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Article(id=1241023934989136452, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406193, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718121600000, receivedDateStr=2024-06-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812763210, onlineDateStr=2026-03-18, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812763210, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812763210, creator=13701087609, updateTime=1773812763210, updator=13701087609, issue=Issue{id=1241023927812682133, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812761500, creator=13701087609, updateTime=1773812858867, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024336258200259, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024336258200260, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=441, endPage=446, ext={EN=ArticleExt(id=1241023935404372566, articleId=1241023934989136452, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between ethylene oxide exposure and sleep disorders: a cross-sectional study based on NHANES from 2015 to 2018, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between blood ethylene oxide exposure levels and sleep disorders.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018, this study selected adults aged 18 and older. The relationship between blood ethylene oxide exposure levels and sleep disorders was analyzed using multivariable logistic regression, subgroup analysis, interaction analysis, and restricted cubic spline analysis.

Results

A total of 2 579 participants were included, with a median blood ethylene oxide exposure concentration of 21.76 pmol/g Hb, and 753 (29.2%) individuals reported sleep disorders. Multivariable logistic regression indicated that compared to the lowest quartile, the risk of sleep disorders increased by 94% in the highest quartile of blood ethylene oxide exposure (OR=1.94, 95%CI: 1.27-2.95, P=0.012). Subgroup analysis revealed a significant association between ethylene oxide exposure and sleep disorders among women, individuals aged 40 to 59, those of other races, individuals with a poverty ratio of 1.3 to 3.5, those with an education level of high school or below or possessing a college degree, individuals engaging in moderate physical activity, and the unmarried population.Interaction analysis showed that these factors did not exhibit interaction effects on sleep. Restricted cubic spline analysis indicated no nonlinear association between ethylene oxide exposure levels and the occurrence of sleep disorders (Pnon-linear=0.09).

Conclusion

There is a significant positive correlation between high blood ethylene oxide exposure levels and sleep disorders.

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目的

探究血液中环氧乙烷暴露浓度和睡眠障碍之间的关联。

方法

基于美国国家营养与健康调查2015—2018年的数据，选取其中18岁以上成年人作为研究对象，利用多因素logistic回归、亚组分析、交互作用分析、限制性立方样条分析血液环氧乙烷暴露浓度和睡眠障碍之间的关系。

结果

共纳入2 579名研究对象，总参与者环氧乙烷暴露浓度的中位数为21.76 pmol/g Hb，753（29.2%）人存在睡眠障碍。多因素logistic回归显示，与最低四分位数组相比，血液环氧乙烷最高四分位数组中睡眠障碍发生风险增加94% (OR=1.94 , 95%CI:1.27 ~ 2.95，P=0.012)。亚组分析结果表明女性、年龄40 ~ 59岁、其他种族、超重、贫困比为1.3 ~ 3.5、教育程度为高中以下或大学、适度体力活动、未婚的人群中，环氧乙烷暴露与睡眠障碍的发生存在关联且具有统计学意义。交互作用结果显示以上因素在影响睡眠方面不具有交互作用。限制性立方样条结果显示环氧乙烷暴露浓度与睡眠障碍的发生不存在非线性关联（P-non-linear=0.09）。

结论

血液环氧乙烷高暴露浓度与睡眠障碍之间存在显著正相关。

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赵梅；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=C/4TFjdNd9IcnxjrakrH7A==, magXml=UoyKeqAdpk9NjnD7F6LMFw==, pdfUrl=null, pdf=SZIhKcb9Q0ROhawl64SZ5Q==, pdfFileSize=1015156, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=CLpN9feSE7fiG4/do50AXQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=0WN2i51QgnfBBlQlcEHySw==, mapNumber=null, authorCompany=null, fund=null, authors=

