慢性失眠与衰弱的相关性分析：基于生化指标和Fried量表的研究

Correlation Analysis between Chronic Insomnia and Frailty: A Study Based on Biochemical Indicators and the Fried Scale

摘要: 目的：探讨慢性失眠与衰弱的关系，并分析炎症、血细胞系、生化等指标在其中的潜在作用。方法：纳入118名受试者，其中慢性失眠组62例，对照组56例。使用Fried量表评估衰弱状态，采用阿森斯量表(Athens Insomnia Scale, AIS)评估失眠程度，并测量白介素-6 (interleukin-6, IL-6)、超敏C反应蛋白(High-sensitivity C-reactive Protein, hs-CRP)、血常规、血脂、简易智力状态测量表(Mini-Mental State Examination, MMSE)评分等生理及认知功能指标。组间比较采用t检验、卡方检验及Mann-Whitney U检验，相关性分析采用Spearman相关分析，并通过Logistic回归分析评估慢性失眠与衰弱的独立关联，并通过中介效应分析探讨IL-6和血红蛋白的中介作用。结果：(1) 慢性失眠组的Fried量表评分显著高于对照组(P < 0.01)。(2) 慢性失眠组IL-6水平显著升高(P < 0.01)，红细胞计数及血红蛋白水平显著降低(P < 0.01)。(3) 慢性失眠组的MMSE评分显著低于对照组(P < 0.01)，但在Logistic回归分析中未显示出统计学意义(P = 0.664)。(4) Spearman相关性分析显示，Fried量表评分与IL-6呈正相关(r = 0.363, P < 0.01)，与血红蛋白、红细胞计数、MMSE评分呈负相关(P < 0.01)；AIS与Fried量表评分、IL-6呈正相关(P < 0.01) (5) 二元逻辑回归评估失眠分组与衰弱状态的关联。分析表明，失眠组发生衰弱的风险较高(OR = 22.19, 95% CI: 1.57~314.07, P = 0.02)，该比值的置信区间异常宽泛，提示当前估计值非常不稳定，仅为探索性证据。(6) IL-6和血红蛋白在失眠与衰弱之间均具有显著的中介效应，效应占比分别为20.99%、33.33%。但横断面数据无法证实因果。结论：慢性失眠与衰弱密切相关，这种关系可能由炎症和贫血介导。值得注意的是，分析结果同时揭示衰弱是失眠的重要独立危险因素。尽管横断面设计无法确立因果关系，但这些发现表明二者可能存在相互联系的恶性循环。衰弱作为失眠诱因的作用需通过纵向研究进一步验证。

Abstract: Objective: To explore the relationship between chronic insomnia and frailty, and to analyze the potential role of indicators such as inflammation, blood cell parameters, and biochemical markers. Methods: A total of 118 subjects were enrolled, including 62 in the chronic insomnia group and 56 in the control group. Frailty status was assessed using the Fried scale, and insomnia severity was assessed using the Athens Insomnia Scale (AIS). Physiological and cognitive function indicators, including interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), complete blood count, blood lipids, and Mini-Mental State Examination (MMSE) scores, were measured. Inter-group comparisons were performed using t-tests, chi-square tests, and the Mann-Whitney U test. Correlation analysis was conducted using Spearman’s rank correlation. The independent association between chronic insomnia and frailty was assessed via Logistic regression analysis. Mediating effect analysis was used to explore the mediating roles of IL-6 and hemoglobin. Results: (1) The Fried scale score was significantly higher in the chronic insomnia group than in the control group (P < 0.01). (2) IL-6 levels were significantly elevated (P < 0.01), while red blood cell count and hemoglobin levels were significantly reduced (P < 0.01) in the chronic insomnia group. (3) The MMSE score was significantly lower in the chronic insomnia group (P < 0.01), but it did not show statistical significance in the Logistic regression analysis (P = 0.664). (4) Spearman correlation analysis showed that the Fried scale score was positively correlated with IL-6 (r = 0.363, P < 0.01) and negatively correlated with hemoglobin, red blood cell count, and MMSE score (P < 0.01). The AIS score was positively correlated with the Fried scale score and IL-6 (P < 0.01). (5) Binary logistic regression assessing the association between the insomnia group and frailty status indicated a higher risk of frailty in the insomnia group (OR = 22.19, 95% CI: 1.57~314.07, P = 0.02). The exceptionally wide confidence interval for this odds ratio suggests the estimate is highly unstable, and thus this result should be considered merely exploratory. (6) Both IL-6 and hemoglobin showed significant mediating effects in the relationship between insomnia and frailty, with effect proportions of 20.99% and 33.33%, respectively. However, the cross-sectional data cannot confirm causality. Conclusion: Chronic insomnia is closely associated with frailty, and this relationship may be mediated by inflammation and anemia. Notably, the analysis also revealed that frailty is a significant independent risk factor for insomnia. Although the cross-sectional design cannot establish causality, these findings suggest a potential interconnected vicious cycle between the two conditions. The role of frailty as a causative factor for insomnia requires further validation through longitudinal studies.