CIRCADIAN VARIATION IN THE FREQUENCY OF ONSET OF ACUTE MYOCARDIAL-INFARCTION
CIRCADIAN VARIATION IN THE FREQUENCY OF ONSET OF ACUTE MYOCARDIAL-INFARCTION
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DOI：
10.1056/nejm198511213132103
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
BRAUNWALD, E
中科院分区：
文献类型：
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作者：
MULLER, JE;STONE, PH;BRAUNWALD, E
为了确定心肌梗死的发作是否在一天中随机发生，我们分析了2999例心肌梗死患者的疼痛发作时间。发病频率存在明显的昼夜节律，高峰期为上午6点至中午（P < 0.01）。703例患者中，血浆肌酸激酶MB（CK-MB）水平首次升高的时间可客观地用于心肌梗死的发病时间。CK-MB估计的时间证实了昼夜节律的存在，在峰值（上午9点）心肌梗死发作的频率增加了3倍。与低谷（晚上11点）相比，时期在心肌梗死前接受β-肾上腺素能阻滞剂治疗的患者中未检测到昼夜节律，但在未接受此类治疗的患者中存在昼夜节律。如果冠状动脉在覆盖动脉粥样硬化斑块的内膜破裂时变得易受阻塞，则心肌梗死的昼夜节律可能是血栓形成倾向的变化所致。如果能够确定驱动心肌梗死发病的昼夜节律的节律过程，则它们的改变可能延迟或预防梗死的发生。
To determine whether the onset of myocardial infarction occurs randomly throughout the day, we analyzed the time of onset of pain 2999 patients admitted with myocardial infarction. A marked circadian rhythm in the frequency of onset was detected, with a peak from 6 a.m. to noon (P < 0.01). In 703 of the patients, the time of the first elevation in the plasma creatine kinase MB (CK-MB) level could be used to time the onset of myocardial infarction objectively. CK-MB-estimated timing confirmed the existence of a circadian rhythm, with a three-fold increase in the frequency of onset of myocardial infarction at peak (9 a.m.) as compared with trough (11 p.m.) periods. The circadian rhythm was not detected in patients receiving beta-adrenergic blocking agents before myocardial infarction but was present in those not receiving such therapy. If coronary arteries become vulnerable to occlusion when the intima covering an atherosclerotic plaque is disrupted, the circadian timing of myocardial infarction may result from a variation in the tendency to thrombosis. If the rhythmic processes that drive the circadian rhythm of myocardial-infarction onset can be identified, their modification may delay or prevent the occurrence of infarction.