基于TOAST分型的急性缺血性卒中临床疗效分析

目的研究急性缺血性卒中TOAST分型与临床短期预后的关系。方法收集2010年5月—2011年4月在三峡中心医院神经内科病房住院治疗的700例急性缺血性卒中患者。缺血性卒中依据TOAST标准分型,即大动脉粥样硬化型(LAA)、心源性栓塞型(CE)、小动脉闭塞型(SAO),其他明确病因型(SOE)和不明原因型(SUE)5型。应用NIHSS评分了解不同亚型患者入院时和出院时的功能状态,以出院时神经功能好转率评价其临床短期预后,分析各亚型与临床短期预后的相关性。结果缺血性脑卒中男性患者发病年龄较女性患者早(P<0.01)。脑卒中亚型:LAA 194例(27.7%),SAO 220例(31.4%),CE 70例(10.0%),SOE8例(1.1%),SUE 208例(29.7%)。其中SAO亚型所占比例最高。各亚型与临床短期预后的关系:CE型患者入院时病情危重,神经功能缺损最严重,NIHSS评分最高(20.11±1.42)分,出院时神经功能好转率显著降低(P<0.01)。SAO亚型入院时病情最轻,NIHSS评分最低(4.10±0.36)分,出院时神经功能好转率显著增高(P<0.01)。结论 SAO亚型入院时病情最轻,临床疗效及临床短期预后最好;CE亚型入院时病情最重,临床疗效及临床短期预后最差。     

早期降压治疗对不同TOAST分型的急性缺血性脑卒中患者1年结局的影响

目的讨论早期降压治疗对不同类肝素药物治疗急性脑卒中试验(TOAST)分型的急性缺血性脑卒中患者1年结局的影响。方法收集2009年8月至2013年5月在解放军第九六〇医院泰安院区和肥城市人民医院住院治疗的发病48 h内伴有高血压的急性缺血性脑卒中非溶栓患者597例。依据TOAST分型分为:大动脉粥样硬化型卒中(LAA)261例,心源性栓塞型卒中(CE)91例,小动脉闭塞型卒中(SAO)225例,其他类型20例。将各分型患者分别分为2组:LAA降压组(n=126)和LAA非降压组(n=135);CE降压组(n=46)和CE非降压组(n=45);SAO降压组(n=115)和SAO非降压组(n=110);其他类型降压组(n=7)和其他类型非降压组(n=13)。降压组24 h内降压10%～20%。观察患者出院后1年的死亡率、死亡/致残率及卒中复发率。采用SPSS 20.0软件进行统计分析。2组间比较采用t检验或χ~2检验。结果随访1年结果显示,在LAA、SAO和其他类型卒中分型中,降压组和非降压组患者1年后的死亡率、死亡/致残率及卒中复发率差异均无统计学意义(P0.05);在CE分型中,降压组患者1年后的死亡/致残率显著低于非降压组(45.6%和66.7%,P0.05),但1年死亡率及卒中复发率与对照组相比差异无统计学意义(P0.05)。结论急性期降压治疗对LAA、SAO型缺血性脑卒中患者1年结局无显著影响,但可显著降低CE型缺血性脑卒中患者的1年死亡/致残率。     

缺血性脑卒中病因分型与临床预后的关系

目的探讨缺血性脑卒中TOAST病因分型与临床预后的关系。方法采用前瞻性队列研究方法,将连续入选的421例首发急性缺血性脑卒中患者的临床资料,按照TOAST分类标准进行病因分型,共分为5个亚型:大动脉粥样硬化型(LAA,73例)、心源性栓塞型(CE,39例)、小动脉闭塞型(SA().130例)、其他明确病因型(SOE,1例)和不明病因型(SUE,178例)。分析各亚型构成、相关危险因素及复发的关系。随访1年,记录终点事件。结果与其他各亚型比较,CE年龄高,男性比例少,差异有统计学意义(P<0.05);CE 1年复发率最高(33.3%)、SAO最低(6.9%);各亚型之间吸烟、高血压、糖尿病、心脏病、TC、LDL-C、纤维蛋白原、血糖比较,差异均有统计学意义(P<0.05)。结论 TOAST病因分型可以为缺血性脑卒中二级预防提供参考依据。     

