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Article(id=1240730057480663968, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411414, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732118400000, receivedDateStr=2024-11-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773742697353, onlineDateStr=2026-03-17, pubDate=1745510400000, pubDateStr=2025-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773742697353, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773742697353, creator=13701087609, updateTime=1773742697353, 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=1441, endPage=1447, ext={EN=ArticleExt(id=1240730057929454519, articleId=1240730057480663968, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between physical activity level and circadian syndrome in Chinese middle-aged and elderly people, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between physical activity level (PAL) and Circadian syndrome (CircS) in Chinese middle-aged and elderly population.

Methods

Based on the 2013 China Health and Retirement Longitudinal Study (CHARLS) data, middle-aged and elderly people ≥45 years old with complete key data were selected. The association between PAL and CircS was analysed by multiple logistic regression. In addition, subgroup analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were performed.

Results

A total of 5 851 middle-aged and older adults were included as study subjects, with a prevalence of CircS of 24.18% and PAL of 4 548 (1 732.5, 10 584)(MET-min/w). Fully adjusted multivariate logistic regression showed a significant negative association between PAL and CircS prevalence (OR=0.73, 95% CI: 0.62-0.87; P<0.001). The consistency of this association was confirmed by subset analyses and interaction tests for multiple subgroups. Smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 3 810 MET-min/w.

Conclusion

There is a negative association between the PAL and the risk of developing CircS. Moderate physical activity may allow early intervention in individuals at risk for CircS.

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目的

探讨中国中老年人体力活动水平与昼夜节律综合征（CircS）的关联。

方法

基于2013年中国健康与养老全国追踪调查数据，选取关键数据完整、年龄≥45岁中老年人，通过多元logistic回归分析体力活动水平和CircS间的关联。并进行亚组分析、交互作用检验、平滑曲线拟合和阈值效应分析以探讨各研究变量间的关系。

结果

共纳入5 851名中老年人，CircS患病率为24.18%，中位体力活动水平为4 548（1 732.5，10 584）（MET-min/w）；体力活动水平与CircS间存在明显负相关（OR=0.73, 95% CI：0.62~0.87；P<0.001）；通过亚组分析和交互作用检验，证实关联的一致性。平滑曲线拟合和阈值效应分析揭示了二者的非线性关系，并检测到临界拐点为3 810 MET-min/w。

结论

体力活动水平与CircS发生风险间呈负相关。适度身体活动可以早期干预有CircS风险的个体。

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周莉，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=OQDqeK0JNLsdRxlVxhy+4A==, magXml=wSwMEUNQv4TVmriCC3raHQ==, pdfUrl=null, pdf=KG1vKR0kzDDtmR/T9HsnLg==, pdfFileSize=827011, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=/dspgls3TTid2RFJVTbuxQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=kp5DF3aME3SRcPzZYTEwJw==, mapNumber=null, authorCompany=null, fund=null, authors=

翟君蓥（1999—），女，硕士在读，研究方向：神经内科

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翟君蓥（1999—），女，硕士在读，研究方向：神经内科

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翟君蓥（1999—），女，硕士在读，研究方向：神经内科

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Mayo Clinic, 2021, 96(12): 3012-3020., articleTitle=U-Shaped association between duration of sports activities and mortality: Copenhagen city heart study, refAbstract=null)], funds=[Fund(id=1241070734261416417, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, awardId=DZMG-LJRC0010, language=CN, fundingSource=高水平中医医院SMI项目(DZMG-LJRC0010), fundOrder=null, country=null), Fund(id=1241070734366274028, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, awardId=null, language=CN, fundingSource=2019年重大疑难疾病中西医临床协作能力建设项目, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241070728196452495, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, xref=1., ext=[AuthorCompanyExt(id=1241070728221618320, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, companyId=1241070728196452495, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Encephalopathy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China), AuthorCompanyExt(id=1241070728230006929, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, companyId=1241070728196452495, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.北京中医药大学东直门医院脑病二科，北京　100700)]), AuthorCompany(id=1241070728318087316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, xref=2., ext=[AuthorCompanyExt(id=1241070728326475925, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, companyId=1241070728318087316, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.中国中医科学院广安门医院感染疾病科)])], figs=[ArticleFig(id=1241070732478837068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=EN, label=Fig.1, caption=Flowchart of the Inclusion Process for Research Subjects, figureFileSmall=/YsMlm8PVW6w051YUT5qug==, figureFileBig=T2NZX7IUgYhzNUKD1uUrMA==, tableContent=null), ArticleFig(id=1241070732629832027, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=CN, label=图1, caption=研究对象纳入流程图

