Tanaka Atsushi, Kawarabayashi Takahiko, Fukuda Daiju, Nishibori Yoshiharu, Sakamoto Tsunemori, Nishida Yukio, Shimada Kenei, Yoshikawa Junichi
Baba Memorial Hospital, Sakai, Japan.
Am J Cardiol. 2004 Jan 1;93(1):1-5. doi: 10.1016/j.amjcard.2003.09.002.
Studies have reported a circadian variation in the onset of acute myocardial infarction (AMI). Pathologic studies have revealed that plaque rupture is 1 of the major causes of AMI, but none of these has looked specifically at the circadian variation of plaque rupture. The aim of this study was to use intravascular ultrasound (IVUS) to investigate the circadian variation of plaque rupture in AMI. This study included 174 consecutive patients with AMI who underwent preinterventional IVUS. All patients were assigned to either a rupture group or a nonrupture group according to the preinterventional IVUS. In the 81 patients (47%) in the rupture group, the frequency of the onset of AMI increased significantly in the period from 6 A.M. to 12 P.M. compared with all other time periods (p <0.05). The clinical features of AMI in the rupture group were characterized as occurring significantly more at rest (67% vs 31%, p <0.01) and after significantly less preinfarction angina (22% vs 57%, p <0.01) compared with the nonrupture group. A different circadian variation was identified in the nonrupture group, characterized as a significant nocturnal nadir (12 to 6 A.M. compared with all other periods, p <0.05). The circadian variation of AMI is the result of a morning increase in incidence of plaque rupture.
研究报告了急性心肌梗死（AMI）发病的昼夜节律变化。病理研究表明，斑块破裂是AMI的主要原因之一，但这些研究均未专门观察斑块破裂的昼夜节律变化。本研究的目的是使用血管内超声（IVUS）来研究AMI中斑块破裂的昼夜节律变化。本研究纳入了174例连续接受介入前IVUS检查的AMI患者。根据介入前IVUS检查结果，将所有患者分为破裂组和非破裂组。在破裂组的81例患者（47%）中，与其他所有时间段相比，AMI发病频率在上午6点至中午12点期间显著增加（p<0.05）。与非破裂组相比，破裂组AMI的临床特征表现为静息时发病显著更多（67%对31%，p<0.01），且梗死前心绞痛显著更少（22%对57%，p<0.01）。在非破裂组中发现了不同的昼夜节律变化，其特征为夜间显著低谷（与其他所有时间段相比，凌晨12点至6点，p<0.05）。AMI的昼夜节律变化是斑块破裂发生率早晨增加的结果。