急性脑血管病患者的发病时间探讨

为探讨急性脑血管病患者发病时间的规律,我们对近8年来收治、资料完整的625例急性脑血管病患者的发病时间进行了分析,现报告如下。临床资料:本组625例中,男380例,女245例;年龄39～82(平均60±7)岁。均经脑CT检查确诊为脑梗塞或脑出血。分析方法:1昼夜发病时间分布:将1日分为四个时间段,即00∶01～06∶00时、06∶01～12∶00时,12∶01～18∶00时、18∶01～24∶00时,计算各时间段的发病例数及其占总发病例数的百分比。2年发病时间分布:将1年分为4个时间段,即1～3月、4～6月、7～9月、10～12月,计算各时间段的发病例数及其占总发病例数的百分比…     

MMP-2 C735T、MMP-9 C1562T基因多态性与缺血性卒中患者的卒中及其亚型大动脉粥样硬化性卒中有关，但与转归无关

目的探讨基质金属蛋白酶（matrix metalloproteinase,MMP）-2C735T和MMP-9C1562T基因多态性与缺血性卒中患者的TOAST分型和转归的关系。方法232例缺血性卒中患者根据TOAST标准分被为大动脉粥样硬化性卒中（large artery atherosclerosis,LAA）（n=37）、心源性脑栓塞（cardioembolism,CE）（n=31）、小动脉闭塞性卒中（small artery occlusion,SAO）（n=65）、其他明确原因导致的卒中（stroke of other demonstrated etiology,SOE）（n=2）和原因不明性卒中（stroke of undemonstrated etiology,SUE）（n=97）;对照组为235名健康者。采用限制性片段长度多态性技术检测MMP-2基因C735T和MMP-9基因C1562T多态性。采用Barthel指数（Barthel Index,BI）评价缺血性卒中患者发病21d和90d时的转归。结果缺血性卒中组（CC基因型：63．36％对54．04％,χ2=4．182,P=0．014;C等位基因：79．31％对74．04％,χ2=3．936;P=0．047）及其LAA亚型（CC基因型：78．37％对54．04％,χ2＝7．740,P=0．005;C等位基因：87．83％对74．04％,χ2=6．655,P=0．01）MMP-2735CC基因型和C等位基因频率均显著高于对照组;缺血性卒中组（CT＋TT基因型：21．98％对13．19％,χ2=6．233,P=0．013;T等位基因：11．64％对7．02％,χ2=5．891,P=0．015）及其LAA亚型（cT＋TT基因型：32．43％对13．19％,χ2=8．892,P=0．003;T等位基因：20．27％对13．19％,χ2=13．950,P=0．000）MMP-91562CT＋TT基因型频率和T等位基因频率也均显著高于对照组。多变量logistic回归分析显示,MMP-2735CC基因型（缺血性卒中：优势比1．099,95％可信区间1．038～1．260,P=0．028;LAA：优势比1．360,95％可信区间1．167～5．774,P=0．009）和MMP-91562TT基因型（缺血性卒中：优势比9．409,95％可信区间1．154—76．722,P=0．036;LAA：优势比8．962,95％可信区间1．380～58．218,P=0．022）携带者缺血性卒中以及LAA亚型发病风险显著增高。MMP-2和MMP-9不同基因型与卒中预后无显著相关性（P均〉0．05）。结论MMP-2735CC基因型和MMP-91562TT基因型与卒中及其LAA亚型的发病风险有关,但与其转归无关。     

心肌梗死发病时间的探讨

目的通过对心肌梗死发病时间的分析,探讨其规律性。方法对48例心肌梗死患者以疼痛或明确的临床症状为发病时间标准,将24h分成8个时间段,统计发病例数。结果6∶00~9∶00有17例患者(35%),为心肌梗死发病的高峰时间,在18∶00~21∶00有11例患者(23%),出现一个次高峰。结论6∶00~9∶00,18∶00~21∶00是人群活动最频繁的时间段,也是心肌梗死的高发时间段,出现先兆症状应及时就医。     

