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Melatonin secretion and metabolism in patients with hepatic encephalopathy
Author(s) -
Chojnacki Cezary,
WachowskaKelly Patrycja,
Błasiak Janusz,
Reiter Russel J,
Chojnacki Jan
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12055
Subject(s) - melatonin , medicine , excretion , endocrinology , hepatic encephalopathy , urine , circadian rhythm , cirrhosis , encephalopathy , nocturnal , gastroenterology
Background and Aim 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. Methods 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 W est‐ H aven 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). Results 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. Conclusions The elevated melatonin blood levels both at night and day may account for some of the clinical manifestations of hepatic encephalopathy (daytime sleepiness, fatigue).