陈磊（1999—），女，硕士在读，研究方向：临床营养

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陈磊（1999—），女，硕士在读，研究方向：临床营养

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Chinese Journal of New Clinical Medicine, 2024, 17(4): 476-480.(In Chinese), articleTitle=Research progress on the interaction between inflammatory cytokines and obstructive sleep apnea, refAbstract=null)], funds=[Fund(id=1241023942039761854, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, awardId=YJS20230173, language=CN, fundingSource=安徽医科大学研究生科研与实践创新项目(YJS20230173), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023937153397422, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, xref=null, ext=[AuthorCompanyExt(id=1241023937161786031, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, companyId=1241023937153397422, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Anhui Medical University, Hefei, Anhui 230032, China), AuthorCompanyExt(id=1241023937170174640, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, companyId=1241023937153397422, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=安徽医科大学护理学院，安徽 合肥 230032)])], figs=[ArticleFig(id=1241023940546589498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=EN, label=Figure 1, caption=Flow chart of research subjects screening, figureFileSmall=s6rZWxgW8eYrUAQ6bz5Z1A==, figureFileBig=CLpN9feSE7fiG4/do50AXQ==, tableContent=null), ArticleFig(id=1241023940655641411, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=CN, label=图1, caption=研究对象筛选流程图, figureFileSmall=s6rZWxgW8eYrUAQ6bz5Z1A==, figureFileBig=CLpN9feSE7fiG4/do50AXQ==, tableContent=null), ArticleFig(id=1241023940936659806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=EN, label=Figure 2, caption=Forest plot of subgroup analysis of ethylene oxide exposure concentration and sleep disorders, figureFileSmall=k30/fw0hzZJyIQEnkW4uvQ==, figureFileBig=oeoYKA/Nh/XChnwNOX8hnA==, tableContent=null), ArticleFig(id=1241023941070877546, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=CN, label=图2, caption=环氧乙烷暴露浓度与睡眠障碍的亚组分析森林图, figureFileSmall=k30/fw0hzZJyIQEnkW4uvQ==, figureFileBig=oeoYKA/Nh/XChnwNOX8hnA==, tableContent=null), ArticleFig(id=1241023941179929462, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=EN, label=Figure 3, caption=Restricted cubic spline analysis of ethylene oxide exposure concentration and sleep disturbance, figureFileSmall=73Qfv1Rjj+ZqjxrBPcRx1Q==, figureFileBig=OWKDWmWGB9WG3lMJGbtSZw==, tableContent=null), ArticleFig(id=1241023941305758594, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=CN, label=图3, caption=环氧乙烷暴露浓度和睡眠障碍的限制性立方样条分析

注：模型已调整了年龄、性别、种族、婚姻状况、BMI、腰围、教育程度、PIR、体力活动、高敏C反应蛋白、血清可替宁水平、咖啡因摄入量、总能量摄入。

, figureFileSmall=73Qfv1Rjj+ZqjxrBPcRx1Q==, figureFileBig=OWKDWmWGB9WG3lMJGbtSZw==, tableContent=null), ArticleFig(id=1241023941435782032, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=EN, label=Table 1, caption=

