Gallerani M, Manfredini R, Ricci L, Cappato R, Grandi E, Dal Monte D, Cugini P, Fersini C
Emergency Department, St. Anna Hospital, Ferrara, Italy.
Jpn Heart J. 1993 Nov;34(6):729-39. doi: 10.1536/ihj.34.729.
The aim of this study was to determine whether the time of occurrence of sudden death exhibits a circadian rhythm depending on its different anatomoclinical causes. A longitudinal prospective investigation of 610 nonhospitalized subjects who died suddenly in the Emergency Room of Ferrara Hospital between January 1983 and December 1990 was conducted. All subjects underwent autopsy. Sudden death was classified on the basis of the following pathological causes; acute myocardial infarction, acute myocardial failure, intracerebral hemorrhage, rupture of aortic aneurysm, pulmonary embolism, and clinical causes, i.e., arrhythmia and circulatory failure. The investigated cases were stratified into 2 groups according to age; Group A = age < 70 years (n = 301, 49.3%), and Group B = age > or = to 70 (n = 309, 51.7%). The assessment of circadian rhythmicity was performed utilizing the single cosinor method. The results by cosinor analysis found a circadian rhythmicity for cases of sudden death (peak at 14.04, n = 610, p = 0.036), and in particular for females (peak at 13.12, n = 200, p = 0.004). Spectral analysis detected a statistical ultradian cycle in males having an 8-hour period (p = 0.015). A statistically significant circadian rhythm was found for cases of sudden death due to acute myocardial infarction (peak at 15.28, n = 330, p = 0.013), pulmonary embolism (peak at 11.46, n = 56, p = 0.003) and arrhythmia (peak at 13.08, n = 291, p = 0.04). In Group A no significant circadian rhythm was found, whereas in Group B a significant rhythmicity was found for sudden death from cardiac causes at 13.32 (n = 249, p = 0.015), from myocardial infarction at 15.02 (n = 154, p = 0.018) and from arrhythmia at 13.07 (n = 122, p = 0.014). Different circadian patterns of onset of sudden death may be shown in various subgroups of patients, due not only to different pathophysiologic mechanisms but also to anatomo-clinical aspects.
本研究的目的是确定猝死的发生时间是否根据其不同的解剖临床病因呈现昼夜节律。对1983年1月至1990年12月期间在费拉拉医院急诊室突然死亡的610名非住院患者进行了纵向前瞻性调查。所有患者均接受了尸检。猝死根据以下病理原因分类：急性心肌梗死、急性心肌衰竭、脑出血、主动脉瘤破裂、肺栓塞以及临床病因，即心律失常和循环衰竭。根据年龄将调查病例分为2组；A组=年龄<70岁（n = 301，49.3%），B组=年龄≥70岁（n = 309，51.7%）。利用单余弦法进行昼夜节律评估。余弦分析结果发现猝死病例存在昼夜节律（峰值在14.04，n = 610，p = 0.036），尤其是女性（峰值在13.12，n = 200，p = 0.004）。频谱分析在男性中检测到一个8小时周期的统计学超日周期（p = 0.015）。因急性心肌梗死导致的猝死病例（峰值在15.28，n = 330，p = 0.013）、肺栓塞（峰值在11.46，n = 56，p = 0.003）和心律失常（峰值在13.08，n = 291，p = 0.04）发现有统计学显著的昼夜节律。在A组未发现显著的昼夜节律，而在B组中，心脏原因导致的猝死在13.32有显著节律（n = 249，p = 0.015），心肌梗死导致的猝死在15.02有显著节律（n = 154，p = 0.018），心律失常导致的猝死在13.07有显著节律（n = 122，p = 0.014）。猝死发作的不同昼夜模式可能在不同亚组患者中表现出来，这不仅归因于不同的病理生理机制，还归因于解剖临床方面。
