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夜班费是卖命钱？JACC：经常上夜班的人，不光眼圈比别人黑，就连心梗面积都比别人大

2022-07-24 梅斯头条 网络

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​夜班费就是卖命钱，经常熬夜心梗面积会更大！

​深夜的出租车载着一具具加班到没有灵魂的躯体归家，凌晨3点的大排档、夜店人声鼎沸，不打烊的便利店随时有夜猫子的光临，医院的急诊部也充斥着各式各样的病患…… 
在我们享受“24小时社会”带来的便利的背后，是无数夜班工作者们付出了自己的睡眠和健康，维持这座城市的夜间运转。
上夜班的人经常是白天睡不好，晚上又靠着烟和咖啡强行清醒，该睡不睡，迟早崩溃，长期上夜班的人不仅黑眼圈比别人重，就连心肌梗死的面积都比别人大！
来自上海交通大学附属仁济医院卜军团队的一项研究就表明：长期夜班工作与心梗患者心肌梗死面积增加有关，不仅如此，在心梗发作后5年内，夜间工作者发生主要心血管不良事件的风险比日间工作者高出了92%！并且夜班工作对心脏造成不良影响是由NR1D1/CLCF1通路介导了这一过程。该研究发表于《美国心脏病学会杂志》。
研究一共纳入412名ST段抬高型心肌梗死患者，平均年龄在58岁，男性占比93%，其中有102人（24.8%）需要长期上夜班。和日间工作者相比，他们更年轻（50岁 vs 59岁），BMI指数更高（25.43kg/m2 vs 24.71kg/m2），吸烟比例更高（75.5% vs 62.9%），高脂血症发生率也更高（57.8% vs 47.7%）。
所有患者均在心梗发生后的12小时内进行了经皮冠状动脉介入手术（PPCI），并于术后5天左右进行了心脏磁共振评估心肌梗死面积。（因此下文所述的心梗面积指的是经历了缺血再灌注后的心梗面积。）
在调整了可能存在的混杂因素如：年龄、性别、BMI、吸烟、高血压、高脂血症、糖尿病、心功能Killip分级后，研究人员发现：
同样是经历了心肌梗死，和日间工作者相比，经常上夜班的人心梗面积明显增加（β=5.94%; 95% CI: 2.94–8.94; P < 0.0001）；发生微血管阻塞（MVO）的风险翻倍（OR: 2.28; 95% CI: 1.26–4.12; P =0.006）；左心室射血分数更低（β=-4.1%; 95% CI: -6.5 ~-1.5; P=0.002）。
在心梗发作后，研究者又对患者们进行了平均长达5年的随访，随访期间有19.2%的患者发生了主要心血管不良事件，包括6例死亡，14例心肌再梗死，48例心衰，7例中风。
上夜班依然与主要心血管不良事件发生风险相关，在调整了可能存在的混杂因素后，和日间上班的人相比，经常上夜班的人发生主要心血管不良事件的风险增加了92%（HR: 1.92; 95% CI: 1.12-3.29; P=0.017）；心衰风险增加106%（HR: 2.06; 95% CI: 1.073.96; P=0.03）。
然而，以上的观察性研究只能说明上夜班与心梗之间存在关联，但不能证明是上夜班直接导致了患者心梗面积增加、预后更差。
于是，研究人员又开始“磨刀霍霍向小鼠”，通过调控小鼠生存环境中的明暗周期（白天熄灯，夜间照灯）破坏小鼠正常的生物钟节律，以此来模拟“上夜班”。
上够8周夜班后，再给小鼠们进行心脏左前降支血管结扎再解开手术，模拟缺血再灌注后形成的心肌梗死。
和人类身上观察到的结果一致，手术后被迫“上夜班”的小鼠心肌梗死的面积明显比正常作息的小鼠大，心肌活力更低，心功能更差，心肌梗死后的死亡率也更高，有力地证明 “上夜班”造成的生物钟节律紊乱，真的能加剧心梗损伤，影响患鼠预后。
不仅如此，考虑到小鼠的心脏比人的小很多，研究人员还特别在大动物（绵羊）身上又进行了类似的实验，同样得到了类似的结果：上了12周夜班的绵羊在缺血再灌注手术后形成的心梗面积比正常作息的绵羊大，凋亡的心脏细胞数量更多，左心室射血分数更低，锤上加锤。
（你做咩乜？）
接下来，就是深入探索为什么“上夜班”会对心脏造成如此影响？研究人员首先想到的就是“上夜班”破坏了正常的生物钟节律。
通过分析“上夜班”情况下生物钟基因表达的改变，研究人员发现“上夜班”使得小鼠和绵羊心脏生物钟NR1D1基因表达降低，BMAL1和PER1基因表达上升，但对于经历“缺血再灌注手术”后的心脏，“上夜班”只会使心肌梗死的心脏NR1D1表达下降。
为了研究NR1D1基因在心肌梗死过程中发挥的作用，研究人员特异性地敲除了小鼠心肌细胞的NR1D1基因（Nr1d1 cKO），再给这些小鼠进行“缺血再灌注”手术，结果显示，Nr1d1 cKO小鼠心肌梗死的面积明显大于普通小鼠，心肌活性和心功能也更差。
然而向“缺血再灌注”手术后的小鼠注射NR1D1激动剂，或让小鼠心肌细胞表达NR1D1都能够显著缓解“上夜班”造成的心肌梗死加剧，改善心肌损伤情况和心功能。
进一步分析后，研究人员发现心肌细胞NR1D1基因表达下降，会使得下游的CLCF1基因（IL-6家族的一员）表达上升，最终导致心肌细胞炎症因子表达增加，吸引外周中性粒细胞浸润，加重心肌炎性水肿。
 