Characteristics of participants ［n（%），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量睡眠正常组(n=1 826)睡眠障碍组 (n=753)总参与者(n=2 579)P值
性别<0.001
女性878 (48.1)417(55.4)1 295(50.2)
男性948 (51.9)336(44.6)1 284(49.8)
年龄（岁）<0.001
18～39624 (34.2)165(21.9)789(30.6)
40～59537 (29.4)260(34.5)797(30.9)
≥60≥665 (36.4)328(43.6)993(38.5)
种族<0.001
墨西哥美国人297 (16.3)88(11.7)385(14.9)
非西班牙裔白人610 (33.4)330(43.8)940(36.4)
非西班牙裔黑人377 (20.6)163(21.6)540(20.9)
其他西班牙裔220 (12.0)74(9.8)294(11.4)
其他种族322 (17.6)98(13.0)420(16.3)
教育程度0.037
高中以下377 (20.6)126(16.7)503(19.5)
高中446 (24.4)177(23.5)623(24.2)
大学及以上1 003 (54.9)450(59.8)1 453(56.3)
婚姻状况0.004
未婚322 (17.6)114(15.1)436(16.9)
丧偶/离婚/和伴侣分开359 (19.7)191(25.4)550(21.3)
已婚/和伴侣同居1 145 (62.7)448(59.5)1 593(61.8)
贫困收入比0.326
<1.3546(29.9)209(27.8)755(29.3)
1.3～3.5746(40.9)303(40.2)1 049(40.7)
>3.5534(29.2)241(32.0)775(30.1)
BMI(kg/m2)<0.001
消瘦(<18.5)22(1.2)12(1.6)34(1.3)
正常(≥18.5～24.9)470(25.7)148(19.7)618(24.0)
超重(≥25～29.9)628(34.4)210(27.9)838(32.5)
肥胖(≥30)706(38.7)383(50.9)1 089(42.2)
体力活动0.049
无935(51.2)395(52.5)1 330(51.6)
适度416(22.8)194(25.8)610(23.7)
剧烈475(26.0)164(21.8)639(24.8)
腰围(cm)98.15(88.23, 109.50)104.00(92.20,115.30)100.00(89.20,111.50)<0.001
环氧乙烷浓度(pmol/gHb)21.61(15.73, 39.98)22.10(16.27,62.70)21.76(15.86,44.40)0.050
咖啡因摄入量(mg/d)95.00(27.63, 187.13)112.00(27.50,225.00)99.00(27.50,194.75)0.008
总能量摄入(kcal/d)1 968.30(1 487.86, 2 557.13)1 838.50(1427.00,2395.50)1 928.50(1469.50,2512.50)0.002
血清可替宁浓度(ng/mL)0.03 (0.01, 4.43)0.04(0.01,36.40)0.03(0.01,8.49)0.120
血清高敏C反应蛋白(mg/L)1.80 (0.80, 4.21)2.42(1.01,5.19)1.95(0.85,4.40)<0.001
), ArticleFig(id=1241023941624525730, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=CN, label=表1, caption=

参与者特征［n（%），M（P25，P75）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量睡眠正常组(n=1 826)睡眠障碍组 (n=753)总参与者(n=2 579)P值
性别<0.001
女性878 (48.1)417(55.4)1 295(50.2)
男性948 (51.9)336(44.6)1 284(49.8)
年龄（岁）<0.001
18～39624 (34.2)165(21.9)789(30.6)
40～59537 (29.4)260(34.5)797(30.9)
≥60≥665 (36.4)328(43.6)993(38.5)
种族<0.001
墨西哥美国人297 (16.3)88(11.7)385(14.9)
非西班牙裔白人610 (33.4)330(43.8)940(36.4)
非西班牙裔黑人377 (20.6)163(21.6)540(20.9)
其他西班牙裔220 (12.0)74(9.8)294(11.4)
其他种族322 (17.6)98(13.0)420(16.3)
教育程度0.037
高中以下377 (20.6)126(16.7)503(19.5)
高中446 (24.4)177(23.5)623(24.2)
大学及以上1 003 (54.9)450(59.8)1 453(56.3)
婚姻状况0.004
未婚322 (17.6)114(15.1)436(16.9)
丧偶/离婚/和伴侣分开359 (19.7)191(25.4)550(21.3)
已婚/和伴侣同居1 145 (62.7)448(59.5)1 593(61.8)
贫困收入比0.326
<1.3546(29.9)209(27.8)755(29.3)
1.3～3.5746(40.9)303(40.2)1 049(40.7)
>3.5534(29.2)241(32.0)775(30.1)
BMI(kg/m2)<0.001
消瘦(<18.5)22(1.2)12(1.6)34(1.3)
正常(≥18.5～24.9)470(25.7)148(19.7)618(24.0)
超重(≥25～29.9)628(34.4)210(27.9)838(32.5)
肥胖(≥30)706(38.7)383(50.9)1 089(42.2)
体力活动0.049
无935(51.2)395(52.5)1 330(51.6)
适度416(22.8)194(25.8)610(23.7)
剧烈475(26.0)164(21.8)639(24.8)
腰围(cm)98.15(88.23, 109.50)104.00(92.20,115.30)100.00(89.20,111.50)<0.001
环氧乙烷浓度(pmol/gHb)21.61(15.73, 39.98)22.10(16.27,62.70)21.76(15.86,44.40)0.050
咖啡因摄入量(mg/d)95.00(27.63, 187.13)112.00(27.50,225.00)99.00(27.50,194.75)0.008
总能量摄入(kcal/d)1 968.30(1 487.86, 2 557.13)1 838.50(1427.00,2395.50)1 928.50(1469.50,2512.50)0.002
血清可替宁浓度(ng/mL)0.03 (0.01, 4.43)0.04(0.01,36.40)0.03(0.01,8.49)0.120
血清高敏C反应蛋白(mg/L)1.80 (0.80, 4.21)2.42(1.01,5.19)1.95(0.85,4.40)<0.001
), ArticleFig(id=1241023941771326382, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=EN, label=Table 2, caption=

