青年急性心肌梗死病人发病节律及机制探讨

Study on Circadian Rhythm and Mechanism of Acute Myocardial Infarction in Young Patients

目的观察青年急性心肌梗死病人发病节律模式,并探讨青年急性心肌梗死病人发病节律机制。方法收集上海两所三级甲等医院2017年9月1日—2018年9月1日收治入院的青年及老年急性心肌梗死病人基本资料和临床信息,并收集青年心肌梗死病人和青年健康志愿者外周静脉血。回顾性探讨青年急性心肌梗死病人发病节律模式,并对参与者外周血的节律基因和纤溶酶原激活物抑制物-1(PAI-1)基因行实时荧光定量聚合酶链式反应(qPCR)检测。结果入组病人中122例(37.20%)年龄≤45岁,206例(62.80%)年龄≥65岁。青年病人更易于上午发生心肌梗死(06:01~12:00),且在5月份发病率较老年病人高。上午发病的青年急性心肌梗死病人外周血中Clock、Bmal1和PAI-1的mRNA表达较青年健康志愿者明显升高。结论青年病人较老年病人更易在上午和5月份罹患急性心肌梗死。而上午高发的原因可能与Clock、Bmal1和PAI-1等基因在上午的表达异常升高有关。此结果可为青年急性心肌梗死病人的时间治疗策略提供理论依据。

Objective To observe the circadian rhythm of acute myocardial infarction(AMI)in young patients,and to explore its mechanism of circadian rhythm of AMI in young patients.Methods All participants were recruited from 2 hospitals during September 1st,2017 to September 1st,2018 in Shanghai,China.A retrospective study was designed to explore the rhythmicity pattern among young patients with AMI.The rhythm genes and plasminogen activator inhibitor-1(PAI-1)genes in the peripheral blood of the participants were detected by real-time fluorescence quantitative polymerase chain reaction(qPCR).Results Among the enrolled participants,122(37.20%)patients were aged≤45 years and the rest 206(62.80%)patients were aged≥65 years.Incidence of AMI within 24 hours showed a morning peak(06:01 to 12:00)and high incidence in May among young patients compared with those of elderly patients.Moreover,mRNA expressions of Clock,Bmal1,and PAI-1 genes were also higher in young AMI patients.Conclusion Young patients are prone to suffer from AMI in the morning and in May.The reason for the high incidence in the morning may be related to the abnormally elevated expression of Clock,Bmal1,and PAI-1 genes in the morning,which might inspire the clinic to develop more targeted strategy for such population.