心肌缺血的昼夜节律性与时辰疗法

Circadian rhythms of myocardial ischemia and chronotherapy

临床上心肌缺血(MI)的发作频率伴有昼夜变化,在清晨和傍晚是发病高峰期。产生这一现象主要是受到机体病理生理机制的昼夜节律性以及外界的环境因素影响。目前β-受体阻断剂、硝酸酯类以及钙通道阻滞剂等药物的治疗作用已经被证明受到机体昼夜节律的影响。因此,笔者对MI发作的昼夜节律特点、病理生理机制以及目前临床上的时辰疗法进行综述,并对未来的治疗策略进行探讨。

The occurrence of the clinical manifestations of myocardial ischemia shows clear circadian rhythmicity. and they are unevenly distributed during the 24 h with higher morbidity during the initial hours of the daily activity span and in the late afternoon or early evening. Such temporal patterns result from circadian rhythms in pathophysiological mechanisms plus cyclic environmental stressors that trigger these clinical events. β-receptor antagonist medications, oral nitrate, and calcium channel blocker have been shown to be influenced by the circadian time of their administration. Here we briefly review the char- acteristics of circadian rhythmicity in MI, the pathophysiological mechanisms as well as the current chronotherapy,and then discuss the future treatment strategies.