Multivariate logistic regression of ethylene oxide exposure concentration and sleep disturbance

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
OR值(95CI)P值OR值(95CI)P值OR值(95CI)P值
环氧乙烷暴露浓度（pmol/gHb）1.18(1.05～1.34)0.0041.33(1.20～1.48)<0.0011.42(1.23～1.62)<0.001
分组
Q1参考参考参考
Q20.95(0.62～1.44)0.8000.92(0.61～1.38)0.7000.91(0.60～1.39)0.700
Q31.12(0.81～1.56)0.5001.20(0.85～1.70)0.3001.21(0.85～1.72)0.300
Q41.43(0.96～2.12)0.0751.87(1.27～2.75)0.0051.94(1.27～2.95)0.012
P趋势值0.074<0.001<0.001
), ArticleFig(id=1241023941880378293, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023934989136452, language=CN, label=表2, caption=

环氧乙烷暴露浓度和睡眠障碍的多因素logistic回归

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
OR值(95CI)P值OR值(95CI)P值OR值(95CI)P值
环氧乙烷暴露浓度（pmol/gHb）1.18(1.05～1.34)0.0041.33(1.20～1.48)<0.0011.42(1.23～1.62)<0.001
分组
Q1参考参考参考
Q20.95(0.62～1.44)0.8000.92(0.61～1.38)0.7000.91(0.60～1.39)0.700
Q31.12(0.81～1.56)0.5001.20(0.85～1.70)0.3001.21(0.85～1.72)0.300
Q41.43(0.96～2.12)0.0751.87(1.27～2.75)0.0051.94(1.27～2.95)0.012
P趋势值0.074<0.001<0.001
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环氧乙烷暴露与睡眠障碍的关联——一项NHANES 2015—2018的横断面研究
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陈磊 , 许月明 , 赵梅
现代预防医学 | 环境与职业卫生 2025,52(3): 441-446
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现代预防医学 | 环境与职业卫生 2025, 52(3): 441-446
环氧乙烷暴露与睡眠障碍的关联——一项NHANES 2015—2018的横断面研究
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陈磊, 许月明, 赵梅
作者信息
  • 安徽医科大学护理学院，安徽 合肥 230032

    • 陈磊（1999—），女，硕士在读，研究方向：临床营养

通讯作者:

赵梅；E-mail:
Association between ethylene oxide exposure and sleep disorders: a cross-sectional study based on NHANES from 2015 to 2018
Lei CHEN, Yue-ming XU, Mei ZHAO
Affiliations
  • School of Nursing, Anhui Medical University, Hefei, Anhui 230032, China
出版时间: 2025-02-10 doi: 10.20043/j.cnki.MPM.202406193
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摘要
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目的

