Department of Cardiology and Cardiac Surgery, Military University Hospital No. 10 with a Polyclinic in Bydgoszcz, Bydgoszcz, Poland.
Med Sci Monit. 2009 Oct;15(10):RA203-208. doi: 10.12659/msm.878203.
The highest risk of cardiovascular events is in the morning, which may be associated with circadian changes in hemostasis. There is a 10% circadian variability in von Willebrand factor (vWF). Circadian periodicity has been noted for both the number of platelets and their aggregability. The highest number of platelets was in the afternoon, while most studies observed an increase in platelet aggregation in the morning. Platelet activity has also been linked with physical activity after waking up. The highest values of coagulation system markers such as fragment 1+2, factor VIIa, and fibrinogen have been recorded in the late morning. Also, coagulation inhibitors such as protein C, antithrombin III, and a tissue factor pathway inhibitor are most active at this time of day. The levels of plasminogen and its activators (alpha 2-antiplasmin, urokinase-like plasminogen activator) do not undergo circadian periodicity, in contrast to changes in tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 levels (PAI-1). The most intensive activity of the fibrinolytic system inhibitor PAI-1 has been noted in the morning. The 24-h changes in the hemostatic system observed in healthy subjects often did not occur in individuals with health problems. The results of various studies suggest that circadian changes in the hemostatic system increase the incidence of cardiovascular events in the morning. This review considers the circadian rhythms of individual components involved in hemostasis (endothelium, platelets, coagulation, and fibrinolysis).
心血管事件的风险最高发生在早上，这可能与止血的昼夜节律变化有关。血管性血友病因子 (vWF) 的昼夜节律变化为 10%。血小板的数量及其聚集性都有昼夜周期性。血小板数量最高出现在下午，而大多数研究观察到早上血小板聚集增加。血小板活性也与醒来后的体力活动有关。凝血系统标志物如片段 1+2、因子 VIIa 和纤维蛋白原的最高值记录在上午晚些时候。此外，凝血抑制剂如蛋白 C、抗凝血酶 III 和组织因子途径抑制剂在一天中的这个时候最为活跃。纤溶系统抑制剂 PAI-1 的水平及其激活剂（α2-抗纤溶酶、尿激酶样纤溶酶原激活剂）没有昼夜周期性，而组织型纤溶酶原激活物 (tPA) 和纤溶酶原激活物抑制剂-1 水平 (PAI-1) 的变化则不同。纤溶系统抑制剂 PAI-1 的活性最高出现在早上。在健康受试者中观察到的止血系统 24 小时变化在有健康问题的个体中并不经常发生。各种研究的结果表明，止血系统的昼夜节律变化会增加早上心血管事件的发生率。这篇综述考虑了参与止血的各个组成部分（内皮细胞、血小板、凝血和纤溶）的昼夜节律。
