睡眠时间和糖尿病肾病尿蛋白进展风险的前瞻性队列研究

A prospective cohort study on the sleep duration and risk of progression of proteinuria among patients with early diabetic kidney disease

目的探讨不同睡眠时间与早期糖尿病肾病(DKD)尿蛋白进展风险的关联。方法收集2015年6月至2017年10月本院肾内科就诊的857例早期DKD患者作为前瞻性观察队列研究。利用多因素Cox回归分析模型分析不同睡眠时间与早期DKD尿蛋白进展风险的关系。结果共有765例早期DKD患者纳入本研究,平均年龄(59.1±6.2)岁,中位随访时间2.8年,DKD尿蛋白进展者123例,进展发生率为16.1%。睡眠时间<6、6~8、>8 h/d进展发生率分别为29.4%(45/153)、12.5%(70/560)、15.4%(8/52)。睡眠时间<6 h/d尿蛋白进展发生率明显升高,差异有统计学意义(P<0.05)。以睡眠时间6~8 h/d为基准相比,调整混杂因素后,睡眠时间<6、>8 h/d发生尿蛋白进展的HR(95%CI)分别为1.82(1.14~2.91)、1.04(0.75~1.44)。对性别、年龄、体质量指数、每日运动量、吸烟、饮酒等进行分层分析,结果显示与调整相关影响因素后人群结果相似,睡眠时间不足与DKD尿蛋白进展风险有统计学关联,但睡眠时间过长与DKD尿蛋白进展风险无统计学关联。结论睡眠不足可能是早期糖尿病肾病尿蛋白进展的危险因素。

Objective To investigate the relationship between sleep duration and the risk of progression of proteinuria in patients with early diabetic kidney disease(DKD).Methods 857 patients with early DKD admitted to our hospital were studied.Cox proportional hazards regression models were used to evaluate the associations between different levels of the sleep duration and the risk of progression of proteinuria in patients with early DKD.Results A total of 765 patients with early DKD were enrolled in our study with an age of(59.1±6.2)years and the median follow-up time was 2.8 years.A total of 123 cases with progression of proteinuria were identified in the cohort study.The total incidence of progression of proteinuria was 16.1%,and those in sleep duration<6,6~8,>8 h/d were 29.4%(45/153),12.5%(70/560)and 15.4%(8/52),respectively,with significant difference(P<0.05).Compared with sleep duration 6~8 h,the multivariate adjusted hazard ratio(95%CI)of progression of proteinuria were 1.82(1.14~2.91)for<6 h and 1.04(0.75~1.44)for>8 h.According to gender,age,BMI,physical activity,smoking and drinking habits,date of the stratified analysis showed that this was consistent with the whole adjusted population.Shorter sleep duration was associated with the risk of progression of proteinuria but no significant association was found between longer sleep duration and the risk.Conclusion Shorter sleep duration seemed to have increased the risk of proteinuria in patients with early DKD.