探究血液中环氧乙烷暴露浓度和睡眠障碍之间的关联。

方法

基于美国国家营养与健康调查2015—2018年的数据，选取其中18岁以上成年人作为研究对象，利用多因素logistic回归、亚组分析、交互作用分析、限制性立方样条分析血液环氧乙烷暴露浓度和睡眠障碍之间的关系。

结果

共纳入2 579名研究对象，总参与者环氧乙烷暴露浓度的中位数为21.76 pmol/g Hb，753（29.2%）人存在睡眠障碍。多因素logistic回归显示，与最低四分位数组相比，血液环氧乙烷最高四分位数组中睡眠障碍发生风险增加94% (OR=1.94 , 95%CI:1.27 ~ 2.95，P=0.012)。亚组分析结果表明女性、年龄40 ~ 59岁、其他种族、超重、贫困比为1.3 ~ 3.5、教育程度为高中以下或大学、适度体力活动、未婚的人群中，环氧乙烷暴露与睡眠障碍的发生存在关联且具有统计学意义。交互作用结果显示以上因素在影响睡眠方面不具有交互作用。限制性立方样条结果显示环氧乙烷暴露浓度与睡眠障碍的发生不存在非线性关联（P-non-linear=0.09）。

结论

血液环氧乙烷高暴露浓度与睡眠障碍之间存在显著正相关。

环氧乙烷  /  睡眠障碍  /  NHANES
Objective

To investigate the association between blood ethylene oxide exposure levels and sleep disorders.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018, this study selected adults aged 18 and older. The relationship between blood ethylene oxide exposure levels and sleep disorders was analyzed using multivariable logistic regression, subgroup analysis, interaction analysis, and restricted cubic spline analysis.

Results

A total of 2 579 participants were included, with a median blood ethylene oxide exposure concentration of 21.76 pmol/g Hb, and 753 (29.2%) individuals reported sleep disorders. Multivariable logistic regression indicated that compared to the lowest quartile, the risk of sleep disorders increased by 94% in the highest quartile of blood ethylene oxide exposure (OR=1.94, 95%CI: 1.27-2.95, P=0.012). Subgroup analysis revealed a significant association between ethylene oxide exposure and sleep disorders among women, individuals aged 40 to 59, those of other races, individuals with a poverty ratio of 1.3 to 3.5, those with an education level of high school or below or possessing a college degree, individuals engaging in moderate physical activity, and the unmarried population.Interaction analysis showed that these factors did not exhibit interaction effects on sleep. Restricted cubic spline analysis indicated no nonlinear association between ethylene oxide exposure levels and the occurrence of sleep disorders (Pnon-linear=0.09).

Conclusion

There is a significant positive correlation between high blood ethylene oxide exposure levels and sleep disorders.

