shift work or regular schedules with day shift, were assessed at baseline. Salivary cortisol samples were collected on two consecutive regular working days, four times a day (including waking, + 4 h, + 8 h, and + 16 h), at both baseline and the one-year follow-up. The diurnal cortisol decline (slope) and total cortisol concentration (area under the curve, AUC) were calculated.
After adjusting for cortisol secretion at baseline and numerous covariates, shift work at baseline significantly predicted a steeper slope ( < 0.01) and a larger AUC ( < 0.05) of diurnal cortisol rhythm at follow-up in this sample of physicians. In particular, waking cortisol at follow-up was significantly higher among those engaged in shift work than day shift ( < 0.01).
Our findings support the notion that shift work changes the diurnal cortisol pattern, and is predictive of increased cortisol secretion consequently in junior physicians.
累积的流行病学证据表明，轮班工作对人类健康有有害影响。然而，其生理机制尚未完全了解。本研究旨在探讨轮班工作对下丘脑-垂体-肾上腺轴失调的影响，即昼夜皮质醇节律。
70名平均年龄30岁的医生参与了这项为期一年的纵向研究。在基线时评估工作时间表，分为轮班工作或日班常规时间表。在基线和一年随访时，在两个连续的正常工作日每天收集4次唾液皮质醇样本（包括醒来时、+4小时、+8小时和+16小时）。计算昼夜皮质醇下降（斜率）和总皮质醇浓度（曲线下面积，AUC）。
在调整基线时的皮质醇分泌和众多协变量后，基线时的轮班工作显著预测了该样本医生随访时昼夜皮质醇节律的更陡斜率（<0.01）和更大的AUC（<0.05）。特别是，随访时从事轮班工作的医生醒来时的皮质醇显著高于日班医生（<0.01）。
我们的研究结果支持以下观点，即轮班工作会改变昼夜皮质醇模式，并预示着初级医生的皮质醇分泌会增加。