急性缺血性脑卒中TOAST分型后早期降压治疗对3个月结局的影响

目的探讨TOAST分型与急性缺血性脑卒中急性期降压治疗预后的关系。方法收集2009年8月~2013年5月在解放军第九六○医院(泰安院区)、肥城市人民医院、东平县人民医院住院的缺血性脑卒中合并高血压、非溶栓患者416例,大动脉粥样硬化型(large artery atherosclerosis,LAA)组168例,降压治疗82例,无降压治疗86例;心源性栓塞型(cardioembolism,CE)组84例,降压治疗43例,无降压治疗41例;小动脉闭塞型(small artery occlusion,SAO)组144例,降压治疗74例,无降压治疗70例;其他病因明确型(10例)和病因不明型组(10例)样本数太少,未做统计学分析。观察患者出院后3个月全因病死率、死亡/致残率。结果LAA组、CE组和SAO组降压治疗患者治疗2周或出院时血压下降幅度明显高于无降压治疗患者,差异有统计学意义(P<0.05,P<0.01)。随访3个月,LAA组降压治疗患者病死率明显高于无降压治疗患者(13.4%vs 3.5%,P=0.041),CE组降压治疗患者病死率明显低于无降压治疗患者(14.0%vs 34.1%,P=0.030),SAO组降压治疗与无降压治疗患者病死率比较,差异无统计学意义(1.4%vs 2.9%,P=0.961)。LAA组、CE组和SAO组死亡/残疾率比较,差异无统计学意义(46.3%vs 39.5%,51.2%vs 70.7%,20.3%vs 20.0%,P>0.05)。结论LAA缺血性脑卒中急性期降压有增加3个月病死率风险;CE缺血性脑卒中急性期应避免血压维持在较高水平,降压治疗是获益的;SAO缺血性脑卒中急性期降压治疗未改变其3个月死亡结局。     

不同亚型卒中患者血清基质金属蛋白酶-2含量及其意义

目的 探讨不同亚型急性缺血性卒中患者血清基质金属蛋白酶-2(matrixmetaUoproteinase-2,MMP-2)含量的变化及其意义.方法 77例急性缺血性卒中患者按照TOAST标准进行病因学分型,大动脉粥样硬化性卒中(large-artery atherosclerosis,LAA)29例(37.66%),小动脉闭塞性卒中(small artery occlusion,sAO)23例(29.87%),心源性脑栓塞(cardioembolism,CE)13例(16.88%),原因不明的缺血性卒中(stroke ofundemomtrated etiology,SUE)7例(9.09%),其他确定原因引发的缺血性卒中(stroke ofother demonstrated etiology,SOE)5例(6.49%).用酶联免疫吸附试验(enzyme-1inked immtmosorbent assay,ELISA)检测急性缺血性卒中患者发病后24 h和7 d时血清MMP-2含量,并与42例对照者进行比较.结果 TOAST病因分型急性缺血性卒中组患者发病后24 h和7d血清MMP-2水平分别为(189.55±24.79)和(307.46±84.16)ng/ml,均显著高于对照组的(159.76 ±10.32)ng/ml(P均<0.05).在TOAST各亚型中,SOE和SUE因例数过少未做分析;在其他各型中,LAA、SAO和CE组发病后24 h血清MMP-2水平分别为(218.60±13.42)、(175.21 ±9.92)和(167.26±9.7)ng/ml,均显著高于对照组(P均<0.05);发病7d时分别为(404.75±10.30)、(293.18 ±10.91)和(211.81±11.14)ng/ml,也均显著高于对照组(P均<0.05).其中,以LAA组增高显著(P<0.01).结论 急性脑梗死患者血清MMP-2水平增高,TOAST各亚型患者组MMP-2水平变化不同,LAA组升高最显著,支持脑梗死亚型的病因不同的论点,血清MMP-2在LAA型脑梗死发病过程中起着重要作用.     