Ethylene oxide  /  Sleep disorders  /  NHANES
陈磊, 许月明, 赵梅. 环氧乙烷暴露与睡眠障碍的关联——一项NHANES 2015—2018的横断面研究. 现代预防医学, 2025 , 52 (3) : 441 -446 . DOI: 10.20043/j.cnki.MPM.202406193
Lei CHEN, Yue-ming XU, Mei ZHAO. Association between ethylene oxide exposure and sleep disorders: a cross-sectional study based on NHANES from 2015 to 2018[J]. Modern Preventive Medicine, 2025 , 52 (3) : 441 -446 . DOI: 10.20043/j.cnki.MPM.202406193
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优质的睡眠在维持机体健康和生活质量等方面发挥着关键作用[1]，是构成生命活动的重要组成部分。睡眠障碍通常由内在的机体疾病因素以及外在的环境因素共同引起，具体表现为入睡困难、浅睡、易醒、阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome, OSAHS）、不宁腿综合症（restless legs syndrome, RLS）等[2]。随着现代生活节奏的加快以及工作压力的增加，全球睡眠质量普遍下降，2020年美国疾病控制与预防中心（CDC）的数据显示约17.8%的成年人在过去30 d存在睡眠障碍[3]。睡眠障碍与精神疾病[4]、神经系统疾病[5]和心血管疾病[6]的发生密切相关，对个人生活质量和公共卫生构成严重的威胁。
环氧乙烷气体是一种有毒的工业化学品，广泛用于医疗设备的消毒以及塑料、纺织品和防冻剂等产品的制造[7]。环氧乙烷在生产或使用过程中可能会释放到空气和水中，进而污染环境。研究表明，短期内吸入大量环氧乙烷会引起头痛、头晕、疲劳、恶心、呕吐、胃肠道不适及呼吸道刺激（如咳嗽、呼吸急促、喘息）等症状[7-8]。而长期接触环氧乙烷则会增加非霍奇金淋巴瘤、骨髓瘤和淋巴细胞白血病等白细胞癌的风险，此外还会增加女性患乳腺癌的风险[9-10]。美国环境保护署（EPA）的一项评估显示，暴露于环氧乙烷的居民其癌症发病率高达全国平均水平的24倍[11]。由此可见，环氧乙烷严重危害人类的生命健康。
国内职业性急性环氧乙烷中毒报告显示环氧乙烷暴露严重损害神经系统，导致失眠、嗜睡等睡眠问题的发生[7-12]。既往研究探讨了空气污染颗粒及气体[13]（如PM2.5、O3、SO2、CO）对睡眠健康的影响，而环氧乙烷作为一种环境污染物，关于其和睡眠障碍关联的流行病学研究开展较为罕见。因此，本研究基于2015—2018年美国国家营养与健康调查（National Health and Nutrition Examination Survey，NHANES），探讨环氧乙烷暴露与睡眠障碍发生之间的关联。
1　资料与方法
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1.1　研究对象
NHANES是由美国国家卫生服务中心（NCHS）执行的全国性调查，采用了分层、多阶段的概率抽样方法，全面收集关于美国民众营养状态和健康风险因素的相关数据。其参与者均已获得知情同意，因此不再需要伦理批准和同意。
本研究利用NHANES数据库中2015—2016和2017—2018年两个周期的数据，共包含19 225名参与者，排除了年龄小于18岁、缺乏睡眠障碍、环氧乙烷暴露以及关键协变量的参与者，最终，2 579名符合条件的参与者被纳入研究。见图1。
1.2　环氧乙烷暴露和睡眠障碍的评估
环氧乙烷的浓度是NHANES实验室的医学技术人员根据程序手册进行测量的，检测结果的报告单位为每克血红蛋白加合物的pmol（pmol/g Hb）。睡眠障碍是根据NHANES睡眠问卷中的问题“是否告诉医生有睡眠问题”分为两类。
1.3　协变量的定义
