摘要
目的探讨不同飞行时间腰椎间盘突出飞行人员血脂代谢异常的分布特征及其影响因素,为制定针对性干预策略提供依据。方法回顾性分析2020年9月至2023年9月于空军特色医学中心收治的诊断为腰椎间盘突出并在入院后24 h进行血脂检测的214例男性飞行人员住院资料。根据飞行时间分为<1000 h组(45例)、1000~<3000 h组(107例)和≥3000 h组(62例)。收集飞行人员血脂生化指标[总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇(non high-density lipoprotein cholesterol,non-HDL-C)]、一般资料及个人史。比较不同飞行时间飞行人员各项血脂代谢异常的检出率。采用线性趋势卡方分析各项血脂异常的检出率是否存在线性变化的趋势;采用多因素Logistic回归分析血脂代谢异常的影响因素。结果不同飞行时间组飞行人员的年龄、总胆固醇、低密度脂蛋白胆固醇和non-HDL-C差异有统计学意义(F=80.76、4.67、4.00、6.35,P<0.001、=0.010、0.020、0.002),1000~<3000 h组飞行人员的总胆固醇、低密度脂蛋白胆固醇和non-HDL-C均高于<1000 h组(P=0.023、0.029、0.003)。飞行人员甘油三酯升高总检出率最高(28.04%)。不同飞行时间组飞行人员低密度脂蛋白胆固醇升高的检出率差异有统计学意义(χ^(2)=6.50,P=0.039),且1000~<3000 h组低密度脂蛋白胆固醇升高的检出率低于<1000 h组(P=0.010)。线性关联卡方分析结果显示,随着飞行时间的增加,3组飞行人员的总胆固醇升高与non-HDL-C升高的检出率存在线性减少趋势(χ^(2)=4.17、4.16,P=0.041、0.041)。单因素Logistic回归分析显示,与<1000 h比较,1000~<3000 h是甘油三酯升高(OR=4.406,95%CI:1.604~12.103)、non-HDL-C升高(OR=6.217,95%CI:1.403~27.551)的影响因素;体质指数是总胆固醇升高(OR=1.237,95%CI:1.055~1.450)、non-HDL-C升高(OR=1.298,95%CI:1.087~1.548)的影响因素,目前吸烟是甘油三酯升高(OR=3.214,95%CI:1.700~6.078)、高密度脂蛋白胆固醇降低(OR=3.200,95%CI:1.724~5.941)的影响因素。多因素Logistic回归分析显示,体质指数是总胆固醇升高(OR=1.245,95%CI:1.054~1.471)、non-HDL-C升高(OR=1.301,95%CI:1.082~1.564)的危险因素。目前吸烟是甘油三酯升高(OR=3.439,95%CI:1.550~7.631)、高密度脂蛋白胆固醇降低(OR=4.047,95%CI:1.901~8.729)的危险因素。结论不同飞行时间腰椎间盘突出飞行人员呈现阶段性血脂代谢异常特征:1000~<3000 h飞行人员需关注甘油三酯水平,<1000 h飞行人员应控制低密度脂蛋白胆固醇水平。建议针对不同飞行阶段实施分层干预,优先控制体质指数、吸烟及饮酒等可调行为因素。
Objective To explore the distribution and determinants of abnormal blood lipid metabolism among flying personnel with lumbar disc herniation and with different flying hours and to provide data for targeted intervention strategies.Methods The hospitalization data of 214 male flying personnel was retrospectively analyzed who were admitted to the Air Force Medical Center between September 2020 and September 2023,diagnosed with lumbar intervertebral disc protrusion,and underwent blood lipid testing within 24 h of admission.According to the hours of flying,they were divided into<1000 h group(45 cases),1000-<3000 h group(107 cases),and≥3000 h group(62 cases).The blood lipid biochemical indicators[total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,non-high-density lipoprotein cholesterol(non-HDL-C)],basic information and personal history of the flying personnel were collected.The detection rates of blood lipid metabolism disorders among flying personnel with different durations of flight were compared.The chi-square test for linear trend was used to find out whether there was a trend of linear changes in the detection rates of various blood lipid disorders.The multivariate Logistic regression analysis was conducted to analyze the determinants of abnormal blood lipid metabolism.Results There were significant differences in age,levels of total cholesterol and low-density lipoprotein cholesterol,and non-HDL-C between flying personnel in different flying hours groups(F=80.76,4.67,4.00,6.35,P<0.001,=0.010,0.020,0.002).The levels of total cholesterol and low-density lipoprotein cholesterol,and non-HDL-C in the 1000-<3000 h group were higher than those in the<1000 h group(P=0.023,0.029,0.003).The total detection rate of elevated triglyceride was the highest(28.04%).There was a significant difference in the detection rate of elevated low-density lipoprotein cholesterol between the 3 groups(χ^(2)=6.50,P=0.039),which was lower in the 1000-<3000 h group than in the<1000 h group(P=0.010).The results of the chi-square analysis of linear association showed that with the increase of flight duration,there was a linear decrease in the detection rates of elevated total cholesterol and elevated non-HDL-C(χ^(2)=4.17,4.16,P=0.041,0.041).The univariate Logistic regression analysis showed that compared with the<1000 h,the 1000-<3000 h was an influencing factor for elevated triglyceride(OR=4.406,95%CI:1.604-12.103)and elevated non-HDL-C(OR=6.217,95%CI:1.403-27.551)while body mass index was an influencing factor for elevated total cholesterol(OR=1.237,95%CI:1.055-1.450)and elevated non-HDL-C(OR=1.298,95%CI:1.087-1.548).Current smoking was an influencing factor for elevated triglyceride(OR=3.214,95%CI:1.700-6.078)and decreased high-density lipoprotein cholesterol(OR=3.200,95%CI:1.724-5.941).The multivariate Logistic regression analysis showed that body mass index was a risk factor for elevated total cholesterol(OR=1.245,95%CI:1.054-1.471)and elevated non-HDL-C(OR=1.301,95%CI:1.082-1.564).Current smoking was a risk factor for elevated triglyceride(OR=3.439,95%CI:1.550-7.631)and decreased high-density lipoprotein cholesterol(OR=4.047,95%CI:1.901-8.729).Conclusions Flying personnel with lumbar intervertebral disc protrusion and with different flying hours exhibit distinct features of phased blood lipid metabolism disorders.The triglyceride levels of those with 1000-<3000 h deserve more attention while the levels of low-density lipoprotein cholesterol should be brought under control for those with<1000 h.It is recommended that hierarchical interventions be exercised according to flight stages,and that priority be given to controlling daily adjustable behavioral factors such as body mass index and smoking.
作者
洪楚奕
齐辉明
王雪建
张小东
叶超群
Hong Chuyi;Qi Huiming;Wang Xuejian;Zhang Xiaodong;Ye Chaoqun(Department of Rehabilitation,Air Force Medical Center,Air Force Medical University,PLA,Beijing 100142,China)
出处
《中华航空航天医学杂志》
2025年第1期26-32,共7页
Chinese Journal of Aerospace Medicine
关键词
血脂异常
腰椎
椎间盘移位
飞行时间
飞行人员
Dyslipidemias
Lumbar vertebrae
Intervertebral disc displacement
Flying hours
Flying personnel
作者简介
通信作者:叶超群,Email:yechaoqun@sina.com。