CHARLS中国健康与养老全国追踪调查

, figureFileSmall=/YsMlm8PVW6w051YUT5qug==, figureFileBig=T2NZX7IUgYhzNUKD1uUrMA==, tableContent=null), ArticleFig(id=1241070732764049769, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=EN, label=Fig.2, caption=Subgroup analysis of the associations between physical activity level and CircS, figureFileSmall=GNRAuZv9DE7MgGixUh8pcA==, figureFileBig=zq09gf4pT3Xiq6A83KQLmw==, tableContent=null), ArticleFig(id=1241070732931821939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=CN, label=图2, caption=体力活动水平与CircS间关联的亚组分析

注：针对年龄、性别、居住地、慢性病、ADL、BMI、社交、吸烟、饮酒进行了调整。在亚组分析中，模型未对分层变量本身进行调整。

, figureFileSmall=GNRAuZv9DE7MgGixUh8pcA==, figureFileBig=zq09gf4pT3Xiq6A83KQLmw==, tableContent=null), ArticleFig(id=1241070733032485247, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=EN, label=Fig.3, caption=Smooth curve fitting for probing physical activity level and CircS, figureFileSmall=13XDhF8LWyU1Z/NKh8sgFA==, figureFileBig=lzxKZImTHhkkqST4ol7cMg==, tableContent=null), ArticleFig(id=1241070733166702988, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=CN, label=图3, caption=用于探查体力活动水平与CircS之间关联的平滑曲线拟合, figureFileSmall=13XDhF8LWyU1Z/NKh8sgFA==, figureFileBig=lzxKZImTHhkkqST4ol7cMg==, tableContent=null), ArticleFig(id=1241070733275754903, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=EN, label=Table 1, caption=

Characteristics of the subjects in the CHARLS 2013 study based on CircS

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称非昼夜节律综合征组昼夜节律综合征组P值
总人数4 436(75.82)1 415(24.18)
年龄（岁） [n（%）]<0.001
45~592 219(50.02)627(44.31)
60~741 871(42.18)678(47.92)
≥75346(7.80)110(7.77)
性别[n（%）]<0.001
女2 085(47.00)1 010(71.38)
男2 351(53.00)405(28.62)
居住地[n（%）]<0.001
城镇1 626(36.65)603(42.61)
农村2 810(63.35)812(57.39)
文化水平[n（%）]<0.001
小学以下1 752(39.50)718(50.74)
小学1 318(29.72)349(24.66)
中学900(20.29)230(16.25)
高中及以上466(10.50)118(8.34)
家庭人均消费（万元）[n（%）]0.691
0~11 779(40.10)563(39.79)
1~22 115(47.68)671(47.42)
2~3281(6.33)102(7.21)
>3261(5.88)79(5.58)
配偶/伴侣共同生活[n（%）]<0.001
否482(10.87)201(14.20)
是3 954(89.13)1214(85.80)
慢性病数量（种）[n（%）]<0.001
01 457(32.84)224(15.83)
11 096(24.71)236(16.68)
≥21 883(42.45)955(67.49)
ADL[n（%）]<0.001
未受损3 657(82.44)996(70.39)
受损779(17.56)419(29.61)
BMI（kg/m2）[n（%）]<0.001
<242 686(60.55)358(25.30)
≥241 750(39.45)1057(74.70)
社交活动[n（%）]0.217
无1 858(41.88)619(43.75)
有2 578(58.12)796(56.25)
饮酒[n（%）]<0.001
否2 247(50.65)901(63.67)
是2 189(49.35)514(36.33)
吸烟[n（%）]<0.001
否2 335(52.64)999(70.60)
是2 101(47.36)416(29.40)
身体活动代谢（MET-min/w）[M（P25，P75）]5 040（1 732.5，10 920）3 832.5（1 732.5，8 136）<0.001
腰围（cm）[M（P25，P75）]84（77.4，90.6）93.4（87.6，100）<0.001
TG（mmol/Ｌ）[M（P25，P75）]5.7（4.3，7.8）10.3（8.0，14.6）<0.001
HDL-C（mmol/Ｌ）[M（P25，P75）]2.9（2.5，3.3）2.5（2.2，2.8）<0.001
收缩压（mmHg）[M（P25，P75）]123（111，136）134（122，147）<0.001
舒张压（mmHg）[M（P25，P75）]73.5（66，81）78.5（71，86）<0.001
FPG（mmol/Ｌ）[M（P25，P75）]5.2（4.8，5.6）5.8（5.3，7.0）<0.001
睡眠（h）[M（P25，P75）]7（6，8）5（4，7）<0.001
CES-D[M（P25，P75）]6（3，10）10（5，15）<0.001
), ArticleFig(id=1241070733389001123, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=CN, label=表1, caption=