本研究的协变量包括年龄（18～39、40～59和≥ 60岁）、性别、种族（墨西哥裔美国人、非西班牙裔白人、非西班牙裔黑人、其他西班牙裔和其他种族）、教育程度（未高中毕业、高中毕业和大学及以上学历）、贫困收入比（PIR<1.3，1.3～3.5和> 3.5，PIR越低则代表家庭经济水平越差）、婚姻状况（已婚/和伴侣同居、丧偶/离婚/分居和从未结婚）、BMI（<18.5 kg/m2、18.5～24.9 kg/m2、25～29.9 kg/m2、≥30 kg/m2）、体力活动（无、适度、剧烈）。总能量摄入和咖啡因摄入量计算方法为两日饮食摄入总和的平均值（如果仅存在第一天的饮食摄入值，则采用该值）。
1.4　数据分析
采用NHANES提供的环氧乙烷特殊的样品权重（WTSA2YR）对样本进行加权。符合正态分布的连续变量用（均数±标准差）表示；偏态分布的连续变量用中位数［M（P25，P75）］表示；分类变量用比例表示。采用t检验、Wilcoxon秩和检验、χ2检验评估有无睡眠障碍的受试者之间的差异。因环氧乙烷浓度呈偏态分布，因此将其进行自然对数转换用于数据分析。采用多因素logistic回归分析探索环氧乙烷暴露与睡眠障碍之间的关联。在模型1中未调整任何混杂因素；模型2调整了年龄、性别、种族、婚姻状况、BMI、腰围、教育程度、PIR；模型3进一步调整体力活动、高敏C反应蛋白、血清可替宁水平、咖啡因摄入量、总能量摄入；在模型中使用比值比（OR）和95%置信区间（CI）评估环氧乙烷暴露和睡眠障碍的关联。此外，通过亚组分析探究环氧乙烷暴露对睡眠的影响。采用加权限制性立方样条探索环氧乙烷暴露与睡眠障碍的非线性关联，采用三个切片点建模。所有统计分析使用R studio（4.3.0版本）进行，检验水准为α=0.05。
2　结果
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2.1　参与者睡眠障碍检出情况
在2 579名参与者中，其中29.2%（753/2 579）存在睡眠障碍。与正常人群相比，睡眠障碍者中女性、40岁以上、非西班牙裔白人和非西班牙裔黑人、教育程度为大学及以上、丧偶/离婚/和伴侣分开、消瘦及肥胖的比例更高，摄入的咖啡因更多、总能量更少，机体内血清高敏C反应蛋白的浓度更高。见表1。
2.2　环氧乙烷暴露情况
总人群中的血液环氧乙烷暴露浓度的中位数为21.76 pmol/g Hb，睡眠障碍组的血液环氧乙烷浓度的中位数为22.10 pmol/g Hb，略高于睡眠正常组（P=0.05）。见表1。
2.3　环氧乙烷暴露与睡眠障碍的关联分析
当环氧乙烷暴露浓度取自然对数作为连续型变量时，在模型1、模型2、模型3中均观察到环氧乙烷暴露浓度与睡眠障碍发生风险存在显著正相关，OR值分别是1.18（95%CI:1.05～1.34）、1.33（95%CI:1.20～1.48）、1.42（95%CI:1.23 ~1.62）。
将环氧乙烷暴露浓度的自然对数按照四分位数进行分组计算，模型2、3研究结果显示，与环氧乙烷暴露浓度最低四分位数组相比，最高四分位数组睡眠障碍的发生风险分别增加了87%和94%，OR值分别是1.87（95%CI:1.27～2.75）、1.94（95%CI:1.27～2.95）。见表2。
2.4　亚组分析
本研究根据不同协变量进行了亚组分析和交互作用分析，见图2。结果显示，女性、年龄40～59岁、其他种族、超重、PIR为1.3～3.5、教育程度为高中以下或获得大学文凭、适度体力活动、未婚的人群中，环氧乙烷暴露浓度与睡眠障碍呈正相关且具有统计学意义。交互作用分析均未发现以上因素与环氧乙烷在影响睡眠方面存在交互作用（P均大于0.05）。
2.5　限制性立方样条
采用限制性立方样条分析研究环氧乙烷暴露浓度与睡眠障碍发生风险的非线性关系。结果如图3所示，环氧乙烷暴露与睡眠障碍不存在非线性关联（P-non-linear=0.09）。
3　讨论
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本研究采用NHANES数据库2015—2018年的数据分析了环氧乙烷暴露浓度与睡眠障碍发生风险的关联。结果表明，较高的环氧乙烷暴露浓度与睡眠障碍的发生显著相关。亚组分析表明两者关联在女性、年龄为40～59岁、其他种族、超重、PIR为1.3～3.5、教育程度为高中以下或大学、适度体力活动、未婚的人群中依旧存在。