血清脂蛋白(a)与缺血性卒中及其病因学亚型的相关性

目的 探讨血清脂蛋白(a)[lipoprotein(a),Lp(a)]水平与急性缺血性卒中及其病因学亚型的相关性.方法 回顾性纳入连续的急性缺血性卒中住院患者(病例组)以及年龄和性别相匹配的同期健康体检者(对照组).收集病例组和对照组人口统计学和基线临床资料以及空腹血糖、纤维蛋白原、高半胱氨酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、Lp(a)浓度.病例组根据TOAST病因学分型标准分为大动脉粥样硬化(large artery atherosclerosis,LAA)、小动脉闭塞(small artery occlusion,SAO)、心源性栓塞(cardioembolism,CE),并排除其他明确病因和病因不明的患者.对病例组和对照组人口统计学和基线临床资料进行比较,并采用多变量logistic回归分析明确血清Lp(a)与急性缺血性卒中及其病因学分型的相关性.结果 共纳入214例缺血性卒中组患者,其中LAA 97例(45.33%),SAO 64例(29.91%),CE 53例(24.77%);对照组118例.病例组高血压、糖尿病、高脂血症、心房颤动和饮酒的比例以及收缩压、舒张压、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、Lp(a)、纤维蛋白原、高半胱氨酸水平与对照组存在统计学差异(P均<0.001).多变量logistic回归分析显示,校正年龄和性别后,Lp(a)是缺血性卒中的独立危险因素[优势比(odds ratio,OR)2.014,95%可信区间(confidence interval,CI)1.273~3.092;P=0.036];LAA的独立危险因素包括高血压(OR 3.353,95%CI 1.714~6.558;P<0.001)、收缩压(OR 2.786,95%CI 1.136~5.538;P=0.016)、高半胱氨酸(OR 1.108,95%CI 1.031~2.191;P=0.005)、总胆固醇(OR 2.169,95%CI 1.599~4.943;P<0.001)、低密度脂蛋白胆固醇(OR 2.782,95%CI 1.093~5.238;P=0.024)和Lp(a)(OR 3.072,95%CI 1.907~8.064;P=0.001),SAO的独立危险因素包括高血压(OR 7.042,95%CI 3.189~25.55;P<0.001)、糖尿病(OR 5.162,95%CI 2.372~11.23;P<0.001)、纤维蛋白原(OR 1.667,95%CI 1.434~2.025;P=0.045)和高半胱氨酸(OR 1.967,95%CI 1.859~1.995;P=0.036),CE的独立危险因素包括心房颤动(OR 13.340,95%CI 4.637~39.20;P<0.001)、纤维蛋白原(OR 2.365,95%CI 1.147~4.904;P=0.029)和Lp(a)(OR 1.656,95%CI 1.996~3.001;P=0.035).结论 Lp(a)是缺血性卒中的独立危险因素,可作为预测缺血性卒中发病风险的血清生物学标记物.不同卒中病因学亚型之间的独立危险因素存在差异,Lp(a)与LAA和CE独立相关,但与SAO无独立性相关性.     

缺血性脑卒中CISS分型的应用价值研究

目的 探讨缺血性脑卒中CISS分型的应用价值.方法 选取2012年4月-2013年4月我院收治的缺血性脑卒中患者340例,由科内两位副主任医师进行盲法CISS分型及TOAST分型,对分型不一致的患者交由全科讨论后确定.比较两种分型法各亚型的构成比、差异.结果 CISS分型中大动脉粥样硬化型（LAA）比例高于TOAST分型（P＜0.05）.两种分型法共有155例（45.6％）患者的分型发生变化,其中CISS分型中LAA增加79例,分别来自TOAST分型中的小动脉闭塞型（SAO） 41例,不明病因型（SUE） 34例,心源性栓塞型（CE）4例.颅内外大动脉粥样硬化机制分型的构成比例依次为：载体动脉（斑块或血栓）阻塞穿支动脉116例（47.9％）,动脉到动脉栓塞52例（21.5％）,低灌注/栓子清除下降51例（21.1％）,混合机制23例（9.5％）.结论 CISS分型与TOAST分型具有较高的一致性.与TOAST分型相比,CISS分型在反映缺血性脑卒中的病因及发病机制方面更准确,更有利于疾病防治.     