基于CHARLS 2013年调查数据CircS人群特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称非昼夜节律综合征组昼夜节律综合征组P值
总人数4 436(75.82)1 415(24.18)
年龄（岁） [n（%）]<0.001
45~592 219(50.02)627(44.31)
60~741 871(42.18)678(47.92)
≥75346(7.80)110(7.77)
性别[n（%）]<0.001
女2 085(47.00)1 010(71.38)
男2 351(53.00)405(28.62)
居住地[n（%）]<0.001
城镇1 626(36.65)603(42.61)
农村2 810(63.35)812(57.39)
文化水平[n（%）]<0.001
小学以下1 752(39.50)718(50.74)
小学1 318(29.72)349(24.66)
中学900(20.29)230(16.25)
高中及以上466(10.50)118(8.34)
家庭人均消费（万元）[n（%）]0.691
0~11 779(40.10)563(39.79)
1~22 115(47.68)671(47.42)
2~3281(6.33)102(7.21)
>3261(5.88)79(5.58)
配偶/伴侣共同生活[n（%）]<0.001
否482(10.87)201(14.20)
是3 954(89.13)1214(85.80)
慢性病数量（种）[n（%）]<0.001
01 457(32.84)224(15.83)
11 096(24.71)236(16.68)
≥21 883(42.45)955(67.49)
ADL[n（%）]<0.001
未受损3 657(82.44)996(70.39)
受损779(17.56)419(29.61)
BMI（kg/m2）[n（%）]<0.001
<242 686(60.55)358(25.30)
≥241 750(39.45)1057(74.70)
社交活动[n（%）]0.217
无1 858(41.88)619(43.75)
有2 578(58.12)796(56.25)
饮酒[n（%）]<0.001
否2 247(50.65)901(63.67)
是2 189(49.35)514(36.33)
吸烟[n（%）]<0.001
否2 335(52.64)999(70.60)
是2 101(47.36)416(29.40)
身体活动代谢（MET-min/w）[M（P25，P75）]5 040（1 732.5，10 920）3 832.5（1 732.5，8 136）<0.001
腰围（cm）[M（P25，P75）]84（77.4，90.6）93.4（87.6，100）<0.001
TG（mmol/Ｌ）[M（P25，P75）]5.7（4.3，7.8）10.3（8.0，14.6）<0.001
HDL-C（mmol/Ｌ）[M（P25，P75）]2.9（2.5，3.3）2.5（2.2，2.8）<0.001
收缩压（mmHg）[M（P25，P75）]123（111，136）134（122，147）<0.001
舒张压（mmHg）[M（P25，P75）]73.5（66，81）78.5（71，86）<0.001
FPG（mmol/Ｌ）[M（P25，P75）]5.2（4.8，5.6）5.8（5.3，7.0）<0.001
睡眠（h）[M（P25，P75）]7（6，8）5（4，7）<0.001
CES-D[M（P25，P75）]6（3，10）10（5，15）<0.001
), ArticleFig(id=1241070733510635952, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=EN, label=Table 2, caption=

Characteristics of the subjects in the CHARLS 2013 study based on physical activity level

