睡眠剥夺对限制能量平衡膳食的减重效果及肠道菌群丰度的影响

目的研究睡眠剥夺对单纯性肥胖患者限制能量平衡膳食（CRD）减重效果、生化指标及肠道菌群丰度变化的影响。 方法观察2018年9月至2019年11月徐州医科大学附属淮安医院肥胖门诊筛选的睡眠剥夺组（8例）及正常睡眠组（8例）的单纯性肥胖患者CRD干预12周前后身体形态指标、生化指标及肠道菌群特征的变化。采用单因素方差分析比较组间差异，配对样本t检验比较同组受试者减重前后指标的差异，采用Kruskal-Wallis检验比较肠道菌群组间差异，采用Spearman相关性分析分析临床指标及宿主菌群的相关性。 结果（1）CRD干预后睡眠剥夺组及正常睡眠组的体质量［（83.85±9.30）kg vs （85.88±8.76）kg；（79.23±14.52）kg vs （88.00±13.16）kg］、腰围［（98.60±6.76）cm vs（100.73±6.14）cm；（96.14±11.26）cm vs （101.61±8.52）cm］及基础代谢率［BMR，（1476.25±146.63）kcal vs（1501.75±149.36）kcal；（1427.00±228.02）kcal vs （1477.38±229.98）kcal］均较干预前下降，差异均具有统计学意义（t=2.898、3.895，P=0.023、0.006；t=3.694、3.103，P=0.008、0.017；t=3.599、5.994，P=0.009、0.001）。（2）睡眠剥夺组患者CRD干预后，体质量变化值［（2.02±1.97）kg vs （8.76±6.36）kg］、体脂肪量变化值［（0.55±1.93）kg vs （5.25±5.10）kg］、体脂肪面积变化值［（-3.25±14.41）cm² vs （36.13±48.94）cm²］、BMR变化值［（25.50±20.04）kcal vs （50.38±23.77）kcal］及总胆固醇变化值［（-0.06±0.37）mmol/L vs （0.77±0.76）mmol/L］均较正常睡眠组小，组间差异均具有统计学意义（t=2.424、1.692、6.102、0.702、3.802，P=0.013、0.029、0.047、0.040、0.014）；（3）2组干预前后的肠道菌群Alpha多样性未见明显差异，研究期间，正常睡眠组Mollicutes菌与BMR呈稳定负相关关系。 结论CRD干预能有效降低单纯性肥胖患者的体质量、腰围、BMR；睡眠剥夺可能在一定程度上减弱CRD的减重效果，影响血脂的代谢；单纯性肥胖人群CRD干预过程中，Mollicutes菌可能是影响CRD减重效果的原因之一。

Effect of sleep deprivation on weight loss and gut microbiota in obese patients on a calorie restricted diet

ObjectiveTo investigate the effect of sleep deprivation on weight loss, biochemical indexes, and gut microbiota abundance in obese patients on a calorie restricted diet (CRD). MethodsObese patients were enrolled in the obesity clinic of Huai'an Hospital Affiliated to Xuzhou Medical College from September 2018 to November 2019 and divided into either a sleep deprivation group (8 cases) or a non-sleep deprivation group (8 cases). The changes of body shape indexes, biochemical indexes, and intestinal microflora characteristics were recorded after CRD intervention for 12 weeks. One-way ANOVA was used to compare the differences in the above indexes between the two groups. Paired sample t-test was used to compare the differences before and after weight loss of subjects in the same group. Kruskal-Wallis test was used to compare the differences between groups of intestinal bacteria. Spearman correlation analysis was used to analyze the correlation between clinical indicators and gut microbiota. ResultsAfter CRD intervention, the body weight (83.85±9.30) kg vs (85.88±8.76) kg, t=2.898, P=0.023; (79.23±14.52) kg vs (88.00±13.16) kg, t=3.895, P=0.006], waist circumference (98.60±6.76) cm vs (100.73±6.14) cm, t=3.694, P=0.008; (96.14±11.26) cm vs (101.61±8.52) cm, t=3.103, P=0.017], and basal metabolic rate BMR; (1476.25±146.63) kcal vs (1501.75±149.36) kcal, t=3.599, P=0.009; (1427.00±228.02) kcal vs (1477.38±229.98) kcal, t=5.994, P=0.001] in both groups all significantly decreased than those before CRD, t=3.599, 5.994, P=0.009, 0.001). The changes in body weight (2.02±1.97) kg vs (8.76±6.36) kg, t=2.424, P=0.013], body fat amount (2.0.55±1.93) kg vs (5.25±5.10) kg, t=1.692, P=0.029], body fat area (-3.25±14.41) cm² vs (36.13±48.94) cm², t=6.102, P=0.047], BMR (25.50±20.04) kcal vs (50.38±23.77) kcal, t=0.702, P=0.040] and total cholesterol (-0.06±0.37) mmol/L vs (0.77±0.76) mmol/L, t=3.802, P=0.014] in the sleep deprivation group were significantly less than those in the non-sleep deprivation group after CRD intervention. There was no significant difference in alpha diversity of gut microbiota before and after the intervention in either group. During the study period, there was a stable negative correlation between Mollicutes and BMR in the non-sleep deprivation group. ConclusionCRD intervention can effectively reduce the weight, waist circumference, and BMR of patients with obesity. The effects of CRD intervention may be weakened by sleep deprivation in terms of weight loss and blood lipid metabolism. Mollicutes bacteria may be one of the factors affecting the weight loss effect of CRD intervention in obese patients without sleep deprivation.