血脂相关剩余风险与大动脉粥样硬化性脑卒中的相关性研究

目的:探讨在不同的LDL-C水平,血脂相关剩余风险与大动脉粥样硬化性脑卒中(large artery atherosclerotic,LAA)的相关性。方法:前瞻性、多中心的中国国家卒中登记研究(China National Stroke Registry,CNSR)数据库中入选的3 492例LAA脑卒中患者,与3 022例非大动脉粥样硬化非小血管闭塞性(non large artery atherosclerosissmall vessel occlusion,Non LAASAO)脑卒中患者作为研究人群,多因素logistic回归分析在不同LDL-C水平,血脂相关剩余风险与LAA脑卒中的关系。结果:在LDL-C≥2.59mml/L,低HDL-C与LAA脑卒中风险增加相关(OR=1.20,P=0.027)。高TG、高nonHDL-C、高TG并低HDL-C均与LAA脑卒中发生不相关。在LDL-C2.59mmol/L,HDL-C每增加1mmol/L,LAA脑卒中发生的相对风险下降45%(OR=0.55,P0.0001)。HDL-C最低三分位(1.04)组与最高三分位(≥1.33)组比较,低HDL-C与LAA脑卒中风险比率增加相关(OR=1.64,P=0.03)。non-HDL-C每增加1mmol/L,LAA脑卒中发生的风险比率增加79%(OR=1.79,P0.0001)。non-HDLC最高三分位(≥2.96)组与最低三分位(2.46)组比较,高non-HDL-C与LAA脑卒中风险增加正相关(OR=1.5,P0.001)。TG水平最低三分位组(0.97)与最高三分位组(≥1.59)比较,高TG水平与LAA脑卒中风险增加正相关(OR=1.38,P0.001)。TG/HDL-C比值每增加1个单位,LAA脑卒中相对风险增加12%[OR=1.12,P=0.002]。TG/HDL-C比值最高三分位与最低三分位比较,TG/HDL-C比值升高与LAA脑卒中风险增加独立相关(OR=1.30,P0.0001)。结论:HDL-C水平降低是LAA脑卒中风险增加的独立危险因素,独立于LDL-C水平。在LDL-C达到2.59mmol/L,高TG、高non-HDLC、高TG并低HDL-C是LAA脑卒中的血脂相关剩余风险。     

Recurrent Stroke Incidence and Etiology in Patients with Embolic Stroke of Undetermined Source and Other Stroke Subtypes

Aims: This study aimed at clarifying the incidence of recurrent stroke and its etiology in patients with embolic stroke of undetermined source (ESUS) and other stroke subtypes in both the acute and chronic periods. Methods: A total of 645 patients who were admitted with acute ischemic stroke (IS) between March 2015 and August 2019 were enrolled. Among them, 511 patients with ESUS, cardioembolism (CE), large artery atherosclerosis (LAA), or small vessel disease (SVD) were analyzed in this study. After discharge, 391 patients who visited the outpatient clinic were followed up until August 2020. The outcome was stroke recurrence. Results: In the acute admission, recurrence rates were 7.6%, 8.1%, 18.8%, and 2.2% in patients with ESUS, CE, LAA, and SVD, respectively, and there were significant differences between the groups. The subtype of recurrence was almost identical to that of the index stroke. In the outpatient clinic, the annual recurrence rates were 4.4%, 4.3%, 6.0%, and 2.9% in ESUS, CE, LAA, and SVD, respectively, and no difference was observed. Subtypes of recurrence in outpatients with ESUS included ESUS, intracerebral hemorrhage (ICH), and SVD. Patients with ESUS and SVD had a higher risk of ICH during follow-up. Conclusions: Although the risk of recurrence was comparable between patients with ESUS and CE and intermediate between patients with LAA and SVD, in the acute admission unit, the risk in outpatients was similar among all subtypes. ESUS was the most recurrent stroke subtype in outpatients with ESUS. The risk of hemorrhagic stroke was significant in patients with SVD and ESUS.     