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称T1T2T3P值
人数1 9201 9791 952
年龄（岁）[n（%）]<0.001
45~59762(39.69)998(50.43)1 086(55.64)
60~74915(47.66)830(41.94)804(41.19)
≥75243(12.66)151(7.63)62(3.18)
性别[n（%）]<0.001
女性1 033(53.80)1 126(56.90)936(47.95)
男性887(46.20)853(43.10)1 016(52.05)
居住地[n（%）]<0.001
城镇847(44.11)867(43.81)515(26.38)
农村1 073(55.89)1 112(56.19)1 437(72.62)
文化水平[n（%）]<0.001
小学以下820(42.71)793(40.07)857(43.90)
小学513(26.72)583(29.46)571(29.25)
中学367(19.11)385(19.45)378(19.36)
高中及以上220(11.46)218(11.02)146(7.48)
家庭年人均消费（万元）[n（%）]0.041
0~1744(38.75)768(38.81)830(42.52)
1~2963(50.16)919(46.44)904(46.31)
2~3111(5.78)147(7.43)125(6.40)
>3102(5.31)145(7.33)93(4.76)
配偶/伴侣共同生活[n（%）]<0.001
否282(14.69)237(11.98)164(8.40)
是1 638(85.31)1 742(88.02)1 788(91.60)
慢性病数量（种）[n（%）]<0.001
0498(25.94)557(28.15)626(32.07)
1440(22.92)430(21.73)462(23.67)
≥2982(51.15)992(50.13)864(44.26)
ADL[n（%）]<0.001
未受损1 426(74.27)1 638(82.77)1 589(81.40)
受损494(25.73)341(17.23)363(18.60)
BMI（kg/m2）[n（%）]<0.001
<24946(49.27)960(48.51)1 138(58.30)
≥24974(50.73)1 019(51.49)814(41.70)
社交活动[n（%）]<0.001
无885(46.09)783(39.57)809(41.44)
有1 035(53.91)1 196(60.43)1 143(58.56)
饮酒[n（%）]<0.001
否1 085(56.51)1 082(54.67)981(50.26)
是835(43.49)897(45.33)971(49.74)
吸烟[n（%）]<0.001
否1 087(56.61)1 203(60.79)1 044(53.48)
是833(43.39)776(39.21)908(46.52)
昼夜节律综合征[n（%）]<0.001
否1 365(71.09)1 492(75.39)1 579(80.89)
是555(28.91)487(24.61)373(19.11)
腰围（cm）[M（P25，P75）]88.0（80.2，95.2）86.8（79.4，94.3）83.9（77.1，90.8）<0.001
TG（mmol/Ｌ）[M（P25，P75）]6.8（4.8，9.9）6.7（4.9，10）5.8（4.3，8.7）<0.001
HDL-C（mmol/Ｌ）[M（P25，P75）]2.7（2.3，3.2）2.8（2.4，3.2）2.9（2.5，3.3）<0.001
收缩压（mmHg）[M（P25，P75）]127（114，142）125（113，140）123（112，137）<0.001
舒张压（mmHg）[M（P25，P75）]75（68，83）74（68，82）74（62，83）0.003
FPG（mmol/Ｌ）[M（P25，P75）]5.3（4.9，6.0）5.3（4.9，5.9）5.2（4.8，5.7）<0.001
睡眠（h）[M（P25，P75）]6（5，8）6（5，8）6（5，8）0.285
CES-D[M（P25，P75）]6（3，12）6（3，11）7（3，13）<0.001
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基于CHARLS 2013年调查数据，根据体力活动水平分层的人群特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称T1T2T3P值
人数1 9201 9791 952
年龄（岁）[n（%）]<0.001
45~59762(39.69)998(50.43)1 086(55.64)
60~74915(47.66)830(41.94)804(41.19)
≥75243(12.66)151(7.63)62(3.18)
性别[n（%）]<0.001
女性1 033(53.80)1 126(56.90)936(47.95)
男性887(46.20)853(43.10)1 016(52.05)
居住地[n（%）]<0.001
城镇847(44.11)867(43.81)515(26.38)
农村1 073(55.89)1 112(56.19)1 437(72.62)
文化水平[n（%）]<0.001
小学以下820(42.71)793(40.07)857(43.90)
小学513(26.72)583(29.46)571(29.25)
中学367(19.11)385(19.45)378(19.36)
高中及以上220(11.46)218(11.02)146(7.48)
家庭年人均消费（万元）[n（%）]0.041
0~1744(38.75)768(38.81)830(42.52)
1~2963(50.16)919(46.44)904(46.31)
2~3111(5.78)147(7.43)125(6.40)
>3102(5.31)145(7.33)93(4.76)
配偶/伴侣共同生活[n（%）]<0.001
否282(14.69)237(11.98)164(8.40)
是1 638(85.31)1 742(88.02)1 788(91.60)
慢性病数量（种）[n（%）]<0.001
0498(25.94)557(28.15)626(32.07)
1440(22.92)430(21.73)462(23.67)
≥2982(51.15)992(50.13)864(44.26)
ADL[n（%）]<0.001
未受损1 426(74.27)1 638(82.77)1 589(81.40)
受损494(25.73)341(17.23)363(18.60)
BMI（kg/m2）[n（%）]<0.001
<24946(49.27)960(48.51)1 138(58.30)
≥24974(50.73)1 019(51.49)814(41.70)
社交活动[n（%）]<0.001
无885(46.09)783(39.57)809(41.44)
有1 035(53.91)1 196(60.43)1 143(58.56)
饮酒[n（%）]<0.001
否1 085(56.51)1 082(54.67)981(50.26)
是835(43.49)897(45.33)971(49.74)
吸烟[n（%）]<0.001
否1 087(56.61)1 203(60.79)1 044(53.48)
是833(43.39)776(39.21)908(46.52)
昼夜节律综合征[n（%）]<0.001
否1 365(71.09)1 492(75.39)1 579(80.89)
是555(28.91)487(24.61)373(19.11)
腰围（cm）[M（P25，P75）]88.0（80.2，95.2）86.8（79.4，94.3）83.9（77.1，90.8）<0.001
TG（mmol/Ｌ）[M（P25，P75）]6.8（4.8，9.9）6.7（4.9，10）5.8（4.3，8.7）<0.001
HDL-C（mmol/Ｌ）[M（P25，P75）]2.7（2.3，3.2）2.8（2.4，3.2）2.9（2.5，3.3）<0.001
收缩压（mmHg）[M（P25，P75）]127（114，142）125（113，140）123（112，137）<0.001
舒张压（mmHg）[M（P25，P75）]75（68，83）74（68，82）74（62，83）0.003
FPG（mmol/Ｌ）[M（P25，P75）]5.3（4.9，6.0）5.3（4.9，5.9）5.2（4.8，5.7）<0.001
睡眠（h）[M（P25，P75）]6（5，8）6（5，8）6（5，8）0.285
CES-D[M（P25，P75）]6（3，12）6（3，11）7（3，13）<0.001
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Association between physical activity level and CircS

