Department of Critical Care, Dalhousie University, Halifax, NS, Canada.
Department of Pediatrics, Western University, London, ON, Canada.
Pediatr Crit Care Med. 2020 Dec;21(12):e1061-e1068. doi: 10.1097/PCC.0000000000002461.
To determine whether total daily 6-sulfatoxymelatonin excretion and diurnal variation of melatonin secretion was maintained during the early phase of PICU admission through examination of the melatonin urinary metabolite, 6-sulfatoxymelatonin.
Exploratory prospective, observational study.
Twelve-bed medical-surgical PICU of a Children's Hospital.
Fifty children 3 months to 18 years old enrolled within 24 hours of PICU admission with access for urinary sampling.
None.
Urine samples were collected at 4-hour intervals for 24 hours and stored at -80C. 6-sulfatoxymelatonin was determined in duplicate by direct enzyme-linked immunosorbent assay. Patients were heterogeneous for diagnosis, had a mean age of 8.1 years (SD = 6.1 yr), and median (interquartile range) Pediatric Risk of Mortality III of 10 (4-13). Mean (SD) total daily 6-sulfatoxymelatonin production was 30.0 µg (25.6 µg) for the first 24 hours, which did not differ significantly from the means on days 2 (p = 0.56) or 3 (p = 0.29), and was similar to literature controls. Mean 6-sulfatoxymelatonin production for the population fit a periodic function well, with a reliable amplitude of 326 ng/hr and peak excretion from 04:00 to 08:00 (F = 4.4, p = 0.01), even when 6-sulfatoxymelatonin was corrected for body weight (F = 3.4, p = 0.03) and when sedation was included in the model (F = 3.95, p = 0.004). There was no significant correlation between lighting and 6-sulfatoxymelatonin excretion at any time period (R values: 0.11-0.25, p = 0.10-0.94). Mean 6-sulfatoxymelatonin excretion did not fit the model for a periodic function well for the subpopulations studied (sepsis [n = 18, F = 1.1, p = 0.32], respiratory failure requiring deep sedation [n = 10, F = 0.4, p = 0.66], and neurologic injury [n = 7, F = 0.6, p = 0.55]).
Total daily and diurnal variation of 6-sulfatoxymelatonin excretion is heterogeneously maintained early in pediatric critical illness. However, this may not hold true for specific diagnostic categories.
通过检测褪黑素尿代谢物 6-硫酸褪黑素，确定在 PICU 入院早期是否维持了褪黑素的总日排泄量和褪黑素分泌的昼夜变化。
探索性前瞻性观察研究。
儿童医院的 12 张病床的内科-外科 PICU。
50 名年龄在 3 个月至 18 岁之间的儿童，在 PICU 入院后 24 小时内入组，并可进行尿液采样。
无。
每 4 小时采集一次尿液样本，持续 24 小时，并储存在-80°C。6-硫酸褪黑素通过直接酶联免疫吸附测定法进行重复检测。患者的诊断存在异质性，平均年龄为 8.1 岁（SD=6.1 岁），儿科死亡率风险 III 中位数（四分位距）为 10（4-13）。第一个 24 小时的总日 6-硫酸褪黑素生成量为 30.0μg（25.6μg），与第 2 天（p=0.56）和第 3 天（p=0.29）的平均值无显著差异，与文献对照相似。人群的 6-硫酸褪黑素生成量很好地符合周期性函数，可靠振幅为 326ng/hr，峰值排泄时间为 04:00 至 08:00（F=4.4，p=0.01），即使校正体重（F=3.4，p=0.03）和将镇静纳入模型（F=3.95，p=0.004）也如此。在任何时间段，光照与 6-硫酸褪黑素排泄均无显著相关性（R 值：0.11-0.25，p=0.10-0.94）。对于研究的亚组（败血症[n=18，F=1.1，p=0.32]、需要深度镇静的呼吸衰竭[n=10，F=0.4，p=0.66]和神经损伤[n=7，F=0.6，p=0.55]），6-硫酸褪黑素排泄不符合周期性函数模型。
在儿科危重病的早期，6-硫酸褪黑素的总日排泄量和昼夜变化保持异质性。然而，这对于特定的诊断类别可能并不成立。
