Associations Between Diurnal Timing of Spinal Cord Injury and Its Etiology and Co-Morbidities.
Associations Between Diurnal Timing of Spinal Cord Injury and Its Etiology and Co-Morbidities.
复制标题
脊髓损伤的昼夜时间与其病因和合并症之间的关联。
DOI：
10.1089/neu.2022.0411
复制
发表时间：
2023
影响因子：
4.2
通讯作者：
Hetman,Michal
中科院分区：
文献类型：
--
作者：
Ugiliweneza,Beatrice;Boakye,Maxwell;Ohri,SujataSaraswat;Whittemore,ScottR;Hetman,Michal
昼夜节律在一天中的风险、中风的严重程度和结果的时间差异中发挥作用。然而，在神经创伤患者中，损伤时间对发生、表现严重程度和急性住院结果的影响尚未报道。因此，我们分析了来自前瞻性NACTN登记处的759例急性脊髓损伤后住院记录，这些记录包含了损伤时间的信息。损伤时间为6:00-12:00、12:00-18:00、18:00-24:00、0:00-6:00，各组间无统计学差异。跌倒和运动/娱乐事故对损伤时间有显著影响，分别在6:00-12:00和18:00-24:00组达到峰值。糖尿病史和药物滥用史也与损伤时间高峰分别在6:00-12:00和18:00-24:00组显著相关。损伤后第一周ASIA评分确定的表现严重程度不受损伤时间的显著影响。然而，两两比较显示，损伤后24 - 6点的运动而非感觉ASIA评分比其他任何组都差。这些数据表明，由于特定的机制，如跌倒或运动相关事故，脊髓损伤风险的昼夜调节。此外，一些合并症可能与这些损伤机制相互作用，例如糖尿病患者跌倒的风险升高。最后，虽然损伤的昼夜时间可能会调节呈现的严重程度，但需要更多的患者记录来验证这些影响。
Circadian rhythms play a role in time-of-day differences in risk, presenting severity and outcomes of stroke. Injury time-of-day effects, however, on occurrence, presenting severity and acute hospital outcomes have not been yet reported in patients with neurotrauma. Therefore, acute post-spinal cord injury hospitalization records of 759 patients from the prospective NACTN registry that contained information about the time of injury were analyzed. No major demographic differences were observed between groups with time of injury between 6:00–12:00, 12:00–18:00, 18:00–24:00, or 0:00–6:00. Two etiological factors including falls or sports/recreation-related accidents showed significant effects of time of injury with peaks in the 6:00–12:00 or 18:00–24:00 groups, respectively. History of diabetes or drug abuse was also significantly related to injury timing peaking in 6:00–12:00 or 18:00–24:00 groups, respectively. ASIA score-determined presenting severity during the first week post-injury was not significantly affected by timing of injury. Pairwise comparisons, however, revealed worse motor but not sensory ASIA scores after injuries at 24:00–6:00 than any other group. These data suggest diurnal modulation of spinal cord injury risk because of specific mechanisms such as falls or sports-related accidents. Moreover, some co-morbidities may interact with those injury mechanisms as exemplified by the established risk elevation of falls in those with diabetes mellitus. Finally, while diurnal timing of the injury may modulate presenting severity, more patient records are needed to verify those effects.