总结一下就是：“上夜班”影响生物钟，导致心肌生物钟基因NR1D1表达下降，加重心肌梗死过程中炎症反应，心肌梗死面积增大，影响心功能，预后变差。”
最后，对于如何降低“上夜班”对心脏的影响，研究人员表示，减少“上夜班”的频率或夜班持续时间或有利于夜班工作者心血管健康，未来还需要更多的研究。
毕竟有些工作总需要有人来做，就拿医生来说，超6成医生一周内值夜班次数达到2次，其中又以住院医师最频繁（数据来自医米调研“医生健康状况调查”），40块钱的夜班费，可以说是卖命钱了。
至于那些不给夜班费、以“违规发放津贴”为由，要求退还夜班费的医院，我只想：
（图源网络）
撰文 | 四五七
编辑 | 阿拉斯加宝

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    2023-01-22 hbwxf

    #JACC#

    0

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    2022-07-26 12498568m50暂无昵称

    #ACC#

    0

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    2022-07-25 张得帅

    不错，学习了

    0

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    2022-07-25 ms7000001673893513

    医生的命贱

    0

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    2022-07-25 weizi75

    急诊科的夜班和影像科的夜班是难兄难弟啊……

    0

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    2022-07-25 浮生云

    猝死边缘

    0

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    2022-07-25 学医无涯

    用命换钱

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1855071, encodeId=94e618550e130, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sun Jan 22 02:05:48 CST 2023, time=2023-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326964, encodeId=efd9132696460, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Jul 26 12:05:48 CST 2022, time=2022-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234557, encodeId=7412123455e42, content=不错，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70778248916, createdName=张得帅, createdTime=Mon Jul 25 10:28:14 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234551, encodeId=669b123455104, content=医生的命贱, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be8b5486381, createdName=ms7000001673893513, createdTime=Mon Jul 25 10:09:56 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234546, encodeId=f2c2123454670, content=急诊科的夜班和影像科的夜班是难兄难弟啊……, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=970d4676167, createdName=weizi75, createdTime=Mon Jul 25 09:41:22 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234533, encodeId=0f121234533a7, content=猝死边缘, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/dWjhY0PAfsvdia0UCxb9SD0icZjG5orpS2MKSvvPicInV825QhAIiaweQXxick0Aicn1icEeZUJmDAK9qIHxmvNJ1icRsQ/132, createdBy=4dfc5305971, createdName=浮生云, createdTime=Mon Jul 25 08:05:17 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234531, encodeId=cd901234531a3, content=用命换钱, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Mon Jul 25 07:30:34 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234528, encodeId=08f11234528ec, content=40块钱的夜班费，可以说是卖命钱了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3a31581237, createdName=zwddoctor, createdTime=Mon Jul 25 07:07:20 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234487, encodeId=d791123448e17, content=不错，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfa6526517, createdName=ms5000000644045955, createdTime=Sun Jul 24 21:58:50 CST 2022, time=2022-07-24, status=1, ipAttribution=)]
    2022-07-25 zwddoctor

    40块钱的夜班费，可以说是卖命钱了！

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1855071, encodeId=94e618550e130, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sun Jan 22 02:05:48 CST 2023, time=2023-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326964, encodeId=efd9132696460, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Jul 26 12:05:48 CST 2022, time=2022-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234557, encodeId=7412123455e42, content=不错，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70778248916, createdName=张得帅, createdTime=Mon Jul 25 10:28:14 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234551, encodeId=669b123455104, content=医生的命贱, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be8b5486381, createdName=ms7000001673893513, createdTime=Mon Jul 25 10:09:56 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234546, encodeId=f2c2123454670, content=急诊科的夜班和影像科的夜班是难兄难弟啊……, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=970d4676167, createdName=weizi75, createdTime=Mon Jul 25 09:41:22 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234533, encodeId=0f121234533a7, content=猝死边缘, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/dWjhY0PAfsvdia0UCxb9SD0icZjG5orpS2MKSvvPicInV825QhAIiaweQXxick0Aicn1icEeZUJmDAK9qIHxmvNJ1icRsQ/132, createdBy=4dfc5305971, createdName=浮生云, createdTime=Mon Jul 25 08:05:17 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234531, encodeId=cd901234531a3, content=用命换钱, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Mon Jul 25 07:30:34 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234528, encodeId=08f11234528ec, content=40块钱的夜班费，可以说是卖命钱了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3a31581237, createdName=zwddoctor, createdTime=Mon Jul 25 07:07:20 CST 2022, time=2022-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1234487, encodeId=d791123448e17, content=不错，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4dfa6526517, createdName=ms5000000644045955, createdTime=Sun Jul 24 21:58:50 CST 2022, time=2022-07-24, status=1, ipAttribution=)]
    2022-07-24 ms5000000644045955

    不错，学习了。

    0