Department of Gastroenterology, Medical University of Lodz, Lodz, Poland.
J Gastroenterol Hepatol. 2013 Feb;28(2):342-7. doi: 10.1111/jgh.12055.
The rhythm of melatonin secretion and its blood level changes in cirrhotic patients, but the causes of these alterations have not been sufficiently appreciated. The aim of study was to estimate the dependence between melatonin secretion and metabolism and the severity of hepatic encephalopathy.
The study included 75 alcoholic cirrhotic patients (A, B, C) with hepatic insufficiency and 25 healthy subjects (group K). Three groups of patients were identified, 25 patients each, with grade 1, 2, and 3 hepatic encephalopathy according to West-Haven Scale. Immunoenzymatic method was used to measure serum melatonin (at 02:00 h and 09:00 h) level and 6-sulfatoxymelatonin (6-HMS) excretion in the urine (during night and day).
Nocturnal serum melatonin levels (pg/mL) in groups were: K-57.1 ± 11.4, A-38.5 ± 11.2, B-53.4 ± 17.9, C-79.5 ± 27.9 (P < 0.01); whereas diurnal levels were: K-10.9 ± 3.5, A-33.5 ± 12.0, B-53.8 ± 23.1, C-98.5 ± 34.6 (P < 0.01). Similar differences were found in the evaluation of 6-HMS excretion (μg/9 h) in urine at night: group K-23.4 ± 14.4, A-16.6 ± 5.4, B-14.3 ± 6.2 (P < 0.01), C-3.3 ± 1.5 (P < 0.001). Diurnal 6-HMS excretion (μg/15 h) was lower only in group C and it was respectively: K-6.9 ± 3.4, A-7.1 ± 1.7, B-7.6 ± 1.7, C-4.3 ± 2.2 (P < 0.001). Serum ammonia concentrations (μg/dL) were: group K-30.4 ± 8.9, A-51.8 ± 25.4 (P < 0.05), B-73.0 ± 29.8 (P < 0.001), C-107.5 ± 34.8 (P < 0.001). No correlation between melatonin and ammonia levels in all groups was found.
The elevated melatonin blood levels both at night and day may account for some of the clinical manifestations of hepatic encephalopathy (daytime sleepiness, fatigue).
肝硬变患者褪黑素分泌节律及其血水平变化，但这些改变的原因尚未得到充分认识。本研究的目的是评估褪黑素分泌和代谢与肝性脑病严重程度之间的关系。
本研究纳入了 75 例酒精性肝硬化患者（A、B、C 组），肝功能不全，25 例健康受试者（K 组）。根据 West-Haven 量表，将患者分为 3 组，每组 25 例，分别为 1 级、2 级和 3 级肝性脑病。采用免疫酶联法测定血清褪黑素（02:00 h 和 09:00 h）水平和 6-硫酸褪黑素（6-HMS）在尿液中的排泄（夜间和白天）。
夜间血清褪黑素水平（pg/mL）：K 组为 57.1±11.4，A 组为 38.5±11.2，B 组为 53.4±17.9，C 组为 79.5±27.9（P<0.01）；白天水平分别为：K 组为 10.9±3.5，A 组为 33.5±12.0，B 组为 53.8±23.1，C 组为 98.5±34.6（P<0.01）。夜间尿 6-HMS 排泄（μg/9 h）评估也存在类似差异：K 组为 23.4±14.4，A 组为 16.6±5.4，B 组为 14.3±6.2（P<0.01），C 组为 3.3±1.5（P<0.001）。仅 C 组白天的 6-HMS 排泄（μg/15 h）较低，分别为：K 组为 6.9±3.4，A 组为 7.1±1.7，B 组为 7.6±1.7，C 组为 4.3±2.2（P<0.001）。血清氨浓度（μg/dL）分别为：K 组为 30.4±8.9，A 组为 51.8±25.4（P<0.05），B 组为 73.0±29.8（P<0.001），C 组为 107.5±34.8（P<0.001）。各组间褪黑素与氨水平无相关性。
夜间和白天褪黑素水平升高可能与肝性脑病的一些临床表现（日间嗜睡、疲劳）有关。
