夜间睡眠不足与患有代谢相关脂肪性肝病的糖尿病患者发生纤维化的风险较高有关。
Insufficient nocturnal sleep was associated with a higher risk of fibrosis in patients with diabetes with metabolic associated fatty liver disease.
作者信息
Zheng Jiaping, Chen Sijie, Cai Yuqing, Lin Su, Ke Sujie, Liu Libin
机构信息
Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China.
Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
出版信息
Ther Adv Endocrinol Metab. 2020 Sep 14;11:2042018820947550. doi: 10.1177/2042018820947550. eCollection 2020.
BACKGROUND
Metabolic associated fatty liver disease (MAFLD) refers to metabolic dysfunction associated with fatty liver disease, and liver fibrosis stage is closely connected with liver-related and all-cause mortality. This study aimed to explore the association of sleep duration with liver fibrosis in the diabetic subgroup of the MAFLD population.
METHODS
This retrospective study analyzed 342 patients with MAFLD. Anthropometric measurements, clinical and biochemical markers, and lifestyle parameters were collected. Fibrosis was defined as fibrosis-4 ⩾1.3. Propensity score matching (PSM) was performed to match cases. Student's -test and chi-square tests were applied for group comparisons, and binary regression models were used to explore the independent risk factors of liver fibrosis.
RESULTS
Among the 342 subjects, 87 (25.4%) were diagnosed with fibrosis and 255 (74.6%) without. Baseline characteristic comparisons showed differences in age and diabetes duration between the two groups, and adjustment was made by PSM. Ultimately, the fibrosis group and nonfibrosis group each had 87 patients. The fibrosis group had shorter duration of nocturnal sleep (6.77 ± 1.59 h) than the nonfibrosis group (7.77 ± 1.92 h, < 0.001). More patients in the fibrosis group stayed up late at night (32.2% 14.9%, < 0.01). Visceral adipose tissue (VAT) areas were larger in the fibrosis group than in the nonfibrosis group ( < 0.001). Glycemic profile, lipid profile, gamma-glutamyl transferase level, and serum uric acid level were not significantly different between the two groups. In the multivariate regression analysis, nocturnal sleep and VAT areas were independently associated with liver fibrosis, with odds ratios of 0.694 [95% confidence interval (CI) 0.551-0.875, < 0.01] for nocturnal sleep and 1.031 (95% CI 1.014-1.048, < 0.001) for VAT areas.
CONCLUSION
Insufficient nocturnal sleep was independently related to a higher risk of fibrosis. Sleep modification might be beneficial in promoting the health of patients with MAFLD.
背景
代谢相关脂肪性肝病（MAFLD）是指与脂肪性肝病相关的代谢功能障碍，肝纤维化阶段与肝脏相关死亡率和全因死亡率密切相关。本研究旨在探讨MAFLD人群糖尿病亚组中睡眠时间与肝纤维化的关联。
方法
这项回顾性研究分析了342例MAFLD患者。收集了人体测量数据、临床和生化指标以及生活方式参数。纤维化定义为纤维化-4≥1.3。进行倾向评分匹配（PSM）以匹配病例。采用学生t检验和卡方检验进行组间比较，并使用二元回归模型探讨肝纤维化的独立危险因素。
结果
在342名受试者中，87例（25.4%）被诊断为纤维化，255例（74.6%）未被诊断为纤维化。基线特征比较显示两组在年龄和糖尿病病程方面存在差异，并通过PSM进行了调整。最终，纤维化组和非纤维化组各有87例患者。纤维化组的夜间睡眠时间（6.77±1.59小时）比非纤维化组（7.77±1.92小时，P<0.001）短。纤维化组中夜间熬夜的患者更多（32.2%对14.9%，P<0.01）。纤维化组的内脏脂肪组织（VAT）面积大于非纤维化组（P<0.001）。两组之间的血糖谱、血脂谱、γ-谷氨酰转移酶水平和血清尿酸水平无显著差异。在多变量回归分析中，夜间睡眠和VAT面积与肝纤维化独立相关，夜间睡眠的比值比为0.694[95%置信区间（CI）0.551-0.875，P<0.01]，VAT面积的比值比为1.031（95%CI 1.014-1.048，P<0.001）。
结论
夜间睡眠不足与纤维化风险较高独立相关。改善睡眠可能有助于促进MAFLD患者的健康。
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