A 3-hour period ultradian rhythm of the sleep-wakefulness cycle and growth hormone secretion in the immature rat

The temporal patterns of the sleep-wakefulness cycle and growth hormone secretion throughout a day in the male and female rat were studied in male and rats at 27 approximately 31 days of age. EEGs were recorded continuously from 27 to 31 days of age, and a time series of the amount of sleep for every 10 min was obtained. Serial blood sampling through an intracardiac cannula at 10-min intervals was performed for each of the 6-h periods beginning at 12:00, 18:00, 00:00 and 06:00 h. By analysis of the power spectrum and the least squares method, the time series was found to have approximately a 3.0-h periodicity in any of the 6-h periods and in either sex. The peak time which was estimated for the time series of GH concentrations was found to occur consistently around 02:00 approximately 03:00, 05:00 approximately 06:00, 08:00 approximately 09:00, 11:00 approximately 12:00, 14:00 approximately 15:00, 17:00 approximately 18:00, 20:00 approximately 21:00 and 23:00 approximately 24:00 h in either the male or the female rat. The time series of the amount of sleep over a 24-h period at 29 days of age revealed an ultradian rhythm with approximately a 3.0-h periodicity, and the peak time was estimated to be the same as that for the GH time series Taking the findings that the GH secretion is related to sleep in the prepubertal rat as described in the accompanying paper (Tsai, 1983), it could be speculated that the rat GH secretory rhythm develops by 30 days of age as a 3.0-h period ultradian rhythm that entrains to the time of day, relating to the rhythm of the sleep-wakefulness cycle.     

Compositional and functional alterations of gut microbiota in patients with stroke

Background and aimsThere is accumulating evidence that gut microbiota plays a key role in cardiovascular diseases. Gut bacteria can transform dietary choline, l-carnitine, and trimethylamine N-oxide (TMAO) into trimethylamine, which can be oxidized into TMAO again in the liver. However, the alterations of the gut microbiota in large artery atherosclerotic (LAA) stroke and cardioembolic (CE) stroke have been less studied.Methods and resultsWe performed a case–control study in patients with LAA and CE types of strokes. We profiled the gut microbiome using Illumina sequencing of the 16S ribosomal RNA gene (V4–V5 regions), and TMAO was determined via liquid chromatography–tandem mass spectrometry. Our results showed that the TMAO levels in the plasma of patients with LAA and CE strokes were significantly higher than those in controls (LAA stroke, 2931 ± 456.4 ng/mL; CE stroke, 4220 ± 577.6 ng/mL; healthy control, 1663 ± 117.8 ng/mL; adjusted p < 0.05). The TMAO level in the plasma of patients with LAA stroke was positively correlated with the carotid plaque area (rho = 0.333, 95% CI = 0.08–0.55, p = 0.0093). Notably, the composition and the function of gut microbiota in the LAA stroke group were significantly different from those in the control group (FDR-adjusted p-value < 0.05). There was no significant association between gut microbiota and CE stroke in our study.ConclusionThis study provides evidence for significant compositional and functional alterations of the gut microbiome in patients with LAA stroke. Gut microbiota might serve as a potential biomarker for patients with LAA stroke.     

急性血栓形成性和栓塞性大脑中动脉闭塞的临床和影像学特点比较——基于弥散加权成像的回顾性研究

目的 探讨急性血栓形成性和栓塞性大脑中动脉闭塞的临床和影像学差异.方法 发病24 h内经弥散加权成像(diffusion-weighted imaging DWI)和磁共振血管造影(magnetic resonance angiography,MRA)证实为急性大脑中动脉主干闭塞的脑梗死患者,根据TOAST分型标准分为...     

