生活方式相关因素与急性心肌梗死昼夜发病模式的关联：日本一项前瞻性观察研究
Association of lifestyle-related factors with circadian onset patterns of acute myocardial infarction: a prospective observational study in Japan.
作者信息
Edahiro Ryuya, Sakata Yasuhiko, Nakatani Daisaku, Suna Shinichiro, Usami Masaya, Matsumoto Sen, Hara Masahiko, Kitamura Tetsuhisa, Sato Hiroshi, Yamashita Shizuya, Nanto Shinsuke, Hikoso Shungo, Sakata Yasushi, Hori Masatsugu, Hamasaki Toshimitsu, Komuro Issei
机构信息
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
出版信息
BMJ Open. 2014 Jun 6;4(6):e005067. doi: 10.1136/bmjopen-2014-005067.
OBJECTIVE
The onset of acute myocardial infarction (AMI) shows characteristic circadian variations involving a definite morning peak and a less-defined night-time peak. However, the factors influencing the circadian patterns of AMI onset and their influence on morning and night-time peaks have not been fully elucidated.
DESIGN, SETTING AND PARTICIPANTS: An analysis of patients registered between 1998 and 2008 in the Osaka Acute Coronary Insufficiency Study, which is a prospective, multicentre observational study of patients with AMI in the Osaka region of Japan. The present study included 7755 consecutive patients with a known time of AMI onset.
MAIN OUTCOMES AND MEASURES
A mixture of two von Mises distributions was used to examine whether a circadian pattern of AMI had uniform, unimodal or bimodal distribution, and the likelihood ratio test was then used to select the best circadian pattern among them. The hierarchical likelihood ratio test was used to identify factors affecting the circadian patterns of AMI onset. The Kaplan-Meier method was used to estimate survival curves of 1-year mortality according to AMI onset time.
RESULTS
The overall population had a bimodal circadian pattern of AMI onset characterised by a high and sharp morning peak and a lower and less-defined night-time peak (bimodal p<0.001). Although several lifestyle-related factors had a statistically significant association with the circadian patterns of AMI onset, serum triglyceride levels had the most prominent association with the circadian patterns of AMI onset. Patients with triglyceride ≥150 mg/dL on admission had only one morning peak in the circadian pattern of AMI onset during weekdays, with no peaks detected on weekends, whereas all other subgroups had two peaks throughout the week.
CONCLUSIONS
The circadian pattern of AMI onset was characterised by bimodality. Notably, several lifestyle-related factors, particularly serum triglyceride levels, had a strong relation with the circadian pattern of AMI onset.
TRIAL REGISTRATION NUMBER
UMIN000004575.
目的
急性心肌梗死（AMI）的发病呈现出特征性的昼夜节律变化，包括明确的早晨高峰和不太明确的夜间高峰。然而，影响AMI发病昼夜模式的因素及其对早晨和夜间高峰的影响尚未完全阐明。
设计、地点和参与者：对1998年至2008年在大阪急性冠状动脉功能不全研究中登记的患者进行分析，该研究是一项对日本大阪地区AMI患者进行的前瞻性、多中心观察性研究。本研究纳入了7755例连续的已知AMI发病时间的患者。
主要结局和测量指标
使用两个冯·米塞斯分布的混合模型来检验AMI的昼夜模式是否具有均匀、单峰或双峰分布，然后使用似然比检验在其中选择最佳的昼夜模式。使用分层似然比检验来识别影响AMI发病昼夜模式的因素。采用Kaplan-Meier方法根据AMI发病时间估计1年死亡率的生存曲线。
结果
总体人群的AMI发病具有双峰昼夜模式，其特征是早晨高峰高且尖锐，夜间高峰较低且不太明确（双峰，p<0.001）。尽管一些与生活方式相关的因素与AMI发病的昼夜模式有统计学显著关联，但血清甘油三酯水平与AMI发病的昼夜模式关联最为显著。入院时甘油三酯≥150 mg/dL的患者在工作日AMI发病的昼夜模式中只有一个早晨高峰，周末未检测到高峰，而所有其他亚组在整个星期都有两个高峰。
结论
AMI发病的昼夜模式以双峰为特征。值得注意的是，一些与生活方式相关的因素，特别是血清甘油三酯水平，与AMI发病的昼夜模式有很强的关系。
试验注册号
UMIN000004575。
Zotero 插件