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体力活动水平Model 1Model 2Model 3
OR（95% CI）P值OR（95% CI）P值OR（95% CI）P值
T1参考参考参考
T20.80(0.70~0.93)0.0030.79(0.68~0.91)0.0020.79(0.67~0.93)0.004
T30.58(0.50~0.67)<0.0010.64(0.55~0.75)<0.0010.73(0.62~0.87)<0.001
), ArticleFig(id=1241070733992980939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730057480663968, language=CN, label=表3, caption=

体力活动水平与CircS间的关联

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体力活动水平Model 1Model 2Model 3
OR（95% CI）P值OR（95% CI）P值OR（95% CI）P值
T1参考参考参考
T20.80(0.70~0.93)0.0030.79(0.68~0.91)0.0020.79(0.67~0.93)0.004
T30.58(0.50~0.67)<0.0010.64(0.55~0.75)<0.0010.73(0.62~0.87)<0.001
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中国中老年人体力活动水平与昼夜节律综合征的关联性研究
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翟君蓥 1 , 王婷 2 , 张天惟 1 , 周莉 1
现代预防医学 | 健康与社会行为 2025,52(8): 1441-1447
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现代预防医学 | 健康与社会行为 2025, 52(8): 1441-1447
中国中老年人体力活动水平与昼夜节律综合征的关联性研究
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翟君蓥1, 王婷2, 张天惟1, 周莉1
作者信息
  • 1.北京中医药大学东直门医院脑病二科，北京　100700
  • 2.中国中医科学院广安门医院感染疾病科

    • 翟君蓥（1999—），女，硕士在读，研究方向：神经内科

通讯作者:

周莉，E-mail:
Association between physical activity level and circadian syndrome in Chinese middle-aged and elderly people
Jun-ying ZHAI1, Ting WANG2, Tian-wei ZHANG1, Li ZHOU1
Affiliations
  • Department of Encephalopathy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
出版时间: 2025-04-25 doi: 10.20043/j.cnki.MPM.202411414
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摘要
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目的

探讨中国中老年人体力活动水平与昼夜节律综合征（CircS）的关联。

方法

基于2013年中国健康与养老全国追踪调查数据，选取关键数据完整、年龄≥45岁中老年人，通过多元logistic回归分析体力活动水平和CircS间的关联。并进行亚组分析、交互作用检验、平滑曲线拟合和阈值效应分析以探讨各研究变量间的关系。

结果

共纳入5 851名中老年人，CircS患病率为24.18%，中位体力活动水平为4 548（1 732.5，10 584）（MET-min/w）；体力活动水平与CircS间存在明显负相关（OR=0.73, 95% CI：0.62~0.87；P<0.001）；通过亚组分析和交互作用检验，证实关联的一致性。平滑曲线拟合和阈值效应分析揭示了二者的非线性关系，并检测到临界拐点为3 810 MET-min/w。

结论

体力活动水平与CircS发生风险间呈负相关。适度身体活动可以早期干预有CircS风险的个体。

体力活动水平  /  昼夜节律综合征  /  中老年
Objective

To explore the association between physical activity level (PAL) and Circadian syndrome (CircS) in Chinese middle-aged and elderly population.

Methods

Based on the 2013 China Health and Retirement Longitudinal Study (CHARLS) data, middle-aged and elderly people ≥45 years old with complete key data were selected. The association between PAL and CircS was analysed by multiple logistic regression. In addition, subgroup analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were performed.

