Department of Neonatology, Children's Hospital, University of Bonn, Bonn, Germany.
Pediatr Crit Care Med. 2012 Mar;13(2):e120-3. doi: 10.1097/PCC.0b013e3182191dc4.
Considering the potential immunomodulatory role of melatonin and its direct antioxidant activity, disturbances of the melatonin secretion pattern in the septic conditions could be particularly unfavorable. The aim of this study was to evaluate the nocturnal melatonin concentration and total 24-hr excretion of 6-sulfatoxymelatoninsulfate, melatonin's major urinary metabolite, in children with sepsis in the pediatric intensive care unit.
Prospective observational pilot study.
A pediatric intensive care unit.
Twenty septic and 20 nonseptic children admitted between February 2008 and January 2010.
None.
Blood and urine samples were obtained from each patient on days 1, 2, 3, 5, and 10. There were no significant differences between the groups concerning age and gender. The median nocturnal melatonin concentrations were not significantly different between septic and nonseptic patients during the study period (p > .05). A subgroup analysis in septic patients showed that the nocturnal melatonin concentrations in nonsurvivors were significantly higher than in survivors, whereas total 6-sulfatoxymelatoninsulfate excretions in nonsurvivors were significantly lower than in survivors (p = .001 and p = .015, respectively). Furthermore, nocturnal melatonin concentrations of septic patients in septic shock state were statistically significantly higher than those of septic patients without septic shock state (p = .002). The 24-hr 6-sulfatoxymelatoninsulfate excretions in septic patients with liver dysfunction were found significantly lower than those in septic patients without liver dysfunction (p = .015). The presence of sedation and mechanical ventilation had no effect on the nocturnal melatonin concentrations in septic patients (p = .953 and p = .922, respectively).
The present study shows that, in contradiction to results in adult patients, the nocturnal melatonin concentrations are not decreased in septic pediatric intensive care unit patients despite severe disease. Further investigations are needed to identify whether treatment with melatonin may have beneficial effects in pediatric intensive care unit patients with sepsis/septic shock.
鉴于褪黑素具有潜在的免疫调节作用及其直接的抗氧化活性，在脓毒症情况下褪黑素分泌模式的紊乱可能特别不利。本研究旨在评估儿科重症监护病房脓毒症患儿的夜间褪黑素浓度和主要代谢产物 6-硫酸褪黑素硫酸盐的 24 小时总排泄量。
前瞻性观察性初步研究。
儿科重症监护病房。
2008 年 2 月至 2010 年 1 月间收治的 20 例脓毒症患儿和 20 例非脓毒症患儿。
无。
在研究期间，每天从每位患者获得血样和尿样。两组在年龄和性别方面无显著差异。在研究期间，脓毒症组和非脓毒症组患者的夜间褪黑素浓度中位数无显著差异（p＞0.05）。在脓毒症患者中进行的亚组分析显示，非幸存者的夜间褪黑素浓度明显高于幸存者，而非幸存者的总 6-硫酸褪黑素硫酸盐排泄量明显低于幸存者（p=0.001 和 p=0.015）。此外，脓毒性休克状态下脓毒症患者的夜间褪黑素浓度明显高于无脓毒性休克状态的脓毒症患者（p=0.002）。肝功能障碍的脓毒症患者的 24 小时 6-硫酸褪黑素硫酸盐排泄量明显低于无肝功能障碍的脓毒症患者（p=0.015）。镇静和机械通气对脓毒症患者的夜间褪黑素浓度无影响（p=0.953 和 p=0.922）。
与成人患者的结果相反，本研究表明，尽管病情严重，儿科重症监护病房脓毒症患儿的夜间褪黑素浓度并未降低。需要进一步研究以确定在脓毒症/脓毒性休克的儿科重症监护病房患者中使用褪黑素治疗是否可能具有有益效果。
