职业心理应激与代谢综合征的关系

Association between occupational psychological stress and metabolic syndrome

目的 探讨职业心理应激与宁夏回汉民族人群代谢综合征（MS）患病的关系.方法 采用1∶1配对病例对照研究方法,收集201 1年10月-2012年10月期间在宁夏医科大学总医院及吴忠市人民医院确诊的20～60岁600例无血缘关系的MS患者为病例组.按照性别、民族、年龄相差≤3岁匹配,从同一时期同一地点进行定期健康检查的人群中选取600例健康人为对照组.采用自行设计的问卷进行一般情况调查以及体检,抽取空腹静脉血进行生化及血常规检测.采用职业应激量表（OSI）调查研究对象的职业因素及应激水平.结果 随应激水平的升高,腰围（WC）、空腹血糖（FPG）、甘油三酯（TG）、天冬氨酸转氨酶（AST）、尿酸（UA）呈上升趋势,腰臀比（WHR）、收缩压（SBP）、舒张压（DBP）呈先上升后下降趋势,高密度脂蛋白胆固醇（HDL-C）呈下降趋势,差异均有统计学意义（P＜0.05或0.01）.MS组应激因素总分、工作负荷、人际关系、家庭/工作平衡、认知负荷和其他来源的评分均高于对照组（t=6.676、10.269、6.569、2.028、8.714、2.838,P＜0.05）,而管理角色、工作责任和组织气氛的差异均无统计学意义（P＞0.05）.回族与汉族人群的应激因素总分及各子因子评分的差异均无统计学意义（P＞0.05）.调整年龄、性别、文化程度、婚姻状况、吸烟和饮酒因素前后,中度应激暴露人群患MS风险分别为轻度应激暴露人群的2.325和2.331倍,重度应激暴露人群患MS风险分别为轻度应激暴露人群的3.000和3.126倍.不同应激水平组间MS各组分腹型肥胖、高TG、低HDL-C、高血压、高血糖及糖尿病检出率的差异均有统计学意义（x2=17.636、8.514、14.640、14.280、33.323,P＜0.01）.多因素条件logistic分析结果显示,MS的危险因素主要有SBP、TG、低密度脂蛋白胆固醇（LDL-C）、UA、体质指数（BMI）、空腹血糖、高血压家族史、糖尿病家族史以及心理应激水平,保护因素为HDL-C.结论 职业心理应激与MS患病密切相关,是影响MS发病的环境危险因素,随着心理应激水平的增加,MS各组分检出率均呈上升趋势、MS的患病风险显著增高,而回汉民族职业心理应激水平无明显差异.

Objective To investigate the association between occupational psychological stress and metabolic syndrome （MS） in Hui and Han populations in Ningxia,China.Methods A 1：1 matched casecontrol study was performed.A total of 600 unrelated patients aged from 20 to 60 years who were clearly diagnosed with MS in General Hospital of Ningxia Medical University and Wuzhong People＇s Hospital from October 2011 to October 2012 were collected as the case group （MS group）.A total of 600 healthy people who underwent a regular health examination in the same hospital during the same period were selected as the control group with matched gender,nationality,and age （≤ ±3 years）.The self-designed questionnaire was used to investigate the general situations and do the physical examination,and the fasting venous blood samples were collected for laboratory biochemical blood tests.The Occupational Stress Inventory （OSI） was used to investigate the subjects＇ occupational stress factors and stress levels.Results With the increase in stress levels,the levels of WC,FPG,TG,AST,and UA were increased,WHR,SBP,and DBP first increased and then decreased,and the level of HDL-C increased.There were statistically significant differences in these parameters between the two groups （P〈0.05 or 0.01）.The occupational psychological stress test results showed that the total score of stress factors （t=6.676,P〈0.05）,workload （t=10.269,P〈0.05）,interpersonal relationship （t=6.569,P〈0.05）,family/work balance （t=2.028,P〈0.05）,cognitive load （t=8.714,P〈0.05）,and other scores （t=2.838,P〈0.05） in the MS group were all significantly higher than those in the control group,but there were no significant differences in the scores of management role,work responsibilities,and organizational climate between the MS group and the control group （P〉0.05）.There were no significant differences in the total score of stress factors and the score of each factor between Hui and Han groups （P〉0.05）.The relative risks of MS in the people with moderate stress exposure were 2.325 and 2.331 times those in the people with mild stress exposure before and after adjustment for age,gender,education level,marriage status,smoking,and drinking,and the relative risks for MS in the people with severe stress exposure were 3.000 and 3.126 times those in the people with mild stress exposure.There were significant differences in the detection rates of abdominal obesity,high TG,low HDL-C,hypertension,hyperglycemia,and diabetes between the sub-groups with different stress levels in the MS group （x2=17.636,8.514,14.640,14.280,and 33.323,P〈0.01）.The results of multivariate conditional logistic regression analysis showed that the risk factors for MS were SBP,TG,LDL-C,UA,BMI,fasting blood glucose,family history of hypertension,family history of diabetes,and the level of psychological stress in Ningxia,and the protective factor for MS was HDL-C.Conclusion The occupational psychological stress is closely associated with MS,and it is an environmental risk factor for MS.With the increase in the stress level,the detection rates of MS components and the relative risk for MS are significantly increased.And there is no significant difference in the level of occupational psychological stress between the Hui and Han nationality groups.