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Article(id=1240730053227639393, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409203, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725897600000, receivedDateStr=2024-09-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773742696339, onlineDateStr=2026-03-17, pubDate=1745510400000, pubDateStr=2025-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773742696339, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773742696339, creator=13701087609, updateTime=1773742696339, updator=13701087609, issue=Issue{id=1240730050669113883, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773742695728, creator=13701087609, updateTime=1773742807836, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240730520988995837, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240730520988995838, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1379, endPage=1385, ext={EN=ArticleExt(id=1240730053445743217, articleId=1240730053227639393, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effect of night shift work and unhealthy lifestyle on hyperhomocysteinemia among railway workers, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze theassociation and interactionof night shift work and unhealthy lifestyle on hyperhomocysteinemia(HHcy), and to provide basis for theHHcy preventionamong railway workers.

Methods

Total of 6 926 railway workers who received physical examination in a hospital in Guangzhou from September to December 2021 were selected as study objects. Binary logistic was performed to analyze correlation, the restricted cubic spline (RCS) model was used to assess the dose-response relationship, and the interaction of night shift work and unhealthy lifestyle with HHcy were analyzed.

Results

The prevalence rate of HHcy among railway workers was 23.3%. Logistic regression showed that night shift work lasted 0-2.9 years (OR=1.340, 95% CI:1.120-1.603), night shift work frequency ≤ 1 d/w (OR=1.302, 95% CI:1.029-1.646) or ≥ 4 d/w (OR=1.516, 95% CI:1.248-1.841), smoking (OR=1.516, 95% CI:1.248-1.841), overweight (OR=1.173, 95% CI: 1.030-1.335) were positively correlated with HHcy. Sleep duration > 7 h/d and exercise were negatively correlated with HHcy (P<0.05). RCS model found a nonlinear relationship of night shift work with HHcy (Ptotal <0.001,Pnon-linear=0.001). No multiplicative and additive interaction of night shift work and any unhealthylifestyle with HHcy were found(P> 0.05). Among different night shift conditions, smoking, almost inactive, overweight/obesity, and ≤ 7 h/d sleep had a higher risk of HHcy (P<0.05).

Conclusion

Night shift work and unhealthy lifestyle are risk factors for HHcy. In different night shift work conditions, smoking, almost inactive, overweight/obesity, sleep duration ≤ 7 h/d can increase HHcy risk.

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目的

分析夜班工作和不良生活方式与高同型半胱氨酸血症(hyperhomocysteinemia，HHcy)的关联和交互作用，为职业人群预防HHcy提供依据。

方法

选取2021年9月—12月在广州某三甲医院体检的 6926名铁路职工为研究对象。采用logistic回归分析相关性，限制性立方样条(restricted cubic spline，RCS)评估夜班年限与HHcy的剂量-反应关系，交互作用分析夜班与不良生活方式对HHcy的影响。

结果

铁路职工HHcy患病率为23.3%，logistic回归显示，夜班<2.9年（OR=1.340，95% CI: 1.120~1.603）、夜班频率≤1 d/w（OR=1.302，95% CI: 1.029~1.646）或≥4 d/w（OR=1.516，95% CI: 1.248~1.841）、吸烟（OR=1.470，95% CI: 1.294~1.671）、超重（OR=1.173，95% CI: 1.030~1.335）与HHcy患病风险呈正相关；睡眠>7 h/d和运动与HHcy患病风险呈负相关（P<0.05）。RCS模型显示，夜班年限与HHcy存在非线性关系（Ptotal<0.001,Pnon-linear= 0.001）。交互作用发现，夜班与各种不良生活方式均不存在相乘和相加交互作用（P>0.05）。在不同夜班情况人群中，吸烟、几乎不运动、超重/肥胖、睡眠≤7 h/d的人群患HHcy风险更高（P<0.05）。

结论

夜班工作和不良生活方式是HHcy的危险因素。在不同夜班工作情况下，吸烟、几乎不运动、超重/肥胖、睡眠 ≤7 h/d均可增加患HHcy风险。

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吴珊和白研为共同通信作者。吴珊，E-mail：；
白研，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=yw4ht5/1hSJT7ZVhMMu5+Q==, magXml=kjUIvXqf/hD6Bs/hQnu76w==, pdfUrl=null, pdf=AePRAIUmzKtJMH6jmybZeg==, pdfFileSize=696186, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=BFEh8j6MOoX31d74hvv6Rw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=VLJehFiOw02lAMT/8u1f5g==, mapNumber=null, authorCompany=null, fund=null, authors=

黄鑫（2000—）,女,硕士在读，研究方向:职业病防治

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黄鑫（2000—）,女,硕士在读，研究方向:职业病防治

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Life Sciences, 2017, 173: 94-106., articleTitle=Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption, refAbstract=null)], funds=[Fund(id=1241070729492492496, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, awardId=82404238, language=CN, fundingSource=国家自然科学基金青年项目(82404238), fundOrder=null, country=null), Fund(id=1241070729626710236, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, awardId=32100082, language=CN, fundingSource=国家自然科学基金青年项目(32100082), fundOrder=null, country=null), Fund(id=1241070729752539365, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, awardId=202210573019, language=CN, fundingSource=国家级大学生创新训练计划项目(202210573019), fundOrder=null, country=null), Fund(id=1241070729836425447, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, awardId=2025A04J3622, language=CN, fundingSource=广州市基础与应用基础研究专题(2025A04J3622), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241070723544969269, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, xref=1., ext=[AuthorCompanyExt(id=1241070723565940790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, companyId=1241070723544969269, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510310, China), AuthorCompanyExt(id=1241070723574329399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, companyId=1241070723544969269, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广东药科大学公共卫生学院，广东　广州　510310)]), AuthorCompany(id=1241070723649826872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, xref=2., ext=[AuthorCompanyExt(id=1241070723658215481, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, companyId=1241070723649826872, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广州市疾病预防控制中心)])], figs=[ArticleFig(id=1241070726309015675, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=EN, label=Fig.1, caption=Dose-response relationship between years of night shifts work and therisk of HHcy among railway workers, figureFileSmall=d5Rosjml0sqUFiB8uX3LRA==, figureFileBig=g1sHzRPBZOTIMhs61FyoHA==, tableContent=null), ArticleFig(id=1241070726392901759, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=CN, label=图1, caption=铁路职工夜班工作年限与HHcy的RCS图

注： 模型调整变量同表3模型3。

, figureFileSmall=d5Rosjml0sqUFiB8uX3LRA==, figureFileBig=g1sHzRPBZOTIMhs61FyoHA==, tableContent=null), ArticleFig(id=1241070726510342276, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=EN, label=Table 1, caption=

