Perdiz P, Wacher N, Laredo-Sánchez F, Halabe Cherem J, Lifshitz A
Departamento de Medicina Interna, Hospital de Gineco-Obsteiricia No. 4, Instituto Mexicano del Seguro Social, México, D.F.
Arch Med Res. 1996 Summer;27(2):157-63.
Circadian variation of temperature, both normal and febrile, is a well known fact. Mediators of fever are also regulators of acute phase response and are associated with stimulation of pituitary hormone production related with defervescence and with a circadian pattern of secretion. Acute phase response may consequently have circadian variations in its components. Measurements of temperature, erythrocyte sedimentation rate, complete blood cell count, serum cortisol and fibrinogen were made at 7:00, 15:00, and 23:00 h during two consecutive days in 35 patients with fever and acute infection, 15 patients with clinically active ankylosing spondylitis without fever and 10 healthy volunteers. Temperature curves showed statistically significant circadian rhythms, with higher values at night and lower ones during early morning. Erythrocyte sedimentation rate, leukocyte count and fibrinogen also showed statistically significant circadian rhythms, but with higher values at 15:00 h. Serum cortisol also showed statistically significant circadian rhythmicity but with a higher rhythm adjusted mean (MESOR), and a 100 degrees (6 h) phase shift in patients with fever, as compared to patients with ankylosing spondylitis and healthy controls. In conclusion, components of acute phase response, including fever, have circadian rhythmicity, but asynchronically. Differences between fever and ankylosing spondylitis can be due to the intensity of acute phase response stimulation.
正常体温和发热时的体温昼夜变化是一个众所周知的事实。发热介质也是急性期反应的调节因子，与刺激与退热相关的垂体激素分泌以及昼夜分泌模式有关。因此，急性期反应的各个成分可能存在昼夜变化。对35例发热并伴有急性感染的患者、15例无发热症状的临床活动期强直性脊柱炎患者和10名健康志愿者，在连续两天的7:00、15:00和23:00测量体温、红细胞沉降率、全血细胞计数、血清皮质醇和纤维蛋白原。体温曲线显示出具有统计学意义的昼夜节律，夜间值较高，清晨较低。红细胞沉降率、白细胞计数和纤维蛋白原也显示出具有统计学意义的昼夜节律，但在15:00时数值较高。血清皮质醇也显示出具有统计学意义的昼夜节律性，但与强直性脊柱炎患者和健康对照相比，发热患者的节律调整均值（MESOR）较高，且有100度（6小时）的相移。总之，包括发热在内的急性期反应成分具有昼夜节律，但不同步。发热与强直性脊柱炎之间的差异可能是由于急性期反应刺激的强度不同。
