摘要
目的探讨醒后卒中(wake-up stroke,WUS)患者夜间褪黑素分泌水平和昼夜节律特征。方法纳入2019年10月至2022年8月期间苏州大学附属第二医院神经内科收治的急性缺血性卒中(acute ischemic stroke,AIS)患者,分为WUS组和非WUS组。在入院后1周内采集唾液样本(采集时间点为同一天的19∶00、20∶00、21∶00、22∶00和23∶00)并测定褪黑素浓度,绘制褪黑素分泌曲线图并计算暗光条件下褪黑素浓度开始升高的时间(dim light melatonin onset,DLMO)来评估昼夜节律。比较WUS组和非WUS组间内源性昼夜节律的差异。通过多变量logistic回归分析确定WUS的相关因素。结果共纳入116例AIS患者,男性79例(68.1%),年龄(59.9±10.3)岁;35例(30.2%)为WUS。单变量分析显示,WUS组梗死部位与非WUS组差异有统计学意义(P=0.019)。WUS组夜间21∶00(P=0.004)和平均(P=0.038)褪黑素水平显著低于非WUS组,且DLMO较非WUS组出现显著延迟(21∶28∶08对20∶57∶57;P=0.015)。多变量logistic回归分析显示,DLMO延迟与WUS显著独立相关(优势比1.792,95%置信区间1.123~2.858;P=0.014)。结论WUS患者可能存在内源性昼夜节律延迟,并且昼夜节律延迟为WUS的独立危险因素。
ObjectiveTo investigate the characteristics of the nocturnal melatonin secretion concentration and circadian rhythm in patients with wake-up stroke(WUS).MethodsPatients with acute ischemia stroke(AIS)admitted to the Department of Neurology,the Second Affiliated Hospital of Soochow University from October 2019 to August 2022 were enrolled.They were divided into WUS group and non-WUS group.Saliva samples within one week after admission were collected(at 19∶00,20∶00,21∶00,22∶00,and 23∶00)and melatonin concentration was measured.Melatonin secretion curve graph was drawn,dim light melatonin onset(DLMO)was calculated,and circadian rhythms were evaluated.The differences in endogenous circadian rhythms between the WUS group and the non-WUS group were compared.The relevant factors of WUS were determined by multivariate logistic regression analysis.ResultsA total of 116 patients with AIS were included,with 79 males(68.1%),aged 59.9±10.3 years;35 patients(30.2%)were WUS.Univariate analysis showed that there was a statistically significant difference in the infarct site between the WUS group and the non-WUS group(P=0.019).At 21:00(P=0.004)and the average(P=0.038)nighttime melatonin concentration in the WUS group were significantly lower than those in the non-WUS group,and DLMO showed a significant delay compared to the non-WUS group(21:28:08 vs.20:57:57;P=0.015).Multivariate logistic regression analysis showed a significant independent correlation between DLMO delay and WUS(odds ratio 1.792,95%confidence interval 1.123-2.858;P=0.014).ConclusionPatients with WUS may have endogenous circadian rhythm delay,which is an independent risk factor for WUS.
作者
陈胜男
孙倩
丁悦
韩菲
陈锐
李洁
Chen Shengnan;Sun Qian;Ding Yue;Han Fei;Chen Rui;Li Jie(Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)
出处
《国际脑血管病杂志》
2024年第1期33-39,共7页
International Journal of Cerebrovascular Diseases
基金
苏州大学附属第二医院神经疾病研究中心研究课题(ND2023A04)
苏州大学附属第二医院科研预研基金项目(SDFEYBS2215)。