Demographic characteristics of the subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数(n=6 926)无HHcy组(n=5 315)HHcy组(n=1 611)χ2/ZP值
性别[n(%)]338.904<0.001
男5 821(84.0)4 230(79.6)1 591(98.8)
女1 105(16.0)1 085(20.4)20(1.2)
年龄[(岁)，M(P25,P75)]42.0(28.0,50.0)44.0(29.0,50)32.0(26.0,49.0)-11.474<0.001
夜班年限[(年)，n(%)]81.710<0.001
从未3 151(45.5)2 522(47.5)629(39.1)
Q1(<2.9)943(13.6)636(12.0)307(19.1)
Q2(3.0~5.9)846(12.2)604(11.4)242(15.0)
Q3(6~11.9)999(14.4)790(14.9)209(13.0)
Q4(≥12)986(14.2)763(14.4)223(13.9)
夜班频率[(d/w)，n(%)]59.870<0.001
无夜班3 024(43.7)2 424(45.6)600(37.2)
≤1493(7.1)365(6.9)128(7.9)
21 588(22.9)1 206(22.7)382(23.7)
31 124(16.2)853(16.0)271(16.8)
≥ 4697(10.1)467(8.8)230(14.3)
夜班情况[n(%)]35.303<0.001
从未3 024(43.7)2 424(45.6)600(37.2)
曾经1 305(18.8)962(18.1)343(21.3)
现在2 597(37.5)1 929(36.3)668(41.5)
BMI[n(%)]16.0550.001
偏瘦197(2.8)168(3.2)29(1.8)
正常3 045(44.0)2 373(44.6)672(41.7)
超重2 717(39.2)2 033(38.3)684(42.5)
肥胖967(14.0)741(13.9)226(14.0)
吸烟[n(%)]128.645<0.001
否4 154(60.0)3 375(63.5)779(48.4)
已戒烟346(5.0)266(5.0)80(5.0)
是2 428(35.0)1 674(31.5)752(46.7)
饮酒[n(%)]8.7970.003
否5 923(85.5)4 582(86.2)1 341(83.2)
是1 003(14.5)733(13.8)270(16.8)
运动强度[n(%)]22.738<0.001
几乎不运动1 170(16.9)847(15.9)323(20.0)
低强度运动3 161(45.6)2 454(46.2)707(43.9)
中强度运动1 769(25.5)1 401(26.4)368(22.8)
高强度运动826(11.9)613(11.5)213(13.2)
睡眠时间[(h/d)，n(%)]11.6460.003
≤5206(3.0)149(2.8)57(3.6)
5.1~74 096(59.1)3 105(58.7)991(62.3)
>72 582(37.3)2 040(38.5)542(34.1)
噪声[n(%)]68.369<0.001
否5 001(72.2)3 968(74.7)1 033(64.1)
是1 925(27.8)1 347(25.3)578(35.9)
粉尘[n(%)]104.767<0.001
否5 028（72.6）4 019（75.6）1 009（62.6）
是1 898（27.4）1 296（24.4）602（37.4）
电离辐射[n(%)]3.8040.051
否6 390（92.3）4 922(92.6)1 468（91.1）
是536（7.7）393（7.4）143（8.9）
高血压[n(%)]21.152<0.001
否5 955(86.0)4 626(87.0)1 329(82.5)
是971(14.0)689(13.0)282(17.5)
高尿酸血症[n(%)]82.496<0.001
否3 817(55.1)3 088(58.1)729(45.3)
是3 109(44.9)2 227(41.9)882(54.7)
糖尿病[n(%)]2.3340.127
否6 510(94.0)4 983(93.8)1 527(94.8)
是416(6.0)332(6.2)84(5.2)
血脂异常[n(%)]0.0820.775
否3 908(56.4)2 994(56.3)914(56.7)
是3 018(43.6)2 321(43.7)697(43.3)
心脑血管疾病家族史[n(%)]20.020<0.001
无4 288(61.9)3 367(63.3)921(57.2)
有2 638(38.1)1 948(36.7)690(42.8)
糖尿病家族史[n(%)]17.761<0.001
无5 834(84.2)4 423(83.2)1 411(87.6)
有1 092(15.8)892(16.8)200(12.4)
高尿酸血症家族史[n(%)]0.0620.803
无6 709(96.9)5 150(96.9)1 559(96.8)
有217(3.1)165(3.1)52(3.2)
夜班工作年限[(年)，M(P25,P75)]1.0(0.0,7.0)1.0(0.0,7.0)1.5(0.0,6.0)-2.8850.004
久坐时间[(h/d)，M(P25,P75)]6.0(4.0,8.0)6.0(4.0,8.0)5.0(3.0,8.0)-5.520<0.001
同型半胱氨酸[(mol/L)，M(P25,P75)]12.88(11.23,14.80)12.15(10.72,13.38)16.24(15.65,19.77)-60.896<0.001
血清肌酐[(μmol/L)，M(P25,P75)]81.0(71.0,90.0)79.0(69.0,88.0)85.0(78.0,95.0)-18.764<0.001
), ArticleFig(id=1241070728045457545, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=CN, label=表1, caption=

