Svanes C, Sothern R B, Sørbye H
Department of Surgery, Haukeland University Hospital, Norway.
Chronobiol Int. 1998 May;15(3):241-64. doi: 10.3109/07420529808998687.
The incidence of ulcer perforation in 1480 patients treated in the Bergen area of Norway between 1935 and 1990 was analyzed for daily (circadian), weekly (circaseptan), and yearly (circannual) time effects. A circadian rhythm was found overall that was reproducible and fairly stable across seasons, decades, and days of the week. After subgrouping, a circadian rhythm was found in younger patients, males, and duodenal perforations, while a 12 h (circasemidian) rhythm characterized ulcer perforation for women and for gastric ulcers. Duodenal perforations showed highest incidence in the afternoon, while gastric perforations showed a major peak around noon and a secondary peak near midnight. For duodenal ulcer perforation, the circannual pattern was characterized by a 6-month rhythm, with significantly higher incidence in May-June-July and in November-December in most subgroups. A circaseptan rhythm was not found, but there was a significantly higher incidence on Thursday-Friday as compared to Sunday-Monday. The pathophysiological mechanisms underlying the perforation of an ulcer thus seemed to show pronounced circadian and 6-month rhythmic variations, much less so circaseptan or circannual rhythms. While it is likely that exogenous environmental and/or societal factors play a significant role, variations in ulcer perforation may be related to endogenous biological rhythms in pathophysiological factors since the circadian pattern of duodenal perforation follows that for gastric acidity. Knowledge of the temporal patterns in peptic ulcer perforation and associated pathophysiologic factors should prove useful in optimizing the chronotherapeutic management of ulcer disease.
对1935年至1990年间在挪威卑尔根地区接受治疗的1480例患者的溃疡穿孔发生率进行了分析，以研究每日（昼夜节律）、每周（七日节律）和每年（年节律）的时间效应。总体上发现了一种昼夜节律，这种节律在不同季节、几十年和一周中的不同日子都是可重复且相当稳定的。分组后发现，年轻患者、男性和十二指肠穿孔存在昼夜节律，而女性和胃溃疡的溃疡穿孔则表现为12小时（半日节律）节律。十二指肠穿孔的发生率在下午最高，而胃穿孔在中午左右有一个主要高峰，在午夜附近有一个次要高峰。对于十二指肠溃疡穿孔，年节律模式的特点是6个月的节律，在大多数亚组中，5月至6月至7月和11月至12月的发生率显著更高。未发现七日节律，但与周日至周一相比，周四至周五的发生率显著更高。因此，溃疡穿孔的病理生理机制似乎表现出明显的昼夜节律和6个月的节律变化，而七日节律或年节律变化则要少得多。虽然外源性环境和/或社会因素可能起重要作用，但溃疡穿孔的变化可能与病理生理因素中的内源性生物节律有关，因为十二指肠穿孔的昼夜模式与胃酸的昼夜模式一致。了解消化性溃疡穿孔的时间模式及相关病理生理因素，应有助于优化溃疡病的时辰治疗管理。
