Steindl P E, Finn B, Bendok B, Rothke S, Zee P C, Blei A T
Northwestern Memorial Hospital, Chicago, Illinois, USA.
Ann Intern Med. 1995 Aug 15;123(4):274-7. doi: 10.7326/0003-4819-123-4-199508150-00005.
To assess 24-hour plasma melatonin profile as a marker of output rhythm from the circadian clock and to study sleep diaries as reflections of subjective sleep quality in patients with liver cirrhosis.
Prospective cohort study.
Clinical research center in a university hospital.
Seven patients with cirrhosis but not alcoholism and seven age-, sex-, and education-matched controls.
Neuropsychological testing to confirm subclinical hepatic encephalopathy. Plasma melatonin levels measured every 30 minutes for 24 hours by radioimmunoassay. Sleep diaries kept for 1 week before admission.
Patients with cirrhosis had markedly elevated melatonin levels during daytime hours; in addition, the time of onset of melatonin increase and the time at which melatonin levels peaked were consistently and significantly delayed in these patients. Sleep diaries indicated more nocturnal awakenings and more frequent daytime naps in patients with cirrhosis.
Disruption of the diurnal rhythm of melatonin may reflect alterations of circadian function that could contribute to the disturbances of the sleep-wake cycle frequently seen in patients with cirrhosis.
评估24小时血浆褪黑素水平，作为昼夜节律钟输出节律的标志物，并研究睡眠日记，以反映肝硬化患者的主观睡眠质量。
前瞻性队列研究。
大学医院的临床研究中心。
7例非酒精性肝硬化患者以及7例年龄、性别和教育程度相匹配的对照者。
进行神经心理学测试以确认亚临床肝性脑病。通过放射免疫分析法每30分钟测量一次24小时血浆褪黑素水平。入院前记录1周的睡眠日记。
肝硬化患者白天的褪黑素水平显著升高；此外，这些患者中褪黑素开始升高的时间以及褪黑素水平达到峰值的时间持续且显著延迟。睡眠日记显示，肝硬化患者夜间觉醒次数更多，白天小睡更频繁。
褪黑素昼夜节律的紊乱可能反映了昼夜节律功能的改变，这可能导致肝硬化患者常见的睡眠-觉醒周期紊乱。