Results

A total of 5 851 middle-aged and older adults were included as study subjects, with a prevalence of CircS of 24.18% and PAL of 4 548 (1 732.5, 10 584)(MET-min/w). Fully adjusted multivariate logistic regression showed a significant negative association between PAL and CircS prevalence (OR=0.73, 95% CI: 0.62-0.87; P<0.001). The consistency of this association was confirmed by subset analyses and interaction tests for multiple subgroups. Smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 3 810 MET-min/w.

Conclusion

There is a negative association between the PAL and the risk of developing CircS. Moderate physical activity may allow early intervention in individuals at risk for CircS.

Circadian syndrome  /  Physical activity level  /  Middle-aged and elderly population  /  China Health and Retirement Longitudinal Study
翟君蓥, 王婷, 张天惟, 周莉. 中国中老年人体力活动水平与昼夜节律综合征的关联性研究. 现代预防医学, 2025 , 52 (8) : 1441 -1447 . DOI: 10.20043/j.cnki.MPM.202411414
Jun-ying ZHAI, Ting WANG, Tian-wei ZHANG, Li ZHOU. Association between physical activity level and circadian syndrome in Chinese middle-aged and elderly people[J]. Modern Preventive Medicine, 2025 , 52 (8) : 1441 -1447 . DOI: 10.20043/j.cnki.MPM.202411414
正文
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昼夜节律综合征（Circadian syndrome，CircS）是代谢综合征（Metabolic Syndrome，MetS）合并抑郁症状和睡眠异常的综合新概念，诊断标准包括血压升高、血脂异常、腹部肥胖、血糖升高、短睡眠时长和抑郁状态等[1]，其发生可能与导致昼夜节律紊乱的原因相关，如夜间照明、社交时差及轮班或夜班工作等[2-3]。既往研究表明CircS中国成年人群中的患病率约为39%，对心血管疾病的预测价值优于MetS [4]，与中风、肾结石、慢性肾病、慢性腹泻等疾病的风险增加有关[5-8]。CircS高患病率及其负面影响强调了早期预防的重要性。
生活方式的改变，尤其是加强运动是MetS根本和首要防控措施之一[9]。适度身体活动不仅有效预防或延缓慢性疾病发生[10]，还可降低多种慢性疾病带来的健康风险。针对睡眠质量较差人群，适量运动可一定程度上抵消短睡眠带来不利影响[11]。此外，体力活动与抑郁风险间存在剂量反应关系，体力活动越大，抑郁风险越低[12]。上述研究说明，运动与改善CircS关键组成部分密切相关，但目前尚缺乏中老年运动水平与CircS之间关联的相关研究。本研究使用2013年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据，对我国中老年人进行横断面分析，探讨不同体力活动水平与CircS发生风险的相关性。
1　资料与方法
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1.1　数据来源
CHARLS是一项大规模、基于中老年人群的横断面调查，样本覆盖全国28个省（自治区、直辖市）的150个县、450个社区（村）。由于最新随访数据不包含血糖、血脂、腹围等与CircS诊断相关的关键指标，考虑到研究目标和分析需求，故使用2013年CHARLS调查数据进行分析，调查数据经北京大学伦理审查委员会批准(No.irb00001052-11015)。
1.2　研究对象
纳入标准：有CircS诊断项目数据的中老年个体；排除标准：年龄<45岁，缺乏关键数据等。最终，5 851名参与者纳入本研究。筛选流程见图1。
1.3　CircS诊断
CircS诊断包含下列7个条目，参与者满足4个条目即可确诊，且不强求必须满足第六和第七条目[1]：（1）腰围异常：最大腰围（男性≥100 cm，女性≥90 cm）；（2）甘油三酯（TG）偏高：≥17 mmol/Ｌ；（3）高密度脂蛋白胆固醇（HDL-C）偏低：男性<1.0 mmol/Ｌ，女性<1.3 mmol/Ｌ；（4）高血压：收缩压≥130 mmHg或舒张压≥85 mmHg；（5）高血糖：空腹血糖（FPG）≥5.6 mmol/Ｌ；（6）短睡眠：睡眠时间≤6 h；（7）抑郁障碍：CES-D评分≥10分。