研究对象人口学特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数(n=6 926)无HHcy组(n=5 315)HHcy组(n=1 611)χ2/ZP值
性别[n(%)]338.904<0.001
男5 821(84.0)4 230(79.6)1 591(98.8)
女1 105(16.0)1 085(20.4)20(1.2)
年龄[(岁)，M(P25,P75)]42.0(28.0,50.0)44.0(29.0,50)32.0(26.0,49.0)-11.474<0.001
夜班年限[(年)，n(%)]81.710<0.001
从未3 151(45.5)2 522(47.5)629(39.1)
Q1(<2.9)943(13.6)636(12.0)307(19.1)
Q2(3.0~5.9)846(12.2)604(11.4)242(15.0)
Q3(6~11.9)999(14.4)790(14.9)209(13.0)
Q4(≥12)986(14.2)763(14.4)223(13.9)
夜班频率[(d/w)，n(%)]59.870<0.001
无夜班3 024(43.7)2 424(45.6)600(37.2)
≤1493(7.1)365(6.9)128(7.9)
21 588(22.9)1 206(22.7)382(23.7)
31 124(16.2)853(16.0)271(16.8)
≥ 4697(10.1)467(8.8)230(14.3)
夜班情况[n(%)]35.303<0.001
从未3 024(43.7)2 424(45.6)600(37.2)
曾经1 305(18.8)962(18.1)343(21.3)
现在2 597(37.5)1 929(36.3)668(41.5)
BMI[n(%)]16.0550.001
偏瘦197(2.8)168(3.2)29(1.8)
正常3 045(44.0)2 373(44.6)672(41.7)
超重2 717(39.2)2 033(38.3)684(42.5)
肥胖967(14.0)741(13.9)226(14.0)
吸烟[n(%)]128.645<0.001
否4 154(60.0)3 375(63.5)779(48.4)
已戒烟346(5.0)266(5.0)80(5.0)
是2 428(35.0)1 674(31.5)752(46.7)
饮酒[n(%)]8.7970.003
否5 923(85.5)4 582(86.2)1 341(83.2)
是1 003(14.5)733(13.8)270(16.8)
运动强度[n(%)]22.738<0.001
几乎不运动1 170(16.9)847(15.9)323(20.0)
低强度运动3 161(45.6)2 454(46.2)707(43.9)
中强度运动1 769(25.5)1 401(26.4)368(22.8)
高强度运动826(11.9)613(11.5)213(13.2)
睡眠时间[(h/d)，n(%)]11.6460.003
≤5206(3.0)149(2.8)57(3.6)
5.1~74 096(59.1)3 105(58.7)991(62.3)
>72 582(37.3)2 040(38.5)542(34.1)
噪声[n(%)]68.369<0.001
否5 001(72.2)3 968(74.7)1 033(64.1)
是1 925(27.8)1 347(25.3)578(35.9)
粉尘[n(%)]104.767<0.001
否5 028（72.6）4 019（75.6）1 009（62.6）
是1 898（27.4）1 296（24.4）602（37.4）
电离辐射[n(%)]3.8040.051
否6 390（92.3）4 922(92.6)1 468（91.1）
是536（7.7）393（7.4）143（8.9）
高血压[n(%)]21.152<0.001
否5 955(86.0)4 626(87.0)1 329(82.5)
是971(14.0)689(13.0)282(17.5)
高尿酸血症[n(%)]82.496<0.001
否3 817(55.1)3 088(58.1)729(45.3)
是3 109(44.9)2 227(41.9)882(54.7)
糖尿病[n(%)]2.3340.127
否6 510(94.0)4 983(93.8)1 527(94.8)
是416(6.0)332(6.2)84(5.2)
血脂异常[n(%)]0.0820.775
否3 908(56.4)2 994(56.3)914(56.7)
是3 018(43.6)2 321(43.7)697(43.3)
心脑血管疾病家族史[n(%)]20.020<0.001
无4 288(61.9)3 367(63.3)921(57.2)
有2 638(38.1)1 948(36.7)690(42.8)
糖尿病家族史[n(%)]17.761<0.001
无5 834(84.2)4 423(83.2)1 411(87.6)
有1 092(15.8)892(16.8)200(12.4)
高尿酸血症家族史[n(%)]0.0620.803
无6 709(96.9)5 150(96.9)1 559(96.8)
有217(3.1)165(3.1)52(3.2)
夜班工作年限[(年)，M(P25,P75)]1.0(0.0,7.0)1.0(0.0,7.0)1.5(0.0,6.0)-2.8850.004
久坐时间[(h/d)，M(P25,P75)]6.0(4.0,8.0)6.0(4.0,8.0)5.0(3.0,8.0)-5.520<0.001
同型半胱氨酸[(mol/L)，M(P25,P75)]12.88(11.23,14.80)12.15(10.72,13.38)16.24(15.65,19.77)-60.896<0.001
血清肌酐[(μmol/L)，M(P25,P75)]81.0(71.0,90.0)79.0(69.0,88.0)85.0(78.0,95.0)-18.764<0.001
), ArticleFig(id=1241070728192258190, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=EN, label=Table 2, caption=

The logistic regression analysis of HHcy among railway workers with night shift indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数[n(%)]OR(95% CI)
模型1模型2模型3
夜班情况
从未3 024(43.7)1.001.001.00
曾经1 305(18.8)1.413(1.211~1.647)a1.177(1.002~1.383)a1.169(0.992~1.377)
现在2 597(37.5)1.412(1.245~1.602)a1.188(1.039~1.358)a1.133(0.988~1.299)
夜班年限(年)
从未3 151(45.5)1.001.001.00
Q1(<2.9)943(13.6)1.948(1.656~2.292)a1.324(1.110~1.579)a1.340(1.120~1.603)a
Q2(3.0~5.9)846(12.2)1.574(1.322~1.875)a1.110(0.921~1.337)1.077(0.891~1.303)
Q3(6~11.9)999(14.4)1.064(0.891~1.269)0.942(0.779~1.139)0.909(0.749~1.104)
Q4(≥12)986(14.2)1.179(0.991~1.402)1.302(1.081~1.568)a1.208(0.999~1.461)
夜班频率(d/w)
从未3 024(43.7)1.001.001.00
≤1493(7.1)1.407(1.127~1.756)a1.282(1.018~1.614)a1.302(1.029~1.646)a
21 588(22.9)1.281(1.106~1.483)a1.115(0.956~1.301)1.090(0.932~1.275)
31 124(16.2)1.283(1.089~1.512)a1.007(0.847~1.197)0.949(0.795~1.132)
≥4697(10.1)1.994(1.662~2.393)a1.594(1.317~1.928)a1.516(1.248~1.841)a
), ArticleFig(id=1241070728301310099, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=CN, label=表2, caption=

各夜班指标对铁路职工患HHcy的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数[n(%)]OR(95% CI)
模型1模型2模型3
夜班情况
从未3 024(43.7)1.001.001.00
曾经1 305(18.8)1.413(1.211~1.647)a1.177(1.002~1.383)a1.169(0.992~1.377)
现在2 597(37.5)1.412(1.245~1.602)a1.188(1.039~1.358)a1.133(0.988~1.299)
夜班年限(年)
从未3 151(45.5)1.001.001.00
Q1(<2.9)943(13.6)1.948(1.656~2.292)a1.324(1.110~1.579)a1.340(1.120~1.603)a
Q2(3.0~5.9)846(12.2)1.574(1.322~1.875)a1.110(0.921~1.337)1.077(0.891~1.303)
Q3(6~11.9)999(14.4)1.064(0.891~1.269)0.942(0.779~1.139)0.909(0.749~1.104)
Q4(≥12)986(14.2)1.179(0.991~1.402)1.302(1.081~1.568)a1.208(0.999~1.461)
夜班频率(d/w)
从未3 024(43.7)1.001.001.00
≤1493(7.1)1.407(1.127~1.756)a1.282(1.018~1.614)a1.302(1.029~1.646)a
21 588(22.9)1.281(1.106~1.483)a1.115(0.956~1.301)1.090(0.932~1.275)
31 124(16.2)1.283(1.089~1.512)a1.007(0.847~1.197)0.949(0.795~1.132)
≥4697(10.1)1.994(1.662~2.393)a1.594(1.317~1.928)a1.516(1.248~1.841)a
), ArticleFig(id=1241070728473276570, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=EN, label=Table 3, caption=