环氧乙烷作为一种危险的空气污染物，是已知的人类致癌物。随着全球生产和使用量不断增加，其生物毒性越来越受到关注。美国一项队列研究结果发现长期的环氧乙烷暴露与女性工人患肺癌、20年后患乳腺癌等存在显著关联[14]。除此之外，长期暴露于环氧乙烷对神经、血液、呼吸、胃肠道、生殖和皮肤系统等多个系统中都有明显的非致癌作用[15-17]。一项病例报告显示，急性职业性环氧乙烷暴露后的患者发生持续恶心、呕吐和反复发作的霹雳性头痛等急性神经系统症状[18]。Finelli[19]等人推测，环氧乙烷可能通过干扰神经元周围的新陈代谢或轴突运输，进而抑制必需代谢物向神经末梢的递送，最终引起神经系统症状。一项探究环氧乙烷暴露与美国普通成年人群糖尿病患病率关联的横断面研究显示，血液中环氧乙烷水平升高与较高的糖化血红蛋白、较低的高密度脂蛋白及糖尿病患病率增加显著相关[20]。由此可见，暴露于环氧乙烷严重影响人类的生命健康。
目前关于环氧乙烷暴露和睡眠的关联研究开展较少。众多研究表明，炎症水平与睡眠障碍的发生密切相关。Kanki[21]等针对英国生物样本库参与者进行调查，最终发现睡眠质量取决于炎症状态，睡眠健康状况差与C反应蛋白水平、白细胞和中性粒细胞计数呈正相关。炎症因子如IL-6可通过调节色氨酸/犬尿氨酸的分泌及甘油磷酸酯的代谢进而影响中枢神经系统，引起神经元损伤，最终诱发睡眠障碍[22]。此外，在兔子、鼠和人类等不同物种的研究中发现，睡眠障碍会增加大脑皮层、外周组织和血液循环中IL-1β的表达和蛋白质水平，炎症因子如TNF-α和IL-1β受体通过其配体激活导致NF-κB转录，进而导致抑制性κB（I-κB）激酶复合物发生磷酸化，最终诱导I-κB泛素化和降解，促进NF-κB易位到细胞核中以诱导调节睡眠的炎症分子的转录[23]。以上研究均表明，炎症水平升高是睡眠障碍发生的主要机制。而较高浓度的环氧乙烷暴露会增加机体炎症水平。动物研究表明，暴露于环氧乙烷的啮齿动物可能发生器官炎症性病变[24]。环氧乙烷是乙二醇单甲醚的中间体，给予雄性Wistar大鼠口服乙二醇单甲醚可致IL-6、TNF-α和IL-1β等促炎介质水平显著升高[25]。岳鑫[26]等人于无菌条件下将消毒后的己内酯/环氧乙烷共聚物植入大鼠脊柱肌肉中，发现埋植初期存在局部组织水肿、炎细胞浸润等炎性反应。另一项研究显示，美国成年人体内环氧乙烷水平升高会促进炎症标志物（包括高敏C反应蛋白、白细胞、中性粒细胞和淋巴细胞计数）单调增加[27]。综上可见，环氧乙烷暴露可能导致机体内炎症水平上升，而炎症水平升高则是影响睡眠的一个关键因素[28-29]。因此血液内环氧乙烷浓度升高引起机体内炎症水平升高可能是睡眠障碍的发生机制。然而，未来仍需要进一步通过动物实验及队列研究探索其潜在的作用机制。
本研究存在一些局限性。如横断面研究无法做出因果推断。此外，本研究的问卷数据来自参与者的回忆，其准确性有待考察。
综上所述，血液环氧乙烷暴露浓度与睡眠障碍之间存在正相关，但未来仍需要开展大样本前瞻性的队列研究来阐明两者之间的因果关系。
基金
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  • 安徽医科大学研究生科研与实践创新项目(YJS20230173)
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2025年第52卷第3期
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doi: 10.20043/j.cnki.MPM.202406193
  • 接收时间：2024-06-12
  • 首发时间：2026-03-18
  • 出版时间：2025-02-10
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  • 收稿日期：2024-06-12
基金
安徽医科大学研究生科研与实践创新项目(YJS20230173)
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    安徽医科大学护理学院，安徽 合肥 230032

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赵梅；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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