1.4　体力活动水平计算
CHARLS问卷调查将体力活动类型分为3种：①高强度体力活动：如耕作、有氧运动等；②中等强度体力活动：如清洁地面、打太极拳、快步走等；③低强度体力活动：如步行、散步等。同时，问卷将每日体力活动类型持续时间划分为5类(0~9 min，10~29 min，30~119 min，120~239 min，≥240 min)，并使用中间值计算高、中、低强度体力活动的运动时间。每周体力活动持续时间=进行体力活动类型的天数×每天体力活动类型持续时间。采用代谢当量(metabolic equivalent, MET)计算中到高强度体力活动的运动量。MET作为一种衡量体力活动强度的指标，根据国际体力活动问卷（international physical activity questionnaire, IPAQ）标准[13]，步行MET赋值3.3，中等强度活动MET赋值4.0，高强度活动MET赋值8.0。每周体力活动水平（MET-min/w）=8.0×总高强度活动每周持续时间+4.0×总中度活动每周持续时间+3.3×总步行每周持续时间[14]。本研究根据研究人群的每周身体活动水平划分为三分位数：T1（<2 292.5 MET-min/w）、T2（2 292.5~7 732.5 MET-min/w）、T3（≥7 732.5 MET-min/w）。
1.5　协变量
根据文献梳理[15-16]，本研究纳入以下变量作为潜在混杂因素：年龄、性别、居住地、文化程度、经济状况、是否有配偶/伴侣共同生活、慢性病数量、日常生活活动能力（ADL）、BMI、社交活动、吸烟状况、饮酒状况。经济状况使用家庭人均消费进行衡量。ADL包括做家务、做饭、自行购物、吃药、管钱5项。ADL中每项均完成无困难则为功能完好，否则为功能受损[17]。BMI的计算是将体重（kg）除以身高（m）的平方。按照BMI将纳入人群分为两类：偏瘦型/正常型(BMI<24 kg/m2)与超重/肥胖型(BMI≥ 24 kg/m2)。有无社交活动参照问卷中DA056的问题“过去一个月是否进行了下列社交活动”，参加任意一项活动即计为有社交活动。
1.6　统计分析
使用stata16进行数据清洗与整理，使用Empower Stats和R 4.2.3 软件进行数据分析。计数资料以频数和百分比表示，组间比较采用χ2检验。计量资料，若符合正态分布，则以（）描述，采用独立样本t检验或One－way ANOVA检验进行统计分析，若不符合正态分布，则以M（P25，P75）描述，采用非参数Mann-Whitney U检验或Kruskal-Wallis H检验。多变量logistic回归分析探讨了体力活动水平与CircS间的关联。使用平滑曲线拟合和广义加性模型分析身体活动总代谢量与CircS间的关系。若检测到非线性关联，则通过递归算法确定拐点，并评估身体活动总代谢量对CircS患病率的阈值影响。采用双侧检验，检验水准α＝0.05。
2　结果
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2.1　研究人群特征
共纳入5 851名受试者，47.10%男性，52.90%女性，其中1 415名CircS患者和4 436名非CircS患者。见表1。年龄、性别、居住地、文化水平、是否有配偶/伴侣共同生活、慢性病、ADL、BMI、吸烟、饮酒、身体活动代谢量在组间存在差异（P<0.05）。非CircS组的人群较年轻，身体活动代谢量较高。
中位身体活动代谢量值为4 548（1 732.5，10 584）（MET-min/w），按照身体活动代谢量将研究人群分为T1（n=1 920）、T2（n=1 979）、T3（n=1 952）组。同时，人口学资料和生化特征等均按组别进行分层。见表2。低身体活动代谢量的群体中女性、文化程度低、家庭人均消费在1~2万元、无配偶/伴侣共同生活、患多种慢性病、ADL受损、无社交活动、不饮酒比例较高，并表现出居住地差异（P<0.05）。
2.2　体力活动水平与CircS之间的关联
表3显示了基于三个模型的体力活动水平与 CircS间的关联。在模型1、模型2和模型3中，与T1组相比，体力活动水平较高的三分位数参与者与CircS患病率较低相关。在调整所有混杂因素后，模型3表明，相对T1组，T3组表现出更低的CircS患病率（OR=0.73,95% CI：0.62~0.87）。
2.3　亚组分析
以森林图形式将亚组分析和交互作用的结果进行可视化。研究结果表明，体力活动水平与CircS患病间的负相关受居住地影响。体力活动水平与CircS的负相关在女性、城镇、无吸烟和饮酒习惯的人群有统计学意义。按年龄、ADL是否受损，BMI和患慢性病数量分层并未明显改变体力活动水平与CircS间的关联。见图2。
2.4　体力活动水平与CircS的非线性关联
使用平滑曲线拟合和阈值效应分析评估，完全调整模型结果说明体力活动水平与CircS间的非线性关系，见图3。阈值效应分析检测到临界拐点为3 810 MET-min/w，在达到拐点之前，体力活动水平显示与CircS呈负相关（OR=0.61,95% CI：0.43~0.87）。在越过拐点后，体力活动与CircS间的负相关不再明显，（OR=0.98,95% CI：0.89~1.07）。
3　讨论
