Rigas B, Torosis J, McDougall C J, Vener K J, Spiro H M
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
J Clin Gastroenterol. 1990 Aug;12(4):409-14. doi: 10.1097/00004836-199008000-00011.
We evaluated 50 consecutive patients with symptomatic gallstones for the clinical features of biliary pain with particular reference to the timing of their painful episodes. Thirty-eight of the 50 patients were able to provide the time of onset of biliary pain in the 24-h cycle. The time of onset of biliary pain displays significant circadian periodicity (p = 0.0032), with its peak at 00:25 h. Forty-five patients had more than 1 episode of pain. Of these 84% had either all or over half of their attacks of biliary pain at the same clock time. Twenty-two patients with renal colic (a close parallel to biliary pain) and 31 patients with episodic abdominal pain from miscellaneous causes showed no circadian or other periodicity in the time of onset of pain. In only 1 of these patients did the abdominal pain recur consistently at the same clock time. "Typical" biliary pain has its onset at night and tends to recur at the same clock time. It is steady and relatively mild, lasting 1-5 h, it is felt in the right upper quadrant or the epigastrium, may radiate to a variety of sites, is associated with some additional symptoms, and is not usually related to meals. The chronobiological and other features of biliary pain reported here should be useful in the diagnostic evaluation of abdominal pain.
我们评估了50例连续的有症状胆结石患者的胆绞痛临床特征，特别关注其疼痛发作的时间。50例患者中有38例能够提供24小时周期内胆绞痛的发作时间。胆绞痛的发作时间显示出显著的昼夜节律性（p = 0.0032），高峰在00:25时。45例患者有不止一次疼痛发作。其中84%的患者所有或超过一半的胆绞痛发作时间相同。22例肾绞痛患者（与胆绞痛情况相近）和31例因其他各种原因导致发作性腹痛的患者，疼痛发作时间没有昼夜节律或其他周期性。这些患者中只有1例腹痛在相同的时钟时间持续复发。“典型”的胆绞痛在夜间发作，且倾向于在相同的时钟时间复发。疼痛稳定且相对较轻，持续1 - 5小时，位于右上腹或上腹部，可放射至多个部位，伴有一些其他症状，通常与进餐无关。本文报道的胆绞痛的时间生物学及其他特征应有助于腹痛的诊断评估。