Logistic regression analysis of unhealthy lifestyle and HHcy

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数[n(%)]OR(95% CI)
模型1模型2模型3
BMI
偏瘦197(2.8)0.619(0.413~0.927)a0.617(0.407~0.934)a0.688(0.452~1.047)
正常3 045(44.0)1.001.001.00
超重2 717(39.2)1.185(1.048~1.339)a1.218(1.072~1.383)a1.173(1.030~1.335)a
肥胖967(14.0)1.085(0.913~1.289)1.071(0.895~1.280)0.995(0.828~1.195)
吸烟
否4 154(60.0)1.001.001.00
已戒烟346(5.0)1.304(1.002~1.697)a1.061(0.811~1.389)1.064(0.810~1.397)
是2 428(35.0)1.923(1.720~2.172)a1.474(1.304~1.665)a1.470(1.294~1.671)a
饮酒
否5 923(85.5)1.001.001.00
是1 003(14.5)1.235(1.059~1.441)a1.164(0.992~1.366)1.023(0.867~1.208)
睡眠时间（h/d）
≤5206(3.0)1.046(0.876~1.640)1.108(0.799~1.536)1.117(0.803~1.554)
5.1~74 096(59.1)1.001.001.00
>72 582(37.3)0.832(0.739~0.937)a0.798(0.705~0.902)a0.829(0.731~0.941)a
久坐时间b(h/d)
≤64 150(59.9)1.001.001.00
>62 776(40.1)1.115(0.995~1.249)1.144(1.016~1.288)a1.120(0.993~1.264)
运动强度
几乎不运动1 170(16.9)1.001.001.00
低强度运动3 161(45.6)0.758(0.649~0.884)a0.765(0.652~0.898)a0.818(0.694~0.963)a
中强度运动1 769(25.5)0.690(0.580~0.820)a0.716(0.598~0.857)a0.774(0.643~0.931)a
高强度运动826(11.9)0.921(0.752~1.128)0.733(0.594~0.905)a0.781(0.630~0.969)a
), ArticleFig(id=1241070728582328479, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=CN, label=表3, caption=

铁路职工不良生活方式与HHcy的关联logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数[n(%)]OR(95% CI)
模型1模型2模型3
BMI
偏瘦197(2.8)0.619(0.413~0.927)a0.617(0.407~0.934)a0.688(0.452~1.047)
正常3 045(44.0)1.001.001.00
超重2 717(39.2)1.185(1.048~1.339)a1.218(1.072~1.383)a1.173(1.030~1.335)a
肥胖967(14.0)1.085(0.913~1.289)1.071(0.895~1.280)0.995(0.828~1.195)
吸烟
否4 154(60.0)1.001.001.00
已戒烟346(5.0)1.304(1.002~1.697)a1.061(0.811~1.389)1.064(0.810~1.397)
是2 428(35.0)1.923(1.720~2.172)a1.474(1.304~1.665)a1.470(1.294~1.671)a
饮酒
否5 923(85.5)1.001.001.00
是1 003(14.5)1.235(1.059~1.441)a1.164(0.992~1.366)1.023(0.867~1.208)
睡眠时间（h/d）
≤5206(3.0)1.046(0.876~1.640)1.108(0.799~1.536)1.117(0.803~1.554)
5.1~74 096(59.1)1.001.001.00
>72 582(37.3)0.832(0.739~0.937)a0.798(0.705~0.902)a0.829(0.731~0.941)a
久坐时间b(h/d)
≤64 150(59.9)1.001.001.00
>62 776(40.1)1.115(0.995~1.249)1.144(1.016~1.288)a1.120(0.993~1.264)
运动强度
几乎不运动1 170(16.9)1.001.001.00
低强度运动3 161(45.6)0.758(0.649~0.884)a0.765(0.652~0.898)a0.818(0.694~0.963)a
中强度运动1 769(25.5)0.690(0.580~0.820)a0.716(0.598~0.857)a0.774(0.643~0.931)a
高强度运动826(11.9)0.921(0.752~1.128)0.733(0.594~0.905)a0.781(0.630~0.969)a
), ArticleFig(id=1241070728825598116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=EN, label=Table 4, caption=

The interaction analysis of night shift work and unhealthy lifestyle on HHcy among railway workers

, figureFileSmall=null, figureFileBig=null, tableContent=
组别OR-inta(95% CI)RERIb(95% CI)APb(95% CI)Sb(95% CI)
不良生活方式+曾经夜班
吸烟+曾经夜班0.843(0.606~1.173)-0.193(-0.671~0.285)-0.120(-0.430~0.190)0.759(0.387~1.489)
饮酒+曾经夜班0.990(0.632~1.553)0.019(-0.553~0.592)0.014(-0.405~0.434)1.059(0.200~5.607)
几乎不运动+曾经夜班0.968(0.626~1.496)0.016(-0.557~0.589)0.011(-0.394~0.417)1.042(0.247~4.401)
超重/肥胖+曾经夜班0.910(0.654~1.266)-0.097(-0.447~0.254)-0.097(-0.453~0.258)-0.053c
久坐>6 h/d+曾经夜班1.068(0.765~1.490)0.067(-0.300~0.435)0.056(-0.243~0.355)1.478(0.133~16.366)
睡眠≤7 h/d+曾经夜班1.009(0.716~1.421)0.002(-0.406~0.410)0.001(-0.283~0.286)1.005(0.390~2.592)
不良生活方式+现在夜班
吸烟+现在夜班0.877(0.672~1.146)-0.140(-0.524~0.244)-0.086(-0.324~0.153)0.818(0.487~1.377)
饮酒+现在夜班0.831(0.582~1.186)-0.181(-0.585~0.223)-0.164(-0.548~0.220)0.366(0.028~4.809)
几乎不运动+现在夜班1.033(0.736~1.448)0.049(-0.387~0.485)0.034(-0.268~0.337)1.130(0.370~3.450)
超重/肥胖+现在夜班0.794(0.608~1.037)-0.254(0.548~0.041)-0.282(0.603~0.039)-0.649c
久坐>6 h/d+现在夜班1.065(0.814~1.395)0.076(-0.210~0.362)0.064(-0.176~0.304)1.703(0.122~23.761)
睡眠≤7 h/d+现在夜班0.867(0.657~1.144)-0.169(-0.510~0.172)-0.126(-0.378~0.126)0.667(0.339~1.313)
), ArticleFig(id=1241070728938844329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=CN, label=表4, caption=