Circadian variation in the frequency of onset of chest pain in elderly patients with acute myocardial infarction.

This study reports the time of onset of chest pain in 792 consecutive elderly patients admitted to a coronary care unit with myocardial infarction during a 10-year period. Statistical analysis demonstrated a bimodal frequency distribution with peaks in the time of onset of chest pain between 23 h 30 and 00 h 30 and between 06 h 30 and 08 h 30.     

Nocturnal blood pressure decline based on different time intervals and long-term cardiovascular risk: the Ohasama Study

A diminished nocturnal decline in blood pressure (BP) represents a risk factor for cardiovascular disease. To define daytime and nighttime ambulatory BP, clock time-dependent methods are used when information on diary-based sleeping time is unavailable. We aimed to compare fixed-clock intervals with diary records to identify nocturnal BP declines as a predictor of long-term cardiovascular risk among the general population. Data were obtained from 1714 participants with no history of cardiovascular disease in Ohasama, Japan (mean age, 60.6 years; 64.9% women). We defined extreme dippers, dippers, non-dippers, and risers as nocturnal systolic BP decline ≥20%, 10–19%. 0–9%, and <0%, respectively. Over a mean follow-up period of 17.0 years, 206 cardiovascular deaths occurred. Based on diary records, multivariable-adjusted hazard ratios (HRs) for cardiovascular death compared with dippers were 1.24 (95% confidence interval [CI], 0.82–1.87) in extreme dippers, 1.21 (0.87–1.69) in non-dippers, and the highest HR of 2.31 (1.47–3.62) was observed in risers. Using a standard fixed-clock interval (daytime 09:00–21:00; nighttime 01:00–06:00), a nighttime 2 h-early shifted fixed-clock (daytime 09:00–21:00; nighttime 23:00–04:00), or a nighttime 2 h-late shifted fixed-clock (daytime 09:00–21:00; nighttime 03:00–08:00), the HR (95%CI) in risers compared with dippers was 1.57 (1.08–2.27), 2.02 (1.33–3.05), or 1.29 (0.86–1.92), respectively. Although use of diary records remains preferable, the standard and nighttime 2 h-early shifted fixed-clock intervals appear feasible for population-based studies.     

Relation of plasma catecholamine levels with pulse wave velocity in hypertensive patients compared with normotensive subjects

Although the circadian variation of catecholamine has been reported, that of the pulse wave velocity (PWV) has not. Brachial ankle (ba) PWV is associated with well-established indices of central stiffness. It is not known whether arterial stiffness is associated with catecholamine. The aim of the present study was to evaluate the changes in baPWV and those on the plasma epinephrine and norepinephrine levels in the morning and evening in hypertensive patients (HPs) and normotensive subjects (NSs). The baPWV and blood pressure (BP) were measured in 14 NSs (14 males, 39 ± 5 years) and 10 HPs (9 males and 1 female, 55 ± 13 years) at 06:00 h, noon, 18:00 h, and midnight, respectively. The plasma epinephrine and norepinephrine levels were measured in 14 NSs and 5 HPs at 06:00 h and 18:00 h, respectively. There was no significant difference in BPs at 06:00 h, noon, 18:00 h, and midnight in either NSs or HPs. The baPWV at 06:00 h was significantly lower than that at noon, 18:00 h, and midnight in NSs (P = 0.01, 0.04, and 0.0008, respectively). The plasma epinephrine and norepinephrine levels at 06:00 h were markedly lower than those at 18:00 h in NSs (P = 0.002 and 0.003, respectively). There were no significant changes in the baPWV of HPs at 06:00 h, noon, 18:00 h, or midnight. The plasma epinephrine and norepinephrine levels at 06:00 h were notably lower than those at 18:00 h in HPs (P = 0.004 and 0.01, respectively). Only NSs showed a significant reduction in the baPWV with a decrease in the plasma catecholamine levels in the morning, suggesting that the baPWV of NSs may be correlated with the variation of the plasma catecholamine levels.