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本文利用CHARLS数据库2013年随访数据，探讨中国中老年人体力活动水平与CircS间的关联。研究发现，2013年中国中老年人CircS的患病率为24%，与美国老年人29%的CircS患病率相比较低[15]，在考虑多个混杂因素后，结果仍表明体力活动水平与CircS风险呈负相关。亚组分析显示了居住地间的相互作用。平滑曲线拟合的结果表明，低于3 810MET-min/w的体力活动水平与CircS发生风险间存在负相关，为未来的研究提供相关证据基础。
MetS是一组包括向心性肥胖、糖代谢受损、血压升高和血脂异常的疾病，这些异常表现已被确定为心血管疾病[9]和其他慢性疾病的危险因素[18]。CircS包括MetS的所有组成部分及抑郁和睡眠障碍的指标。健康饮食模式[19]和合理运动[20]与MetS风险降低相关。近期研究表明，大量摄入蔬菜、水果、海鲜、橄榄油及坚果，可减少CircS风险，已为饮食质量作为老年人CircS的潜在调节因素的重要性提供了证据[15]。但目前运动与CircS的相关研究尚不足。
本研究发现，中老年人体力活动水平与CircS间呈负相关，这与此前相关研究结果报告的运动与MetS、睡眠、抑郁等疾病间呈负相关的结果一致。身体活动与MetS风险因素间具有负相关，且在进行有氧运动的同时进行抗阻运动，可更好地降低MetS风险[21]。本研究结果表明，不同体力活动强度与CircS风险不同，未来仍需要更多的研究全面评估不同运动类型对CircS的影响。
昼夜节律在机体中发挥重要作用，对代谢、免疫、神经和消化系统等有广泛影响[22]，这提示基于昼夜节律干预疾病的必要性。动物实验证明，除光照外，运动也会影昼夜节律系统[23]。但目前运动在调节昼夜节律系统中的作用尚未得到充分证明[24]。有研究表明，针对经历严重昼夜节律失调的人，可通过运动改善，但晚间运动可能会加剧早期时型的昼夜节律失调。故针对不同的昼夜节律失调，需选择个性化运动时间处方[25]。
既往研究将每周体力活动水平划分为低强度体力活动(<600 MET-min/w)、中强度体力活动(600~3 000 MET-min/w)和高强度体力活动(>3 000 MET-min/w)[14]，平滑曲线拟合的结果表明，在超过3 810 MET-min/w的体力活动水平后，体力活动水平与CircS发生风险间的负相关不明显，故为了预防CircS风险，不推荐进行过高强度的体力活动。长期的过度运动对身体机能和新陈代谢造成不利影响，甚至加速衰老[26-27]。
亚组分析提示体力活动水平与CircS间的关联基于居住地的不同而具差异，城市人群的体力活动水平与CircS风险呈负相关。可能的原因如下：城市医疗资源充足，居民疾病预防意识更强；城市公共体育运动设施供相对充足，居民对体育运动认识及重视程度较高，具有运动意识和需求。
本研究存在一定的局限性：CircS诊断标准中血压、血糖和血脂异常综合考虑了血检指标和调查问卷中问题DA007“是否有医生曾经告诉过您有以下这些慢性病”，由于缺失值较多，服药情况未被纳入考虑；体力活动类型和时间基于参与者的自我报告，尽管这是大规模的流行病学调查唯一可行的方法，但自我报告可能给研究带来潜在的混杂因素和偏差；饮食情况是影响代谢与昼夜节律的一个重要因素。然而，CHARLS数据库中的问卷未涉及具体的饮食模式和饮食内容，故未能纳入饮食这一协变量。本研究通过横断面研究分析了体力活动水平与CircS发病风险间的相关关系，未来需更多的大规模前瞻性队列研究深入探讨不同体力活动水平与CircS发生风险间的关系。
综上，体力活动水平与CircS发生风险间呈负相关，二者呈非线性关系，适度身体活动可以早期干预有CircS风险的人群。
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  • 高水平中医医院SMI项目(DZMG-LJRC0010)
  • 2019年重大疑难疾病中西医临床协作能力建设项目
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2025年第52卷第8期
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doi: 10.20043/j.cnki.MPM.202411414
  • 接收时间：2024-11-21
  • 首发时间：2026-03-17
  • 出版时间：2025-04-25
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  • 收稿日期：2024-11-21
基金
高水平中医医院SMI项目(DZMG-LJRC0010)
2019年重大疑难疾病中西医临床协作能力建设项目
作者信息
    1.北京中医药大学东直门医院脑病二科，北京　100700
    2.中国中医科学院广安门医院感染疾病科

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2种不同金属材料的力学参数
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species		 占总种数比例
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total species (%)		 属
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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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