Klerman E B, Goldenberg D L, Brown E N, Maliszewski A M, Adler G K
Endocrine-Hypertension Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
J Clin Endocrinol Metab. 2001 Mar;86(3):1034-9. doi: 10.1210/jcem.86.3.7293.
Fibromyalgia syndrome is a chronic and debilitating disorder characterized by widespread nonarticular musculoskeletal pain whose etiology is unknown. Many of the symptoms of this syndrome, including difficulty sleeping, fatigue, malaise, myalgias, gastrointestinal complaints, and decreased cognitive function, are similar to those observed in individuals whose circadian pacemaker is abnormally aligned with their sleep-wake schedule or with local environmental time. Abnormalities in melatonin and cortisol, two hormones whose secretion is strongly influenced by the circadian pacemaker, have been reported in women with fibromyalgia. We studied the circadian rhythms of 10 women with fibromyalgia and 12 control healthy women. The protocol controlled factors known to affect markers of the circadian system, including light levels, posture, sleep-wake state, meals, and activity. The timing of the events in the protocol were calculated relative to the habitual sleep-wake schedule of each individual subject. Under these conditions, we found no significant difference between the women with fibromyalgia and control women in the circadian amplitude or phase of rhythms of melatonin, cortisol, and core body temperature. The average circadian phases expressed in hours posthabitual bedtime for women with and without fibromyalgia were 3:43 +/- 0:19 and 3:46 +/- 0:13, respectively, for melatonin; 10:13 +/- 0:23 and 10:32 +/- 0:20, respectively for cortisol; and 5:19 +/- 0:19 and 4:57 +/- 0:33, respectively, for core body temperature phases. Both groups of women had similar circadian rhythms in self-reported alertness. Although pain and stiffness were significantly increased in women with fibromyalgia compared with healthy women, there were no circadian rhythms in either parameter. We suggest that abnormalities in circadian rhythmicity are not a primary cause of fibromyalgia or its symptoms.
纤维肌痛综合征是一种慢性致残性疾病，其特征为广泛的非关节性肌肉骨骼疼痛，病因不明。该综合征的许多症状，包括睡眠困难、疲劳、不适、肌痛、胃肠道不适以及认知功能下降，与昼夜节律起搏器与睡眠-清醒时间表或当地环境时间异常同步的个体所观察到的症状相似。在纤维肌痛女性中，已报告褪黑素和皮质醇这两种受昼夜节律起搏器强烈影响分泌的激素存在异常。我们研究了10名纤维肌痛女性和12名健康对照女性的昼夜节律。该方案控制了已知会影响昼夜节律系统标志物的因素，包括光照水平、姿势、睡眠-清醒状态、饮食和活动。方案中各项事件的时间是相对于每个个体受试者的习惯性睡眠-清醒时间表计算的。在这些条件下，我们发现纤维肌痛女性和对照女性在褪黑素、皮质醇和核心体温节律的昼夜振幅或相位上没有显著差异。有和没有纤维肌痛的女性，以习惯性就寝时间后小时数表示的平均昼夜相位，褪黑素分别为3:43±0:19和3:46±0:13；皮质醇分别为10:13±0:23和10:32±0:20；核心体温相位分别为5:19±0:19和4:57±0:33。两组女性在自我报告的警觉性方面具有相似的昼夜节律。尽管与健康女性相比，纤维肌痛女性的疼痛和僵硬明显增加，但这两个参数均无昼夜节律。我们认为昼夜节律异常不是纤维肌痛或其症状的主要原因。