夜班与不良生活方式的交互作用对铁路职工患HHcy的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
组别OR-inta(95% CI)RERIb(95% CI)APb(95% CI)Sb(95% CI)
不良生活方式+曾经夜班
吸烟+曾经夜班0.843(0.606~1.173)-0.193(-0.671~0.285)-0.120(-0.430~0.190)0.759(0.387~1.489)
饮酒+曾经夜班0.990(0.632~1.553)0.019(-0.553~0.592)0.014(-0.405~0.434)1.059(0.200~5.607)
几乎不运动+曾经夜班0.968(0.626~1.496)0.016(-0.557~0.589)0.011(-0.394~0.417)1.042(0.247~4.401)
超重/肥胖+曾经夜班0.910(0.654~1.266)-0.097(-0.447~0.254)-0.097(-0.453~0.258)-0.053c
久坐>6 h/d+曾经夜班1.068(0.765~1.490)0.067(-0.300~0.435)0.056(-0.243~0.355)1.478(0.133~16.366)
睡眠≤7 h/d+曾经夜班1.009(0.716~1.421)0.002(-0.406~0.410)0.001(-0.283~0.286)1.005(0.390~2.592)
不良生活方式+现在夜班
吸烟+现在夜班0.877(0.672~1.146)-0.140(-0.524~0.244)-0.086(-0.324~0.153)0.818(0.487~1.377)
饮酒+现在夜班0.831(0.582~1.186)-0.181(-0.585~0.223)-0.164(-0.548~0.220)0.366(0.028~4.809)
几乎不运动+现在夜班1.033(0.736~1.448)0.049(-0.387~0.485)0.034(-0.268~0.337)1.130(0.370~3.450)
超重/肥胖+现在夜班0.794(0.608~1.037)-0.254(0.548~0.041)-0.282(0.603~0.039)-0.649c
久坐>6 h/d+现在夜班1.065(0.814~1.395)0.076(-0.210~0.362)0.064(-0.176~0.304)1.703(0.122~23.761)
睡眠≤7 h/d+现在夜班0.867(0.657~1.144)-0.169(-0.510~0.172)-0.126(-0.378~0.126)0.667(0.339~1.313)
), ArticleFig(id=1241070729056284851, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=EN, label=Table 5, caption=

The effects of night shift work andunhealthy lifestyle on HHcy among railway workers

, figureFileSmall=null, figureFileBig=null, tableContent=
组别HHcy[n(%)]总人数(n)OR值(95% CI)
吸烟+夜班
无夜班+不吸烟324(20.1)2 1001.000
无夜班+吸烟276(17.1)9141.637(1.346~1.991)a
曾经夜班+不吸烟185(11.5)8301.196(0.964~1.483)
曾经夜班+吸烟158(9.8)4751.670(1.314~2.123)a
现在夜班+不吸烟351(21.8)1 5711.126(0.942~1.348)
现在夜班+吸烟317(19.7)1 0261.625(1.342~1.968)a
饮酒+夜班
无夜班+不饮酒500(31.0)2 6301.000
无夜班+饮酒100(6.2)3941.186(0.914~1.539)
曾经夜班+不饮酒287(17.8)1 1201.126(0.943~1.343)
曾经夜班+饮酒56(3.5)1851.344(0.948~1.904)
现在夜班+不饮酒554(34.4)2 1731.110(0.959~1.284)
现在夜班+饮酒114(7.1)4241.111(0.868~1.421)
运动+夜班
无夜班+运动487(30.2)2 5641.000
无夜班+几乎不运动113(7.0)4601.296(1.010~1.663)a
曾经夜班+运动281(17.4)1 1001.124(0.941~1.343)
曾经夜班+几乎不运动62(3.8)2051.475(1.054~2.064)a
现在夜班+运动520(32.3)2 0921.075(0.926~1.247)
现在夜班+几乎不运动148(9.2)5051.418(1.128~1.782)a
夜班+BMI
无夜班+正常267(16.6)1 4941.000
无夜班+超重/肥胖333(20.7)1 5300.936(0.769~1.139)
曾经夜班+正常361(22.4)1 4281.173(0.918~1.498)
曾经夜班+超重/肥胖420(26.1)1 7771.018(0.811~1.278)
现在夜班+正常314(19.5)1 1531.224(1.004~1.493)a
现在夜班+超重/肥胖354(22.0)1 4440.910(0.749~1.105)
夜班+久坐时间（h/d）
无夜班+久坐≤6359(22.3)1 8161.000
无夜班+久坐>6241(15.0)1 2081.053(0.867~1.278)
曾经夜班+久坐≤6446(27.7)1 9161.092(0.886~1.347)
曾经夜班+久坐>6335(20.7)1 2891.241(0.977~1.576)
现在夜班+久坐≤6374(23.2)1 5311.055(0.887~1.255)
现在夜班+久坐>6294(18.2)1 0661.173(0.972~1.415)
夜班+睡眠时间（h/d）
无夜班+睡眠>7206(12.8)1 1691.000
无夜班+睡眠≤7387(24.0)1 8411.302(1.068~1.588)a
曾经夜班+睡眠>7265(16.4)1 1541.139(0.867~1.495)
曾经夜班+睡眠≤7505(31.3)2 0291.455(1.160~1.824)a
现在夜班+睡眠>7226(14.0)9331.198(0.960~1.496)
现在夜班+睡眠≤7439(27.3)1 6511.325(1.090~1.496)a
), ArticleFig(id=1241070729161142458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730053227639393, language=CN, label=表5, caption=

夜班与不良生活方式对铁路职工患HHcy的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
组别HHcy[n(%)]总人数(n)OR值(95% CI)
吸烟+夜班
无夜班+不吸烟324(20.1)2 1001.000
无夜班+吸烟276(17.1)9141.637(1.346~1.991)a
曾经夜班+不吸烟185(11.5)8301.196(0.964~1.483)
曾经夜班+吸烟158(9.8)4751.670(1.314~2.123)a
现在夜班+不吸烟351(21.8)1 5711.126(0.942~1.348)
现在夜班+吸烟317(19.7)1 0261.625(1.342~1.968)a
饮酒+夜班
无夜班+不饮酒500(31.0)2 6301.000
无夜班+饮酒100(6.2)3941.186(0.914~1.539)
曾经夜班+不饮酒287(17.8)1 1201.126(0.943~1.343)
曾经夜班+饮酒56(3.5)1851.344(0.948~1.904)
现在夜班+不饮酒554(34.4)2 1731.110(0.959~1.284)
现在夜班+饮酒114(7.1)4241.111(0.868~1.421)
运动+夜班
无夜班+运动487(30.2)2 5641.000
无夜班+几乎不运动113(7.0)4601.296(1.010~1.663)a
曾经夜班+运动281(17.4)1 1001.124(0.941~1.343)
曾经夜班+几乎不运动62(3.8)2051.475(1.054~2.064)a
现在夜班+运动520(32.3)2 0921.075(0.926~1.247)
现在夜班+几乎不运动148(9.2)5051.418(1.128~1.782)a
夜班+BMI
无夜班+正常267(16.6)1 4941.000
无夜班+超重/肥胖333(20.7)1 5300.936(0.769~1.139)
曾经夜班+正常361(22.4)1 4281.173(0.918~1.498)
曾经夜班+超重/肥胖420(26.1)1 7771.018(0.811~1.278)
现在夜班+正常314(19.5)1 1531.224(1.004~1.493)a
现在夜班+超重/肥胖354(22.0)1 4440.910(0.749~1.105)
夜班+久坐时间（h/d）
无夜班+久坐≤6359(22.3)1 8161.000
无夜班+久坐>6241(15.0)1 2081.053(0.867~1.278)
曾经夜班+久坐≤6446(27.7)1 9161.092(0.886~1.347)
曾经夜班+久坐>6335(20.7)1 2891.241(0.977~1.576)
现在夜班+久坐≤6374(23.2)1 5311.055(0.887~1.255)
现在夜班+久坐>6294(18.2)1 0661.173(0.972~1.415)
夜班+睡眠时间（h/d）
无夜班+睡眠>7206(12.8)1 1691.000
无夜班+睡眠≤7387(24.0)1 8411.302(1.068~1.588)a
曾经夜班+睡眠>7265(16.4)1 1541.139(0.867~1.495)
曾经夜班+睡眠≤7505(31.3)2 0291.455(1.160~1.824)a
现在夜班+睡眠>7226(14.0)9331.198(0.960~1.496)
现在夜班+睡眠≤7439(27.3)1 6511.325(1.090~1.496)a
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夜班工作与不良生活方式对铁路职工高同型半胱氨酸血症的影响
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黄鑫 1 , 顾浩琰 1 , 陈怡然 2 , 白研 1 , 吴珊 1
现代预防医学 | 环境与职业卫生 2025,52(8): 1379-1385
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现代预防医学 | 环境与职业卫生 2025, 52(8): 1379-1385
夜班工作与不良生活方式对铁路职工高同型半胱氨酸血症的影响
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黄鑫1, 顾浩琰1, 陈怡然2, 白研1 , 吴珊1
作者信息
  • 1.广东药科大学公共卫生学院，广东　广州　510310
  • 2.广州市疾病预防控制中心

    • 黄鑫（2000—）,女,硕士在读，研究方向:职业病防治

通讯作者:

吴珊和白研为共同通信作者。吴珊，E-mail：；
白研，E-mail：
Effect of night shift work and unhealthy lifestyle on hyperhomocysteinemia among railway workers
Xin HUANG1, Hao-yan GU1, Yi-ran CHEN2, Yan BAI1 , Shan WU1
Affiliations
  • School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510310, China
出版时间: 2025-04-25 doi: 10.20043/j.cnki.MPM.202409203
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摘要
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目的

分析夜班工作和不良生活方式与高同型半胱氨酸血症(hyperhomocysteinemia，HHcy)的关联和交互作用，为职业人群预防HHcy提供依据。

方法

选取2021年9月—12月在广州某三甲医院体检的 6926名铁路职工为研究对象。采用logistic回归分析相关性，限制性立方样条(restricted cubic spline，RCS)评估夜班年限与HHcy的剂量-反应关系，交互作用分析夜班与不良生活方式对HHcy的影响。

结果

铁路职工HHcy患病率为23.3%，logistic回归显示，夜班<2.9年（OR=1.340，95% CI: 1.120~1.603）、夜班频率≤1 d/w（OR=1.302，95% CI: 1.029~1.646）或≥4 d/w（OR=1.516，95% CI: 1.248~1.841）、吸烟（OR=1.470，95% CI: 1.294~1.671）、超重（OR=1.173，95% CI: 1.030~1.335）与HHcy患病风险呈正相关；睡眠>7 h/d和运动与HHcy患病风险呈负相关（P<0.05）。RCS模型显示，夜班年限与HHcy存在非线性关系（Ptotal<0.001,Pnon-linear= 0.001）。交互作用发现，夜班与各种不良生活方式均不存在相乘和相加交互作用（P>0.05）。在不同夜班情况人群中，吸烟、几乎不运动、超重/肥胖、睡眠≤7 h/d的人群患HHcy风险更高（P<0.05）。

结论

夜班工作和不良生活方式是HHcy的危险因素。在不同夜班工作情况下，吸烟、几乎不运动、超重/肥胖、睡眠 ≤7 h/d均可增加患HHcy风险。

夜班  /  不良生活方式  /  铁路职工  /  同型半胱氨酸血症  /  交互作用
Objective

To analyze theassociation and interactionof night shift work and unhealthy lifestyle on hyperhomocysteinemia(HHcy), and to provide basis for theHHcy preventionamong railway workers.

Methods

Total of 6 926 railway workers who received physical examination in a hospital in Guangzhou from September to December 2021 were selected as study objects. Binary logistic was performed to analyze correlation, the restricted cubic spline (RCS) model was used to assess the dose-response relationship, and the interaction of night shift work and unhealthy lifestyle with HHcy were analyzed.

Results

The prevalence rate of HHcy among railway workers was 23.3%. Logistic regression showed that night shift work lasted 0-2.9 years (OR=1.340, 95% CI:1.120-1.603), night shift work frequency ≤ 1 d/w (OR=1.302, 95% CI:1.029-1.646) or ≥ 4 d/w (OR=1.516, 95% CI:1.248-1.841), smoking (OR=1.516, 95% CI:1.248-1.841), overweight (OR=1.173, 95% CI: 1.030-1.335) were positively correlated with HHcy. Sleep duration > 7 h/d and exercise were negatively correlated with HHcy (P<0.05). RCS model found a nonlinear relationship of night shift work with HHcy (Ptotal <0.001,Pnon-linear=0.001). No multiplicative and additive interaction of night shift work and any unhealthylifestyle with HHcy were found(P> 0.05). Among different night shift conditions, smoking, almost inactive, overweight/obesity, and ≤ 7 h/d sleep had a higher risk of HHcy (P<0.05).

Conclusion

Night shift work and unhealthy lifestyle are risk factors for HHcy. In different night shift work conditions, smoking, almost inactive, overweight/obesity, sleep duration ≤ 7 h/d can increase HHcy risk.

Night shift work  /  Unhealthy lifestyle  /  Railway workers  /  Hyperhomocysteinemia  /  Interaction
黄鑫, 顾浩琰, 陈怡然, 白研, 吴珊. 夜班工作与不良生活方式对铁路职工高同型半胱氨酸血症的影响. 现代预防医学, 2025 , 52 (8) : 1379 -1385 . DOI: 10.20043/j.cnki.MPM.202409203
Xin HUANG, Hao-yan GU, Yi-ran CHEN, Yan BAI, Shan WU. Effect of night shift work and unhealthy lifestyle on hyperhomocysteinemia among railway workers[J]. Modern Preventive Medicine, 2025 , 52 (8) : 1379 -1385 . DOI: 10.20043/j.cnki.MPM.202409203
正文
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在现代社会中，铁路作为国民经济的大动脉，铁路职工的工作量和工作压力不断增加[1]。铁路职工的工作状态与健康问题引起了社会广泛关注，而夜班作为最明显的工作特征之一，可能扰乱其昼夜节律，增加高同型半胱氨酸血症(hyperhomocysteinemia，HHcy)患病风险[2]。同型半胱氨酸(homocysteine，Hcy)是体内的一种含硫氨基酸，当人体中Hcy水平因代谢障碍而超过正常值上限时称为HHcy[3]，与多种代谢性疾病、心血管疾病、癌症等密切相关[4-6]。研究表明，HHcy患病率逐年上升，成为亟待解决的公共卫生问题[7]。除遗传、年龄等因素外，HHcy的发生也受吸烟、饮酒等不良生活习惯的影响[8]。近年来有研究表明夜班与HHcy的发生有关[2]，但目前关于夜班与不良生活方式的交互作用对HHcy影响的研究较少，因此，本文将分析铁路职工夜班工作和不良生活方式与HHcy间的关联及交互作用，为铁路职工的健康管理和疾病预防提供科学依据。
1　对象与方法
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1.1　对象
以2021年9月—12月在广州某三甲医院体检的8 107名铁路职工为研究对象。在知情同意的前提下，剔除问卷信息不完整、身体测量数据缺失、患严重疾病（如恶性肿瘤和自身免疫性疾病等）和未采血样者，最后纳入6 926名。本研究已获得广东药科大学第一附属医院医学伦理委员会批准(伦理批号:医伦理[2019]第109号)。
1.2　方法
1.2.1　问卷调查
调查前先对相关人员进行培训和考核，采取面对面访谈的方式收集职工的人口学信息(性别、年龄等)、职业史(夜班情况及年限等)、生活习惯(吸烟、饮酒、运动、久坐时间等)。
1.2.2　体格检查
根据国家标准完成身高、体重等检查。隔夜禁食 ≥8 h后，采集外周静脉血液，检测血脂、血糖等相关指标。
1.2.3　变量定义
（1）高同型半胱氨酸血症：成人空腹血清Hcy>15 μmol/L[9]。（2）高血压：在未使用降压药物的情况下收缩压≥140 mm Hg，或舒张压≥90 mm Hg，或自我报告诊断高血压者[10]。（3）高尿酸血症[11]：空腹血尿酸男性>420 μmol/L，女性>357 μmol/L。（4）夜班：除早上7/8时至18时左右以外不规则的工作时间[12]。（5）夜班情况：从未、曾经(曾夜班 ≥3个月且已有≥6个月无夜班)、现在(调查6个月内至少上3个月夜班)。（6）现在吸烟：否、已戒烟(戒烟 ≥6个月)、是(持续 ≥6个月每天吸烟>1支)。（7）体质指数（Body Mass Index，BMI）=体重 ÷身高2，分：偏瘦(<18.5 kg/m2)、正常(18.5~23.9 kg/m2)、超重(24~27.9 kg/m2)、肥胖(≥28 kg/m2)。（8）饮酒：每周饮酒≥ 1次且持续半年。（9）睡眠时间：近1个月内平均每晚的睡眠时长，分：≤5 h/d、>5~7 h/d、>7 h/d[13]。（10）运动强度：根据计算出的每周总代谢当量(MET-min/w)分为：几乎不运动（<1.5 METs）、低强度运动（1.5~2.9 METs）、中强度运动（3~5.9 METs）、高强度运动（6 METs）[14]。（11）久坐时间：指近1个月内平均每天坐着的时间（包括坐着工作、学习等静态行为）。（12）血脂异常：血清总胆固醇≥6.2 mmol/L和/或甘油三酯≥2.3 mmol/L和/或低密度脂蛋白胆固醇≥4.1 mmol/L和/或高密度脂蛋白胆固醇<1.0 mmol/L[15]。（13）糖尿病：空腹血糖 ≥7.0 mmol/L或糖化血红蛋白≥ 6.5%或自我报告确诊糖尿病者[16]。
1.3　统计学分析
用SPSS 27.0、R 4.3.3统计分析。连续变量用中位数（上下四分位数）[M(P25，P75)]描述，分类变量用频数（百分比）[n(%)]描述，中位数和有序变量组间比较用Mann-Whitney U检验，无序变量组间比较用χ2检验。用logistic回归分析不良生活方式和夜班年限与HHcy的关联。构建限制性立方样条(restricted cubic spline，RCS)模型分析夜班年限与HHcy的剂量-反应关系。通过delta法计算夜班与不良生活方式对HHcy的交互作用，当相对超额危险度（relative excess risk due to interaction, RERI）、归因比（attributable proportion due to interaction, AP）和交互作用指数（synergy index,S）的95% CI均不包含1可认为存在相加交互作用。检验水准α为0.05(双侧)。
2　结果
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2.1　研究对象基本特征
纳入6 926名铁路职工，1 611名患HHcy（23.3%），其中男性1 591名（98.8%），整体Hcy水平12.88(11.23, 14.80) mol/L，夜班年限整体水平1.0(0.0,7.0) y，与无HHcy组相比，HHcy组职工男性更多、血清肌酐值更低，高血压和高尿酸血症患病率更高，并且更多人现在仍从事夜班工作,夜班频率较高且夜班年限更长，更多人有粉尘、噪声接触史和心脑血管疾病家族史，更多人超重肥胖且有吸烟、饮酒习惯（P<0.05）。但HHcy组年龄更小，久坐时间更短，夜班工作年限7 y以上的人更少、高强度运动的人更多（P<0.05）。见表1。
2.2　各夜班工作指标与HHcy的多因素分析
以是否患HHcy为因变量，以夜班情况、夜班工作年限、夜班频率分别为自变量，调整混杂因素后，结果显示，夜班工作年限< 2.9 y（OR=1.340，95% CI: 1.120~1.603）、夜班频率 ≤ 1 d/w（OR=1.302，95% CI: 1.029~1.646）或 ≥ 4 d/w（OR=1.516，95% CI: 1.248~1.841）的铁路职工患HHcy风险更高。见表2。
2.3　不良生活方式与HHcy的多因素logistic回归分析
以是否患HHcy为因变量，以BMI、吸烟、饮酒、运动、久坐时间和睡眠时间分别为自变量，校正混杂因素后，结果显示，超重的职工患HHcy的风险比BMI正常职工更高（OR=1.173，95% CI: 1.030~1.335）。与不吸烟职工相比，吸烟的铁路职工患病风险更高（OR=1.470，95% CI: 1.294~1.671）。睡眠时间、运动与HHcy患病风险呈负相关（P<0.05）。久坐时间与HHcy患病风险之间无明显统计学意义（P>0.05）。见表3。
2.4　夜班工作年限与HHcy患病风险的剂量-反应关系
如图1，校正混杂因素后，夜班年限与HHcy存在非线性关系（Ptotal <0.001，P non-linear=0.001）。夜班工作年限在0~1.61 y时HHcy患病风险逐渐升高，在3.02~14.07 y时HHcy患病风险先降后升；在1.61~3.02 y或超过14.07 y后，与HHcy患病风险无明显统计学意义。
2.5　夜班情况和不良生活方式的交互作用分析
以无夜班+任一健康的生活方式为对照，按夜班情况(曾经、现在)进行交互作用分析，结果显示，夜班情况与不良生活方式均不存在相乘和相加的交互作用（P> 0.05),详见表4。
2.6　夜班情况和不良生活方式的亚组分析
根据不同类型的不良生活方式和夜班情况划分不同亚组分析发现，与无夜班+任一健康生活方式人群相比，无夜班+吸烟（OR=1.637，95% CI: 1.346~1.991）、曾经夜班+吸烟（OR=1.670，95% CI: 1.314~2.123）、现在夜班+吸烟（OR=1.625，95% CI: 1.342~1.968）、无夜班+几乎不运动（OR=1.296，95% CI: 1.010~1.663）、曾经夜班+几乎不运动（OR=1.475，95% CI: 1.054~2.064）、现在夜班+几乎不运动（OR=1.418，95% CI: 1.128~1.782）、无夜班+睡眠时间≤7 h/d（OR=1.302，95% CI: 1.068~1.588）、曾经夜班+睡眠时间 ≤7 h/d（OR=1.455，95% CI: 1.160~1.824）、现在夜班+睡眠时间 ≤7 h/d（OR=1.325，95% CI: 1.090~1.496）、现在夜班+体重正常（OR=1.224，95% CI: 1.004~1.493)的人群患HHcy的风险更高，详见表5。
3　讨论
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本研究人群HHcy患病率（23.3%）低于全国（37.2%）[7]，可能与地理位置和不同生活习惯有关。本研究HHcy患者多为男性（98.8%），可能是因为铁路行业男性从业人员更多。与不患HHcy组相比，HHcy组更多人出现超重/肥胖且吸烟、饮酒，与之前的研究一致[8]，说明不良生活方式对HHcy患病风险有影响。此外，HHcy组的血清肌酐值更低，高血压和高尿酸血症的患病率更高，说明HHcy患者更容易发生慢性非传染性疾病。HHcy组更多人有职业有害因素接触史，说明接触职业有害因素可能与罹患HHcy有关。但是，HHcy组久坐时间更短，高强度运动的人更多，与之前的研究矛盾[8]，可能是HHcy组年龄更小，有更多精力进行高强度运动。
本研究发现夜班工作年限0~2.9 y、夜班频率 ≤1 d/w或 ≥4 d/w与HHcy患病风险呈正相关（P<0.05），这与之前的研究相似[2,17]。一项针对韩国仁川某钢铁公司的横断面调查发现，长期夜班工人患HHcy风险是无夜班工人的2.00倍（OR=2.00，95% CI: 1.07~3.74）[2]。为进一探究夜班年限和HHcy患病风险之间的关系，本研究构建了RCS模型，显示夜班年限在0~1.61 y时HHcy患病风险逐渐升高，在3.02~14.07 y时HHcy患病风险先降后升，这与之前的研究结果不太一致[17]，可能是刚开始上夜班时，机体未能适应致使身体节律紊乱从而增加患病风险，而在工作一定年限后身体已能够代偿，出现幸存者偏倚[18]。此外，本研究中夜班工作年限[1.0(0.0.7.0) y]的整体水平不长，拥有10年以上夜班工作年限的职工不多，RCS模型可能存在偏差。再者，随年龄增长，慢性疾病患病率逐年上升，部分工人可能因身体状况不佳而不再从事夜班工作[19]。因此，企业应该重视职工间管理，合理调配岗位。
本研究通过对不良生活方式和HHcy的关联分析发现，BMI、吸烟是HHcy的危险因素，睡眠时间和运动是HHcy的保护因素，这与既往研究结果一致[8]。在本研究中饮酒对HHcy的影响无明显统计学意义，这与文献[17]报道存在矛盾，可能是对饮酒量的定义不同所致。交互作用分析发现，夜班与各种不良生活方式均不存在相加和相乘交互作用。进一步根据夜班情况和不同类的不良生活方式划分不同人群进行亚组分析发现，相较于无夜班且无任一不良生活方式的人群，具有吸烟、BMI、运动、睡眠任一不良生活方式或夜班的人群患HHcy风险更高，这提示有必要关注夜班工作人群的生活方式健康状况，从而改善代谢水平，降低HHcy患病风险。
目前，夜班工作与不良生活方式对HHcy影响的机制尚未完全清晰。有研究发现，夜班工作影响身体昼夜节律，导致蛋氨酸代谢和葡萄糖代谢障碍，使得机体Hcy水平升高[20]。还有研究表明，夜班工作人群因夜间光线照射和睡眠时间少而导致生物钟和外部世界明暗周期之间不同步可能会抑制褪黑素的分泌，而褪黑素水平低可能会导致血Hcy浓度增加，从而导致HHcy[21-22]。此外，在夜班工人中不良生活方式更为常见，如吸烟、睡眠时间短（≤ 7 h/d）和缺少运动，导致夜班工作者的血脂、血糖等各类代谢水平紊乱，进而增加罹患HHcy的风险[2,8,17]。
本研究样本量较大，有足够的检验效能评估夜班和HHcy的关联和剂量反应关系，分析夜班与不良生活方式的交互作用。此外，在多种统计分析模型中，调整了多个协变量，包括人口学特征、生活行为方式、人体测量特征和其他慢性疾病等，降低了混杂偏倚的风险。但是本研究依然存在一些不足之处。首先，本研究是横断面研究，不能确定夜班、不良生活方式与HHcy的因果关系；其次，Hcy来自于食物中蛋氨酸，饮食结构对其影响较大，本研究未纳入饮食信息。未来的研究可以通过扩大样本量和采用纵向追踪的方法来进一步验证。
综上所述，夜班和不良生活方式与HHcy的患病风险存在一定联系。夜班工作和不良生活方式是HHcy的危险因素，夜班工作年限与HHcy存在非线性关系，在不同夜班情况人群中，吸烟、几乎不运动、超重/肥胖、睡眠时间 ≤7 h/d者患HHcy风险更高。企业应该应定期开展职业健康体检，及时了解工人的健康状况，倡导健康的生活方式，制定个体化管理计划，建立更科学合理的夜班工作模式。
基金
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  • 国家自然科学基金青年项目(82404238)
  • 国家自然科学基金青年项目(32100082)
  • 国家级大学生创新训练计划项目(202210573019)
  • 广州市基础与应用基础研究专题(2025A04J3622)
文献
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doi: 10.20043/j.cnki.MPM.202409203
  • 接收时间：2024-09-10
  • 首发时间：2026-03-17
  • 出版时间：2025-04-25
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  • 收稿日期：2024-09-10
基金
国家自然科学基金青年项目(82404238)
国家自然科学基金青年项目(32100082)
国家级大学生创新训练计划项目(202210573019)
广州市基础与应用基础研究专题(2025A04J3622)
作者信息
    1.广东药科大学公共卫生学院，广东　广州　510310
    2.广州市疾病预防控制中心

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吴珊和白研为共同通信作者。吴珊，E-mail：；
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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